Surgical treatment of aneurysms of the ascending aorta.

From January 1970 to April 1975, 132 patients underwent surgical repair of aneurysms of the ascending aorta at this institution, 24 of whom had acute dissections. In almost all cases the ascending aorta was replaced with a Dacron tube graft. Aortic valve replacement was performed in 100 patients and 23 patients underwent coronary artery revision or bypass.

Surgical treatment of left ventricular outflow tract obstruction with apicoaortic valved conduit.

From Aug. 13, 1975, through May, 1976, nine patients underwent creation of a left ventricular "vent" for relief of severe left ventricular outflow tract obstruction. A Dacron fabric graft containing a heterograft valve was used to establish a conduit from the left ventricle to the abdominal aorta.

Surgical versus medical treatment of coronary artery disease: long-term survival.

In an attempt to answer the question as to whether or not aortocoronary bypass (ACB) does increase life expectancy of patients with coronary artery occlusive disease (CAOD), 4,766 consecutive patients undergoing ACB at the Texas Heart Institute from October, 1969 through June, 1975, were reviewed and followed for five and one half years. Overall early mortality was reduced from 9.7 percent during the first full year (1970) of the study to 3.

Occlusion of the left main coronary artery secondary to left ventricular angioma.

Our experience with a patient who had an angioma of the anterior wall of the left ventricle that produced complete occlusion of the left main coronary artery is presented. Diagnosis was made before surgery from findings on cineangiographic studies. Successful surgical treatment consisted of a double aortocoronary bypass to the left anterior descending and obtuse marginal coronary arteries.

Transaortic repair of double-outlet right ventricle with situs versus, l-loop, l-malposition (I,L,L), subaortic ventricular septal defect, and associated anomalies.

Successful total correction of a rare form of double-outlet right ventricle (I.L.L.

Mitral valve replacement for idiopathic hypertrophic subaortic stenosis. Results in 27 patients.

Treatment of idiopathic hypertrophic subaortic stenosis (IHSS) remains a controversial problem and depending upon many factors, medical or surgical treatment may be elected. When medical therapy fails and surgery is recommended, choice of an appropriate surgical technique may be difficult. An analysis is given of 27 patients who have undergone only mitral valve replacement as definitive treatment.

The surgical treatment of congenital coronary to pulmonary artery fistula.

Six patients with coronary to pulmonary artery fistula underwent surgical treatment between January 1973 and August 1975. All fistula terminated in the main pulmonary artery just distal to the pulmonary valve. Two patients had severe coronary artery disease associated with the fistula.

Association of ostium secundum atrial septal defects with mitral valve prolapse.

Severe prolapse of the mitral valve leaflets was seen at left ventricular angiography in 16 of 92 patients with a secundum type atrial septal defect studied prospectively from 1970 to 1974. The patients were aged 15 to 69 years; angioplasty or mitral valve replacement was carried out in nine. In 9 of 122 patients aged 15 to 55 years who were operated on for closure of a secundum type atrial septal defect between 1956 and 1969, mitral regurgitation due to prolapse but with intact chordae tendineae was seen at operation.

Interruption of the aortic arch. Surgical considerations.

During a 10 year period, January, 1965, through January, 1975, 5 patients with interruption of the aortic arch (IAA) underwent operation at the Texas Heart Institute. The mortality rate was 60 per cent; 2 patients survived the operation. One 11-day-old infant with IAA, type A, a ventricular septal defect (VSD), and a patent ductus arteriosus (PDA) underwent successful two-stage treatment.

Aneurysm of right-sided cervical arch: surgical removal and graft replacement.

Right-sided cervial aortic arch is a rare congenital anomaly which may cause respiratory symptoms or dysphagia. In the past, surgical correction of the cervical arch has not been attempted except in one patient in whom an erroeous diagnosis of aneurysm of the innominate artery led to an unsuccessful operation. A case is reported of a 39-year-old woman with an extensive fusiform aneurysm of a right-sided cervical arch.

Supravalvular stenosing ring of the left atrium.

Two patients with supravalvular stenosing ring of the left atrium are described. In 1 patient with an associated ventricular septal defect and Wolff-Parkinson-White syndrome, the diagnosis of supravalvular stenosing ring was only suspected. This patient underwent correction but died 34 days after the operation because of pulmonary embolism.

