Biomedical subjects

D R Hockmuth

Publications and source records attributed to D R Hockmuth.

5 recordsLinked to original sources

PubMed1993

Technical advances in the treatment of left ventricular aneurysm.

The resulting abnormal geometry after surgical treatment of left ventricular aneurysm has concerned a number of surgeons since the first successful repair in 1958, but little attention was placed on the altered geometry until attempts were made to effect a more physiologic aneurysmorrhaphy in 1973. Substantial attention was focused on a concept of geometric reconstruction from within the left ventricle in 1985. A prosthetic patch was employed with the concept to redirect normal muscle bundles to their original orientation and position. Further refinements include use of improved materials for the repair, preservation and bypass of the left anterior descending coronary artery, ablation of ventricular arrhythmias when indicated, and the absence of prosthetic material used in contact with the pericardial surface. Our experience with repair of 61 left ventricular aneurysms at West Jefferson Medical Center over a 4 1/2-year period with a 3.3% mortality rate has prompted a change from the standard linear repair to routine use of a modified endoventricular repair. Currently, the low surgical risk due to advances in left ventricular aneurysmorrhaphy combined with the knowledge that contractile areas will progressively deteriorate in ventricles stressed by poor hemodynamics and with data showing improved left ventricular function postoperatively have led to more liberal recommendations for early left ventricular aneurysm repair.

Heart Aneurysm↗

PubMed1993

Right gastroepiploic artery used for coronary artery bypass grafting. Evaluation of flow characteristics and size.

Questions remain concerning the physiologic capabilities of the right gastroepiploic artery as a bypass graft in the clinical setting. Our last 90 consecutive pedicle right gastroepiploic artery grafts were prepared with intraluminal papaverine and verapamil. Our series comprised 81 male and 9 female patients with average body surface areas of 1.92 m2. Ages ranged from 11 to 79 years (mean 57.2 years). A second to fourth revascularization was undertaken in 32 patients (35.5%). The following arteries were bypassed: posterior descending artery, 63; right coronary artery, 23; distal right, 4; circumflex, 2; left anterior descending, 1; and diagonal, 1. Free flow rates ranged from 42 to 660 ml/min (mean 179.96 ml/min). Internal diameters measured 1.5 to 4.0 mm (mean 2.20 mm) at the anastomotic sites. Pedicle lengths ranged from 16 to 26 cm (mean 19.2 cm). Inotropic support was required in 11 patients (12%) and had no adverse effects on right gastroepiploic artery grafts. There were 2 hospital deaths (2.2%). Angina has recurred in 6 patients. One patient with cardiomyopathy required transplantation 2 years after coronary bypass grafting. Repeat angiography showed widely patent grafts in 18 patients and generalized narrowing in 4 grafts. In only 2 patients of our total experience has right gastroepiploic artery grafting been aborted because of inadequate conduit size. One right gastroepiploic artery had visible atherosclerosis. This study shows that distal right gastroepiploic artery sizes are comparable with sizes of target coronary arteries. However, neither flow nor size is as consistent when compared with internal thoracic artery grafts. Higher flow rates are related to graft anatomic characteristics and larger body surface areas. Spasm, secondary to harvest in these vasoreactive grafts, can be managed appropriately by intraluminal vasodilating drugs. However, use of the right gastroepiploic artery should be avoided in a setting with possible competition of flow.

Adolescent↗

PubMed1991

Free arterial grafts.

The use of free arterial grafts has increased since the late patency of free internal mammary artery grafts was found to approach that of pedicle internal mammary artery grafts. An intensified search for other suitable arterial grafts has resulted in reports on the use of free gastroepiploic artery grafts and free inferior epigastric artery grafts. Free arterial heterografts and free homograft saphenous veins have had very disappointing results in general. The lateral costal artery, when available, offers another possible arterial conduit in approximately 10% of patients. To effect a wider use of arterial conduits for coronary bypass grafts, a number of techniques have been devised to use the internal mammary artery and other arterial grafts as free grafts.

Animals↗

PubMed1991

Technical considerations for myocardial protection during the course of coronary artery bypass reoperation: the impact of functioning saphenous vein and internal mammary artery grafts.

New technical challenges involving the delivery of cardioplegia during the course of coronary artery bypass operation continue to be presented to the surgeon. Functioning saphenous grafts at reoperation that are at risk for distal embolization, are managed by altering the standard cardioplegia delivery techniques. Management of patent internal mammary artery (IMA) grafts depends upon the status of the native circulation and coronary collateral. The reoperation may be performed with a fibrillating heart, standard cardioplegia with a clamped mammary graft, or cardioplegia delivered during simultaneous circulatory arrest. Myocardial temperature measurements, during the course of more complex operations, are useful in choosing the appropriate technique for myocardial protection.

Collateral Circulation↗

PubMed1989

Sudden cardiac death.

This article reviews the epidemiology of sudden cardiac death, and outlines suggested management of patients who are successfully resuscitated from cardiac arrest. Emphasis is placed on the favorable impact of newer means of therapy on the very high recurrence rate using empiric antiarrhythmic treatment.

Death, Sudden↗