bluuebunny/crossref_metadata_2025 huggingface dataset:
Favorable Results of Coronary Artery Bypass and/or Valve Replacement in Octogenarians
Authors: Yashar J. J. , Yashar A. G. , Torres D. , Hittner K.
Published: September 2022

Between October 1987 and July 1990, of 763 patients undergoing open heart surgery, 43 (5.6%) were 80 (mean and median 82) years of age or older. There were 20 men and 23 women. Eighteen patients (42%) were initially assessed using the angina score of the New York Heart Association or Canadian Cardiovascular Association as class IV. Nine procedures (21%) were performed electively and 34 (79%) urgently. A total of 26 patients (60%) underwent coronary bypass surgery, while 11 (26%) had valve replacements and six (14%) had both coronary bypass surgery and valve replacement; 74% of the patients received two or more grafts. The hospital mortality rate of the octogenarian patients was 9% (four of 43), significantly higher ( P< 0.05) than the overall hospital mortality rate of 3.6% for patients ? 79 years of age. A history of myocardial infarction within 2 weeks before the procedure was obtained in nine of 43 patients (21%); 22 (51%) had experienced at least one myocardial infarction before surgery. Ejection fractions were ‘normal’ in 28 patients (65%), ‘fair’ in nine (21%) and ‘poor’ in six (14%). The mean length of hospital stay for the octogenarian patients was 19 (range 8–64) days. Thirty-five of the 39 operative survivors were followed for a mean of 14 (range 3–35) months. The actuarial probability of survival was 86% at the end of this time. A total of 31 patients (79%) assessed using the angina score of the New York Heart Association or Canadian Cardiovascular Association were class I or II. During the follow-up period, it was necessary to rehospitalize six patients, four because of cardiac problems; 27 of the 36 surviving patients (75%) had no cardiac symptoms. For those whose symptoms recurred, the mean time from operation to recurrence was 11 months.
Impaired Pulmonary Oxygenation of Diabetic Origin in Patients Undergoing Coronary Artery Bypass Grafting
Authors: Seki S. , Yoshidat H. , Momokit Y. , Oobat O. , Teramoto S. , Komoto Y.
Published: September 2022

The effect of a disposition to diabetes meliitus on pulmonary function was determined by dividing 70 consecutive patients who underwent coronary artery bypass grafting (CABG) into a group of 41 patients with such a disposition and a group of 29 without. Indices of pulmonary function studied were the ratio of the arterial partial pressure of oxygen to the inspired oxygen fraction ( PaO2/ FiO2), the alveolar-arterial oxygen gradient (A—aDO2) and the respiratory index (A—aDO2/ PaO2). These were determined before CABG, at the maximum level of blood glucose and when FiO2 was in the range 0.4–0.7 within 6 h after CABG. Even before bypass, all indices were significantly worse in the group with a disposition to diabetes meliitus than in that without. After surgery, these dysfunctions were more severely exacerbated in the former group. FiO2 was the best predictor of the current state of pulmonary function in both groups. Variables that strongly affected pulmonary function were pulmonary arterial wedge pressure in the group with no diabetic disposition and central venous pressure in those with such a disposition. Thus, pulmonary dysfunction of diabetic origin exists not only before CABG, but also after the procedure. Attending physicians must be careful not to increase wedge pressure and central venous pressure.
Congenital Coronary Aneurysm Associated with a Single Coronary Artery
Authors: Shigenobu M. , Ohta T. , Senoo Y. , Teramoto S.
Published: September 2022

Successful removal of a congenital coronary aneurysm associated with a single coronary artery in a 36-year-old man is reported. The rarity of this combination and clues to its diagnosis are discussed.
An Unusual Case of Cor Triatriatum: Clinical Presentation and the Haemodynamics of a Rare Anomaly
Authors: Radermecker M. A. , Grenade T. , Jalali H. , Legrand V. , de Leval M. R.
Published: September 2022

The case of a 24-year-old woman with cor triatriatum sinister and a persistent left superior vena cava connected to the junction of the left upper pulmonary vein and left atrium is reported. A diagnosis of partial anomalous pulmonary venous return had been made and the patient underwent surgery. Inspection of the left atrium revealed a complex form of left triatrial heart. The general haemodynamics of the malformation are discussed, with particular emphasis on the features accounting for variation in the clinical presentation. This rare anomaly often remains undiagnosed before surgery and should be considered whenever obstruction of pulmonary venous flow above the mitral valve is not explained by pulmonary vein stenosis, mitral or mitral valve-linked abnormalities, atrial tumours or anomalous pulmonary venous drainage with high resistance to flow.
Current Challenges in Peripheral Vascular Surgery: Traditions in Transition
Authors: Barnes R. W.
Published: September 2022

The field of peripheral vascular surgery is changing as a result of many forces, including altered disease demographics, advances in technology, encroachment by competing specialties, evolution of training programs, governmental and reimbursement controls, and changing public expectations. The gradual evolution of program content of the annual meetings of the North American Chapter of The International Society for Cardiovascular Surgery for the past 20 years and the challenges for the future of vascular surgery in the USA are reviewed. During the past 20 years, 455 scientific papers and 20 presidential addresses were delivered to the North American Chapter. Papers on peripheral arterial and cerebrovascular disease have remained constant in number. Venous and cardiac contributions have declined in number and are covered in other societal meetings. Vascular radiologic interventions, diagnostic technology and research presentations have filled the void. Other topics, including epidemiology, manpower, outcomes, economics and governmental relations, have increased in number. The presidential addresses, while including topics of historical and clinical interest, have increasingly emphasized educational and socioeconomic issues. Vascular surgery, like other disciplines, is a dynamic specialty. As with medicine in general in the USA, this specialty will be increasingly challenged by socioeconomic pressures, which will lead to new issues that have not previously been addressed in the Chapter program, including preventive medicine and health services research.
Iliofemoral Bypass: A 10-Year Review
Authors: Oliveira M. , Wilson S. E. , Williams R. , Freischlag J. A.
Published: September 2022

