Calcified aneurysms in coronary arteries of a 48-year-old patient.

This is a case report of a 48-year-old female patient with a compatible history of Kawasaki disease during childhood, who was admitted to the emergency coronary unit with unstable angina pectoris. Coronary angiography identified two coronary aneurysms, one causing right coronary occlusion and the other causing severe obstruction of the left anterior descending coronary artery. Coronary artery bypass surgery was indicated.

Effects of prostaglandin E1 in twelve-hour lung preservation.

The effects of hypothermic lung preservation were evaluated in 12 mongrel dogs receiving double lung allografts. Animals underwent transplant procedures after 12 hours of static preservation at 4 degrees C following pulmonary artery flush with 60 to 80 ml/kg cold modified Collins solution. Donors were pretreated with allopurinol and recipients with methylprednisolone and perireperfusion deferoxamine. Six donor animals received a PGE1 infusion (20 to 500 ng/kg/min) for 20 minutes before harvest at doses causing a significant reduction in pulmonary vascular resistance. After implantation, recipients were maintained at ventilator settings identical to those used in donors. A fixed FIO2 (0.4) was maintained, except for 15-minute periods of FIO2 1.0 that were used to measure left-to-right intrapulmonary shunt fraction (Qs/Qt) and alveolar-arterial oxygen gradients (PAO2-PaO2). Cardiopulmonary function was studied for 20 hours. Pretreatment with PGE1 resulted in reduced survival (p less than 0.05) and increased PAO2-PaO2 (p less than 0.05) and Qs/Qt (p less than 0.05) 30 minutes after reperfusion. After 60 minutes of reperfusion, mean arterial pO2 (FIO2 0.4) was 148 mm Hg in controls and 80.5 mm Hg in the PGE1 group (p less than 0.02). There was no significant difference in pulmonary vascular resistance, cardiac output, mixed venous oxygen saturation, airway resistance, compliance and physiologic dead space between groups at any time after implantation. After 20 hours of reperfusion, pO2 (FIO2 0.4) in the control group was well maintained at 140 (+/- 52) mm Hg. The method of lung preservation in control animals resulted in good survival and adequate gas exchange after 12 hours of ischemia and 20 hours of reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute physiologic changes after extended pulmonary preservation.

The physiologic effects of 12-hour lung preservation were assessed in six mongrel dogs studied for 20 hours after double-lung allograft implantation. Donor animals were pretreated with allopurinol (30 mg/kg) and methylprednisolone (500 mg) intravenously at anesthesia induction. Heart-lung blocks were harvested after cardioplegic arrest, and a simple pulmonary artery flush of 4 degrees C modified Collins' solution was administered at 15 ml/kg/min. The lungs were ventilated with 100% nitrogen during flushing and inflation. Recipient animals received an infusion of deferoxamine (20 mg/kg) during implantation and were pretreated with methylprednisolone (500 mg) intravenously. All six implantations were technically successful. Two animals died of cardiac standstill 12 and 24 hours postoperatively. Gas exchange deteriorated after implantation compared with donor levels but remained in a range compatible with survival, and at 20 hours arterial oxygen tension (FiO2 0.4) was 138 +/- 91 mm Hg. Similar changes were seen in alveolar-arterial oxygen gradients and arterial-alveolar oxygen tension fraction. Elimination of carbon dioxide was satisfactory. Pulmonary venous shunt fraction rose significantly at the end of the study. Hemodynamic changes consisted of a gradual increase in pulmonary vascular resistance and a reduction in cardiac output. Lung mechanics also deteriorated, with a gradual rise in airway resistance and a fall in compliance. The double-lung model allows detailed assessment of the early effects of preservation and may have certain advantages over heart-lung models of preservation. The preservation technique warrants further study.

Canine double-lung allotransplantation: operative technique and results for 12-h preservation studies.

A canine double-lung allotransplantation model was developed to study the effects of 12-h static pulmonary preservation. This model has not been used extensively for such experiments but allows a detailed evaluation of the quality of preservation. An operative technique is described in which cautery dissection and preliminary devascularization of the recipient right lung allows the period of cardiopulmonary bypass to be limited and reduces postoperative bleeding. Six double-lung blocks were successfully orthotopically transplanted and recipient animals were studied for 12 h postoperatively. All animals survived the study period and had a mean PO2 (FIO2 0.4) of 141 mm Hg, 12 h following reimplantation suggesting adequate pulmonary preservation. There was no evidence of pulmonary edema at any time following implantation, although airway pressures and pulmonary vascular resistance were elevated. The role of this model in lung preservation studies is discussed.

