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Biomedical subjects

G C Kaiser

Publications and source records attributed to G C Kaiser.

At least 127 records · Page 7Linked to original sources

Implantable pacemakers in children.

Permanent pacemakers were implanted in 12 children, ages 2 weeks to 6 years. The cause of the arrhythmia was congenital in three, postoperative in six, viral in one, and unknown in two. One operative death occurred on the second postoperative day. Two late deaths occurred five and 10-1/2 years postoperatively. The late deaths were in patients with good cardiac capture in whom the block followed repair of tetralogy of Fallot. Ventricular arrhythmias were believed to be the cause of death. Reoperation was required 37 times: for pacemaker exhaustion, 17; electrode problems, 15; wound problems, four; and arrhythmia, one. Nine of 12 patients are alive nine months to ten years eight months postoperatively. The remaining three survived for eight to ten years. Frequent reoperation and dilligent correction of defective pacing is rewarded with long, active lives in children requiring implantable pacemakers.

Adolescent↗

The Blalock-Hanlon procedure. Simple transposition of the great arteries.

Between 1959 and 1975 at St. Louis University Medical Center, 71 patients underwent surgery with the Blalock-Hanlon technique. Thirty-nine had simple transposition of the great vessels. The mean age at the time of operation was 3.4 weeks. Sixty-four percent were less than 1 month of age. Eighty-five percent survived the operation. In 11 the Blalock-Hanlon procedure was performed after failure of ballon septostomy. Arterial saturation was increased from a mean of 47% to 73%. There were three late deaths prior to Mustard repair (intra-atrial baffle procedure). Sixteeen patients underwent Mustard repair at a mean age of 4 years and a mean follow-up of 2 1/2 years. There were three deaths after surgery and three late deaths after the Mustard procedure. The Blalock-Hanlon procedure achieves prolonged palliation, avoiding an emergency Mustard procedure in infancy with its risk of late vena caval obstruction.

Cardiac Surgical Procedures↗

Major complications of median sternotomy.

Major sternal infections developed in eleven of 1,550 patients undergoing median sternotomy for operations on the heart. Nine patients had myocardial revascularization, six with internal mammary artery as the conduit. Seven of these patients have been salvaged by aggressive local wound management and systemic support. These survivors have a good outlook for treatment of their basic cardiac disease.

Cardiac Surgical Procedures↗

Myocardial injury and bypass grafting. Value of serum enzymes in diagnosis.

To clarify the value of serum enzymes in the detection of intraoperative and postoperative myocardial injury associated with coronary artery bypass grafting, we evaluated 70 consecutive patients (151 grafts). We used electrocardiograms and serial determinations of serum levels: serum glutamic oxaloacetic transaminase (SGOT), creatinine phosphokinase (CPK), lactic dehydrogenase (LDH), and LDH isoenzymes on Days zero, 1, 3, 5, 7, and 10. Patency of all grafts 1 week postoperatively was 92 per cent. Fourteen patients (20 per cent) had ECG evidence of acute myocardial infarction (AMI) or ischemia lasting longer than 48 hours. This incidence of AMI was attendant with no deaths or discernible changes in postoperative ventriculography. LDH-1 (cardiac fraction) was elevated in all patients with myocardial injury. Late elevation of LDH-1 occurred in 2 patients at the time of postoperative catheterization, 1 of whom had negative findings on ECG. Diagnostic correlation was not observed with total LDH, CPK, or SGOT. Predisposing factors to AMI included preinfarction angina (4 of 14 patients), occluded grafts (4 of 14), and a bypass time greater than 120 minutes.

Angina Pectoris↗