Repair of coarctation of the aorta in adults with simultaneous aortic valve replacement and coronary artery bypass grafting.

The authors present three patients who had either coronary artery disease or severe aortic stenosis or both along with congenital coarction of the aorta. The use of a heterotopic bypass (Dacron tube implanted between the ascending and descending aorta) allowed the surgeons to correct the coarction through a median sternotomy and perform the coronary artery bypass grafting and valve replacement at the same time. The authors are convinced that the scarcely mentioned heterotopic bypassing of the coarcted aorta should be added to the armamentarium of the surgeons who operate on patients with coarctation or recoarctation of the aorta in adulthood or with coarctation that is associated with cardiac lesions.

[Implantable pacemaker-cardioconverter-defibrillator].

The aim of this article is to introduce the automatic, implantable cardioverter-defibrillator (AICD) device in connection with the first two cases in Hungary. At present time, the indications of the AICD implantation in the European Community are as follows: recurrent sustained episodes of ventricular tachycardia ventricular fibrillation or aborted sudden cardiac (arrhythmic) death, when the treatment of the underlying heart disease and/or the application of antiarrhythmic drugs, antitachycardia surgery (or catheter ablation procedures) proved to be unsuccessful in the prevention of the ventricular tachyarrhythmias (guided by serial intracardiac electrophysiologic testing and exercise testing), Holter monitoring. On the one hand the implantation of an AICD is not a causative treatment, on the other hand the cost of an AICD is extremely expensive.

[Surgical management of left cor triatriatum in adults].

Cor triatriatum sinistrum is a rare congenital cardiac anomaly in which a membrane divides the left atrium. Severity of the disease depends on the size of the opening on the membrane. The anomaly presents with severe pulmonary hypertension and prognosis is unfavourable without surgery.

Total correction of tetralogy of Fallot in adolescents and adults.

From 1976 to 1988, 23 adolescent and adult patients underwent total correction of tetralogy of Fallot. There were 13 males and 10 females, ranging in age from 16 to 47 years (mean 24.3 +/- 8.

Ruptured aneurysms of the sinus of Valsalva.

From 1969 to 1989, 15 patients with an aneurysm of the sinus of Valsalva underwent operative correction. This represents 0.23% of 6515 cardiac operations with cardiopulmonary bypass during that time.

[Thrombolysis by tissue plasminogen activator in acute myocardial infarct].

The authors participated in the European multicenter investigation, ESPRIT, organized by the Wellcome Research Laboratories. Thrombolytic treatment by intravenous tissue plasminogen activator was performed in 25 patients with early (less than 6h) myocardial infarction. The efficacy of the treatment was controlled by repeat coronary arteriography at 60 minutes, at 90 minutes and at 24 hours of the tpA treatment.

Preoperative silent myocardial ischemia. Has it prognostic significance?

We studied the prognostic significance of preoperative silent myocardial ischemia in patients undergoing coronary artery bypass grafting (CABG). Nonfatal and fatal perioperative myocardial infarction were regarded as prognostically important endpoints. Ninety-five patients (9 women) with stable-effort angina pectoris were studied during their hospital stay in the surgery ward before CABG.

[A case of surgically treated septum perforation associated with acute myocardial infarct].

The authors present the case-history of an elderly female patient with acute myocardial infarction complicated by ventricular septal defect (VSD). She was operated on in order the VSD to be corrected but--probably because of sutural insufficiency--it temporarily reopened, later closed spontaneously. The significance of certain tests in the differential diagnosis of systolic murmur after acute myocardial infarction is discussed, and the importance of these findings compared to the clinical picture is emphasized.

[Value of Doppler echocardiography in the indications for correction of tricuspid valve insufficiency in the course of mitral valve implantation].

To assess the postoperative reversibility of functional tricuspid regurgitation (FTR) and its relation to preoperative pulmonary artery systolic pressure (PASP) 103 patients were studied by Doppler echocardiography (DE) in whom at the time of mitral valve replacement the correction of the FTR was not considered to be necessary by the surgeon. Moderate or severe FTR was found in 36% of patients preoperatively, and it diminished or disappeared early after operation if the preoperative PASP was more than 60 mmHg, while the improvement of FTR was found only in the half of patients with PASP less than 60 mmHg. Persistent FTR was still unchanged in 7 of 10 patients at 1 year follow-up.

