We describe a new technique for the placing and fixing of extracorporeal circulation cannulae in the heart. Two devices are involved, the first for an atrial or venous return cannula and the second for an aortic perfusion cannula. These allow quick easy cannulation which is very important in emergency surgery.

Cardiac Catheterization↗

PubMedDate not supplied

Abdominal aortic aneurysmectomy in octogenarian patients.

The authors report 56 patients. 80 years of age or older who had an abdominal aortic aneurysm (AAA): twenty seven were operated upon as emergencies, 7 with intra-peritoneal (Group I) and 20 with retro-peritoneal rupture (Group II). Twenty nine underwent elective surgery (Group III). Renal pulmonary and cardiac disease are frequent in octogenarian patients. The surgical repair consisted of 40 knitted bifurcated grafts and 16 aorto-aortic woven grafts. The overall in-hospital mortality rate is high (28.5%: 16 patients) essentially in "emergency" surgery: 71% for the seven Group I patients and 45% for the twenty Group II patients. The in-hospital mortality rate of 6.9% for the Group III of "elective" procedure is higher than the mortality rate of patients of all ages operated on for asymptomatic AAA in our institution which is 4.3%. Once a patient has been operated on successfully his life expectancy tends to parallel that of a normal population for his age group. These results can be improved with preventive measures such as elective surgery for asymptomatic AAA with a diameter of 6 cm or more. Operative contraindications are severe congestive heart failure, advanced pulmonary disease or neoplastic disease. The age "per se" is not a contraindication to aneurysmectomy. Physiologic rather than chronologic age should determine the selection for AAA in the over-80 age group. CT scans and MR are safe fast and non-invasive preoperative examinations for AAA.

Aged↗

PubMedDate not supplied

Isolated aneurysm of the left sinus of Valsalva. Rupture into the left atrium, left ventricle and dynamic coronary constriction.

Aneurysms of the left sinus of Valsalva are exceptional. They may cause aortic regurgitation and may rupture into an extra or intra-cardiac location. We report an aneurysm of the left Sinus of Valsalva associated with 3 unusual complications: rupture into the left atrium, infected rupture into the left ventricle inducing aortic regurgitation and compression of the left circumflex coronary artery. These caused cardiac failure, coronary insufficiency and paroxysmal ventricular fibrillation. A review of the literature on the LASV has been undertaken.

Aged↗

PubMedDate not supplied

Internal mammary artery dissection: a three dimensional sternal retractor.

Explore the source record for details and available documents.

Humans↗

PubMedDate not supplied

Cardiac damage in nonpenetrating chest injuries. Report of 5 cases.

The Authors report 5 cases of cardiac injury after blunt chest trauma: (a) one right atrial disruption with acute tamponade treated successfully; (b) two left ventricular perforations with rib fractures: one patient was exsanguinated and died, the other one presented a late subacute cardiac tamponade with successful operative repair; (c) one isolated traumatic tricuspid insufficiency which was well tolerated; (d) one atrio-inferior caval disruption with acute tamponade. Cardiac damage secondary to nonpenetrating chest trauma is uncommon but with the present modes of high speed transportation they are occurring with increasing frequency; correct management of cardiac ruptures depends upon rapid recognition of the injury and expeditious surgical repair. The occurrence of tricuspid valvular lesions alone as a result of nonpenetrating trauma is not common. Echocardiographic examination after blunt chest trauma is a useful diagnosis procedure.

Accidents, Traffic↗

PubMedDate not supplied

Cardiovascular surgery and heparin induced thrombocytopenia.

The Authors report a series of 21 cases of heparin induced thrombocytopenia (HIT) observed in a Department of Cardiovascular Surgery. The indication for heparin treatment was a cardiac procedure in 12 cases, peripheral arterial reconstructive surgery in 3 cases and in 6 cases a prevention of embolism. Two routes were used for heparin administration: subcutaneous and intravenous injections. The diagnosis was biological on low platelet counts (p.c.) in 4 cases, in 7 cases a deep venous thrombophlebitis and in 9 cases an acute arterial ischemia complicated the heparin treatment. From the 7th to 15th day after heparin treatment the p.c. had risen to the average value of 46,857/mm3. The diagnosis was clinical in 3 cases, biological with a positive aggregation test in the presence of heparin in 11 cases out of 14 biological tests performed and pathological with observation of white clots in 11 cases. The related mortality rate to HIT was 28.5% of the cases (6 cases). HIT is a rare but severe complication often associated with thrombo-embolic complications. The routine check of p.c. before and after the first week of heparin treatment is reasonable. The negative aggregation test in the presence of heparin does not permit to confirm this diagnosis. The drop in the p.c. between the 6th to 10th day after heparin treatment required an immediate arrest of this type of anticoagulation and replacement with Coumadin. The low molecular weight Heparin may induce cross matching reactions with heparin and therefore is not used as treatment for HIT. In emergency, cardiac surgery with the use of the extra-corporeal circulation device can be performed with success with heparin (2 cases).

Adult↗