Iliofemoral bypass is available to patients with unilateral iliac occlusive disease. Experience with iliofemoral bypass in terms of graft patency and patient outcome is reviewed. From January 1981 to February 1991, iliofemoral grafts were placed in 19 patients. Of these, 16 had medical records available for review; all were men and the mean age was 65 (range 46–72) years. Risk factors associated with peripheral vascular disease included tobacco use (16 patients), hypertension (ten), coronary artery disease (seven) and diabetes mellitus (four). Six patients had undergone previous peripheral vascular procedures. Angiography revealed an ipsilateral iliac artery suitable for bypass. Indications for operation included claudication (five patients), rest pain (six) and non-healing ulcer or gangrene (five). Ten bypasses were placed on the left and six on the right. The mean(s.d.) ankle: brachial pressure Index before operation was 0.39(0.24): 0.55(0.19) in patients with claudication and 0.29(0.22) in those treated for threat of limb loss. After surgery patients with claudication demonstrated improvement of this index to a mean(s.d.) of 0.83(0.24); in those with threat of limb loss it improved to 0.60(0.16). One wound infection resolved with antibiotic therapy alone. Two patients had early (< 30 days) graft failure leading to amputation and subsequent perioperative death. Three other grafts failed, one each at 8, 9 and 13 months. All five grafts failed in patients with preoperative threat of limb loss. The cumulative patency rate was 72% at 1 year and 64% at 2–5 years. It is concluded that: iliofemoral bypass is an alternative procedure in patients with unilateral iliac occlusive disease: graft failures occurred early and resulted in low patency rates: the perioperative mortality rate was high, which perhaps reflects the medical condition of patients before surgery: and iliofemoral bypass should be reserved for patients with unilateral iliac occlusive disease that cannot be treated by transluminal angioplasty and who are not candidates for aortofemoral bypass because of pre-existing medical illness.
Brachiocephalic Fistula: A Useful Alternative for Vascular Access in Chronic Hemodialysis
Authors: Rubens F. , Wellington J. L.
Published: September 2022

Construction of a Cimino-Brescia radiocephalic fistula is the current method of choice for vascular access in most patients on chronic hemodialysis. However, previous vascular access procedures, cephalic vein thrombosis or intrinsic arterial disease may render this procedure impracticable. The brachiocephalic fistula, which provides many advantages over the use of saphenous vein or prosthetic grafts for fistula access, is frequently overlooked as a surgical alternative in patients on chronic hemodialysis. Brachiocephalic fistula constructed directly between the brachial artery and cephalic vein at the level of the cubital fossa is associated with a 4.5-year patency rate of 80%. The incidence of complications is relatively low compared with that when interposition graft materials are used. However, two patients developed severe swelling of the upper extremity secondary to unrecognized preoperative subclavian vein thrombosis. The possibility of this complication should be suspected in any patient who has undergone previous percutaneous subclavian access.
Revascularization of the Occluded Donor Artery of a Femorofemoral Crossover by Axillary Bypass
Authors: Kambayashi J.-I. , Kawasaki T. , Ouji Y. , Mori T.
Published: September 2022

In patients over 70 years of age with disabling leg ischaemia, femorofemoral crossover bypass with an externally supported polytetrafluoroethylene (PTFE) graft is the treatment of choice for unilateral occlusion of the iliac artery. Over a 6-year period, 18 elderly patients underwent femorofemoral bypass, six of whom had received percutaneous transluminal angioplasty before surgery for stenosis of the contralateral external iliac artery (donor artery). Symptoms of ischaemia recurred in three patients because of deterioration of the donor iliac artery more than 2 years after surgery, although all three grafts were well visualized by angiography. Revascularization was attempted in these three patients by an axillary bypass. Disabling symptoms of ischaemia were completely relieved by this procedure, although two patients underwent reoperation 9 and 16 months after the axillary bypass respectively. All three patients are now free from symptoms of ischaemia. It is concluded that: deterioration of the donor iliac artery after femorofemoral bypass does occur, although it has been considered unlikely because of decreased peripheral resistance; in spite of complete occlusion of the donor artery, grafts remain patent, proving the excellent antithrombogenic activity of externally supported PTFE; and revascularization using additional axillary bypass is a feasible procedure in such cases.
New Prosthetic Ring for Aortic Valve Annuloplasty
Authors: Duran C. M. G. , Gallo R. , Prabhakar G. , Kumar N. , Hainau B.
Published: September 2022

Aortic valve repair is recently receiving more attention. To broaden the indications for this procedure a prosthetic annuloplasty ring has been developed and tested in animals. Thirty-two sheep underwent implantation of such a ring in the pulmonary (14) and aortic (18) positions. In the 12 survivors followed for a maximum of 200 days the ring was found epithelialized and free from thrombus. One ring was dehiscent; no haemolysis was detected. It is concluded that a small clinical study is warranted.
Severe Adult Respiratory Distress Syndrome Associated with Transfusion of Antileukocyte Antibodies
Authors: Connery C. P. , Stewart S. , Lund N. , Papadakos P. J.
Published: September 2022

