Retrograde cerebral perfusion for aortic operations through left thoractomy.

Retrograde cerebral perfusion during deep hypothermic circulatory arrest is a technique used largely during operations on the ascending aorta, aortic arch, or both through a median sternotomy. This method is not frequently used for operations performed through a left thoracotomy because of problematic access to the right side of the heart. We propose a technique allowing retrograde cerebral perfusion through a left thoracotomy in a quick, simple, and efficient manner.

Experimental right ventricular outflow tract reconstruction with a composite Mitrathane monocusp patch: preliminary results.

Twenty large white pigs underwent normothermic right ventricular bypass, pulmonary artery valve excision and right ventricular outflow tract (RVOT) reconstruction using a synthetic material (Mitrathane). The animals were divided in two groups (ten for each group) for the RVOT reconstruction model: Group I with a composite monocusp patch (with a new design geometrically related to pulmonary artery circumference) and Group II without a valve mechanism. Four early postoperative deaths occurred in Group I (unrelated to monocusp patch function) and seven in Group II (due to acute right ventricular failure). Follow up of the six animals of Group I was 600-630 (average 617.5) days and of the three Group II animals was 95-110 (average 101.6) days. In Group I haemodynamic studies showed no significant difference from preoperative values at 5 months while at 20 months there was a moderate valve insufficiency in all animals. In Group II severe right ventricular insufficiency was present in all animals and spontaneous death occurred after about 3 months. In Group I angiographic studies disclosed no evidence of graft calcification or stenosis while in Group II there was a moderate pulmonary trunk dilatation. Post mortem examination showed no signs of degeneration in any graft. Microscopic studies of both groups revealed an acellular layer of fibrin on the external surface and fibrous deposit on the inner part of the suture with the right ventricle. In Group I there were leukocyte and histocyte infiltration of the grafts. In these experiments our synthetic monocusp model showed good function and durability in comparison to a RVOT reconstruction without a valve mechanism.

[Microscopic analysis of saphenous veins used for aortocoronary bypass]. / Analisi microscopica di vene safene utilizzate per bypass aorto-coronarico.

The Authors describe a study performed on a sample of 88 saphenous veins used as aorto-coronary bypass grafts. The patients underwent surgery in the Department of Cardiovascular Surgery of Ancona from Jan. 1981 to Dec. 1984. The morphological analysis (light and electron microscope) was conducted with a comparative method between two surgical techniques (ST). The first refers (Group I) to 1981-82, the second (Group II) to 1983-84. In Group I the veins were taken with a conventional surgical technique. In Group II the ST was performed using an atraumatic procedure, topic vasodilators, distension of the vein with autologous blood and driving pressure less than 150 mmHg, and storage of the vein in blood at room temperature. The results show that in Group II there is better preservation of the endothelial venous layer. The distending pressure of the venous graft (less than 150 mmHg) and prevention of venous spasm were statistically relevant (p less than 0.05). The AA. conclude that vein graft damage during surgery can be avoided by means of the following procedures: dissection of the vein with atraumatic technique; prevention of venous spasm with topic vasodilators; distension of the vein at pressure less than 150 mmHg.

[Infarct rupture of the heart. A clinical case operated on with success]. / Rottura infartuale del cuore. Caso clinico operato con successo.

A 48-year-old woman was admitted for acute myocardial infarction with a normal clinical course. On the fifth day a new chest pain occurred, with low cardiac output and high central venous pressure; a pericardial effusion was present at the echocardiogram. The clinical picture improved with intensive medical care but, on the tenth day, there was a relapse with a life-threatening heart tamponade. An emergency operation was performed without previous heart catheterization. The pericardium was tense and contained about 300 ml of clots; in a wide infarcted area of the lateral wall of the left ventricle two small perforations were evident. Primary reconstruction was accomplished with interrupted stitches supported by Teflon felt strips. The bypass weaning was easy and the postoperative clinical course uneventful. We believe that the cardiac rupture is a surgical emergency; the non-invasive diagnosis is possible; the coronary angiography and revascularization must be postponed.

In vitro computerized evaluation of biological cardiac prosthesis calcification.

The late valvular bioprostheses failure is mainly related to leaflet calcification. This study reports a new approach to testing the biological prostheses calcification applying a computerized technique to x-ray picture. A bovine glutaraldehyde-fixed bioprostheses (BB) was implanted in two sheep in mitral position. The experimental procedure was performed on valves explanted six months after surgery. The BB x-ray pictures were tested by means of a video display computer (VDC) that can process radiographic, photographic or microscopic images and also evaluate the optical density of image quantifiable. The calcification zone assumes different values according to the calcification degree. The VDC can colour the BB x-ray images and display them on monitors (one black and white, one colour) with the colours strictly related to the grey levels of the image.

Giant left atrium and mitral valve disease: early and late results of surgical treatment in 40 cases.

