bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of the 21 -mm Björk-Shiley Monostrut Valve in Patients with a Narrow Aortic Root
Authors: Hashimoto K. , Mashiko K. , Nakano M. , Horikoshi S. , Kurosawa H. , Arai T.
Published: September 2024

Technical considerations regarding the insertion of 21-mm Björk-Shiley Monostrut valves, particularly regarding decalcification of a calcified annulus with an ultrasonic surgical dissector, in patients with aortic stenosis and a narrow aortic root are described. Short-term follow-up (mean(s.d.) 37(10) months) is also presented. Ten adults whose body surface area ranged from 1.26 to 1.47 m2 underwent implantation of a 21-mm valve without outflow patch or annuloplasty. One operative death occurred; there were no other complications. The New York Heart Association functional class decreased from a mean of 3.2 before surgery to 1 in all cases. The mean(s.d.) end-diastolic volume decreased from 129(44) ml to 80(21) ml, and the end-systolic volume from 41 (21) ml to 27(10) ml ( P< 0.01). The mean(s.d.) maximum velocity, as measured by Doppler echocardiography in the aortic position, decreased from 4.35(0.55) m/s to 2.42(0.59) m/s ( P< 0.01). This degree of improvement was not meaningfully different from that of the 23-mm valve. However, there was a negative correlation between the reduction in left ventricular mass and body surface area ( r = −0.72, P< 0.03). It is concluded that the 21-mm Björk-Shiley Monostrut valve can be inserted using a modified technique in most patients with a narrow aortic root. This size valve is satisfactory when the patient's body surface area is < 1.45 m2.
Postoperative Pseudoaneurysm of Ascending Aorta: Role of Ultrafast Computed Tomography Imaging
Authors: Piotin M. , Beyssen B. , Kadouch R. , Carpentier A. , Gaux J. C.
Published: September 2024

A 34-year-old woman, who had undergone a thoracic aortic aneurysmectomy and replacement with a prosthetic tube graft several months previously, presented with a pseudoaneurysm arising from the proximal anastomotic site. This pseudoaneurysm was studied with contrast-enhanced ultrafast computed tomography. The exact location of the suture dehiscence was located by the presence of a contrast jet flow through the aortic wall. This case shows the feasibility of demonstrating blood flow at the entry site of a pseudoaneurysm with ultrafast computed tomography which may avoid conventional angiography.
Aortic Rupture and False Aneurysm Formation following Balloon Angioplasty of Coarctation in an Adult: Successful Treatment by Urgent Surgery
Authors: Guvendik L. , Sarkar K. , Dyet J. , Aber C.
Published: September 2024

A 25-year-old man developed a false aneurysm as a result of acute disruption of the aortic wall immediately after successful balloon dilatation of his coarctation. He underwent emergency resection of the false aneurysm and end-to-end anastomosis of the descending aorta with an excellent result. The diagnosis and management of this complication are discussed.
Mucormycosis of a Median Sternotomy Wound
Authors: Abter E. I. M. , Lutwick S. M. , Chapnick E. K. , Chittivelu S. , Lutwick L. I. , Sabado M. , Jacobowitz I.
Published: September 2024

Mucormycosis is an unusual complication of cardiothoracic surgery. The fungi may infect the sternotomy wound causing a progressive gangrene or seed the implanted prosthetic valve or graft resulting in endocarditis or graft failure. There have been six previous reports of mucormycosis following cardiothoracic surgical procedures. Four cases involved prosthetic devices, the remaining two are examples of sternal wound mucormycosis acquired from the use of contaminated elasticized bandages. The first case of sternal wound mucormycosis not associated with elasticized bandages is reported here. The infection occurred in a diabetic patient who had undergone coronary artery bypass surgery and mitral valve replacement. The patient received corticosteroids and broad-spectrum antibiotics at the time of and after operation. The patient developed invasive sternal mucormycosis and died on day 10 after surgery, despite aggressive surgical débridement and amphotericin B therapy. No elasticized bandages were used and the source of the infection was not identified. Previous cases of mucormycosis in cardiothoracic surgery are reviewed and the specific clinical setting in which this fungal disease should be suspected defined.
Isolated Iliac Artery Aneurysm and Its Management
Authors: Minato N. , Itoh T. , Natsuaki M. , Nakayama Y. , Yamamoto H.
Published: September 2024

The records of 16 patients with 44 aneurysms of the iliac artery during a 12-year period (1981 to 1992) were retrospectively reviewed. The mean age was 71.2 (range 53-81) years; the male/female ratio was 7:1. An extremely high incidence of isolated iliac artery aneurysm was noted relative to abdominal aortic aneurysm (11.7%) during the same period. Aneurysms ranged in size from 2 to 12 cm. Rupture occurred in four patients (25%). Six patients presented urologic complications of ureteral stenosis, with hydronephrosis caused by perianeurysmal fibrosis in five. Thirteen patients underwent surgical treatment with emergency operation performed in four with rupture and one with impending rupture. The mortality rate for ruptured aneurysm was high (50%). The operative procedures for common iliac aneurysms were open resection in 18, aneurysmectomy in two, and thromboexclusion in three. For internal iliac aneurysms, the procedures were aneurysmorrhaphy (partial resection) in five, obliterative endoaneurysmorrhaphy in seven, aneurysmectomy in two, and thromboexclusion in two, with appropriate graft replacement. Endarterectomy and reimplantation of the inferior mesenteric artery, and internal iliac artery graft interposition were performed to prevent colon ischaemia in three and two patients, respectively. Ureterolysis was performed in three patients with ureteral stenosis caused by perianeurysmal fibrosis, which improved hydronephrosis and renal function in two. Early diagnosis and elective surgery before rupture is the treatment of choice for saving the patient's life. The importance of preventing colon ischaemia for bilateral internal iliac aneurysms and ureterolysis for ureter entrapped within perianeurysmal fibrosis is emphasized.
Percutaneous Transluminal Angioplasty: Follow-up with Treadmill Exercise Testing
Authors: Tong Y. , Somjen G. , Teeuwsen W. , Royle J. P.
Published: September 2024