The use of blood products is common in the period after cardiopulmonary bypass. A rare cause of adult respiratory distress syndrome is a reaction to antileukocyte antibodies. The plasma transfused may contain a potent leukocyte antibody that may cause severe problems in the intensive care unit.
Buerger's Disease: Diagnosis and Management
Authors: Shionoya S.
Published: September 2022

Buerger's disease is characterized by peripheral arterial occlusion of the extremities in young male smokers. In true Buerger's disease lesions rarely occur in the proximal arteries. The incidence of the disease is low in Europe and the USA. but its management remains a major problem for vascular surgeons in Asia where its incidence is higher. Aetiology of the disease remains unknown, but there is a clear relationship between tobacco abuse and its occurrence or recurrence; complete cessation of smoking renders the disease benign. Despite a high incidence of digital gangrene or ulceration, a functional foot or hand can generally be preserved because of the good healing potential of the trophic lesions. Specificity of the disease is characterized by peripheral ischaemia of an inflammatory nature and with a self-limiting course. The clinical term Buerger's disease is preferred to the pathological term thromboangiitis obliterans. Diagnosis is based on knowledge of the natural history of the disease, which aids prognosis and the decision to undertake surgical or conservative management. Treatment of Buerger's disease should avoid premature, possibly unnecessary, surgery. The condition is no longer a disease of misconceptions; its diagnosis and management should be based on a clear understanding of the pathophysiology.
An 11 -Year Experience with Aortofemoral Bypass Grafting
Authors: Littooy F. N. , Steffan G. , Steinam S. , Saletta C. , Greisler H. P.
Published: September 2022

Over the past 11 years, 224 patients (440 limbs) underwent aortofemoral bypass grafting for claudication (63%) or limb-threatening ischemia (37%). The distal anastomosis included the profunda femoris artery directly or only as a profundaplasty in 163 limbs (37.0%). Concomitant distal bypasses were carried out in 19 limbs (4.3%). The perioperative mortality rate was 4.9%; over half of the deaths (six) were from myocardial infarction. There were ten early graft limb occlusions (2.3%). Only five major amputations (1.1%) occurred. Long-term follow-up of 416 limbs averaged 58.5 (range 2-142) months. Cumulative primary and secondary patency rates were 88 and 93% respectively at 5 years, and 73 and 89% respectively at 10 years. The cumulative limb salvage rate was 95% at 5 years and 91% at 10 years. Improvement of claudication or relief from limb-threatening ischemia occurred in 90% of limbs early after treatment. Only 5.9% of limbs were worse after operation. During follow-up, 55 patients (38.5%) died, over half from cardiac causes. Long-term graft-related complications included pseudoaneurysm in 16 limbs (3.8%) and graft limb thrombosis in 33 (7.9%). occurring at a mean of 57.8 and 24.8 months respectively. Graft infection occurred in four patients (1.9%). Excluding operations for graft infection, the operative mortality rate In 72 reoperations on 45 patients was 5.5%. In summary, aortofemoral bypass grafting can be performed safely with excellent long-term patency and limb salvage rates. Improvements in the perioperative mortality rate could best be addressed by improvements in cardiac evaluation and perioperative monitoring. Long-term graft limb complications do occur and. therefore, these patients require lifetime surveillance.
Analysis of Graft Healing in a New Elastomer-Coated Vascular Prosthesis
Authors: Granke K. , Ochsner J. L. , McClugage S. G. , Zdrahal P.
Published: September 2022

The need for a vascular prosthesis that does not require preclotting is apparent. The use of biological biodegradable coatings may carry the potential disadvantages of undesirable healing, inflammatory or antigenic reactions, and increased thrombogenicity. A graft has been developed to minimize porosity by coating only the outer surface with a bioinert non-absorbable elastomer (mainly Silastic) so as to leave the inner surface unchanged. Thoracoabdominal aortic 8-mm grafts (ten knitted and five woven coated grafts, six uncoated Dacron grafts) 12 cm long were implanted in mongrel dogs for 6 months. Differences in patency and healing in coated and uncoated grafts were observed by angiography, and by scanning electron and light microscopy. Statistical analysis included Fisher's exact test and Student's unpaired t test. Clinically, no ill effects were noted in coated grafts, and the transinterstitial blood loss was similar to that in preclotted uncoated grafts. One graft in each group occluded for technical reasons. One knitted coated graft developed perigraft seroma. The woven coated grafts and control prostheses had similar handling properties; however, needles appeared to pass through the coated graft material more easily and with less suture drag. Scanning electron microscopy was used to demonstrate similar presence of endothelial-like cells in both groups. Comparisons between coated and control grafts using light microscopy were as follows: pseudoendothelium, 0.26 versus 0.31 mm ( P not significant): Inflammation. 0.21 versus 0.73 ( P < 0.01); giant cell formation, 0.02 versus 0.88 ( P < 0.01); fibrosis. 1.31 versus 1.80 ( P < 0.03). Tissue ingrowth into and around the Dacron fibers from the outer surface was similar. This study demonstrates that microporous elastomer-coated vascular prostheses can prevent blood loss. They are safe and comparable to controls with respect to healing and tissue ingrowth. They appear to elicit less inflammation and fibrosis, all of which supports the concept that the graft material and not porosity per se ensures better graft healing.
Aplasia of the Radial Artery
Authors: Odero A. , Chierichetti F. , Canidio E. , Savasta S.
Published: September 2022