[Right ventricular myxoma simulating pulmonary valve stenosis. A case report]. / Mixoma de ventrículo direito simulando estenose valvular pulmonar. Relato de caso.

A 17 year old girl was asymptomatic until 3 months ago, when she noticed palpitations and chest pain. Physical examination revealed a systolic murmur + + +/6 in the pulmonary area. Chest X-ray showed discrete dilatation of the pulmonary trunk and the electrocardiogram a first degree heart block. The diagnosis of myxoma was established after echocardiogram and cardiac catheterization when a mobile cardiac mass was identified in the right ventricular outflow tract. The tumor was removed using extracorporeal circulation and the ventricular access through the right atrium. After a 16 month follow-up the patient is dealing a normal life and there are no signs of recurrence.

Heart-lung transplantation.

Since the successful clinical reintroduction of heart and lung transplantation in 1981, more than 350 of these procedures have been performed worldwide. Although survival following this operation is less than that reported for heart transplantation, the results are improving. It is clear that the increased technical difficulty of the procedure combined with the exquisite susceptibility of the transplanted lung to postoperative injury from infection, rejection or other causes account for these differences. In this report we provide an overview of the experience in heart-lung transplantation and discuss recent advances. The late complication of chronic obliterative bronchiolitis, which may progress inexorably, has cast a shadow over the potential long-term success of this therapeutic procedure. Current research efforts are directed toward the cause, diagnosis, and treatment of this complication.

Cardiopulmonary transplantation: current practice.

Heart-lung transplantation has become an effective form of therapy for end-stage cardiopulmonary disease. Early results have steadily improved, and a 1-year survival rate of over 60% is now expected. The fact that lungs can be preserved for an extended period allows organs to be procured almost anywhere and this, in turn, has slightly improved the availability of organs for transplant. A diagnosis of lung rejection remains imprecise and progress still needs to be made in this area. Obliterative bronchiolitis of a variable degree remains the major medium-term complication, probably representing chronic graft rejection. Although long-term progress cannot yet be predicted, heart-lung transplantation remains the only option for a normal life for this special group of patients.

Technique of clinical double-lung transplantation.

Clinical double-lung transplantation has now been successfully performed at the University of Minnesota, Minneapolis. Donor care and operation are similar to heart-lung donor management. The most important parts of the recipient operation are to remove the lungs without injury to the phrenic, vagal, or recurrent nerves and to ensure hemostasis. In addition, the integrity of the tracheal anastomosis should be ensured by an omental wrap. The operative technique, developed and modified from our laboratory experience, is described.

Bullets retained within the heart: diagnosis and management in three cases.

Three cases of gunshot wounds of the chest are reported, in each of which a bullet was retained within the heart. Although it is rare, the surgeon should consider this possibility if the missile overlies the cardiac silhouette on the plain chest radiograph. Fluoroscopy played an important part in confirming the diagnosis. Cardiopulmonary bypass was used in all cases and provides operating circumstances that improve the prospects of success.

Trauma toracico. / Thoracic trauma

Os autores apresentam sua experiencia inicial em 100 pacientes com traumatismo toracico, admitidos no Hospital Sao Vicente de Paula no periodo de agosto de 1979 a janeiro de 1981. Discutem os principios gerais no atendimento a estes pacientes,as situacoes especificas e enfatizam a necessidade de drenagem pleural adequada, da toracotomia imediata na persistencia de hemorragia e choque apesar do tratamento inicial, e que especial atencao deve ser dada as lesoes associadas, pois aqui contribuiram com 45% dos obitos de um total de 11 pacientes

Toracotomia axilar limitada no manejo do pneumotorax espontaneo recidivante / Limited axillary thoracotomy in the management of recurrent spontaneous pneumothorax

Os autores apresentam sua experiencia em 23 pacientes operados por pneumotorax espontaneo recidivante no periodo de janeiro 1972 a dezembro de 1979 no Brompton Hospital, Londres, Inglaterra. Em pacientes selecionados, uma pequena toracotomia axilar tranversa, pleurodese por abrasao e obliteracao de bolhas subpleurais com o "Stapler" mostrou ser um metodo seguro, eficaz e estetico no manejo destes pacientes

Fistula arterio-venosa subclavica traumatica. / Traumatic subclavian arteriovenous fistula

Sao apresentados dois casos de fistula arterio-venosa apos ferimento penetrante na regiao cervico-toracica. A necessidade do diagnostico preciso e precoce, bem como a correta abordagem cirurgica nesta situacao sao discutidos