Between 1986 and 1992, 308 percutaneous transluminal angioplasties in 252 patients were reviewed in the vascular laboratory of the Austin Hospital. The follow-up period ranged from 1 month to 6 years. Treadmill exercise testing was used as an additional mode of assessment to resting ankle/brachial pressure indices in monitoring outcome. Early haemodynamic improvement rate was 86.7%. In 267 successful cases, 199 had increased the mean(s.d.) resting ankle/brachial pressure index from 0.68(0.15) to 0.96(0.14) ( P<0.05) and another 68 with normal or unchanged resting ankle/brachial pressure indices after the procedure increased the mean(s.d.) post-exercise pressure index from 0.45(0.24) to 0.82(0.23) (P< 0.05). The primary haemodynamic improvement rate of initially successful percutaneous transluminal angioplasties was 80.1% at 1 year and was maintained in 46.1% of cases 5 years after. Treadmill exercise testing revealed reduction of the ankle/brachial pressure index in 69 patients during follow-up, indicating restenosis of the dilated lesion or development of a new arterial stenosis. Fifty-two of the 69 patients exhibited a significant drop in the resting pressure index. However, in the 17 remaining patients, only the post-exercise index decrease indicated haemodymamic deterioration. Treadmill exercise testing proved to be valuable adjunct in detecting haemodynamic changes after percutaneous transluminal angioplasty.
Polydioxanone Absorbable Sutures in Vascular Anastomoses: Experimental and Preliminary Clinical Studies
Authors: Wang Z.-G. , Pu Li-Q. , Li G. D. , Du W. , Symes J. F.
Published: September 2024

To assess the safety and efficacy of polydioxanone suture (PDS) for vascular anastomoses, bilateral carotid end-to-end anastomoses using PDSs on the left and Dacron sutures on the right in 18 dogs were performed. The anastomoses were assessed at 4, 6 and 8 weeks after surgery. A breaking-strength test (300 mmHg) did not show a significant difference between PDS and Dacron anastomoses, but partial absorption was grossly evident in the PDS group. Some 35 venous and 21 arterial reconstructive procedures were also carried out using PDS in 53 patients. At follow-up of 3–5 (mean 3.5) years, none of the patients had experienced any suture-related complications. The results indicate that PDS maintains an adequate tensile strength in anastomoses until suture-line healing occurs, suggesting that this material may be safety used in venous or small arterial anastomoses. In addition, because it is absorbable, resulting in decreased foreign-body reactions, PDS may have the potential to improve the long-term patency of venous or small arterial reconstructions.
Pseudoaneurysm of the External Carotid Artery following Radical Neck Dissection and Irradiation: A Case Report and Review of the Literature
Authors: Minion D. J. , Lynch T. G. , Baxter B. T. , Lieberman R.
Published: September 2024

A 54-year-old man developed a pseudoaneurysm of the left external carotid artery 8 years after concluding treatment for squamous cell carcinoma of the tongue. Treatment included radiation therapy, radical neck dissection and a myocutaneous pectoralls major flap. Percutaneous transcatheter embolization resulted in thrombosis of the pseudoaneurysm. A review of the literature yielded only six other reported cases of pseudoaneurysm of the external carotid artery proper.
Fibromuscular Dysplasia as a Cause of Abdominal Aortic Aneurysm
Authors: Matsushita M. , Yano T. , Ikezawa T. , Sakurai T. , Nimura Y. , Shionoya S.
Published: September 2024

A 53-year-old woman presented with abdominal discomfort and was diagnosed using ultrasonography to have an abdominal aortic aneurysm. Aortography revealed a saccular aneurysm 4 cm in diameter of the infrarenal aorta with a ‘string of beads’ appearance. The renal and other visceral arteries appeared to be normal. Resection and graft replacement was performed because of the possibility of rupture. Histological examination of the specimen revealed the most common type of fibromuscular dysplasia, namely medial fibroplasia. Fibromuscular dysplasia should be considered as a potential cause of abdominal aortic aneurysm in female patients with no atherosclerosis risk factors.
Left-Side Inferior Vena Cava and Inflammatory Abdominal Aortic Aneurysms: A Case Report
Authors: Gargiulo M. , Stella A. , Pedrini L. , Faggioli G. L. , Mirelli M. , Caputo M.
Published: September 2024

The incidence of isolated left-side inferior vena cava ranges from 0.2–0.5%. This anomaly is associated infrequently with an abdominal aortic aneurysm. A case is reported of left-side inferior vena cava associated with a symptomatic, 5-cm inflammatory abdominal aortic aneurysm. Preoperative computed tomography showed a perianeurysmal mantle strongly adherent to a left-side inferior vena cava. This report is the first of an infrarenal inferior vena cava anomaly associated with an inflammatory abdominal aortic aneurysm. The technical details required to perform the aortic reconstruction via a transperitoneal approach are described and discussed.
Reoperative Myocardial Revascularization: An Analysis of 458 Reoperations and 2645 Single Operations
Authors: Schmuziger M. , Christenson J. T. , Maurice J. , Mosimann E. , Simonet F. , Velebit V.
Published: September 2024