A 2-year-old girl with asymmetrical upper limbs and underdevelopment of the bones of the left forearm, wrist and hand with associated muscular and osteal hypoplasia is described. Doppler ultrasonography of the arterial trunks of the upper limb suggested a normal ulnar trunk in the left upper arm, an arterial vessel extending from the bend of the elbow to the distal third of the forearm, and the absence of any other arterial trunks in the radial region. Angiography confirmed that vascularization of the forearm was sustained by the ulnar artery, which supported the dorsal arch of the carpus and digital arteries arising from it. The interosseal artery was morphologically normal but there was aplasia of the radial artery. It is suggested that this malformation is the result of suppressed development of the vascular system of the left radial segment as other pathologies normally associated with the condition were absent.
Use of the Internal Mammary Artery for Urgent Myocardial Revascularization
Authors: Elami A. , Merin G. , Shushan Y.
Published: September 2022

The effect of using the internal mammary artery (IMA) as a conduit for revascularization on the outcome of early (<30 days) coronary artery bypass graft surgery after acute myocardial infarction was determined. Forty patients were studied: 27 underwent urgent operation for ongoing ischaemia and/or haemodynamic instability early after acute myocardial infarction and 13 had emergency surgery for failed percutaneous transluminal coronary angioplasty associated with clinical and enzymatic evidence of myocardial infarction. Nine patients experienced low cardiac output before operation, in six of whom intra-aortic balloon counterpulsation was used to treat cardiogenic shock. In 26 patients (group 1) the left IMA was utilized with or without additional vein grafts. In the remainder (group 2, n = 14), only vein grafts were used. Group 1 patients were younger than those in group 2 (mean(s.d.) age 55(9) versus 67(8) years, P = 0.0001). Other preoperative and perioperative variables were similar in the two groups. There was one death in hospital (2%. group 2). Eight (31%) group 1 patients sustained postoperative low cardiac output compared with ten (71%) in group 2 ( P<0.04). Preoperative low cardiac output ( P<0.025) and non-use of the IMA ( P<0.05) were identified by univariate and multivariate analysis as the most significant independent predictors of low cardiac output after operation. Although age was excluded as a predictor of low cardiac output, it is concluded that the IMA is an adequate conduit that can safely be used in patients younger than 70 years of age undergoing myocardial revascularization during or early after acute myocardial infarction.
Tetralogy of Fallot: Intracardiac Repair in 840 Subjects
Authors: John S. , John C. , Bashi V. V. , Ravikumar E. , Kaul P. , Choudhury S. P. , Prasad K. M. Shyam , Kanhere V. M. , Jha A. , Krishnaswami S.
Published: September 2022

Since 1967. when the first intracardiac repair was performed in this centre, until 1991, 840 symptomatic subjects with tetralogy of Fallot have undergone corrective surgery. Cardiac catheterization and angiocardiography were carried out in all patients. Cardinal findings on the clinical status of these subjects are outlined. A substantial number of patients (244; 29.0%) were >15 years of age. Historically, a transannular pericardial gusset has been utilized in 578 (68.8%). and in 423 (93.0%) during the past decade. The incidence of residual interventricular septal defects has been 0.68% and occurrence of complete heart block after surgery 0.4%. Death occurred in 86 patients (10.2%) within 30 days of operation and later in 40 subjects (4.8%). Long-term results have been excellent with good haemodynamic status In >90% of subjects in the follow-up period. Associated features including absent pulmonary valve, absent left pulmonary artery, and previous palliative shunts did not alter the outcome: however, a raised haematocrit (>0.65) was associated with an increased mortality rate.
Flow Study of Coronary-Coronary Bypass Grafting
Authors: Nishida H. , Grooters R. K. , Endo M. , Koyanagi H. , Merkleyt D. F. , Thieman K. C. , Schneider R. F. , Soltanzadeh H.
Published: September 2022

Coronary-coronary bypass grafting was recently Introduced for patients with either calcification of the ascending aorta or an inadequate length of graft. Row in the coronary-coronary bypass graft and that in aortocoronary bypass to the same coronary bed was compared in eight mongrel dogs. How reserve of the proximal right coronary artery as a donor vessel to the coronary-coronary bypass graft was also measured. Both a coronary-coronary and aortocoronary bypass were constructed to the proximally ligated left anterior descending artery. The flow in each graft was measured with the other graft temporarily occluded. Flow reserve of the right coronary artery (mean internal diameter 1.5 mm) proximal to the anastomosis was measured before and after opening of the coronary-coronary bypass. Mean(s.d.) flow was 50.0(12.3) ml/min in the coronary-coronary bypass graft and 54.9(14.8) ml/min in the aortocoronary bypass, which was not significantly different. Flow curve studies demonstrated early systolic flow reversal in the aortocoronary bypass, while the coronary-coronary bypass showed only forward flow. Mean(s.d.) flow in the proximal right coronary artery increased from 35.4(11.8) to 76.0(15.3) ml/min after opening the coronary-coronary bypass graft, which had a flow rate of 42.2(10.4) ml/min. It is concluded that the coronary-coronary bypass graft can provide nearly the same flow rate as aortocoronary bypass, and that the proximal right coronary artery has sufficient flow reserve for this technique.
Tracheal Approach to Pulmonary Artery Sling Associated with Funnel-Shaped Tracheal Stenosis
Authors: Tsang V. , Goldstraw P.
Published: September 2022

