During a 9 year period between January 1977 and December 1985, 98 consecutive infants under 3 months of age underwent surgical repair of symptomatic aortic coarctation. Resection and end-to-end anastomosis was performed in 73, subclavian flap angioplasty in 14, and other procedures in 11 patients. There were 20 (20.5%) early and 12 (12.5%) late deaths. No early deaths occurred in the isolated coarctation group. Associated complex cardiac malformations and age under 2 weeks at operation influenced significantly early and late outcome but not any particular surgical procedure. The survivors were followed from 6 months to 8 years and 8 months postoperatively. There were 16 (28%) re-coarctations among 56 survivors after end-to-end anastomosis requiring re-operation in 7 (12%) infants and 3 (30%) re-coarctations among 10 survivors after subclavian flap angioplasty requiring re-operation in 1 infant. After end-to-end anastomosis re-coarctation as well as re-operation rate was markedly lower when an interrupted suture line for the entire anastomosis was used as compared to the group with a continuous suture line of the posterior aortic wall (21% vs. 33% re-coarctation rate and 4% vs. 18% re-operation rate respectively). From our results it is concluded that subclavian flap angioplasty for relief of aortic coarctation in early infancy is not superior to resection and end-to-end anastomosis. In the end-to-end anastomosis group an interrupted suture line has a lower re-coarctation as well as re-operation rate as compared to a continuous suture line of the posterior aortic wall.

Anastomosis, Surgical↗

PubMedDate not supplied

Clinical comparison between membrane and bubble oxygenators in cardiopulmonary bypass.

The clinical course of two similar patient groups was compared in whom, during cardiopulmonary bypass, a membrane or bubble oxygenator was employed. According to our results there is no significant functional difference between the two types of oxygenators as long as the perfusion time does not exceed 90 minutes. Beyond this time limit, the membrane oxygenator has distinct advantages, particularly with regard to hemolysis. We presently prefer the bubble oxygenator. The use of a membrane oxygenator is restricted to complex open heart procedures with suspected technical problems.

Adult↗

PubMedDate not supplied

Combined application of metabolic myocardial arrest and general profound hypothermia in aortic valve replacement.

To determine the value of general hypothermia in combination with magnesium-aspartate-procaine induced metabolic myocardial arrest, the surgical results of 2 similar groups of patients subjected to aortic valve replacement were compared. Metabolic arrest of the myocardium was achieved under mild hypothermic conditions in group I (71 patients) and in profound hypothermia in group II (48 patients). The operative mortality was 5.6% in group I and 4.1% in group II. There was no cardiac related with in group II. In group I two deaths were due to a low cardiac output state. In addition, 3 patients required inotropic support during the early postoperative period. Our results indicate, that magnesium-aspartate-procaine induced cardioplegia in combination with general profound hypothermia can provide effective myocardial protection during aortic valve replacement.

Adult↗

PubMedDate not supplied

Estimation of adequate subendocardial blood flow by online computation of systolic pressure time index and diastolic pressure time index after cardiopulmonary bypass.

Subendocardial perfusion was monitored in 48 patients subjected to valve replacement by calculation of diastolic pressure time index (DPTI), systolic pressure time index (TTI) and DPTI/TTI. An on-line computer which derives these values from the systemic pressure and wave-form was applied. For myocardial protection general body hypothermia (esophageal temperature 25 degrees C) and hypothermic injection cardioplegia were employed. No low cardiac output state occurred and no inotropic drugs were required. In all patients DPTI/TTI rose above 1 within 60 minutes from termination of cardiopulmonary bypass so that the necessity to intraaortic balloon counterpulsation could be denied in all cases. We believe that the calculation of DPTI/TTI after extracorporeal circulation is a useful modality to predict the adequacy of subendocardial perfusion and monitor myocardial performance.

Cardiac Catheterization↗

PubMedDate not supplied

Surgical treatment of acute dissecting aneurysm of the ascending aorta.

Since 1959, 51 patients underwent open heart surgery for correction of an acute dissecting aneurysm of the ascending aorta. Upon admission, 33 patients were severely hypotensive or in progressive heart failure. Acute aortic insufficiency was found in 24 patients, and hemiplegia or hemiparesis in four. In 45 patients the ascending aorta was reconstructed with a woven Dacron graft. After excision of the dissected part of the aorta, primary anastomosis or patch aortoplasty was performed in six patients. The aortic valve remained intact in 26 patients, and resuspension of the commissures restored competence of the aortic valve in another nine. Sixteen patients required aortic valve replacement because of disrupture of the commissures. Dissection extended into the coronary ostia in nine cases. Reconstruction of the coronary system was accomplished by reimplantation of the ostia, interposition of a vein graft or aortocoronary bypass. Nine patients died within the early postoperative course from uncontrollable hemorrhage (four), further dissection (three) and myocardial infarction (two). Within the first year after surgery, another five patients died from acute aortic dissection (two), pseudomonas infection causing rupture of the proximal graft anastomosis (one) and myocardial infarction (two). Contraindications of antihypertensive treatment of acute dissection of the ascending aorta are discussed. We recommend prompt surgical intervention in acute dissecting aneurysms of the ascending aorta.

Acute Disease↗