Longterm complications of Beall prosthetic valve: a case report.

A case of malfunctioning Beall prosthetic mitral valve causing severe heart failure is presented. The unusual aspect of this malfunction was the finding of disc dislodgment despite the absence of pathology in the disc itself. The dislodgment was caused by excessive tissue ingrowth around the suture ring. The need for close clinical follow-up of this type of prosthetic valve is emphasized.

Intramesenteric perforation of sigmoid diverticulitis with nonfatal venous intravasation.

Complications from barium enema are rare (0.035 per cent). A patient with venous intravasation during barium enema complicated by pylephlebitis and portal vein obstruction is the tenth to be reported on, the fourth to survive. This accident was associated with colon disease in eight of the patients studied, five of whom had diverticular disease.

Arterial prosthesis of microporous expanded polytetrafluoroethylene for construction of aorta-pulmonary shunts.

A new arterial prosthesis made of polytetrafluoroethylene (OTFE) was evaluated in 10 infants with complex cyanotic congenital heart disease. All grafts used were 4 mm. in diameter and varied in length from 0.8 to 6 cm. The grafts were anastomosed to the main pulmonary artery or its bifurcation in 8 infants and to the right and left pulmonary arteries in one each. There were two early deaths, one of which was related to shunt failure. The advantages of a shunt to the main pulmonary artery are obvious, and the intraoperative procedure is facilitated with the prosthesis. Follow-up averages 9 months in the 8 survivors, and the patients have nearly doubled their preoperative weight. A shunt murmur is present in each case and the children have mild-to-moderate cyanosis at rest. Repeat aortograms in 2 patients, 8 and 10 months postoperatively, show a smooth graft without luminal narrowing. The aortic oxygen saturations were 73 per cent. The PTFE graft and/or anastomoses will not grow with the growth of the child and therefore may not accommodate growth by increased flow. This may prove to be a limiting factor in its long-term use in fants. We reserve the use of these grafts for infants with complex cyanotic defects undergoing emergency surgery or in older children in whom a conventional shunt is not possible or a previous shunt has failed.

Vascular manifestations of the thoracic outlet syndrome. A surgical urgency.

Although the vascular manifestations of the thoracic outlet syndrome are infrequent, their presence is an ominous portent for the affected limb. The cases of two recent patients indicate the importance of prompt recognition, urgent angiography, and definitive surgery. Regarding the surgical procedure, we used a two-incision approach-supraclavicular and intraclavicular-combining scalenotomy, resections of the cervical rib if present, the first thoracic rib, and the subclavian artery with retroclavicular interposition woven Dacron graft reconstruction. Preceding graft replacement, a Fogarty catheter thrombectomy of the distal brachial artery tree is done with completion arteriography to ensure freedom from retained distal thrombus. First rib resection is easily performed; subsequent vascular repair is also carried out, using this approach. We did not add sympathectomy to these cases, believing that early recognition and treatment will obviate its necessity. Follow-up has supported the efficacy of the treatment plan as presented.

Microporous expanded polytetrafluoroethylene arterial prosthesis for construction of aortopulmonary shunts: experimental and clinical results.

A new microporous, expanded polytetrafluoroethylene arterial prosthesis was evaluated in dogs. The material appears to produce an adequate prosthesis for aortopulmonary anastomosis in animals and can conduct a high rate of blood flow. The graft has been used in 3 patients with pulmonary atresia aged 2 days, 2 months, and 6 months. Thus far all patients are well, growing, and have a loud shunt murmur. The desirable features of this type of anastomosis are presented.

Ascending aorta insertion of the dual-chambered intraaortic balloon for counterpulsation during cardiac operations.

A patient with left ventricular power failure after aortocoronary saphenous vein bypass was successfully managed by intraaortic dual-chambered balloon counterpulsation through the ascending aorta. This insertion route reverses the orientation of the spherical distal chamber, which inflates early in diastole and partially occludes the aorta. This position achieved an effective augmentation pressure during left ventricular diastole and reduced arterial end-diastolic pressure considerably. The technique of insertion and events at operation and postoperatively are discussed.

Postinfarction ventricular aneurysm. Successful surgical treatment.

Over a two-year period, 18 patients with postinfarction ventricular aneurysms were treated surgically. There were no operative or early deaths, and only one (5.5%) late (20 months) death. The indications for surgery included angina, congestive heart failure, and serious arrhythmias. Electrocardiograms and plain chest roentgenograms were unreliable in making the diagnosis. All patients had cardiac catheterization and, at operation, a definite localized aneurysm was demonstrable. In 15 patients (83%), coronary artery bypass grafts were performed at the time the aneurysm was excised. Good results should be expected from surgical treatment of symptomatic ventricular aneurysms. Simultaneous bypass grafting should be performed when indicated.