Pulmonary artery sling with concomitant funnel-shaped tracheal stenosis is a rare but potentially lethal congenital condition. Conventional surgical division and reanastomosis of the aberrant left pulmonary artery to the main pulmonary artery carries a high risk of postoperative ventilatory difficulty from an uncorrected tracheal stenosis. A primary tracheal approach via a right thoracotomy without pulmonary bypass is described.
Aneurysm of the Left Atrium
Authors: Huang Q.-H. , Wang N.-D. , Yang D.-Y. , Doty D. B.
Published: September 2022

A case of aneurysm of the body of the left atrium is reported. Diagnosis of this condition should be considered in patients presenting with supraventricular tachyarrhythmia and a mass on the left side of the heart. Surgery to remove the aneurysm is the treatment of choice.
Carotid Endarterectomy: Current Status, and Effects of Clinical Trials
Authors: Strandness D. E.
Published: September 2022

With the interim results of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) now reported, it has been shown that carotid endarterectomy is superior to conventional medical therapy for the treatment of symptomatic patients with >70% diameter-reducing stenosis. The Veterans' Administration trial in asymptomatic patients with a >50% diameter-reducing stenosis has shown that endarterectomy is superior to conventional non-operative treatment for the prevention of transient ischemic attacks and strokes when these events are combined. The design, impact and potential shortcomings of these trials are reviewed.
Studies of Reperfusion Injury in Skeletal Muscle: Controlled Limb Reperfusion to Reduce Post-Ischaemic Syndrome
Authors: Beyersdorf F. , Sarai K. , Mitrev Z. , Eckel L. , Ihnken K. , Satter P.
Published: September 2022

Revascularization after prolonged complete limb ischaemia may result in both severe damage to skeletal muscle and various systemic manifestations of the postischaemic syndrome. Previous experimental studies performed by the authors have shown that these are caused, to a large extent, by normal reperfusion at normal systemic pressure and that this additional injury can be substantially reduced by controlled reperfusion of the revascularized limb before restoration of the normal circulation. This treatment includes control of the conditions of reperfusion and composition of the initial reperfusate. In the present study, this concept of controlled limb reperfusion was applied to patients with prolonged severe lower limb ischaemia. Controlled limb reperfusion was used in 11 patients after prolonged complete unilateral or bilateral ischaemia. The ischaemic interval ranged from 5 to 21 h. Two patients were in cardiogenic shock, ten had a history of associated cardiac disease and seven coexistent peripheral vascular disease. After systemic heparinization, thromboembolectomy was undertaken using a Fogarty catheter. Cannulas were placed in the iliac, profunda and superficial femoral arteries and connected to a reperfusion set. Oxygenated blood was drawn from the iliac artery and mixed with an asanguineous solution (ratio 6:1). This controlled reperfusate was returned to the profunda and superficial femoral arteries using a single roller pump. The system allows control of both the composition of the reperfusate (Ca2+, pH, osmolarity, glucose, substrate, PO2, free radical scavengers) and the conditions of reperfusion (pressure, flow, temperature). After 30 min of controlled limb reperfusion, the cannulas were removed, the arteriotomy closed and normal blood reperfusion started. All nine patients who were haemodynamically stable before operation survived the procedure and were discharged with full functional recovery, including one patient with acute aortic occlusion of several hours' duration. Thus controlled limb reperfusion avoided the need for amputation and the development of systemic complications. Two patients, who were in cardiogenic shock before operation, died from progressive cardiac failure. It is concluded that controlled arterioarterial limb reperfusion may reduce the local manifestation of the postischaemic syndrome after prolonged periods of ischaemia, salvage limbs thought to be irreversibly damaged by prolonged ischaemia and is easily performed in the operating room.
Leucocyte count: A Predictor of Early Femoropopliteal Graft Failure
Authors: Thomas P. R. S. , Quraishy M. S. , Bowyer R. , Scott R. A. P. , Bland J. M. , Dormandy J. A.
Published: September 2022

The patency of 90 elective femoropopliteal reconstructions was asessed 6 months after surgery. The preoperative white cell count was found to be a highly significant predictor of early graft failure ( P < 0.0001) independent of other previously recognized predictors of occlusion such as smoking and run-off.
Role of the Neutrophil in Abdominal Aortic Aneurysm Development
Authors: Cohen J. R. , Parikh S. , Grella L. , Sarfati I. , Corbie G. , Danna D. , Wise L.
Published: September 2022

Elastase release by neutrophils has been implicated in the etiology of abdominal aortic aneurysm (AAA). The present study investigated whether neutrophils in patients with AAA actively synthesize the neutrophil elastase enzyme and the effect of elastin-derived peptides on neutrophil elastase release. Total neutrophil elastase in patients with AAA was significantly higher than in those with aortic occlusive disease and controls. The neutrophil elastase gene was not expressed in any patient group. Elastin-derived peptides induced elastase release, which was significantly higher in patients with AAA than in those with aortic occlusive disease and controls. These data indicate that the peptides of elastin degradation stimulate the release of elastase, but that continuing production of elastase is absent in circulating neutrophils. It is concluded that: (1) neutrophils do not actively synthesize elastase but act as ‘mules’ or carriers of the enzyme: and (2) elastin breakdown products stimulate the release of elastase at the aortic wall by circulating neutrophils, which in patients with AAA have a predetermined increased amount of elastase.
Cavernous Hemangioma of the Cephalic Vein
Authors: Jarrett F.
Published: September 2022