A consecutive series of 2645 patients underwent primary coronary bypass grafting while 4S8 patients underwent reoperative bypass during a 9-year period. The mean age (61 years), sex distribution (83% men) and preoperative risk factors were identical in the two groups. Significantly more patients belonged to New York Heart Association (NYHA) class 4 and were clinically unstable in the reoperative group ( P< 0.001). The internal mammary artery was used in 43% of the single operation group but in only 23% of patients who subsequently required reoperation (P< 0.001). In reoperations 61 % of the patients had an internal mammary artery graft (P< 0.001). The overall operative mortality rate for single operation was 2.3% (62/2645) versus 9.2% (42/458) for reoperations. Patients with a reoperative interval of more than 1 year had a 8.4% mortality rate, compared with 28% in those reoperated on 1 year or less after the initial operation (P<0.01). Preoperative myocardial infarction, intra-aortic balloon pump insertion, prolonged ventilatory support and ventricular arrhythmias were all prevalent after reoperations (ail P> 0.001), while postoperative myocardial infarctions and re-sternotomy for bleeding did not differ between the groups. Emergency operation, preoperative NYHA class 3–4 and poor left ventricular function were predictors of perioperative mortality in both groups. Left main stem stenosis was an added factor in the reoperative group. After reoperation 93% of the hospital survivors were alive at 5 years after surgery; the cardiac event-free rate was 59% and > 90% of the patients showed improvement of their NYHA class during the follow-up. Reoperative coronary artery bypass grafting is effective, but has an Increased operative mortality and morbidity, especially in patients with unstable angina, left main stem stenosis and poor preoperative left ventricular function.
Effects of R80122, a New Phosphodiesterase Inhibitor, on Liver and Global Haemodynamics in Patients Undergoing Coronary Artery Bypass Surgery
Authors: Autschbach R. , Lange H. , Stephan H. , Mohr F. W. , Becker B. , Sonntag H.
Published: September 2024

R80122 (0.3 mg/kg body weight), a new phosphodiesterase inhibitor, was tested in ten patients undergoing coronary artery bypass surgery. Haemodynamic measurements were made and hepatic blood flow assessed by the indocyanine green infusion method using liver vein catheterization. Cardiac index increased by 63% and systemic vascular resistance decreased by 47%. Hepatic blood flow and intestinal vascular resistance were not significantly affected; nor was hepatic oxygen consumption. It is concluded that R80122 is a highly cardioselective phosphodiesterase inhibitor and that the reduction in systemic vascular resistance by this drug is not an effect of extensive intestinal vasodilatation.
Thrombosed Coronary Artery Fistula as a Cause of Paroxysmal Atrial Fibrillation and Ventricular Arrhythmia
Authors: Rämö O. J. , Tötterman K. J. , Harjula A. L. J.
Published: September 2024

This case report presents a 68-year-old woman with a symptomatic coronary artery fistula. Usually these rare congenital malformations are symptom-free but in this patient the fistula began to cause various arrhythmias after it thrombosed. Her symptoms resolved completely after connective surgery.
Reperfusion Injury in Skeletal Muscle: Controlled Limb Reperfusion Reduces Local and Systemic Complications after Prolonged Ischaemia
Authors: Mitrev Z. , Beyersdorf F. , Hallmann R. , Poloczek Y. , Herold K. Ihnken. H. , Unkelbach U. , Zimmer G. , Freisleben H-J. , Satter P.
Published: September 2024

Previous studies in isolated limbs using crystalloid perfusion solutions have shown that control of the initial reperfusion reduces postischaemic complications. However, no experimental study has been undertaken to evaluate the concept of controlled limb reperfusion experimentally in an in vivo blood-perfused model and to assess the local as well as systemic effects of normal blood reperfusion and controlled limb reperfusion. Of 20 pigs undergoing preparation of the infrarenal aorta and iliac arteries, six were observed for 7.5 h and served as controls; 14 others underwent 6 h of complete infrarenal occlusion. Thereafter, embolectomy was simulated in eight pigs by removing the aortic clamp and establishing normal blood reperfusion at systemic pressure. In six other pigs, the composition of the reperfusate and the conditions of reperfusion were controlled during the first 30 min, followed by normal blood reperfusion. Some 6 h of infrarenal aortic occlusion leads to a severe decrease in high-energy phosphates and muscle temperature, together with a slight increase in creatine kinase and potassium in the systemic circulation. Normal blood reperfusion resulted in severe reperfusion injury: massive oedema developed, the tissue showed a marked decrease in oxygen consumption, glucose consumption. tissue ATP. total adenine nucleotides, muscle pH and total calcium in the femoral vein. Furthermore, a massive increase was seen in plasma creatine kinase concentration and potassium, together with the development of muscle rigidity. In sharp contrast, initial treatment of the ischaemic skeletal muscle by controlled limb reperfusion resulted in normal water content, oxygen consumption, glucose consumption, flow and muscle rigidity. Furthermore, controlled limb reperfusion resulted in higher total adenine nucleotides content. less tissue acidosis, markedly reduced creatine kinase release, and potassium release as compared with that of normal blood reperfusion. This study shows that 6 h of acute infrarenal aortic occlusion will result in severe reperfusion injury (postischaemic syndrome) if normal blood at systemic pressure is given in the initial reperfusion phase. In contrast, initial treatment of the ischaemic skeletal muscle by controlled limb reperfusion reduces the metabolic, functional and biochemical alterations.
Relative Risks of Limb Revascularization and Amputation in the Modern Era
Authors: Schina M. J. , Atnip R. G. , Healy D. A. , Thiele B. L.
Published: September 2024

