Left heart decompression via the pulmonary artery.

A technique of left heart decompression is presented which is simple and easy to apply. Cannulation of the main pulmonary artery with a coiled wire reinforced venous cannula provides access for continuous suction and effectively decompresses both the left and right sides of the heart. An in-line vacuum release valve controls the amount of suction.

Percutaneous transluminal angioplasty of a large septal artery.

A severely stenotic, large-caliber, first septal artery was successfully dilated in a patient with refractory angina and nonsurgical, multivessel coronary artery disease. The success of this dilatation was related to favorable coronary anatomy and to the availability of a guidewire-directed dilatation catheter. Septal artery stenosis with or without surgically accessible stenoses in other coronary vessels represents a potential indication for percutaneous transluminal coronary angioplasty.

Biologic reconstruction of the right ventricular outflow tract. Preliminary experimental analysis and clinical application in a neonate with type I truncus arteriosus.

A unique concept of right ventricular outflow tract reconstruction is presented. Applications of this concept, employing a glutaraldehyde-preserved heterograft mitral valve leaflet mounted directly to the right ventricle, was studied in six immature goat models. Interval evaluation of these models demonstrated no significant outflow tract obstruction or aneurysm. Only one animal had significant pulmonary outflow regurgitation angiographically at the time of sacrifice. All heterograft valve leaflets showed a degree of calcification and/or retraction directly related to the time interval between implant and sacrifice. Encouraging early results were obtained with this method of pulmonary outflow tract reconstruction in a 2,400 gram neonate with type I truncus arteriosus.

Septal wall motion. Its significance on outcome of left ventricular scar resection.

To assess the importance of septal wall motion on patient outcome after resection of large akinetic and dyskinetic segments of left ventricle, the records of 70 patients undergoing left ventricular scar excision alone or in combination with myocardial revascularization procedures between January 1970 and January 1977 were reviewed. Patients requiring simultaneous prosthetic valve replacement were excluded. Preoperative left anterior oblique ventriculograms categorized this series of patients into two distinct groups, group A (36 patients) having normal septal wall motion and group B (34 patients) having akinetic or dyskinetic septal walls. Indications for operation and preoperative ejection fractions were similar in both groups. Analysis of these patients subjected to surgery with and without preoperative evidence of septal wall motion demonstrated no significant difference in either functional clinical capacity or in mortality. Mortality for both groups was 11%. Absence of ventricular septal wall motion has no significant effect on outcome of left ventricular scar resection and should not be used as a contraindication to surgery.

Current status of prosthetic cardiac valves.

The majority of patients with acquired valvular heart disease have severe damage to valves which is not amenable to repair but can now be treated by valve replacement with an acceptable mortality and morbidity. The caged ball or disc valve is widely used and is proving clinically satisfactory for cardiac valve replacement. Thromboembolism is the significant complication. With improvement in technique the incidence of infection, detachment and other complications has been reduced.