Although capillary and venous hemangiomas are common problems in children, cavernous hemangiomas of extremity veins in adults are unusual. Successful operative removal of a cavernous hemangioma in the right forearm of a 37-year-old man is described. To the author's knowledge, such lesions in named upper-extremity veins have not previously been reported.
Outlet Strut Fracture of a 23-mm Björk-Shiley 70° Convexo-Concave Aortic Valve
Authors: Abad C.
Published: September 2022

The following brief report describes a fatal complication of a case of outlet strut fracture in a 23-mm Björk-Shiley 70° convexo-concave aortic valve. The valve ruptured 6 years after the operation; diagnosis was made at post-mortem examination. In addition to the high risk of rupture of patients with large-size mitral 60° and 70° convexo-concave Björk-Shiley valves, small-size 70° aortic valves can also present with this complication.
Intimal Sarcoma of the Left Pulmonary Artery: Diagnosis, Treatment and Survival
Authors: Gosalbez F. , Gudin C. , Miralles M. , Naya J. , Valle J. M.
Published: September 2022

A rare caseof intimal sarcoma of the left pulmonary artery, diagnosed by fine needle aspiration biopsy and treated by pneumonectomy, is presented. Survival was nearly 4 years and the patient died as the result of attempted resection of a local recurrence. The literature is reviewed.
Culture of Intraluminal Thrombus during Abdominal Aortic Aneurysm Resection: Significant Contamination is Rare
Authors: Steed D. L. , Higgins R. S. D. , Pasculle A. , Webster M. W.
Published: September 2022

The significance of positive bacterial cultures from intraluminal thrombus in patients undergoing repair of abdominal aortic aneurysm remains controversial. Over the last 4 years, thrombus was cultured during aneurysm repair in 116 patients. All patients received cephalosporin antibiotic before and for 48 h after operation. Although none of the aneurysms appeared to be clinically infected, six patients (5.2%) had positive cultures. Four groups were identified based on the bacteria cultured: group I, coagulase-negative staphylococci, light growth (three patients); group II, coagulase-negative staphylococci, light growth and ‘Streptococcus viridans’ (one patient); group III, Bacillus sp., heavy growth (Gram-negative stain) (one patient); group IV, Clostridium perfringens, occasional growth (one patient). One of the six patients died during resection; the other five are alive without graft infection at 5–24 (mean 12) months after operation. The absence of graft infection suggests that positive cultures were not clinically significant or were adequately covered by the antibiotic prophylaxis. The incidence of positive cultures was lower than previously reported. Routine culture of aneurysm thrombus in the absence of clinical infection is probably not cost-effective.
Ultrasonic Characterization of the Saphenous Vein
Authors: Kupinski A. M. , Evans S. M. , Khan A. M. , Zorn T. J. , Darling R. C. , Chang B. B. , Leather R. P. , Shah D. M.
Published: September 2022

The most frequently used conduit for infrainguinal or coronary artery bypass is the saphenous vein, and this report describes the ultrasonic evaluation of anatomic variations in over 1400 limbs. The thigh portion of the greater saphenous vein consisted of a single venous conduit in 67% of the limbs, a complete double system in 8%, a branching double system in 18% and a closed loop double system in 7%. In 92% of the cases, the vein was in medial position, with the remaining 8% positioned laterally. In the calf, a single vein was observed in 65% of the limbs with the remainder demonstrating a double venous system. The vein was positioned anteriorly in 85% of the limbs. The remaining 15% were positioned posteriorly, with 7% of these being a single dominant vein. Proper knowledge of saphenous vein anatomy is vital to the surgeon preparing to use this vein as a bypass conduit and can aid in its preoperative assessment.
Prophylactic Myocardial Revascularization Based on Dipyridamole-Thallium Scanning before Peripheral Vascular Surgery
Authors: Steinberg J. B. , Kresowik T. F. , Behrendt D. M.
Published: September 2022

Cardiac events continue to be the leading cause of perioperative mortality following peripheral vascular reconstruction. The role of preoperative cardiac screening and prophylactic myocardial revascularization in patients without clinical evidence of coronary artery disease is undefined. Fifteen patients with no clinical evidence of coronary artery disease who were found to have reversible defects on dipyridamole-thallium scans and severe correctable coronary artery disease underwent aortocoronary artery bypass grafting. There was one (6.7%) operative death. Three patients (20%) developed postoperative complications: two atrial fibrillation and one breakdown of the saphenous vein harvest site. Thirteen patients underwent subsequent peripheral vascular surgery: seven had abdominal aortic procedures, three infrainguinal reconstruction, two carotid endarterectomy and one carotid-subclavian artery bypass. There were no perioperative or late deaths, cardiac complications, electrocardiographic changes, or episodes of angina associated with the peripheral vascular procedures. Thus, dipyridamole-thallium imaging appears to help select a group of symptom-free, but high cardiac risk, vascular patients in whom preparatory myocardial revascularization and subsequent peripheral vascular surgery can be performed with acceptable mortality and morbidity. The life expectancy of these patients may be improved and, specifically, the risk of their subsequent vascular surgery may be reduced by this approach.
Survival Predictors in Patients with a Left Ventricular Ejection Fraction of 10–30% Receiving a Coronary Bypass: Analysis of Preoperative Variables
Authors: Hausmann H. , Warnecke H. , Ennker J. , Topp H. , Schiessler A. , Hempel B. , Friedel N. , Schmitt D. , Hetzer R.
Published: September 2022

