Reducing neurological complications after cardiac transplantation: technical considerations.

As the survival rate for cardiac transplantation improves, attention focuses on morbid events that occur perioperatively. Neurological problems have been recognized after transplantation, and appear to have multiple etiologies including thromboembolism, hypoperfusion syndromes, cerebral hemorrhage, and drug toxicities. Since 1988, 113 consecutive adults with end-stage cardiomyopathy were transplanted using a surgical technique that emphasizes precise everting atrial and great vessel anastomoses, a modified order of anastomoses, continuous endocardial and topical cold irrigation, and careful de-airing of the heart. Although a significant fraction of the patients were at high risk for cerebral events, the incidence of early and late neurological complications were each under 2%. The rate of early graft dysfunction was low and no patient was found to develop intracardiac thrombus on intermediate-term follow-up. These technical modifications may contribute to improved neurological outcomes after transplantation.

Incidence of abdominal aortic aneurysms in patients with atheromatous arterial disease.

Seventy-three patients with atherosclerotic peripheral vascular disease underwent prospective evaluation of the abdominal aorta by both physical examination and ultrasonography. The objective was to find out the incidence of abdominal aortic aneurysms by these two methods. Early diagnosis may decrease the morbidity and mortality associated with the disease. Ultrasonography established an incidence of 9.6 percent, whereas physical examination only demonstrated a 2.6 percent incidence. We recommend that routine ultrasonographic examination be performed on patients with peripheral atherosclerotic vascular disease in order to demonstrate the presence or absence of abdominal aortic aneurysm.