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Biomedical subjects

J M Craver

Publications and source records attributed to J M Craver.

101 records · Page 6Linked to original sources
PubMed1977

Concomitant aortic valve replacement and myocardial revascularization.

Twenty-six consecutive patients underwent combined aortic valve replacement and myocardial revascularization at the Emory University Affiliated Hospitals between May, 1973 and March, 1976. Acute myocardial infarction resulted in two operative deaths (8%). There have been four late deaths, all Class IV preoperative. The age range was 37 to 79 years with an average age of 60. Preoperatively all patients were Class IV or late Class III. Twenty-three patients had symptoms of angina pectoris; congestive heart failure was evident in 56%. Postoperatively, 70% are now Class 1 or II. Single coronary bypass was performed in 16 patients, double in 6, and triple in three. Double bypass plus mitral valve replacement was required in two with aneurysmectomy in one. The rate of intraoperative infarction was 27% for the series but only 7% in the last year. The methods of intraoperative myocardial preservation and the technical approach for the operative procedures were variable. Results with each method are correlated, and currently preferred techniques are presented and discussed. Best results were obtained in patients who presented early in their symptomatic course with isolated proximal coronary lesions and good renoff vessels. Excellent results could be achieved despite advanced age of patients, requirement for multiple bypass grafts, and correction of other associated cardiac lesions. Poorest results were obtained when long-standing ventricular failure was combined with poor vessels distal to coronary stenoses.

Adult↗
PubMed1977

Repeat myocardial revascularization for uncontrollable angina after occlusion of prior aortocoronary bypass.

Twelve patients at Emory University Hospital have had repeat myocardial revascularization for recurrent, uncontrollable, disabling angina pectoris after previous coronary artery bypass grafts. The interval betweeen initial bypass procedure and reoperation ranged from six weeks to six years. The native coronary circulation remained unchanged in six, had developed additional proximal (left main) obstruction in four, and had advanced stenosis at the site of former anastomosis in three. Repeat revascularization consisted of new vein graft construction in eight and vein and internal mammary artery graft in four, with an average of 1.9 grafts per patient. There were no deaths. Seven of 12 patients (60%) are now asymptomatic and three of 12 (25%) are significantly improved. Patency of new grafts studied by elective repeat coronary angiography in six patients showed patency of all grafts to the left anterior descending artery and four of six grafts to other vessels. Analysis of the initial graft closures, method for selecting patients to undergo a second procedure, and operative technics believed important in safety of reoperation and avoidance of repeat early graft occlusion are presented.

Adult↗
PubMed1976

Cardiac valve replacement in the first 21 years of life.

From 1969 through 1974, 25 patients under age 21 years had prosthetic cardiac vlave replacement at the Emory University Hospital. Twenty-nine valves were replaced in this group. Patients ranged in age from 2 to 21 years, with a mean of 14 years. Concomitant correction of associated cardiac lesions was required in 14 (56%). Five (21%) had had prior open valvuoplastic procedures. Operative mortality for the entire group was 12%, with an additional late mortality of 8%. There have been no early or late deaths in the last three years' experience. Best results are obtained when early correction of isolated valvular lesions is done as soon as clinical deterioration on vigorous medical management is recognized. The presence of multiple intrcardiac lesions or prior valve surgery does not preclude excellent results. Current indications for surgical correction and follow-up management are presented.

Adolescent↗
PubMed1975

The lesser saphenous vein. An alternative graft for coronary revascularization.

In patients with surgically removed or varicose greater saphenous veins and atherosclerotic or small internal mammary arteries, or in patients requiring three or more coronary bypasses, the lesser saphenous vein can be considered for aortocoronary revascularization procedures. Its suitability can be demonstrated preoperatively by careful clinical examination and by venography. This report describes the successful use of the lesser saphenous vein in 3 patients, with long-term follow-up.

Coronary Artery Bypass↗
PubMed1975

Resection of acute posterior ventricular aneurysm with repair of ventricular septal defect after acute myocardial infarction.

Three patients with true posterior myocardial infarctions and ventricular septal defects were treated by posterior infarctectomy, closure of the defect, and appropriate combinations of mitral valve replacement and coronary grafting. Aortic balloon pumping was not used. The technique of infarctectomy and ventricular septal defect closure is illustrated. Two of the 3 patients have excellent long-term results.

Aged↗