Concomitant coronary artery revascularization and right pneumonectomy without cardiopulmonary bypass.

Combined coronary artery bypass grafting (CABG) and pneumonectomy has a high morbidity and mortality rate, especially when the right lung has to be removed. A patient is described who underwent a CABG operation through a midline sternotomy without the use of cardiopulmonary bypass (CPB), and a right pneumonectomy through a right lateral thoracotomy in one operative session. To our knowledge, this is the first case in which this operative strategy was employed. CABG operations without the use of CPB might put concomitant lung surgery in a new perspective.

Isolated pericardial rupture with left-sided haematothorax after blunt chest trauma.

Pericardial rupture after blunt chest trauma is described in the literature. The rupture is mostly caused by high velocity trauma with associated injuries. As a result the patients are often critically ill. We describe a case of a 59-year-old man who suffered from an isolated pericardial rupture with a left-sided haematothorax diagnosed 3 months after minimal blunt chest trauma. The patient was operated upon and the defect was closed without detrimental sequelae.

Lipomatous hypertrophy of the interatrial septum: indication for surgery?

A fortuitous finding during open heart surgery of lipomatous hypertrophy of the interatrial septum is described in a 65-year old man with ischaemic heart complaints due to coronary artery disease and with premature ventricular contractions. An incision biopsy confirmed the diagnosis. The choice of treatment of lipomatous hypertrophy of the interatrial septum is controversial. Indications for surgery and surgical techniques are discussed.

Asymptomatic right atrial aneurysm: fortuitous finding and resection.

A rare right atrial aneurysm is described in a 36-year-old man. After median sternotomy for coronary bypass, a thin-walled aneurysmal dilatation of the right atrium was seen by chance. The patient was in sinus rhythm. The aneurysm was surgically resected. The postoperative course was uneventful.

Surgical repair of subacute left ventricular free wall rupture.

BACKGROUND: The natural course of subacute ventricular free wall rupture (FWR) as a complication of acute myocardial infarction (MI) is usually lethal. The aim of this study was to investigate the curability of this entity and to report on five patients successfully treated by rapid diagnosis, hemodynamic stabilization, and emergency surgical repair. METHODS: Five patients with subacute FWR of the left ventricle after previous MI were operated on. Infarctectomy with subsequent closure of the ruptured area was carried out in two patients with anterolateral infarction. Three other patients (two with posterior and one with lateral infarction) were treated by direct closure and the application of a patch. Furthermore, in two patients, concomitant myocardial revascularization was performed. RESULTS: All patients survived the procedure and were alive and well at long-term follow-up (mean 36.4 months). None of the patients suffered recurrent MI. CONCLUSIONS: Our experience and a review of the literature shows that prompt diagnosis and emergency surgical intervention may save the patient. Anterior rupture (with a moderate sized infarcted area) is best treated by infarctectomy and subsequent closure of the ventriculotomy with sutures buttressed with felt, whereas posterior rupture may be treated by direct closure and the application of an epicardial patch. Considering our results, we cannot conclude whether additional coronary artery bypass grafting is beneficial or not. Our suggestion is to perform additional myocardial revascularization only if indicated.

In vitro evaluation of the influence of pulsatile intraventricular pumping on ventricular pressure patterns.

The Pulsatile catheter (PUCA) pump consists of a single port membrane pump connected to an indwelling valved catheter. This so-called transarterial blood pump was originally designed to be introduced through a superficial artery into the left ventricular cavity to pump blood from the left ventricle into the ascending aorta. By introducing the catheter directly into the thoracic aorta or the pulmonary artery, the possibility is created of applying large-diameter catheter PUCA pumps as left, right, or biventricular assist devices (LVAD, RVAD, or BIVAD) without damaging any of the structures of the heart. The pump performance of an 8 mm PUCA pump prototype (internal diameter catheter, 8 mm; catheter length, 40 cm; stroke volume, 80 ml) was studied in a mock circulation to investigate the influence of pulsatile intraventricular pumping on ventricular pressure patterns. The pumping mode of the PUCA pump was changed from approximately 1:1 ([n + 1]:n) to 1:2 ([1/2n + 1]:n) and 1:3 ([1/3n + 1]:n) in relation to the frequency of a ventricle-simulating membrane pump. Apart from the pumping mode, timing of the PUCA pump driving system (ejection phase) seems to be crucial in obtaining optimal unloading of the ventricle.

In-vivo evaluation of the "HIA-VAD": a new German ventricular assist device.

Helmholtz Ventricular Assist Devices (VAD) are pneumatically driven polyurethane membrane pumps with various volumes. The pumps are placed paracorporeally and connected with commercially available cannulas between the left atrium and aorta (left ventricular assist device) and/or right atrium and pulmonary artery (right ventricular assist device, bi-ventricular assist device). The pumps can be driven with a stand-alone driving system or with a Helmholtz IABP-console interface. Seventeen animal experiments (on calves) with Helmholtz VAD's were performed to evaluate experimental protocols, to optimize surgical techniques, and to improve design and manufacturing techniques. Blood chemistry and cell counts demonstrated that the tested HIA-70 produces low mechanical blood damage. In the course of the animal experiments the Helmholtz VAD's were made totally transparent, whereby they became easy to de-air, efficient, and affordable.