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Biomedical subjects

M W Burlingame

Publications and source records attributed to M W Burlingame.

15 recordsLinked to original sources
PubMed1996

Maximal utilization of the left internal mammary artery for coronary bypass grafting.

A technique is described for using the internal mammary artery to bypass the left anterior descending coronary artery and another adjacent coronary artery even when the alignment of the two vessels is not favorable for a conventional sequential graft. The distal end of the mammary artery is amputated and used to construct a Y graft to the anterior descending artery and to the secondary target vessel.

Coronary Vessels↗
PubMed1993

Cox/maze procedure for atrial septal defect with atrial fibrillation: management strategies.

Atrial fibrillation is found at late follow-up in approximately half of all adults who have had correction of atrial septal defect, even if it was not present preoperatively. These patients are thus exposed to the risks of stroke and chronic drug therapy even after a successful operation. Simultaneous surgical correction of atrial septal defect and atrial fibrillation was accomplished in a 52-year-old man by means of the Cox/maze procedure. The small added risk and the substantial benefit of eliminating atrial fibrillation suggest that this approach is warranted in selected adults with atrial septal defect.

Atrial Fibrillation↗
PubMed1992

A simple and safe technique of left ventricular venting.

Left ventricular venting has many physiologic and practical benefits. A venting technique is described that employs a simple, closed system which allows the perfusionist to monitor left ventricular distention. By monitoring the left ventricular volume the perfusionist can regulate the degree of negative pressure on the vent and thus reduce the chance of air entering the heart.

Coronary Artery Bypass↗
PubMed1992

Applicability of noncardioplegic coronary bypass to high-risk patients. Selection of patients, technique, and clinical experience in 3000 patients.

Although some surgeons still prefer noncardioplegic coronary bypass, most surgeons are skeptical of its suitability for high-risk patients. We analyzed the first 3000 patients who had primary coronary bypass without cardioplegia since our program's inception. Patients with reoperations, valve operations, or carotid endarterectomies were excluded. Multivariate predictors of operative death included age, sex, left ventricular dysfunction, preoperative intraaortic balloon pumping, and urgency of operation. Eight hundred seventy-nine patients (29%) were more than 70 years of age; 795 (27%) were female; 290 (9.7%) had an ejection fraction less than 0.30, and another 77 (2.6%) had left ventricular aneurysms; 196 (6.5%) had an acute myocardial infarction, and another 397 (13%) had a myocardial infarction less than 1 week preoperatively; 917 (31%) had rest pain in the hospital (preinfarction angina). Only 790 (26%) had elective operations. The overall operative mortality rate was 1.47% (44/3000): The mortality rate for elective operations was 0.5% (4/790); urgent 1.7% (28/1687); emergency 2.3% (12/523). In patients with an ejection fraction less than 0.30 the mortality rate was 6.2% (18/290); with age more than 70 years, it was 3.9% (34 of 879); with acute myocardial infarction it was 3.1% (6/196); and with left ventricular aneurysmectomy it was 1.3% (1/77). Inotropic support after leaving the operating room was needed in 6.6% (199 patients), and 1% (30 patients) required new intraaortic balloon pumping postoperatively (two of these 30 patients died). These results provide reassurance that noncardioplegic coronary artery bypass grafting provides excellent myocardial protection and operating conditions for primary coronary bypass and is particularly suitable for high-risk patients.

Adult↗
PubMed1990

Coronary bypass with substrate-enhanced cardioplegia versus non-cardioplegic technique for early revascularization in acute infarction.

Nine patients chosen at random received substrate enhanced cardioplegia (SECP) for early (less than 4 h) revascularization in acute infarction. A control group of 9 patients with similar clinical characteristics was chosen from the larger group revascularized concurrently with a noncardioplegic technique (NCP). There were no significant differences between the NCP and SECP groups respectively in preoperative clinical parameters such as age (62.8 vs. 62.3 years), sex (7 men, 2 women in both groups), ejection fraction (50% vs. 56%) or number of diseased vessels (2.1 vs 2.3). Intraoperative aortic clamp times were significantly shorter in NCP patients (11 vs. 38 min), and 4 NCP patients had no clamping. The internal mammary artery (IMA) was used in 6 NCP patients and 1 SECP patient (to a nonoccluded branch vessel). Postoperatively, NCP patients had higher peak CPK-MB (284 vs. 190 IU/l), longer use of inotropes (10 vs. 2.7 h) and intraaortic balloon pump (15 vs. 8 h), and a higher ejection fraction before discharge from hospital, but none of these differences were significant. SECP appears to provide better myocardial performance early postoperatively, but lasting benefits were not apparent in this subset of patients with early revascularization. Because the IMA has a powerful effect on long term survival but is very difficult to use with antegrade SECP, we continue to favor the IMA without SECP in hemodynamically stable, young patients (less than 65 years) who are revascularized early after infarction.

