Biomedical subjects
Publications and source records attributed to J M Fritz.
We present the unusual case of a 56-year-old man with acute dissection of the ascending aorta (DeBakey type I) whose presenting symptoms were those of lower gastrointestinal (GI) bleeding. Surgical repair was successfully accomplished with resection of the aorta with a Dacron tubular graft combined with aortic valvular replacement after obtaining bowel viability.
A Fontan operation was performed on a 10-year-old child for correction of tricuspid atresia. A xenograft, valved conduit was used to establish continuity between the right atrium and the small right ventricle. Atrial and ventricular septal defects were repaired with Dacron patches. Two hours postoperatively, the patient suffered a cardiac arrest secondary to hypoxia and was successfully resuscitated. Partial recurrence of a right-to-left shunt at the atrial level necessitated the patient's return to surgery. The insufficient conduit was replaced and the leaking patches were resutured. The conduit was shortened to one-third its length, and the conduit valve was repositioned directly at the proximal end, over the right atriotomy. Ten months postoperatively, the patient remains in stable condition.
In the intensive care unit immediately after a triple aortocoronary bypass procedure, a 62-year-old man presented with copious amounts of frothy secretions in the endotracheal tube, became severely hypotensive, and remained hypoxic in the presence of maximum respiratory support. Chest roentgenograms showed pronounced pulmonary edema. Prior to leaving the operating room, the patient had received 1 unit of whole blood. A leukoagglutinin reaction to this blood transfusion was determined to be the cause of the pulmonary edema. When the patient continued to deteriorate after administration of diuretics, vasopressors, corticosteroids, albumin, and maximum respiratory support, the Sci-Med membrane oxygenator was inserted by the right femoral vein-artery. Bypass was continued for approximately 8 hours, until the PaO2 increased and the patient's condition stabilized. We think this is the first reported case of membrane oxygenation for treatment of noncardiogenic pulmonary edema due to leukoagglutinin reaction. It indicates the need for early diagnosis and utilization of the membrane oxygenator when other methods of treatment fail.
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