A total of 224 patients with angina pectoris and a left ventricular ejection fraction in the range of 10–30% (mean 24.2%) underwent coronary artery bypass grafting between April 1986 and August 1991. These patients received a mean (s.d.) of 2.9 (0.3) aortocoronary vein grafts. The overall operative mortality rate was 8.9%. The 1-, 2- and 3-year survival rates were 87.7%, 86.7% and 85.2%, respectively. Analysis of operative risk factors showed that patients with an end-diastolic left ventricular pressure >24 mmHg were significantly more at risk (mortality rate 20.0%, P<0.05) than those with an end-diastolic left ventricular pressure ≤24 mmHg (mortality rate 6.2%). Patients with a perioperative cardiac index <2.51 min−1m−2 had higher mortality (25.4%) than those with a cardiac index 2.51 min−1m−2 (mortality 1.9%, P<0.001). The operative mortality rate of patients with a cardiac index <2.51 min−1m−2 and an end-diastolic left ventricular pressure >24 mmHg was 40.5%. Patients with a left ventricular ejection fraction of 10–20% were not significantly more at risk ( P>0.05) than those with a left ventricular ejection fraction of 21–30%.
Surgical Treatment of the Wolff-Parkinson—White Syndrome in Children
Authors: Onoe M. , Mori A. , Watarida S. , Sugita T. , Shiraishi S. , Nojima T. , Fujiseki Y. , Tabata R. , Matsuno S.
Published: September 2022

From 1986 to 1989, seven children ranging in age from 5 months to 16 years underwent surgical treatment for the Wolff-Parkinson—White syndrome at the Shiga University of Medical Science. None of the patients had any other associated congenital heart disease. There was a right free wall accessory pathway in four patients and a left free wall accessory pathway in three. Surgical ablation of these accessory pathways was performed on eight occasions, using the endocardial approach three times and the epicardial approach five. All the children are alive and none has since had episodes of tachycardia. Only one patient had a recurrent delta wave, which was noted 18 months after the operation. Surgical ablation of the accessory pathway for the Wolff-Parkinson—White syndrome can be performed safely, even in infants and children; it is concluded that this useful procedure is capable of improving a patient's quality of life.
Technical Considerations and Intermediate-Term Results with Modified Devega Tricuspid Annuloplasty
Authors: Hashimoto K. , Arai T. , Kurosawa H.
Published: September 2022

Because of unsatisfactory long-term results with current DeVega tricuspid annuloplasty, 43 patients with secondary tricuspid regurgitation associated with mitral disease were treated with a modified DeVega operation. This procedure continues the suture line to the tendon of Todaro, resulting in almost circumferential traction of the tricuspid annulus. The suture is tied securely around a 29-mm or 31-mm (for women and men, respectively) ball-shaped obturator. Atrioventricular block was not observed. One patient died during the early postoperative period. During a mean(s.d.) follow-up of 5.0(2.0) years, one patient died from causes unrelated to tricuspid regurgitation 2 years after surgery. The mean(s.d.) functional class (New York Heart Association) was 3.1(0.5) on admission and improved to 1.2(0.4) at the end of follow-up The mean(s.d.) cardiothoracic ratio improved from 67(6) to 60(5)% at 1 month after operation and was 59(5)% at the final examination. Preoperative Doppler echocardiography revealed a mean(s.d.) regurgitation grade of 2.7(0.7). (Grades 1–4 are equivalent to mild, moderate, severe and massive regurgitation, respectively.) At 1 month, regurgitation was corrected almost completely in all patients (grade 0.2(0.4)) and remained significantly improved at follow-up (grade 0.5(0.6)). The actuarial freedom rate at 5 years for moderate or severe reguritiation (> grade 2) was 93%. This modification of the DeVega technique substantially improved early and late tricuspid valve competence.
Prolongation of Rat Cardiac Allograft Survival by a Monoclonal Antibody: Anti-Rat Intercellular Adhesion Molecule-1
Authors: Kobayashi H. , Miyano T. , Yamataka A. , Yamataka T. , Yagita H. , Eto H. , Ligo Y. , Tansyo S. , Kojima Y. , Tamatani T. , Miyasaka M. , Nozawa M. , Okumura K.
Published: September 2022

A mouse monoclonal antibody 1A29, which binds to the rat intercellular adhesion molecule-1 (ICAM-1), was studied for its effect on cardiac allograft survival. Expression of ICAM-1 was detectable only on vascular endothelium in normal heart, but was induced on myocardium associated with interstitial mononuclear cell infiltration during acute rejection. Treatment with monoclonal antibody 1A29 for 10 days after transplantation in 15 rats significantly prolonged allograft survival (mean(s.d.) 18(2) days; P<0.001), as compared with 15 isotype-matched control monoclonal antibody (mean(s.d.) 10(1) days) recipients. Five-day treatment with monoclonal antibody 1A29, when started at 5 days after transplantation (the time for which acute rejection is ongoing), also significantly extended the survival (mean(s.d.) 12(1) days; P<0.01) in seven rats. On histological examination, treatment with monoclonal antibody 1A29 reduced the degree of T-cell infiltration of both CD4+ and CD8+ subsets, and greatly reduced myocardial necrosis, vascular injury and intravenous thrombi. These results indicate that an anti-ICAM-1 monoclonal antibody can be used to prevent or treat acute rejection in the rat cardiac allograft model and suggest that human ICAM-1 is an important target for immunosuppression in clinical organ transplantation.
Cervical Aortic Arch Associated with Tetralogy of Fallot
Authors: Patel K. R. , Hurwitz J. L. , Clauss R. H.
Published: September 2022

