The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Nov 1980
Massive air embolism during cardiopulmonary bypass. Causes, prevention, and management.
Massive air embolism during cardiopulmonary bypass is a frightening complication requiring immediate response and carrying strong medicolegal implications. From July, 1971, to July, 1979, there were eight instances of massive air embolism during 3,620 cardiopulmonary bypass operations. Five such accidents from other institutions are included in this report. ⋯ Cerebral injury which resolved within a 2 month period occurred in three patients. The remainder had no neurologic sequelae. Nonfatal cerebral air injury may be associated with prolonged convalescence yet complete recovery, as compared to embolism from debris or clot, which offers a poorer prognosis.
-
J. Thorac. Cardiovasc. Surg. · Nov 1980
Early and late results of total correction of tetralogy of Fallot.
Two hundred and nine patients underwent total repair of tetralogy of Fallot without congenital pulmonary atresia from 1971 to 1979. The age of the patients ranged from 22 months to 27 years (mean 6.8 years). Previous palliative shunts were present in 130 patients (62.2%). ⋯ Pulmonary valvular insufficiency was well tolerated postoperatively in the absence of distal pulmonary artery obstruction. This experience supports a policy of aggressive relief of the right ventricular outflow tract obstruction including liberal use of transannular patching and, when indicated, extensive reconstruction of the pulmonary artery branches. We also recommend a two-stage treatment program for symptomatic infants with unfavorable anatomy consisting of initial Blalock-Taussig shunt followed by total repair at about 3 years of age.
-
J. Thorac. Cardiovasc. Surg. · Sep 1980
Comparative StudyBypass grafts to the left anterior descending coronary artery: saphenous vein versus internal mammary artery.
During the interval 1972 to 1977, of 1,522 patients undergoing isolated coronary artery bypass grafting (CABG), 1,459 received grafts to the left anterior descending coronary artery (LAD). Internal mammary artery (IMA) was used in 765 patients and reversed saphenous vein graft (SVG) in 694 patients. Choice of bypass graft was nonrandom. ⋯ Maintenance and/or restoration of normal left ventricular function was more common in IMA patients operated upon after the initial 2 year experience. IMA grafts are recommended for LAD bypass when the LAD is 2.0 mm in diameter or less. Early results with sequential SVG to the LAD suggest that this may be a realistic alternative to the IMA and may approach the 1 year IMA graft patency rate of 92.6%.
-
Brachial plexus injuries are annoyingly common after median sternotomies and vary from those causing minor symptoms to those producing major disability. We compared two groups of patients operated upon with the arms either abducted to a 90 degree angle or at the sides and found no difference in the incidence of brachial plexus injury. ⋯ A concomitant autopsy study demonstrated fractured first ribs penetrating the brachial plexus in 11 of 15 patients whose sternum was opened with the sternal retractor placed in the usual location, but in none in 15 patients whose sternum was opened with the retractor displaced two intercostal spaces caudally. The injury can be minimized by opening the sternal retractor as little as is necessary and by placing it as caudally as possible commensurate with adequate exposure.
-
One hundred eighty-one patients with 218 acute cervicothoracic vascular injuries underwent operations for diagnosis, resuscitation, and control of hemorrhage. The patients were divided into three clinical groups depending on their clinical status. Group I consisted of 105 patients who were hemodynamically stable and able to undergo diagnostic measures: Group II consisted of 41 patients who remained unstable and required immediate operation; Group III consisted of 35 patients who were moribund and underwent emergency room thoracotomy. ⋯ Thirty-five Group III patients had thoracotomy performed in the emergency room and seven survived (20%). A vigorous clinical approach is recommended to minimize morbidity. A different approach is described for each of the three clinical groups of patients.