The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Sep 1982
Case ReportsUrgent myocardial revascularization for dissection of the left main coronary artery: a complication of coronary angiography.
Acute subintimal dissection of the left main coronary artery (LMCA) is a rare but devastating complication of selective coronary angiography. The compromise of the coronary blood flow to an extensive area of myocardium becomes clinically evident in most patients shortly after the injury. Three patients who had catheter-induced LMCA dissection were successfully managed with aorta-coronary artery bypass. We recommend that urgent myocardial revascularization using standard techniques should be carried out in all patients following this injury.
-
J. Thorac. Cardiovasc. Surg. · Sep 1982
Comparative StudyMechanical circulatory support via the left ventricular vent: the concept of left ventricular copulsation.
Left ventricular copulsation was evaluated as a means of circulatory support in an experimental canine cardiogenic shock preparation. Copulsation was effected by a commercially available pulsatile assist device which was attached to an apical left ventricular vent cannula. ⋯ The improvement in these variables was significantly greater during left ventricular copulsation than during IABP (p less than 0.05). The method is simple, uses equipment that is readily available, and is potentially a powerful intermediate circulatory support modality between IABP and more complex techniques.
-
J. Thorac. Cardiovasc. Surg. · Aug 1982
Thromboxane and prostacyclin changes during cardiopulmonary bypass with and without pulsatile flow.
Nonpulsatile cardiopulmonary bypass, in patients with coronary artery disease, produces a significant increase in thromboxane, a potent platelet aggregant and putative coronary vasoconstrictor. Pulsatile flow may decrease the incidence of perioperative infarction and the hormonal stress response to bypass. This study assessed the effect of pulsatile blood flow on plasma thromboxane and prostacyclin profiles during cardiopulmonary bypass by serial measurement of their stable metabolites, thromboxane B2 (TxB2) and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha). ⋯ There were no intragroup differences of plasma hemoglobin, hematocrit, or platelet count. These data demonstrate that pulsatile flow significantly alters prostacyclin and thromboxane profiles during cardiopulmonary bypass and favors production of the coronary vasodilator and platelet disaggregant prostacyclin. This may be an important factor in some of the clinical advantages previously reported with this modality.
-
Twenty-three patients with spontaneous rupture of a pulmonary cavity with a pyopneumothorax resulting from coccidioidomycosis are presented. Clinical and laboratory findings, medical and surgical treatment, and complications are detailed. Skin tests are not helpful in making a diagnosis. ⋯ The extent of surgical resection may have to be limited because of the extensive contamination of the pleural space. Amphotericin B was administered in 10 patients. The drug should be administered when the cavity ruptures in the acute phase of the disease, in all patients with diabetes, in delayed operations, in patients with concomitant medical problems, and when the extent of resection is limited to obtain immediate obliteration of the pleural space.
-
J. Thorac. Cardiovasc. Surg. · Jul 1982
Classic shunting operations for congenital cyanotic heart defects.
A total of 297 consecutive classic systemic artery-pulmonary artery shunts were performed in 281 patients over the past 9 years. This experience includes 200 Blalock-Taussig shunts (67.3%), 84 Waterston shunts (28.2%), and 13 Potts shunts (4.3%). The overall early mortality after the Blalock-Taussig shunt (5.5%) was significantly lower (p less than 0.02) than for the Waterston shunt (13%). ⋯ However, the Blalock-Taussig shunt had a significantly lower (p less than 0.04) probability of early postoperative death than the Waterston shunt among patients with complex lesions. The Blalock-Taussig shunt also revealed a lower incidence of important late postoperative complications and did not affect adversely the hemodynamic result after intracardiac correction, as evidenced by late postoperative cardiac catheterization. This study also confirms the feasibility of the Blalock-Taussig shunt during the neonatal period without significantly increased age-related risk of postoperative death (p = 0.13) and with good early and late long-term patency rates.