A retrospective review of 266 patients undergoing infrainguinal revascularization for limb salvage and/or major amputation (transmetatarsal, below-knee or above-knee) from 1984 to 1990 was conducted to determine comprehensive procedure-specific 30-day operative morbidity and mortality rates. Some 211 patients underwent 295 infrainguinal vascular reconstructions (195 primary and 100 secondary reconstructions). There were 122 major amputations in 98 patients (29 above-knee. 70 below-knee and 23 *transmetatarsal). Most amputations were performed in patients with unreconstructable vascular disease, including 39 patients (41 extremities) with failed infrainguinal reconstruction. Procedure-specific morbidity and mortality rates were 48 and 2% for primary revascularization. 35 and 2% for secondary revascularization and 37 and 4%. for amputation, respectively. The difference in mortality between revascularization and amputation approached but did not achieve statistical significance. Cardiac, graft and wound complications were the major causes of morbidity in all groups. Nine of the 12 deaths were of cardiac etiology. Revascularization can be performed in almost all patients with advanced limb ischemia, with a mortality rate equivalent to, or perhaps lower than, that of amputation. When limb amputation Is required, it can be performed with a mortality rate remarkably lower than that described in the older literature.
Duplex Ultrasonography of Recurrent Varicose Veins
Authors: Quigley F. G. , Raptis S. , Cashman M.
Published: September 2024

Varicose veins are a common clinical finding with a high recurrence rate following treatment with either surgery or sclerotherapy. Patterns of incompetence in 100 limbs with recurrent varicose veins were determined using duplex ultrasonography. Saphenofemoral or recurrent groin tributary incompetence was present in 44 limbs, an incompetent long saphenous remnant in 20, saphenopopliteal incompetence in 28, perforator incompetence in 35 and deep venous incompetence in 22. No significant incompetence was detected in 15 limbs. The findings suggest an important role for deep venous incompetence in recurrent veins and show that a re-exploration of the groin is unnecessary in over half of limbs with recurrent veins.
Subadventitial Rupture of the Splanchnic Arteries as the Result of Blunt Abdominal Trauma Presenting with Acute Gastric Dilatation
Authors: Hassen-Khodja R. , Declemy S. , Batt M. , Chechler E. , Le Bas P.
Published: September 2024

Two patients are reported who presented with intestinal ischaemia caused by a subadventitial rupture of the origin of the coeliac trunk and superior and inferior mesenteric arteries after blunt trauma from deceleration injury. In both cases the initial clinical examination revealed a painful abdomen without any ‘peritonism’. Abdominal ultrasonographic examination showed no abnormality. Plain abdominal radiography showed gastric dilatation in both patients. In the first the diagnosis was made by laparatomy but only after Z days. In the second, diagnosis was made by aortography performed because of the early appearance of gastric dilatation. Both patients died as a result of extensive associated Injuries and delay in diagnosis.
Infrainguinal Arterial Reconstruction in End-Stage Renal Disease
Authors: Sakurai T. , Kobayashi M. , Harasawa H. , Itoh A. , Yamazaki C. , Masuko K.
Published: September 2024

A total of 14 infrainguinal revascularizations in 11 patients with end-stage renal disease resulting from diabetes mellitus were reviewed. Indications for surgery comprised gangrene or non-healing ulcerations in eight patients (11 limbs), ischaemic rest pain in two (two limbs) and disabling claudication in one (one limb). No graft failures occurred during the period of observation. There were two immediate postoperative deaths, one amputation, and four persistent non-healing foot ulcers. The remaining four patients showed improvement. Six deaths occurred, including two perioperative deaths. Four patients with non-healing ulcers died within 1 year and 10 months after revascularization, but their deaths were not associated with the foot ulcers. The cumulative patient survival rate was 42% at 1 year. Infrainguinal revascularization in patients with end-stage renal disease caused by diabetes mellitus is feasible when meticulous preoperative assessment and careful perioperative management are employed to minimize operative risk.
Balloon Angioplasty before Wheat's Operation in a Patient with Turner's Syndrome
Authors: Imamura M. , Aoki H. , Eya K. , Murakami T. , Yasuda K.
Published: September 2024

The case of a 19-year-old woman with Turner's syndrome, dissecting aneurysm of the ascending aorta, coarctation of the aorta and bicuspid aortic valve stenosis is presented. Balloon angioplasty was performed before surgery to relieve the pressure gradient caused by coarctation of the aorta. Successful surgical treatment was carried out using Wheat's method. Four-year follow-up has revealed no signs of complications such as restenosis or aneurysm formation.
Does an Aortopulmonary Shunt before Repair of Tetralogy of Fallot Limit Exercise Tolerance in Long-Term Survivors?
Authors: Leyh R. , Böhle A. , Sievers H.-H. , Bernhard A.
Published: September 2024

