Use of pericardium for esophagoplasty in congenital esophageal stenosis.
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Biomedical subjects
Publications and source records attributed to B Vidne.
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The incidence of erysipelas in extremities used for saphenous vein donation was evaluated by interviewing 302 patients who had undergone coronary artery bypass surgery. Erysipelas occurred in 6.2% of patients, and was twice as common as in patients with a history of varicose vein stripping. The difference, however, was not statistically significant.
The effect of acetylcholine on cardiac muscle contractility and hemodynamics was investigated in human atrial strips and in isolated working rat heart. Activation of the muscarinic receptor in the heart muscle is generally known to result in negative chronotropic and inotropic effects. In our study, positive inotropic effects of acetylcholine (ACh) were observed in both human right atrial strips and in the working rat heart. Exposure of the human right atrial strips to ACh (10(-7)-10(-4) M) produced a dose dependent tri-phasic (positive-negative-positive) inotropic effect in approximately 40% of the strips. In muscle strips that exhibited only a negative inotropic effect, a positive response was observed following washout of ACh. Both positive and negative effects were antagonized by atropine. Exposure of the paced working rat heart to ACh (10(-7) - 10(-5) M) resulted in a dose dependent decrease in mean coronary flow followed by depression in cardiac function. When the heart was initially treated with the vasodilator adenosine (2 x 10(-6) M), exposure to ACh (10(-7) - 10(-5) M) had no effect on coronary flow and produced a dose dependent augmentation of all cardiodynamic indices: left ventricular pressure, isovolumic pressure, cardiac output, maximal aortic flow and stroke work. This positive response was antagonized by atropine. Exposure of the rat ventricular strips increased the formation of [3H]phosphoinositide breakdown products (e.g. inositol phosphates IP, IP2, IP3). These observations demonstrate that cholinergic muscarinic stimulation may produce positive inotropic effects in both human and rat cardiac muscle. Furthermore, our results suggest that IP3 may be a mediator in this process.
Forty-two patients were treated for combat injuries of the chest, caused by shrapnel fragments, bullet wounds, blunt trauma and blast injury. Twenty-three required only intercostal tube drainage, while 19 underwent thoracotomy. There were two deaths, both unrelated to the thoracic injury. Our indications for emergency thoracotomy were hemorrhage of 1,000 ml with the initial insertion of the chest tube or 500 ml of fresh bleeding during the first 2 hr after insertion of the chest tube, massive air leak, extensive chest wall injury, the location of metal fragments in the mediastinum, evidence of cardiac tamponade or significant mediastinal shift. The positive results obtained in this series of cases were due to the effective first aid treatment on the battlefield and in field hospitals, and to an aggressive policy of operative intervention where indicated, together with intensive postoperative care.
An analysis of 37 patients surgically treated for left ventricular aneurysms provides preoperative clinical information regarding surgical risk. Operative mortality can be correlated with clinical and cardiac functional data as well as with the extent of coronary artery disease. Review of operative mortality in relation to the surgical procedure and the functional status of survivors indicates that aorto-coronary bypass grafting, complementary to aneurysmectomy, not only relieves angina pectoris, but also improves the functional status of the residual myocardium.
The case of a two year old girl with anomalous origin of the left coronary artery from the pulmonary artery is described. She was never in heart failure but had cardiomegaly and anginal pain. The ECG showed a typical infarct pattern with left ventricular hypertrophy. An unusual finding was a prolonged QTc of 0.52. During cardiac catheterization and twice 24 hours later she developed ventricular fibrillation treated with electroshock and prevented later with propranolol. The QTc returned to normal after surgery. Echocardiography showed diastolic flutter and early systolic closure of the pulmonary valve. This disappeared after surgical correction. Transverse 2D echo of the aortic root showed a large right coronary artery which decreased in size after surgery. The left coronary artery was not seen on echocardiography. At cardiac catheterization the diagnosis of an anomalous origin of the left coronary artery from the pulmonary artery was established, with a large shunt to the pulmonary artery through the anomalous artery. Mild pulmonary hypertension and mild mitral regurgitation were present. At surgery, since direct implantation was technically impossible, the left coronary artery was successfully connected to the aorta via a 6 mm expanded Poly-Tetra-Fluoro-Ethylene (P.T.F.E.) graft.
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This is the eighth reported case of successful repair of tetralogy of Fallot associated with complete atrioventricular canal, Type C. The high surgical mortality rate in this combination is in part due to failure to recognise the associated anomaly pre-operatively, and in part to not closing the ventricular septal defect completely. In our case the atrial and ventricular septal defects were closed with two separate patches. The undivided hemivalves were attached to the septal patches by interrupted mattress sutures. The right ventricular outflow tract obstruction was relieved by infundibulectomy, pulmonary valvotomy and the placement of a Dacron patch over the infundibulum. One year postoperatively, the condition of the patient is satisfactory without the need for diuretics or digitalis.