Protection of the sinus node in Mustard's operation.

The occurrence of dysrhythmias after the Mustard operation for transposition of the great arteries was compared in 70 patients operated upon before and 58 patients operated upon after January 1972 when surgical modifications aimed at preserving the sino-atrial node and its arterial supply were initiated. The surgical modifications included changing the site of the superior vena cava (SVC) cannulation away from the SVC-right atrial junction, incision into the right atrial wall anterior to the sulcus terminalis, and sewing of the superior part of the baffle patch away from the sino-atrial node area. A significant decrease in the incidence of dysrhythmias occurred in the group of patients operated upon after the surgical modifications.

Myocardial revascularization. Early and late results after reoperation.

In a series of 4,522 consecutive patients who underwent aorta-coronary bypass (ACB) with the saphenous vein at the Texas Heart Institute, 32 had a second revascularization procedure. All patients were reoperated upon because of recurrence of incapacitating angina. Reappearance of angina was related to obstruction of the grafts alone in 6 patients, to the disease of other arteries alone in 16, and to both sources in the remaining 10 patients.

Aortocoronary artery bypass: present indications and risk factors.

From 1969 through 1974, a total of 4,522 patients were operated on for coronary artery occlusive disease. This article is an in-depth analysis of a consecutive series of 275 of these patients, operated on during 1974. The mortality was 1.

Technical considerations in cardiovascular surgery for neonates.

Cardiovascular surgical techniques used in neonatal patients demand that instruments of appropriate size and configuration be available. A specially designed set of small instruments has been developed to fulfill these needs.

Repair of ventricular septal defect after pulmonary artery banding.

Since 1964, 90 patients have undergone two-stage surgical repair of ventricular septal defect (VSD) with pulmonary artery banding (PAB) in early infancy and total repair at an average age of 4 years. Reconstruction of the pulmonary artery was accomplished with a pericardial patch, woven Dacron patch, or transverse angioplasty. The VSD was closed with a knitted Dacron patch in 75 patients and by primary suture technique in 13 patients.

A new approach to repair of pulmonary branch stenosis following ascending aorta-right pulmonary artery anastomosis.

Ascending aorta-right pulmonary artery anastomosis may result in branch stenosis or occlusion of the right pulmonary artery from growth or from failure to place the anastomosis on the posterior surface of the aorta at the time of construction. Closure of the anastomosis is usually easily accomplished by simple suture through the ascending aorta. When branch stenosis is present at the site of anastomosis, reconstruction of the pulmonary artery is necessary.

Intraventricular repair of transposition complexes with ventricular septal defect.

Repair of transposition of the great arteries by the technique developed by Mustard is the method routinely used for correction of such anomalies. Intraventricular repair of transposition complexes associated with a large ventricular septal defect can prevent some of the limitations and late complications of the intra-atrial operation. A technique is described of intraventricular repair of an unusual Taussig-Bing type of anomaly with a pericardial patch as a baffle to channel left ventricular outflow to the aorta and right ventricular outflow to the pulmonary artery.

Early and late results after surgical treatment of preinfarction angina.

Among 3,707 patients who underwent aortocoronary bypass, 302 had preinfarction angina. Coronary angiography revealed single-vessel disease in 43 patients, double-vessel disease in 81, and triple in 178 patients. Plane ventriculography showed contractility to be normal in 178 patients, fair in 88, and poor in 36 patients.

Surgical repair of atrial septal defect in patients over 60 years of age. Long-term results.

In order to evaluate results of surgical repair of secundum atrial septal defect (ASD) in patients 60 years of age or older, a review was made of 16 patients who had undergone such operation between January 1964 and December 1974. Before operation eight patients were in functional classification III (New York Heart Association), seven were in class II, and one was in class I. Twelve patients had a left-to-right shunt greater than 3:1.

Long-term survival following aortocoronary artery bypass. Analysis of 4,522 consecutive patients.

At the Texas Heart Institute, from October 1969 through December 1974 a consecutive series of 4,522 patients who underwent aortocoronary bypass procedures was analyzed. Our experience with this procedure over a 5-year period demonstrated a decreasing operative and long-term mortality. This included patients who had aortocoronary bypass alone or in combination with other procedures such as resection of a left ventricular aneurysm or aortic and mitral valve procedures.