The purpose of this study was to evaluate the impact of an aortopulmonary shunt on exercise capacity in long-term survivors after total repair of tetralogy of Fallot (17.6(2.0) years' follow-up). Submaximal exercise tests, pulmonary function tests, lung diffusion tests for carbon monoxide, two-dimensional and Doppler echocardiography were performed in 12 patients with an aortopulmonary shunt (group A) and in 21 patients (group B) without a shunt before repair. There were no significant differences in two-dimensional and Doppler echocardiographic findings nor in pulmonary function. Group A showed a significantly lower diffusion capacity of the lung for carbon monoxide at rest (66.2(13.0)% versus 84.1 (9.5)%; P<0.01) and at the anaerobic threshold (71.8(11.0)% versus 87.2(9.8)%; P< 0.01) as well as a significantly reduced physical working capacity at ventilatory anaerobic threshold (1.6) (0.32) W/kg versus 2.41 (0.43) W/kg; P<0.01). A negative correlation was observed between the duration of palliative shunts and diffusion capacity of the lung for carbon monoxide at rest at ventilatory anaerobic threshold (r = −0.8635 and −0.9108 respectively). A shunt placed before definitive repair impairs the long-term working capacity, probably by diminishing the diffusion capacity of the lung for carbon monoxide, especially if the shunt is in place for more than 20 months.
Pressure Characteristics in Arterial Grafts for Coronary Bypass Surgery
Authors: Tedoriya T. , Kawasuji M. , Sakakibara N. , Ueyama K. , Watanabe Y.
Published: September 2024

The haemodynamic properties of arterial grafts were studied by measuring the pressure waveform at the tip of the grafts in 28 patients who underwent coronary artery bypass surgery (CABG). The internal thoracic and gastroepiploic arteries were harvested as pedicles for CABG. Pressure wave of the ascending aorta and arterial grafts were simultaneously recorded with an electrocardiogram under stable haemodynamic conditions before cardiopulmonary bypass. Systolic, diastolic and mean pressures were measured, and mean systolic and diastolic pressures calculated for systolic and diastolic areas divided by time. The ascending aorta showed high sustained diastolic pressure that decreased gradually. Pressures in the internal thoracic and gastroepiploic artery grafts had narrow contours and decreased rapidly. Pressure waveforms in the internal thoracic and gastroepiploic artery grafts had a notch between the systolic and diastolic contours. There was no difference in systolic pressure between the ascending aorta and internal thoracic and gastroepiploic artery grafts. Diastolic pressures were 64(9), 55(7), and 51(6) mmHg in the ascending aorta and internal thoracic and gastroepiploic artery, respectively. Mean(s.d.) pressures were 75(9), 65(9) and 59(7) mmHg in the ascending aorta and internal thoracic and gastroepiploic artery grafts, respectively. Diastolic and mean pressures in the internal thoracic artery grafts were significantly lower than in the ascending aorta but significantly higher than in the gastroepiploic artery grafts. The mean(s.d.) calculated diastolic pressure in the internal thoracic artery grafts was significantly lower than in the ascending aorta but significantly higher than in the gastroepiploic artery grafts. The inferior capacity of flow through the arterial grafts may be mainly attributable to reduced diastolic pressure, which is caused by anatomical characteristics. Arterial grafts originating from a systolic-dominant circulation far away from the heart have a limited ability to supply blood to the diastolic-dominant coronary circulation.
Beneficial Effects of Prostacyclin Treatment on Reperfusion of the Myocardium
Authors: Ğlu S. F. Katircio , Küçükaksu D. S. , Bozdayi M. , Taşdemir O. , Bayazit K.
Published: September 2024

A total of 20 patients with coronary artery disease were studied in order to assess the benefits of prostacyclin administration on reperfusion of the ischaemic myocardium after cardiopulmonary bypass. Ten received prostacyclin (25ng/kg per min) while ten were untreated controls. There was no difference between groups with regard to age, preoperative ejection fraction and aortic cross-clamping times. There were no in-hospital deaths in either group. The administration of prostacyclin significantly altered the metabolic side effects of reperfusion followed by hypothermic cardioplegic arrest. Myocardial oxygen consumption after cardiopulmonary bypass was significantly higher in the prostacyclin-treated group than in controls (18.5 ml versus 13 ml; P<0.01). Prostacyclin treatment significantly reduced the leucocyte activity: leukotriene B4 concentrations were 58 pmol/l in prostacyclin-treated patients compared with 93 pmol/l in controls ( P<0.01). Such recovery of metabolic status during reperfusion resulted in better haemodynamic function in patients receiving prostacyclin.
Autogenous Venous Bypass Grafts and Limb Salvage: 5-Year Results in 1971 and 1991
Authors: Green R. M. , Donarye C. , DeWeese J. A.
Published: September 2024

Claims have been made that the increased utilization of arterial reconstruction has not resulted in improved limb salvage. This report compares the resultsss of two series of patients with autogenous venous bypass grafts and examines the institutional trends at a major regional vascular center with these procedures. The two groups of patients underwent operation between 1957 and 1964 (group I) and 1982 and 1985 (group II) respectively. Each patient was followed for a minimum of 5 years or until death. This review showed that the demographics of the population and the nature of the operation changed dramatically over the 20-year period. Patients were older, had more medical co-morbid conditions, more operations were performed for salvage and more to vessels below the Knee joint in the latter series. Despite these adverse factors, the 30-day patency rates were significantly better in the later group, 93% versus 76%. Likewise, limb salvage rates were improved both initially and after the 5-year period of observation. The 5-year primary patency, however, was no different between groups I and II, 60% versus 56%. Since both series preceded the use of duplex scanning for graft surveillance, even further improvements in both graft patency and limb salvage rates would be expected in patients currently treated.
Tensile Strength and Histological Changes of Abdominal Aorta of Malnourished Rats
Authors: Yoshida W. B. , Müller S. S. , Carvalho I. , Fabris V. E. , Naresse L. E. , Maffei F. H. A.
Published: September 2024