Forty-seven cases of cervical aortic arch have been reported in the literature. Eleven of these patients had congenital cardiac defects, including tetralogy of Fallot in three. An additional case of cervical aortic arch and tetralogy of Fallot is presented along with a brief review of the literature pertaining to this rare condition.
Anomalous Left Pulmonary Artery (Pulmonary Sling): Result of a Surgical Approach
Authors: Pasic M. , von Segesser L. , Carrel T. , Arbenz U. , Tönz M. , Niederhäuser U. , Vogt P. , Turina M.
Published: September 2022

Between 1977 and 1992, four infants with an anomalous left pulmonary artery and subsequent compression of the tracheobronchial tree were operated on at the University Hospital Zurich. The operation consisted of mobilization of the abnormal left pulmonary artery with reimplantation into the main pulmonary trunk in three patients; the left pulmonary artery was transected and restored in front of the trachea by end-to-end anastomosis in one. Mean follow-up was 7 years (range 2 months to 14.3 years). There were no early and no late deaths. All patients have shown significant symptomatic improvement without respiratory infection or disturbance of normal life activities. Surgical therapy in this rare condition can be safely undertaken with good long-term results. In symptomatic patients the operation should be performed early before occurrence of severe respiratory symptoms and bronchial collapse.
Ventricular Tumors: Surgical Options
Authors: Dietl C. A. , Torres A. R. , Favaloro R. G.
Published: September 2022

Primary cardiac tumors of the ventricles are very uncommon. During an 8-year period only, nine such patients were encountered: the tumor was primarily in the right ventricle in six, in the left ventricle in two and biventricular in one. There were seven children and two adults in this series. Histologically, the neoplasm was benign in all patients. The tumor was obstructive in six patients, Ave of whom underwent surgery (complete resection in three, partial excision in one and a Fontan—Kreutzer procedure in one): one neonate died before an operation could be performed. In addition, one patient with an epicardial tumor underwent complete resection. There were no early or late deaths among the six patients treated surgically. The tumor was small and non-obstructive in two patients, who were not operated on: one died suddenly, and the other was followed without intervention. In summary, complete or partial excision of ventricular neoplasms can usually be accomplished with good long-term results. If resection is not possible, effective palliation may be achieved with a Fontan-type operation, excluding the right ventricle from the circulation.
Combined Transaortic—Transpulmonary Approach for Surgical Repair of Aortic Insufficiency Associated with Ventricular Septal Defect
Authors: Dietl C. A. , Torres A. R.
Published: September 2022

Between September 1980 and August 1988, 21 patients, of mean age 7.3 (range 1–19) years, with ventricular septal defect and aortic valve prolapse, underwent surgery. Aortic insufficiency was mild in three patients, moderate in 13 and severe in five. Surgical repair was performed using a combined transaortic and transpulmonary approach. The prolapsed leaflets were evaluated through the ventricular septal defect before and after valvuloplasty. Using the Trusler technique, the prolapsed cusps were plicated at the level of the commissures; only one patient required aortic valve replacement. After functional assessment of the valve repair, through the ventricular septal defect, during infusion of cardioplegia in the aortic root, the defects were closed through the pulmonary artery, or through a right atrlotomy. Mean follow-up was 51.5 (range 3–108) months. One patient developed bacterial endocarditis and died 3 months after surgery. The other 20 patients remain symptom-free. There are no residual ventricular septal defects, and mild residual aortic insufficiency is present In six patients. The mean(s.d.) cardiothoracic ratio decreased from 0.61 (0.07) before to 0.49(0.05) after surgery. In summary, preservation and repair of the prolapsed aortic valve is possible even in the presence of severe aortic insufficiency. The combined approach through both great arteries enables good visualization with minimal traction, and accurate assessment of the aortic valvuloplasty through the ventricular septal defect. In addition, problems associated with a right ventriculotomy are avoided.
Experiences with Retrograde Delivery of Cardioplegia in Coronary Reoperations
Authors: Noyez L. , Van Son J. A. M. , Lacquet L. K.
Published: September 2022

Myocardial protection is the cornerstone of cardiac surgery especially in coronary reoperation, where the most striking problem is perioperative myocardial infarction. Use of retrograde delivery of cardioplegic solution may be preferable in coronary reoperation. Experience is described with retrograde cardioplegia in 48 reoperations for myocardial revascularization, and the advantages and limitations of this technique discussed.
Use of a Thin Retrocardial Drain to Prevent Pericardial Effusion
Authors: Pirk J. , Hronek I.
Published: September 2022

A thin (3.125 mm) drain was placed retrocardially in 21 patients undergoing cardiac surgical procedures and its efficacy In the prevention of the formation of pericardial effusions was determined with two-dimensional echocardiography. Some 29 patients without such a drain acted as controls. No effusions developed In patients with a retrocardial drain. Nine of 29 (31%) patients without a retrocardial drain had an effusion of 7–18mm. The effusions were most commonly found behind the left ventricle. Using Fisher's exact test as a contingency table, the results were significant ( P = 0.05). Insertion of a thin retrocardial drain may prevent the incidence of pericardial effusions in the early postoperative period and is not associated with local complications.