In 17 patients who underwent openheart surgery with cardiopulmonary bypass using heparinized fresh blood for priming the heart-lung machine the following investigations were done: Blood samples taken at different periods of surgery were assayed for total calcium (Catot), ionized calcium (Ca++), magnesium (Mg), hemoglobin, total pasma proteins, and the acid-base-status. Considering the different kinds of cardiopulmonary bypass the patients were divided into three groups: In the first group the results ofsurgical procedure with and without hemodilution perfusion were compared. During hemodilution perfusion Catot decreased markedly whereas Ca++ remained nearly constant. In the second group the influence of different calcium concentrations of the prime solution on Catot and Ca was tested. A low calcium content of 2.8 mEq/1 lowered Catot and Ca++ to subnormal levels. In the third group results of Mg-induced cardioplegia were compared with findings during surgical procedure with anoxic cardiac arrest. A remarkable increase of magnesium at the perfusion onset could be observed. Magnesium remained within the upper level of normal range until surgery end and decreased to normal values in the postoperative stage. Since energy requirements of the arrested heart and thus the velocity of ATP-breakdown during ischemia are closely related to the Ca++ concentration of the extracellular space low plasma calcium levels are considered to be advantageous during cardiopulmonary bypass. Only at the end of partial bypass before the heart fully takes over circulating work a sufficient calcium substitution is recommended.

Adolescent↗

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Aortoventriculoplasty for different types of left ventricular outflow tract obstructions.

Since the first clinical application of aortoventriculoplasty for tunnel subaortic stenosis in 1974 the indication for this method was extended to other types of left ventricular outflow tract stenoses (LVOTO). The operative technique consists of enlarging both the left and right ventricular outflow tracts and inserting an aortic prosthetic valve. 47 operations have been performed in patients with various types of LVOTO: 8 narrow annulus, 23 diffuse subaortic stenosis (multiple level stenosis), 9 complex forms of tunnel subaortic stenosis (Shone complex) 3 outgrown prosthesis, 4 obstructive idiopathic hypertrophic subaortic stenosis. Patients ages ranged from 4 to 35 years. Overall mortality was 13%, there were no late deaths, in the last 34 patients there was no death. In 25 patients there had been 1, and in 13 patients 2 previous procedures. As a result of the operation 9 patients developed complete right bundle branch block or left anterior hemi-block; 2 patients developed total a-v block with the need of a permanent pacemaker 25 patients had catheterization postoperatively. The mean gradient across the left ventricular outflow tract was significantly reduced from 91.5 +/- 21 mm Hg to 13.1 +/- 15 mm Hg. According to our experience aortoventriculoplasty can be used routinely in all forms of diffuse subaortic stenosis, narrow aortic annulus, reoperation in HOCM, multiple level stenosis and outgrown aortic prosthesis.

Adolescent↗