[The incidence of endocarditis caused by a prosthetic valve and its risk factors].

Unlabelled: To study the incidence and risk factors of prosthetic valve endocarditis (PVE) we followed 99.5% of 912 patients who had valve replacement from January 1, 1981 through December 31, 1985, for 1 to 6 (mean 3) years. PVE occurred in 27 patients (2.

[Symptomless (silent) myocardial ischemia and its prognostic significance].

The authors studied the prognostic significance of Silent myocardial ischemia. To study the correlation between the silent ischemia before the operation of coronary revascularization and the perioperative complications (infarction, mortality) Holter-monitoring (HM) was performed with 26 patients. The average time of HM was 43 +/- 3.

Surgical treatment of infective endocarditis in the active stage.

The study summarizes the results of surgical treatment of active infective valvular endocarditis (IE) in two cardiac surgical centres in Hungary and the Soviet Union between 1969-1987. Most (92.9%) of the 241 patients operated on were in severe condition pre-operatively (NYHA Class III and IV), their mean age was 38.

Successful repair of a left ventricular aneurysm after blunt chest trauma in a child.

A 5-year-old boy sustained multiple serious injuries, including compression trauma to the chest, when he was struck by a piece of timber. Two-dimensional echocardiography and left ventricular angiography revealed a left ventricular apical aneurysm, which was successfully repaired with the use of cardiopulmonary bypass. To our knowledge, this is only the 5th case in which a left ventricular aneurysm resulting from closed-chest injury in a child has been successfully treated.

Incidence and risk factors of prosthetic valve endocarditis.

Unlabelled: To study the incidence and risk factors of prosthetic valve endocarditis (PVE) we followed 99.5% of 912 patients who had valve replacements from 1 January 1981 to 31 December 1985 for 1-6 (mean 3) years. PVE occurred in 27 patients (2.

Scientific prognosis of trends in the development of cardiovascular surgery in the socialist countries.

The growing incidence and importance of cardiovascular diseases in a number of countries calls for systematic quest for most efficient methods of treatment, which besides prevention and drug therapy include also surgical treatment. A group of experts from member countries of the Council for Mutual Economic Assistance (CMEA) has worked out a scientific prognosis of trends of the development of cardiovascular surgery, which include surgical treatment of ischaemic heart disease, congenital and acquired heart defects, renovascular hypertension and affection of the aortic arch. The prognosis includes also an estimate of the number of operations which will have to be performed in the mentioned diseases per 1 million inhabitants of the CMEA member countries.

Accessory mitral valve tissue causing left ventricular outflow tract obstruction.

Among the various causes of left ventricular outflow tract obstruction accessory mitral valve tissue is the least common. To the best of our knowledge there have been only five such cases reported to date. The aim of presenting two more cases and reviewing the literature is to bring attention to this rare anomaly as it is easy to treat provided it has been diagnosed preoperatively or recognised at surgery.

Bilateral congenital coronary artery-pulmonary artery fistulas. Report of two cases and review of the literature.

Congenital coronary arteriovenous fistulas involving both coronary arteries are rare. Two cases are presented where the origin and termination of the fistulous communication have been visualized by selective coronary angiography. Both patients underwent successful surgical treatment.

Surgical treatment of left ventricular thrombi: two-dimensional echocardiographic diagnosis.

Two cases of successful surgical removal of left ventricular thrombi are presented. Two-dimensional echocardiography revealed in the first case multiple masses of thrombi in the dilated ventricle consistent with congestive cardiomyopathy and emergency surgery was performed for cerebral embolism. In the second case the thrombus was pedunculated and calcified, a probable sequel of a 17-year old myocardial infarction.

Surgical experience with thrombotic and fibrotic forms of non-tropical eosinophilic endomyocardial disease.

Surgical treatment in 8 cases of non-tropical eosinophilic endomyocardial diseases with (4 patients) and without (4 patients) eosinophilia is reported. Follow-up results (1 to 4 years) in the 6 survivors, including hemodynamic re-study, were excellent even in patients operated on in the thrombotic stage (3) or with hypereosinophilia (2), or with dominant right ventricular involvement (3). Two-dimensional echocardiography gave the correct description of the pathologic stage and ventricular involvement in 6 of the 8 cases before catheterization.