Experimental coronary air embolism. Assessment of time course of myocardial ischemia and the protective effect of cardiopulmonary bypass.

In 74 mongrel dogs 0.02 ml air/kg of body weight was injected into the left anterior descending coronary artery (LAD). Forty-three dogs were studied without (group I) and 31 with (group II) extracorporeal circulation (ECC).

Thymolipoma--a rare, benign tumor of the thymus gland two case reports and review of the literature.

Two case reports of thymolipoma are presented. In a review of the literature on the subject, the clinical and etiologic features of this nonmalignant tumor in the anterior mediastinum are discussed. Although rare, thymolipoma should be considered in the differential diagnosis of mediastinal tumors.

Partial repair followed by total correction in congenital heart anomalies.

A two stage corrective operative approach is required for a variety of complex heart anomalies. Different anomalies require different approaches in the various age groups. The technique, results, and complications of elective primary partial repair followed by full correction are described.

Cardiac valve replacement. Problems solved and unsolved.

In this review the present state of cardiac valve replacement is summarized on the basis of the literature and personal experience in approximately 1500 cases, using various prosthetic models. Durability, hemodynamic performance at rest and during exercise, and thromboembolic risk are considered in particular and our choice of the various valve models is discussed on these grounds. The long-term durability has been significantly improved and has possibly been solved in the more advanced mechanical valves, while this question is still open in the present biological prostheses.

Transmitral resection of subpulmonary stenosis in transposition of the great arteries.

Adequate surgical relief of left ventricular outflow obstruction (LVOO) in transposition of the great arteries (TGA) with atrio-ventricular concordance and intact ventricular septum, may to a significant degree depend on the severity of the lesion and the anatomic location of the ventricular septum and the mitral valve. A new approach to resection of subpulmonary obstruction in TGA through the left atrium and the retracted mitral valve is described. In contrast to dynamic stenosis, transmitral resection of a fixed subpulmonary narrowing will usually lead to a significant decrease of LVOO in TGA, with good clinical results.

[Incidence of ventricular arrhythmias after aneurysmectomy (author's transl)].

Incidence and type of premature ventricular contractions (PVC) were studied by ambulatory monitoring in 66 patients at the average 20 months after left ventricular aneurysmectomy. In 25 of these patients long-term-Ecg-monitoring was obtained before and after surgical intervention. After aneurysmectomy only 30% of all patients showed no PVCs; 35% had few PVCs and 35% demonstrated frequent PVCs.

A thresholding method for automatic cell image segmentation.

An algorithm for automatic segmentation of PAP-stained cell images and its digital implementation is described. First, the image is filtered in order to eliminate the granularily and small objects in the image which may upset the segmentation procedure. In a second step, information on gradient and compactness is extracted from the filtered image and stored in three histograms as functions of the extinction.

[Conservative and surgical treatment of thoracic aortic aneurysm].

34 patients with aneurysms of the ascending and descending thoracic aorta are analyzed with regard to treatment (surgical, n = 23, or conservative, n = 11) and survival. In 17 patients the aneurysm was true and in 17 dissecting (acute in 3, chronic in 14). Mean age, sex, symptoms, main clinical data and the relation between true and dissecting aneurysm were comparable in both groups.

[Retroperitoneal vascular injuries (author's transl)].

From 1973-1977, 21 retroperitoneal vascular injuries were seen at the Medical School of Hannover. Vascular lesions of polytraumatized patients were treated 12 times. The rest were iatrogenic traumas after laminectomy, herniotomy, and hip replacement as well as after urologic and gynecologic operations.

[Hemodynamic comparison of Starr-Edwards, Lillehei-Kaster and homograft valves in the mitral position (author's transl)].

In 16 patients with Starr-Edwards (SE) disc valves, 10 patients with Lillehei-Kaster (LK) valves, and 4 patients with fresh aortic homografts (HG) in the mitral position the hemodynamic qualities of the valves were studied. All three valve types in general showed similar results, but they differed clearly as far as special parameters are concerned. So SE valves had the highest pressure gradients, HG valves the lowest, whereas LK valves were in between.

[Left ventricular dynamics with exercise after revascularization in advanced coronary heart disease (author's transl)].

66 patients with 2 and 3 vessel coronary heart disease were studied before and after complete successful revascularization. Hemodynamic measurements and biplane left ventricular angiograms were obtained at rest and during supine bicycle exercise.--After operation a significant overall decrease of LVEDP with exercise was seen; exercise LVEF increased in cases with left main disease and in most cases with double vessel disease and double bypass.

[Reconstruction of the aorta in mycotic aortic aneurysm--report of two cases of salmonella infection (author's transl)].

Two patients with infected aortic aneurysm underwent surgical treatment. When using autologous tissue in place of the infected aorta a recurrent aneurysm was observed four months later. Extraanatomical bypass of the infected area with prosthetic material and consecutive removal of all infected tissue seems to be the only successful management.

[Efficiency of sequential aorta-coronary vein-bypass (author's transl)].

From 1976 to 1977 308 patients were treated with multiple aorto-coronary vein-bypass. Fiftytwo patients receiving sequential bypasses were compared with 256 patients in whom conventional multiple anastomoses were performed. The rate of postoperative bypass failure did not differ significantly in the two types of anastomoses: 16 per cent in sequential as compared to 18 per cent in conventional bypass.

[Results after resection of left ventricular aneurysm (author's transl)].

This resport concerns 105 left ventricular aneurysmectomies, 44 of which were combined with additional operations. Mortality in hospital was 7.6%, the survival rate after 4 years 84%.

Leftsided thoracotomy for coronary artery reoperation.

3 cases of coronary reoperations are described in which a leftsided thoracotomy offered considerable advantages. This approach is recommended for certain types of reoperations on the left coronary system.

[Unstable angina pectoris from surgical view (author's transl)].

Unlabelled: Between January 1974 and September 1977 37 patients with unstable angina pectoris have been treated (7,6% of the patients operated upon). 49% suffered from an old myocardial infarct, 86% had a 2 or more coronary vessel disease, and only 4 patients showed critical stenoses on the left main stem. We preferred a combined medical and surgical treatment.

[Clinical behaviour after aorto-coronary vein bypass grafting related to the degree of revascularization (author's transl)].

The clinical behaviour after bypass-surgery was analysed with regard to anginal symptoms at rest and during daily exercise, working habits and postoperative medication in 135 patients, 3 to 28 months (average 18 months) postoperatively. All patients underwent postoperative coronary and left ventricular angiography, allowing a close correlation between postoperative clinics and patency-rate (average 84%) as well as the degree of revascularization (average 64%). 80% of the patients were clinically improved and, furthermore, there was a close correlation between the degree of improvement and revascularization.