The resistance of the abdominal aorta of rats after 6, 7 and 8 weeks of malnutrition, compared with control animals, was evaluated by longitudinal tensiometry. Weakness of this vessel in malnourished rats was demonstrated; microscopic examination of the aorta stained by Masson, Calleja and hematoxylin-eosin methods showed a decrease in amorphous ground substance and an increase in the width of elastic laminae. There was no visible alteration either in the endothelial lining layer or in the smooth muscle fibers. Such alterations of the aorta are, to the authors' knowledge, the first reported modifications in the peripheral vasculature after malnutrition.
Left Ventricular Function on Exercise after Surgical Treatment of Small Aortic Annuli
Authors: Kitamura M. , Yamazaki K. , Ohta T. , Nakano K. , Hashimoto A. , Koyanagi H.
Published: September 2024

To evaluate left ventricular function during exercise after aortic annular enlargement 15 patients with either aortic (group I, n = 8) or aortomitral (group II, n = 7) annuloplasty for small aortic annuli and eight patients (group III) with standard valve replacement for aortic stenosis without small aortic annuli received gated cardiac pool imaging by technetium-99m-labelled red blood cells at rest and during exercise at a mean of 23 months after operation. Left ventricular ejection fraction, preload requitable stroke work and stroke power index (preload requitable stroke work/systolic ejection period) were measured. Compared with resting values, left ventricular performance and stroke work rate on exercise after aortic annular enlargements increased significantly, as did those after standard aortic valve replacement. These results suggest that aortic annular enlargement can be indicated for surgical treatment of valvular heart diseases associated with small aortic annuli.
Acute Infectious Mitroaortic Endocarditis in Association with Acute Aortic Dissection. Surgical Management of an Unusual Combination of Diseases
Authors: Abad C.
Published: September 2024

A 58-year-old man with acute mitral and aortic endocarditis suffered an acute ascending aortic dissection. The patient had a double valve replacement, combined with replacement of the ascending aorta with a Dacron graft and sealing and closure of the proximal and distal aortic segments with surgical glue. Six months after the operation the patient is doing well with normal function of both valve prostheses and aortic vascular graft.
Splenic Infarction from Cholesterol Embolization following Cardiopulmonary Bypass
Authors: Cernilia J. , Godbe D. H. , Ott R. , Waxman K.
Published: September 2024

The authors report a case of symptomatic splenic infarction secondary to cholesterol embolization after coronary artery bypass grafting in a 59-year-old woman. The patient was treated with urgent splenectomy, which was curative. The diagnosis, investigations and management of the condition are discussed.
Five Hundred Consecutive Carotid Endarterectomies: Emphasis on Vein Patch Closure
Authors: Lawhorne T. W. , Brooks H. B. , Cunningham J. M.
Published: September 2024

This study reviews 500 consecutive carotid endarterectomies performed in 429 patients in one practice over a 12-year period, emphasis being placed on the technique of vein patch closure and its durability. The records of all such patients were reviewed. Data collected included indication, age, sex, angiogram and duplex scan results, technique of carotid closure, complications within 30 days, and follow-up postoperative duplex scans. The technique emphasized generous exposure, distal arteriotomy, routine shunting, and narrow vein patch angioplasty. The mean patient age was 68 years; 245 (57.1%) were men, and 184 (42.9%) were women. Indications for surgery were transient ischemic attack 256 (51.2%); symptom-free stenosis 144 (28.8%); recovered stroke 60 (12%); and non-hemispheric symptoms 40 (8%). The arteriotomy was closed primarily in 71 (14.2%) instances and with a patch in 429 (85.8%). Complications included five (1%) deaths, one (0.2%) stroke, nine (1.8%) transient ischemic attacks, and four (0.8%) wound hematomas. One (0.2%) vein patch rupture occurred. Serial postoperative duplex scans were reviewed in 455 (91%) patients. No significant residual disease was found in any of these patients; three (0.7%) patients were identified with recurrent symptom-free stenoses of >80%; one (0.2%) silent carotid occlusion occurred; and no aneurysms were identified. Classic descriptions of carotid endarterectomy limited the carotid arteriotomy to the bulb area, while contemporary carotid surgery emphasizes wide internal carotid exposure and distal arteriotomy. The authors' experience with vein patch closure confirms the validity of this technique and its low short- and long-term morbidity.
Clinical Results of Greenfield Filter Use in Patients with Cancer
Authors: Greenfield L. J. , Proctor M. C. , Saluja A.
Published: September 2024

The purpose of this report is to examine the outcomes for patients with an underlying diagnosis of malignancy who have had Greenfield vena caval filters placed for protection from pulmonary embolism, and to identify areas requiring further study. This was a retrospective review of data obtained from the Greenfield filter registry and the Univeristy of Michigan Tumor Registry for 166 patients treated at the University of Michigan Medical Center between January 1988 and June 1994. The 84 men and 82 women (mean age 57.8 years) had a mean survival time of 10 (range 1–68) months. This differs significantly from patients in the filter registry who do not have malignancy ( P<0.0001). Some 51% experienced recurrence of their malignancy at a mean of 20 months; this timing corresponds to development of new or recurrent thrombembolism and filter placement. Distant metastases were present in 72% of patients at the time of filter placement. In conclusion, as anticipated, filter patients with malignancy have a significantly shorter survival time than those with other concurrent diseases. A temporal association between the progression of the malignancy and the occurrence of thromboembolism is observed in this population and requires further study. Future studies regarding the use of vena caval filters in these patients and the role of diagnostic screening for deep venous thrombosis and occult recurrence of malignancy should focus on efficacy, safety, cost and patient quality of life rather than on survival.
Progress in Abdominal Aortic Aneurysm Surgery: Four Decades of Experience at a Teaching Center
Authors: Chen J. C. , Hildebrand H. D. , Salvian A. J. , Hsiang Y. N. , Taylor D. C.
Published: September 2024

