The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 1976
Case ReportsCongenital aortic stenosis. Experience with 43 patients.
Between September, 1967, and January, 1975, 43 patients underwent intracardiac repair for congenital aortic stenosis at the Buffalo Children's Hospital. The patients ranged in age from 2 days to 24 years, 6 of them being below one year of age. Valvular aortic stenosis was found in 21 cases (4 infants [Group I-A] and 17 older patients [Group I-B]), discrete subaortic membranous diaphragm in 11 (Group II); diffuse subvalvular muscular obstruction in 3 (Group III), supravalvular stenosis in 4 (Group IV), and multiple-level obstruction in 4 (2 infants [Group V-A] and 2 older patients [Group V-B]). ⋯ Results were fair or poor in Groups, I-A, V-A, and V-B. In children and adolescents, effective relief of the obstruction and of the symptoms can be obtained with minimal operative risk and minimal morbidity. In symptomatic infants, despite the high operative mortality rate, surgical intervention is indicated because of the poor prognosis.
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J. Thorac. Cardiovasc. Surg. · Jul 1976
Reconstruction of right ventricular-pulmonary artery continuity with a valved external conduit: unusual technical considerations.
The Hancock conduit containing a porcine xenograft valve has been used as part of the repair in 14 patients having complex congenital heart disease. The single death in this series resulted from the consequences of pulmonary vascular disease in a patient with truncus arteriosus. Several unusual technical considerations such as previous pulmonary artery banding, angulated Waterston anastomoses, and dextroversion required modifications in the standard approach to the correction of several of the anomalies encountered. This conduit has provided a satisfactory method to establish right ventricular-pulmonary artery continuity.
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J. Thorac. Cardiovasc. Surg. · May 1976
Long-term follow-up of cloth-covered Starr-Edwards prostheses.
One hundred patients in whom cloth-covered Starr-Edwards prostheses were implanted have now been followed for 3 to 7 years. The hospital mortality rate was 5 per cent, and survival at five years was 70 per cent. ⋯ The results indicate that cloth-covered prostheses have significantly lowered the incidence of thromboembolism and eliminated poppet dysfunction. The problem of strut cloth wear was clinically observed only twice in 500 patient-years of follow-up.
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J. Thorac. Cardiovasc. Surg. · Apr 1976
Surgical management of congenital cardiovascular anomalies with the use of profound hypothermia and circulatory arrest. Analysis of 180 consecutive cases.
An initial series of 180 patients subjected to definitive repair of cardiac malformations during infancy is presented. The operations were performed with profound hypothermia and circulatory stasis. Statistics relating to the entire series of patients are presented and discussed, after which the results among eleven individual groups of patients categorized by type of cardiovascular lesion are analyzed. ⋯ The mortality rate was highest among patients severely ill preoperatively and among those with complex malformations. Deaths were also more frequent among infants under 6 months of age and less than 5 kilograms in weight. Analysis shows a steady increase in percentage of patient survival over the years reported from December, 1967, to April, 1975.
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J. Thorac. Cardiovasc. Surg. · Mar 1976
Surgical treatment of unstable angina by saphenous vein and internal mammary artery bypass grafting.
During a 3 year period, direct myocardial revascularization was performed on an urgent basis in 48 patients with intermittent resting chest pain which persisted more than 24 hours despite in-hospital medical therapy and was accompanied by electrocardiographic changes representative of ischemia. Sixteen patients had saphenous vein (SV) grafts exclusively, and 32 patients each had one or two internal mammary artery (IMA) grafts with or without additional vein grafts. Follow-up ranges from 5 to 41 months (mean, 22 months). ⋯ No significant differences were observed between mean preoperative and postoperative left ventricular end-diastolic pressures or ejection fractions, but these parameters were noted to improve after operation in several patients. The remarkably high early and late survival rates, the low incidence of myocardial infarction, and the excellent functional results after rather long follow-up indicate that emergency coronary revascularization provides an effective therapy for unstable angina. The use of IMA grafts, when feasible, is a safe and possibly preferable approach in these patients.