Aged↗
PubMed1988

Postoperative fibrous cardiac constriction.

Two patients with postoperative fibrous cardiac constriction are described. Unlike postoperative pericardial or epicardial constriction, the fibrous constricting layer in these patients envelopes the vein bypass grafts and is separate from the pericardium, which is not involved. Surgical management of these patients is difficult and hazardous; a strategy is outlined.

Cardiomyopathies↗
PubMed1988

Left thoracotomy for reoperative coronary bypass.

The left thoracotomy approach for reoperative circumflex coronary revascularization is described in three cases. This approach is an excellent alternative to repeat sternotomy in select patients.

Aged↗
PubMed1987

Coronary artery bypass without cardioplegia.

Cardioplegic myocardial protection has become the standard for coronary artery bypass. In contrast, we report 500 consecutive coronary artery bypass operations with intermittent aortic clamping for distal anastomoses, left ventricular venting, and 30 degrees C hypothermia. Average patient age was 62 years (range of 30 to 89 years). The number of patients who had urgent or emergency operations was 194 (39%); 251 patients had unstable angina, and 123 others had preinfarction angina (pain at rest in the hospital); 27 had evolving myocardial infarction. The average number of grafts was 3.3 per patient, and the average ischemic time was 7.65 minutes per graft. There were five hospital deaths (1%); none resulted from poor myocardial protection that caused low cardiac output. Only three survivors (0.6%) required a balloon pump to be weaned from cardiopulmonary bypass: two had acute infarctions preoperatively, and the other had an ejection fraction of 0.30 and intractable atrial arrhythmias. Only two other patients (0.4%) received any inotropic infusions postoperatively. Eighteen patients (3.6%) had a perioperative infarction. These results, particularly the virtual absence of postoperative inotropic support, in unselected patients of whom 80% had acute coronary syndromes, indicate that intermittent ischemia can provide excellent myocardial protection for coronary bypass. Brief periods of intermittent ischemia alleviate concern about cardioplegic protection via occluded coronaries or internal mammary grafts and provide a simple and safe option for myocardial protection during coronary artery bypass.

Adult↗
PubMed1987

Accuracy of sizers for aortic valve prostheses.

Accurate sizing of the aortic anulus is a prerequisite of prosthetic valve implantation, because it is usually desirable to insert the largest possible prosthesis. Although it is generally assumed that commercial valve sizers are accurately labeled, our measurements reveal that the sizers for the St. Jude Medical, Björk-Shiley, and Ionescu-Shiley prostheses are larger than their nominal sizes. These findings are relevant to the selection of prosthetic valves.

Aortic Valve↗
PubMed1979

Splenectomy for hematologic disease.

One hundred and thirty splenectomies were performed at the University Hospital in Birmingham for hematologic disorders during a 12 year period. There were seven deaths of which four were related to sepsis in patients with malignant growths which probably impaired immune competence. Splenectomy was found to be uniformly satisfactory for hereditary hemolytic anemia, for hypersplenism complicating rheumatoid arthritis and for the rare instance of primary hypersplenism. Splenectomy was usually salutary in didopathic thrombocytopenic purpura and in antoimmune hemolytic anemia. When done for diagnosis, splenectomy was definitive in about 50 per cent of the instances. Individual patients with thrombotic thrombocyeosinophilia syndrome benefited. Splenectomy for hypoplastic or aplastic anemia in an actual circulation offered only questionable benefit and is rarely necessary for hyperplenism secondary to portal hypertension.

Adult↗
PubMedDate not supplied

Hypoxemia and pulmonary hyperperfusion due to systemic collateral arteries after total repair of transposition of the great arteries.

Two cases of hypoxemia and pulmonary hyperperfusion due to large bronchial collateral arteries after total repair of simple transposition of the great arteries (TGA) are presented. Pulmonary hyperperfusion was not present before total repair. Hypoxemia and congestive heart failure quickly abated after surgical ligation of these enlarged bronchial collateral arteries. The patients were totally corrected quite late (at 21 and 22 months respectively) by current standards. It is suggested that: (1) large bronchial collaterals may develop in patients with simple TGA especially if total correction is delayed; (2) preoperative angiographic evaluation of patients with simple TGA who come in for total correction late, should include special aortic root injection to exclude the presence of bronchial collaterals; (3) hypoxemia and pulmonary congestion after total correction of TGA by atrial switch procedure (Mustard or Senning) may in fact be due to bronchial collaterals and not obstruction of the pulmonary veins.

Bronchial Arteries↗