The purpose of this study was to examine the changing trends in surgical management of patients with abdominal aortic aneurysms at a tertiary care teaching hospital over the past 40 years, by analysis of demographic data, perioperative variables and outcomes on all patients having abdominal aortic aneurysm surgery between 1955 and 1993. Some 1604 abdominal aortic aneurysms were assessed. The annual rate of abdominal aortic aneurysm surgery increased from 17.6 to 67.8 cases per year. The non-ruptured to ruptured abdominal aortic aneurysm ratio increased from 2.4: 1 in the first decade to 3.4: 1 in the last 5 years. In non-ruptured abdominal aortic aneurysm repairs, the following variables changed over the four decades: patients age over 80 years increased (2.4% to 8.0%; P<0.04), concomitant lower-limb occlusive disease increased (12.2% to 23.7%; P<0.02), prevalence of smaller aneurysms (4–6 cm) increased (16.0% to 54.2%; P<0.0001); intraoperative hypotension decreased (9.0% to 0.7%; P<0.0001). postoperative hemorrhage decreased (8.2% to 0.0%, P<0.0001), postoperative leg ischemia decreased (5.7% to 1.1%; P<0.02) and postoperative amputation rate decreased (3.2% to 0.0%; P<0.03). There was a significant decrease in perioperative mortality (17.0% to 3.4%; P<0.0001). For ruptured aneurysms, early operation (within 1 h of admission) increased from 8.7% to 55.8% ( P<0.0001), prevalence of intraoperative hypotension decreased (50.0% to 23.5%; P<0.001), and major venous injury decreased (18.0% to 5.2%; P<0.05). Mortality, however, did not decrease significantly (54.2% to 44.2%; P= 0.32). In conclusion, there was a significant decrease in mortality and morbidity associated with non-ruptured abdominal aortic aneurysm repair over the four decades studied. In addition, older patients with smaller aneurysms and more co-morbid conditions were operated on during this period. Mortality for patients operated on for ruptured abdominal aortic aneurysm repair has not changed significantly.
Activated Protein C Resistance, Factor V Leiden and Peripheral Vascular Disease
Authors: Foley P. W. X. , Irvine C. D. , Standen G. R. , Morse C. , Smith F. T. , McGrath C. , Baird R. N. , Lamont P. M.
Published: September 2024

Activated protein C resistance caused by factor V Leiden is an important thrombophilia disorder which predisposes to venous thromboembolism. Some studies also suggest a role in the pathogenesis of arterial thrombosis and atherosclerosis. The authors have investigated the prevalence of activated protein C resistance and factor V Leiden in a series of 45 patients with peripheral vascular disease. Twelve patients were receiving warfarin. The activated protein C resistance ratios were significantly lower in the group of 33 non-warfarinized patients with peripheral vascular disease (median 2.82 (range 1.36–3.83)) compared with 33 age- and sex-matched controls (median 2.97 range 2.24–4.11): P<0.005; Wilcoxon rank sum). Eight patients (24%) had activated protein C resistance (ratio <2.2). The prevalence of factor V Leiden in patients with peripheral vascular disease was 17.8% (8/45). This is significantly increased compared with the local population and UK published frequency of 3.5% for this genotype. The presence of factor V Leiden did not affect the late outcome of arterial reconstructive surgery in terms of graft patency ( P = 0.5. Fisher's Exact test).
Ultrasound Enhancement of Rabbit Femoral Artery Thrombolysis
Authors: Riggs P. N. , Francis C. W. , Bartos S. R. , Penney D. P.
Published: September 2024

Experiments were conducted to evaluate the potential of low-intensity, externally applied ultrasound to accelerate arterial thrombolysis in an animal model and to characterize potential effects of ultrasound exposure on vessel wall morphology. The femoral arteries of 32 rabbits were exposed, a flowprobe was positioned around the vessel, and a stenosis produced with two circumferential silk sutures to reduce flow by 50%. Thrombosis was achieved by injecting thrombin through the cannulated superficial epigastric branch into a 1-cm segment of femoral artery which was isolated for 20 min. Streptokinase was administered intravenously as a 15 000 U/kg bolus followed by an infusion of 15 000 U/kg per h. Ultrasound (1 MHz, 2 W/cm2) was delivered to the thrombosed vessel during streptokinase administration in 17 animals, and 15 control animals received sham ultrasound only. Thrombolysis occurred in nine of 17 (53%) animals receiving both streptokinase and ultrasound, and this was significantly greater than the rate in animals receiving streptokinase alone (2/15, 13%; P = 0.025). Ultrasound caused a mean temperature elevation of 4°C in exposed tissues. Light and electron microscopy demonstrated increased platelet accumulation on thrombi in ultrasound-treated vessels compared with controls. Endothelial cell vacuolation was seen by electron microscopy in ultrasound-exposed vessels. The results indicate that externally applied, low-intensity ultrasound can significantly enhance thrombolysis in a rabbit arterial model. Possible adverse effects are minor and include platelet accumulation, temperature elevation and minor endothelial changes. Externally applied ultrasound has potential value as an adjunct to thrombolytic therapy.
Surgical Treatment of Cardiac Myxomas: A 20-Year Follow-up
Authors: Lukács L. , Lengyel M. , Szedö F. , Haán A. , Nagy L. , Thomka I. , Kassai I.
Published: September 2024

