Biomedical subjects
Publications and source records attributed to C Chartrand.
Puppy hearts were engrafted to C6-deficient rabbits, and also to complement-sufficient animals in order to determine the influence of the sixth component of complement on xenograft rejection. Delayed rejection was observed in the puppy hearts engrafted to the C6-deficient animals indicating that complement sufficiency of C6 is required for hyperacute xenograft rejection.
Surgical treatment of coarctation of the aorta in the newborn often recurs during childhood. As a means of avoiding this complication segmental replacement of the thoracic aorta with autologous pericardium was evaluated. The isthmic aorta of seven mongrel puppies was replaced by a tubular live pericardial autograft. Between 5 and 36 months (average 15) after surgery, the status of the graft was evaluated by hemodynamic, angiographic, macroscopical and histological studies. Growth of the graft was appreciated by comparing its diameter to that of the descending aorta DG/DA. No pressure gradient across the graft was noted. No significant structure of the graft was observed. The internal surface of the graft was smooth, and the wall, slightly thinner than that of the aorta showed no aneurysm. The diameter of the graft was increased (DG mean 37 %) proportionally to the increase of the aorta (DA mean 36 %). Histologically the graft was endothelialized, the wall was thickened and made up of concentric collagen fibers, live fibroblasts and muscular cells. These results show that during the first months of life, the isthmus of the aorta can be replaced by an autologous pericardial graft which will follow the growth of the normal aorta and adapt to its hemodynamic regimen.
The follow-up of 44 patients with simple d-transposition of the great arteries is presented. All had balloon atrial septotomy shortly after birth. If an operation was needed at or before one year of age, atrial septectomy was carried out. Correction was done between the ages of 19 and 64 months. Of the 44 patients, 34 (77 per cent) are living and doing well (27 after the Mustard procedure), 3 (7 per cent) are lost to follow-up, and 7 (16 per cent) are dead. Death was due to technical problems during initial catheterization and balloon septotomy in 2 patients, occurred after septectomy in one (3 per cent), and after the Mustard procedure in one (4 per cent). There was one sudden inexplicable death in a 1 1/2-month-old patient, and 2 patients died with pulmonary vascular obstructive disease. Because of the relatively low over-all mortality and morbidity and the low surgical mortality rate for both palliation and correction, we believe that two-stage surgical correction of transposition of the great arteries is preferable to early one-stage correction in the infant.
Nine children with partial anomalous pulmonary venous drainage into the superior vena cava were operated upon. The technique consisted essentially of partitioning and enlargement of the superior vena cava. The partitioning was done in all but one patient, with a longitudinal suture starting above the highest pulmonary vein directing the pulmonary venous flow through the enlarged atrial septal defect into the left atrium. The anterior cavo-auricular tunnel was enlarged with a right atrial appendage-superior vena cava angioplasty. Follow-up studies were done between 1 and 3 years after surgery. The hemodynamic data were normal in 7 patients. In 8 children, the superior vena cava was unobstructed and its diameter was normal as demonstrated by cavograms. In all patients, the angiographic evaluation of the pulmonary venous return was normal. These results are encouraging and indicate that this new approach is superior to those which have previously been reported.
The object of this investigation was to demonstrate the hemodynamic features of cardiac rejection. The postoperative functional evolution of a homogeneous group of unmodified homografts was compared with that of a group of autografts studied by the same protocol. On the 4th postoperative day, a significant decrease was observed initially in the maximum systolic output, the maximum systolic rate index, the mean systolic ejection rate and also in the strength, work and, especially, acceleration of the left ventricles of the homografts. In the terminal phase, the abnormalities already present in these parameters worsened; there was a large decrease in cardiac output, in the stroke volume, in the voltage of the electrocardiogram, and a slowdown in cardiac emptying. During terminal heart failure, the aortic pressure became depressed and the central venous pressure increased rapidly. The hemodynamic reaction following the homoplastic graft was totally different after the 4th day. The comparison of the results obtained from these two experimental groups established that the functional cardiac failure described for the homoplastic transplant represents the hemodynamic expression of acute rejection.
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These experiments were designed in order to determine normal hematological and biochemical values of normal dogs living in a laboratory environment. The findings were conclusive. Serial studies of some of the basic parameters have been done in a second group of animals. After a short period of conditioning, daily changes in weight, temperature, hematocrit and hemoglobin are minimal if the methods of analysis are standardized and reproducible.
The authors demonstrate the effects of hyperoxemia in dogs subjected to extracorporeal circulation. Arterial Po2 was maintained between 100 and 140 mm Hg in a control group and above 200 mm Hg in another group. There was no morbidity or mortality in these experiments. Postoperative functional status as well as hematological and biochemical data were similar in both groups. However, free plasma hemoglobin was 50% higher in animals subjected to hyperoxygenation. It is thus concluded that on the basis of these results hyperoxygenation has no beneficial effect on the animals submitted to total body bypass and moreover that arterial Po2 over 200 mm Hg increases hemolysis.
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We have reviewed the cases operated upon for correction of congenital aortic stenosis at l'Hôpital Ste-Justine between 1959 and 1969.Twenty-five of the 26 patients were readmitted for complete clinical, radiological and hemodynamic investigation. Fourteen had a valvular stenosis, eight a diaphragmatic subvalvular lesion, and three had mixed lesions.The results lead us to believe that the surgical treatment of this malformation is justified. The indications for surgery must take into account all available clinical, radiological, electrocardiographic and hemodynamic data.
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