Forty consecutive patients undergoing mitral valve replacement with a giant left atrium, form the basis of this report. Two groups could be identified: (a) isolated giant left atrium (11 cases); (b) combined left and right atrial enlargement (29 cases). Tricuspid regurgitation was only detected in the latter group. The early hospital mortality was 20% and was related to the pulmonary arterial systolic pressure. A giant left atrium increased the operative mortality from 7% to 20% among patients submitted to mitral valve replacement in our unit (p less than 0.05).

Autologous monocusp pulmonary valve: preliminary results of a new surgical technique.

A new technique for constructing a pulmonary valve from the wall of the pulmonary artery is described. Hemodynamic studies conducted following this procedure demonstrated no systolic gradient and good diastolic competence. A long-term study of this procedure is needed to determine whether or not the technique has clinical applicability.

[Emergency surgical treatment of infectious endocarditis. Experience developed on 19 consecutive cases]. / Terapia chirurgica di urgenza dell'endocardite infettiva. Esperienza svolta su 19 casi consecutivi.

Our experience with the emergency surgical treatment of 19 consecutive cases of infective endocarditis (IE) is reported. The aortic valve was always affected, either alone (n = 16) or together with the mitral valve (n = 3). All patients were male. In 10 cases it was possible to identify the infecting agent (a staphylococcus was found in 6). Congestive heart failure (CHF) was the principal indication for surgery in 14 cases (in 6 active IE was associated). Five patients (1 with CHF) underwent operative treatment because of systemic emboli. Fifteen patients were in New York Heart Association (NYHA) functional class IV, 3 in class III and 1 was in class II. Two patients (10.5%), both operated on for CHF, died in the early postoperative period. Early prosthetic valve dehiscence occurred in 2 cases, reoperation was successful in both. Follow-up of operative survivors ranges between 7 and 108 months (mean = 53.24 +/- 41.89). One patients died 10 months after operation with CHF following late prosthetic dehiscence. Out of 16 currently surviving patients 14 are in NHYA functional class I, 1 is in class II and 1 in class III. No one of them has had relapse of IE.

[Anastomosis in coronary surgery: technical improvement using a vein-holding instrument]. / Anastomosi in chirurgia coronarica: miglioramento tecnico con l'impiego di uno strumento reggi-vena.

A vein holder for vascular surgery is described. Distal (direct or sequential) as well as proximal anastomoses in aorto-coronary bypass surgery can be easily performed with that instrument. It minimizes handling of the graft and provides an excellent visualization in placing sutures in half of the circumference at both ends of the venous graft.

[Coronary spasm following myocardial revascularization. Clinico-therapeutic considerations in a successfully treated case]. / Spasmo coronarico dopo rivascolarizzazione miocardica. Considerazioni clinico-terapeutiche relative ad un caso trattato con successo.

A 30-year-old man had a spasm of the anterior descending coronary artery and received a bypass graft. The spasm which caused several cardiac arrests was relieved by intracoronary injection of nitrates and verapamil. The patient was discharged 13 days after surgery, receiving nitrates and calcium antagonists. Four months after operation he remains asymptomatic.

Antley-Bixler syndrome in sisters: a term newborn and a prenatally diagnosed fetus.

Sisters with the Antley-Bixler syndrome are reported herein. The first infant died at 14 days of respiratory failure and the following findings characteristic of the syndrome: craniosynostosis of coronal and lambdoid sutures, brachycephaly, frontal bossing, severe midface hypoplasia with proptosis and choanal stenosis/atresia, humero-radial synostosis, medial bowing of ulnae, long slender fingers with camptodactyly, narrow iliac wings, anterior bowing of femora, cardiac and renal malformations. Unlike two previously published cases, she did not have connatal fractures, but she had vaginal atresia. Ultrasound examination in a subsequent pregnancy showed immobility at the elbows of the fetus, humero-radial synostosis, medial bowing of ulnae, and long hands and fingers. The fetus also had mild bowing of femora. The pregnancy was terminated in the 21st week and the findings were confirmed by clinical and radiologic examinations. Additional autopsy findings included cardiac and renal malformations. The Antley-Bixler syndrome is a recognizable malformation syndrome with a probable autosomal recessive mode of inheritance, which can be diagnosed in the fetus by midtrimester ultrasound examination.

Transatrial repair of double-outlet right ventricle in infants.

In three infant cases of double outlet right ventricle (DORV), two with normally related great arteries (NGA) and one with side-by-side great arteries, a transatrial repair was carried out. In all three cases, the results were excellent. It is concluded that in the small baby with DORV with NGA and in DORV with side-by-side great arteries with a hypoplastic crista, a transatrial repair should be successful. This is dependent on the VSD being in the perimembranous (and, therefore, subaortic) location and on the absence of infundibular pulmonary stenosis. In all other varieties of DORV the repair should probably be done through the ventricle.