Clinical experience in the diagnosis and management of 50 cases of cardiac myxoma seen over a 20-year period from 1974 to 1994 has been reviewed. There were 17 men and 33 women of mean age 55.2 (range 16–81) years. Echocardiography confirmed the diagnosis in all patients. The location of myxomas was as follows: left atrial alone in 42 patients, right atrial alone in three, right ventricular alone in one, left atrial+right atrial in two, left atrial+right atrial+right ventricular in one, and left atrial+left ventricular in one. Nineteen patients were operated on within 48 hours of the diagnosis. All tumours were successfully removed with the aid of cardiopulmonary bypass. The hospital mortality rate was 10%. Excision of the tumour resulted in marked symptomatic improvement. There was one late death. The current survivors are symptom-free at a mean follow-up of 76.4 (range 1–241) months. Echocardiographic studies were performed in all survivors and no recurrences have been observed. It is concluded that excision of cardiac myxomas is curative and long-term survival is excellent. Radical tumour excision may prevent recurrences.
Stentless Valve Replacement in the Small Aortic Root
Authors: Walther T. , Falk V. , Diegeler A. , Gummert J. , Autschbach R. , Mohr F. W.
Published: September 2024

Despite the variety of different artificial heart valves available, no ideal prosthesis for the small aortic root has yet been identified. The aim of this study was to evaluate the haemodynamic performance and clinical outcome after stentless aortic valve replacement. A total of 70 patients with a small aortic root underwent Toronto ( n = 61) or Freestyle ( n = 9) stentless aortic valve replacement. All but three patients had aortic stenosis. Mean (s.d.) age at operation was 71.2(7.9) years. The mean annular diameter was 21.4(1.2) mm. Using controlled oversizing adjusting valve size to the sinotubular junction diameter, a 23-mm prosthesis was implanted in 23 patients and a 25-mm prosthesis in 47 patients. The maximum pressure gradient was 19.1(6.8) mmHg and effective valve orifice area was 1.47(0.27) cm2. At discharge and at follow-up, all patients were in New York Heart Association class I or II. At follow-up there was a significant reduction in pressure gradients, an increase in effective valve orifice areas, and decrease of pre-existing left ventricular hypertrophy. In conclusion, with controlled oversizing a gain in prosthesis size of 2 to 4 mm can be achieved. Implantation of oversized stentless valves leads to improved haemodynamics and to left ventricular remodelling in patients with a small aortic root.
The Isolated Post Ischaemic Rat Heart is More Vulnerable to Protamine Sulphate Than the Non-Ischaemic Heart
Authors: Halpern P. , Hochhauser E. , Puzhevsky A. , Rudick V. , Sorkine P. , Vidne B.
Published: September 2024

Protamine sulphate is currently used for the reversal of heparin anticoagulation but is known to cause direct myocardial depression. The purpose of this study was to compare the effects of protamine sulphate on the isolated heart with and without cardioplegic ischaemia. Isolated rat hearts (Langendorff preparation) were electrically paced at 300 beats/min and perfused with Krebs—Henseleit solution. Five groups were tested: (1) control: no ischaemia, no protamine; (2) no ischaemia, protamine; (3) no ischaemia, protamine (time-matched control to groups 4 and 5): (4) control: ischaemia, no protamine; and (5) ischaemia, protamine. Protamine sulphate was infused for 15 min at 10 μg/ml. In groups 4 and 5, cardioplegic ischemia was maintained for 30 min at 30°C before protamine exposure. Protamine decreased myocardial performance in a time- and dose-dependent manner. Protamine depressed mean (s.d.) myocardial left ventricular pressure in both non-ischaemic hearts (groups 2 and 3, to 49(4)% and 50(4)% from baseline, respectively) and post ischaemic hearts (group 5, to 28(8%). Mean (s.d.) left ventricular-developed pressure only partially recovered after protamine in post-ischaemic hearts (to 55(13)% of baseline) compared with full recovery of the non-ischaemic group. Protamine depressed coronary flow to 70(5)% and 74(8)% in non-ischaemic hearts (groups 2 and 3, respectively) and to 58(7)% in group 5. Coronary flow recovered completely at the end of the experiments in all protamine-treated groups. In conclusion, isolated rat hearts subjected to cardioplegic ischaemia are more vulnerable to protamine than are non-ischaemic hearts.
Surgery of Cavo-Atrial Renal Carcinoma Employing Circulatory Arrest: Immediate and Mid-Term Results
Authors: Donatelli F. , Pocar M. , Triggiani M. , Moneta A. , Lazzarini I. , D'Ancona G. , Pelenghi S. , Grossi A.
Published: September 2024

From 1990 to 1995, 12 patients with cavo-atrial renal cell carcinoma underwent resection of the tumor. Circulatory arrest was employed in 11/12 cases. The neoplasm extended to the inferior vena cava in two patients and to the intrahepatic veins or right atrium in five cases. Two severely cardiac compromised patients died perioperatively. Of five patients who showed preoperative suspicion of isolated metastases, 3 patients died postoperatively because of relapsing disease after a mean period of 10.8 months. Five patients are alive and doing well after a mean follow-up of 14.8 months. In our experience myocardial dysfunction determined poor immediate survival. Mid-term survival was influenced by preoperative metastases and lymph-node involvement, but not by intracaval extension. Circulatory arrest appears to be a relatively safe technique to remove renal carcinoma with cavo-atrial extension and should be indicated whenever there are no metastases.