Coronary reconnection in emergency "conduit operation" for acute type-a aortic dissection with aortic insufficiency: experience with 24 cases.

Twenty-four cases of acute type-A aortic dissection with aortic valvular insufficiency were treated in our institution by means of an emergency operation in which the aortic valve, ascending aorta, and aortic arch were resected and replaced with a valved conduit that had been lengthened with a tubular Dacron graft. The procedure included the use of deep hypothermia for cerebral protection, as well as extracorporeal circulation. Aortic resection was performed from the aortic valve to the origin of the descending thoracic aorta; the aortic graft was anastomosed proximally to the valve annulus and distally to the descending aorta. The carotid orifices were connected to the side of the graft in a single tissue button. The coronary arteries were then reconnected by means of double venous bypass grafts to the innominate artery, to allow for inclusion of the graft. Within 1 month after operation, four patients died of the consequences of dissection. Six months postoperatively, one patient succumbed to an infarction. Six months to 5 years after operation, the remaining 19 patients are still alive. On the basis of this experience, we believe that acute type-A aortic dissection with aortic valvular insufficiency should be treated during the first hours after the onset of symptoms. The above-described procedure proved effective in the control of bleeding, which is the major risk in emergency operations of this type.

[Metabolic preparation for surgical operations and the problem of chronic shock]. / La preparazione metabolica all'intervento chirurgico e il problema dello shock cronico.

Surgical patients with a chronic energy deficit display a particulare metabolic situation known as chronic shock, marked by deficient utilisation of energy. The picture is related to functional disorders of the cell enzymes, following incomplete resynthesis due to the lack of substrates. The main features are: a) lactic metabolic acidosis due to anaerobic oxidation, usually with insufficiency of the Krebs cycle; b) exaggerated protein catabolism, due to utilisation of amino acids as the energy substrate; c) incomplete utilisation of the (mostly endogenous) substrates available, with lactacidaemia, aminoacidaemia, and increased lipidaemia. A rational form of treatment is proposed after careful analysis of these features and their corresponding clinical phenomena.

[Role of surgical deobstruction in massive pulmonary emboli. Review of 12 operated cases]. / Ruolo della disostruzione chirurgica nell'embolia polmonare massiva. Revisione di 12 casi operati.

A brief survey is made of a personal series of 12 embolectomies performed under varying clinical conditions for the management of massive pulmonary embolism. Four satisfactory results were achieved. This operation is carried out under CEC and is a sound procedure. Stress is laid on its fundamental importance in the treatment of cases of this kind. Its early choice should be made in the light of the clinical picture.

Aneurysm of the gastroduodenal artery.

A case of aneurysm of the gastroduodenal artery associated with obstruction of celiac axis, is presented. The patient underwent successful surgical correction. The clinical and surgical aspects of this patient are discussed.