Direct ostioplasty of the left main coronary artery for isolated nonarteriosclerotic ostial stenosis.
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Biomedical subjects
Publications and source records attributed to W I Brenner.
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A cluster of sternal wound infections (SWI) requiring muscle flap closure occurred in a California hospital in 1988. Review of SWI rates by surgical team revealed that a single team (Team A) was associated with a cluster of SWI requiring muscle flap repair (MFR). Team A's rate of SWI requiring MFR was 2.27% in 441 heart operations. A case/control study was conducted to determine if the higher rate of SWI requiring MFR could be attributed to disproportionately large numbers of patients at high risk treated by Team A. Data on major risk factors for SWI collected for case and control groups included the following: age at operation, weight, body surface area, history of obesity, diabetes mellitus, or cigarette smoking, duration of cardiopulmonary bypass, use of internal mammary artery graft, number of coronary arteries bypassed, use of prostheses, operating room staffing, and emergent nature of operation. No statistically significant differences between Team A cases requiring MFR and control cases were observed for predisposing risk factors. Surgical technique remains a principal suspected risk factor for SWI requiring MFR in this cluster.
A 36-year-old woman with classic clinical and biochemical features of pheochromocytoma was found to have a cardiac pheochromocytoma originating in the interatrial septum and a significant obstructive lesion in the left anterior descending coronary artery. Complete resection of the pheochromocytoma and an aortosaphenous vein graft were performed. This is the first reported case of successful resection of an interatrial pheochromocytoma.
Chylothorax occurred as a manifestation of severe congestive heart failure resulting from rheumatic mitral stenosis. Following replacement of the mitral valve, chylothorax recurred and was treated by thoracocentesis initially and then resolved during six months of therapy with a diet of medium-chain triglycerides. Ultimately, the patient resumed a regular diet with no further accumulation of pleural fluid.
A patient who underwent cardiopulmonary bypass developed a syndrome of malignant hypertension with agitated delirium, unresponsive to antihypertensive agents, following abrupt withdrawal of clonidine. The literature on this syndrome is reviewed with emphasis placed on prompt recognition. The syndrome can be reversed by resumption of clonidine administration and can be prevented by maintenance of clonidine levels through the perioperative period.