[Emergency management of type A aortic dissection in the acute rupture phase with pericardial tamponade]. / Notfallmässige Versorgung einer Aortendissektion Typ A im Stadium der akuten Ruptur mit Perikardtamponade.

A case of successful operative repair of a previously unknown aortic dissection type A after intrapericardial rupture is presented. Under resuscitative measures an inferior pericardiotomy was done, followed by sternotomy to control bleeding under then stabilized circulation. Without detailed diagnostic evaluation, immediate operation with resection of the aneurysm and supracoronary prosthesis interposition was carried out. The diagnostic methods and problems, the differential diagnosis, and comparable cases from the literature are discussed.

[Histologic examinations of internal mammary artery, saphenous vein and aorta specimens collected during heart surgery]. / Badania histologiczne wycinków tetnicy piersiowej wewnetrznej, zly odpiszczelowej wielkiej i aorty pobranych w czasie operacji kardiochirurgicznych.

133 patients with coronary heart disease were treated surgically. 60 patients had Internal Mammary Artery (IMA) grafting performed together with saphenous vein grafts (IMA group), another 70 patients had saphenous vein grafts only (SVG group). Material for histological examination was intraoperatively taken from saphenous vein and ascending aorta and in IMA group also from the distal part of internal mammary artery. The intensity of atherosclerosis was estimated with 5-grade scale from 0 to 4 (0-no atherosclerosis, 1-minimal, 2-insignificant, 3-moderate, 4-pronounced). To visualize and to assess the blood flow through the internal mammary artery Digital Subtraction Angiography (DSA) was performed between day 6 and day 8 postoperatively in the IMA group. Results obtained were correlated with the intensity of atherosclerosis estimated histologically and the numeric data were statistically analysed. In the IMA grafts mean atherosclerosis intensity was 0.94 which is the evidence of minimal atherosclerotic changes. In saphenous vein the corresponding value was in the IMA group 2.14 and in the SVG group 2.17, in aortic scraps 2.64 in the IMA group and 2.73 in the SVG group. Patients in the SVG group were average 8.4 years older than in the IMA group. The difference is statistically significant. Despite the age difference, the intensity of atherosclerosis was not statistically different in aortic and saphenous vein scraps. Among 63 patients in the IMA group in 31 patients (49.2%) no atherosclerosis was found during histological examination and in 32 patients (50.8%) changes ranged from minimal to moderate. There were no IMA grafts with the pronounced atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of digital subtraction angiography for estimation of early results of myocardial revascularization after internal mammary artery grafting]. / Znaczenie dotetniczej cyfrowej angiografii subtrakcyjnej dla oceny wczesnych wyników rewaskularyzacji tetnic wiencowych przy zastosowaniu przeszczepu tetnicy piersiowej wewnetrznej.

Between 1st January and 31st December 1987 126 consecutive patients underwent full myocardial revascularization using at least one internal mammary artery bypass grafting in Department of Cardiovascular Surgery of University of Freiburg. In 78 patients (75 males, 3 females) DSA was performed within 8 days after surgery to evaluate dynamics of IMA-graft. The age ranged from 38 to 67 years (mean 53.4 years). DSA study was performed through the brachial artery, contrast medium was injected with flow of 10 ml/sec. in counter current. It was only one series of angiograms necessary to visualise flow from subclavian artery, through IMA to coronary artery. Among 78 investigated patients in 61 (78%) the distal anastomosis appeared to be widely patent and flow through the IMA and anastomosed coronary artery was sufficient. Patency of one of the branches of IMA or stenosis of IMA graft contributed to inadequate flow in 12 patients (15.6%). In 5 (6.4%) operated patients the IMA graft was not patent. Counter current intraarterial DSA requires much smaller amount of contrast medium than classical angiography, moreover avoiding of aortic catheterization with all risks involved. The counter current intraatrial DSA is an excellent technics of estimation of the flow to grafted coronary arteries. The method is easy to perform, repetitive and carry very small risk for the patient. Early postoperative evaluation of IMA-graft patency is essential for estimation of effectiveness of myocardial revascularisation and prognosis for the patient.

Significance of early angiographic follow-up after internal thoracic artery anastomosis in coronary surgery.

The authors report about the radiological checking of the patency of the internal thoracic artery transplant in 75 patients with coronary artery disease, using intraarterial DSA in the early postoperative phase (between 6th and 8th postoperative day). The left or the right brachial artery was punctated and the contrast medium was injected at a dosage of 50 ml in counter-current. Only one angiogram series per patient was necessary to appraise the anastomosis and the perfusion of the bypass applied. In 5 patients a stenosis and in 4 patients an occlusion of the transplant could to be diagnosed. Early postoperative angiography enables quality control. In case of occlusion reoperation may be indicated.

Computerised tomography after abdominal aortic aneurysm repair.

CT scan early after AAA resection and graft implantation enables the detection of local complications such as extensive haematomas around the implanted graft (25 cases), gas bubbles (7 cases) fluid collections, inflammatory infiltration in the tissue around the graft and compression of organs in the neighbourhood (1 case) to be detected. The possibility of detecting these complications as early as possible allows effective treatment. The addition of CT guided needle biopsy to allow culture of suspicious material makes this a very useful technique. For these reasons routine postoperative CT scanning after aortic aneurysm surgery is recommended.