Postinfarction ventricular aneurysmectomy.

Most operations performed for the treatment of ventricular aneurysm do not achieve maximal rehabilitation of the damaged heart. Cardiac surgeons generally ignore the importance of the flail septum that results from anteroseptal infarction. Many believe that the obstructed left anterior descending coronary artery must be carefully avoided during closure of the ventriculotomy incision.

Operative approaches to the left atrium and mitral valve apparatus.

Traditional and alternative approaches to the mitral valve apparatus are presented. The median sternotomy and vertical left atriotomy approach affords adequate exposure in most cases. However, there are occasions when an alternative approach may be warranted.

Management of aneurysms in segments of saphenous vein grafts.

A technique to manage aneurysmal dilatation of a segment of saphenous vein is presented. A vein sleeve is used to cover the dilated segment. Avoidance of subsequent venovenous anastomosis and the ease of application justify its clinical use.

Nonoperative management of unusual blunt traumatic rupture of the thoracic aorta.

A conservative nonoperative method of management was utilized in an atypical case of blunt traumatic rupture of the thoracic aorta. In unusual or complicated tears of the aortic arch, as described here, a delayed or expectant method of management may be justified.

A comparative study of cephapirin, cephalothin, and methicillin in cardiovascular surgery.

An open, randomized study involving 217 patients undergoing elective cardiovascular surgery was undertaken to compare the effectiveness of cephapirin, cephalothin, and methicillin in preventing postoperative infections. One of the three antibiotics was assigned randomly to each patient and administered beginning 2 h before operation and continuing every 6 h for 5 days. There was no significant difference between the three study groups with respect to the incidence of infection (p = 0.

Myocardial revascularization 1978.

After more than ten years of clinical application, direct myocardial revascularization with saphenous or mammary vein grafts is becomining one of the most common types of elective major surgery performed in the United States. The need for and the results of revascularization surgery are determined by cine coronary arteriography. The principles on which this type of surgery is based are simple.

Humoral response in blood group P phenotype persons subjected to an avian environment.

The avian environment contains among many antigens, the blood group substance P1-P1 antigen is present in certain Enterobacteriaceae found in bird droppings. Examples include Enterobacter, Klebsiella, E. coli, Enterobacter Haffniae and Proteus.

Aortic valve replacement combined with myocardial revascularization. Late clinical results and survival of surgically-treated aortic valve patients with and without coronary artery disease.

From 1967 through 1973, 80 consecutive patients underwent simultaneous aortic valve replacement (AVR) and coronary bypass grafting. Fourteen (18%) experienced no angina pectoris and had no history or electrocardiographic evidence of coronary atherosclerosis. Seven of these 14 had severe multiple vessel disease.

The P blood group system in pigeon breeders and pigeon breeder's disease.

A blood group P1-like antigen has been found in gram-negative bacilli isolated from pigeon droppings, in pigeon serum, and on pigeon red blood cells. As a probable resident of the environment of the pigeon loft, the antigen stimulated formation of anti-P1 antibody in eight of 11 pigeon breeders who belonged to the P2 blood group. Only one of 11 random hospitalized patients with the P2 blood phenotype had a detectable titer of anti-P1 antibody (P less than 0.

Cannulation of the ascending aorta for cardiopulmonary bypass. Experience with 9,000 cases.

The Cleveland Clinic team has now accumulated experience with cannulation of the ascending aorta for arterial return in more than 9,000 patients. Since adoption of this technique, only one lethal dissection has occurred and other related complications have been minimal. Technique, surgical pitfalls, contraindications, and complications of ascending aortic cannulation are discussed in this communication.

The structural study of the saphenous vein.

From November, 1971, to September, 1974, 1,179 patients received aortocoronary saphenous vein bypass grafts at the Cleveland Clinic Hospital. Segments of saphenous vein from each patient were sent for microscopical analysis. These vein segments were classified as normal or abnormal (phlebosclerotic).

Internal mammary--coronary artery anastomosis. "No-touch" technique.

A simple technique for internal mammary--coronary artery anastomosis that can be applied to all branches of the coronary circulation is described. The anastomosis can be constructed in 10 to 15 minutes. This technique eliminates pinching of the internal mammary artery by forceps.