The aortic homograft: evolution of indications, techniques, and results in 107 patients.

Background: Homograft aortic valve replacement has been performed in 107 patients during the past 7 years. Two primary methods of implantation were used (intraaortic and root replacement). Results of both methods are presented.

Early experience with homograft aortic root replacement for complex aortic pathology.

Background: Complex aortic valve and root pathology presents a serious operative challenge.

Methods: During the last 45 months 21 cryopreserved homograft root replacements have been performed in 19 patients. The ages of the patients ranged from 28 to 77 years; there were 15 men and four women.

Descending necrotizing mediastinitis: transcervical drainage is not enough.

One of the most lethal forms of mediastinitis is descending necrotizing mediastinitis, in which infection arising from the oropharynx spreads to the mediastinum. Two recently treated patients are reported, and the English-language literature on this disease is reviewed from 1960 to the present. Despite the development of computed tomographic scanning to aid in the early diagnosis of mediastinitis, the mortality for descending necrotizing mediastinitis has not changed over the past 30 years, in large part because of continued dependence on transcervical mediastinal drainage.

The efficacy and timing of operative intervention for spontaneous pneumothorax.

To reassess the role and timing of operative intervention for spontaneous pneumothorax, 119 patients were retrospectively reviewed to compare recurrences, complications, and hospital stay between a nonoperative group (Group 1) and an operative group (Group 2). Total hospital days were greater in Group 2, but excluding the length of preoperative stay, the number of hospital days were similar in both groups. Group 1 patients more than 40 years old had a longer postoperative hospitalization, but not a higher rate of complication.

Evacuation of calcific valvular debris using a standard Ellik evacuator.

A simple but effective technique is described for removing calcific and other debris following aortic and mitral valve replacement. This technique uses an Ellik evacuator , which is readily available in most operating rooms. An 11-year experience is presented, documenting the efficacy of this method in several hospitals.

Acute reaction to protamine. Its importance to surgeons.

Three open heart surgery patients developed noncardiogenic pulmonary edema after administration of protamine following cardiopulmonary bypass. A catastrophic series of events are characteristic of this reaction: 1) sudden onset; 2) severe bronchoconstriction with early extreme difficulty in ventilation; 3) hyperinflation of the lungs; 4) pulmonary hypertension with normal pulmonary wedge or left atrial pressures; 5) progression to fulminant noncardiogenic pulmonary edema; 6) significant mortality; and 7) ventilatory perfusion abnormalities in survivors. Review of the literature reveals three types of reactions to protamine injection of varying severity: 1) brief hypotension; 2) anaphylactoid generalized reaction; and 3) high protein noncardiogenic pulmonary edema with cardiopulmonary collapse.

Serum and urinary amylase levels following pulsatile and continuous cardiopulmonary bypass.

The incidence of elevated serum and urine amylase values was examined in a prospective clinical study of patients subjected to either continuous or pulsatile extracorporeal perfusion. Mean postoperative values for urine and serum amylase were higher in the continuous group, and the incidence of abnormal values was also greater in the continuous group (70 percent versus 32 percent, p less than 0.01).

The treatment of acute traumatic rupture of the aorta: a 10-year experience.

Forty-three patients with aortic rupture secondardy to blunt trauma have been treated at the University of Micigan within the past 10 years with an overall salvage rate of 70%. The diagnosis should be suspected in anyone who has sustained a high speed decelerating injury, if the chest roentgenogram shows media-stinal widening, whether or not there is hypertension of the upper extremities; systolic murmur, or external evidence of chest injury. Aortography should be employed to confirm the diagnosis and to determine the site or sites of rupture.

A different approach for the total correction of tricuspid atresia.

A new surgical procedure has been used successfully to correct tricuspid atresia in a 9-year-old girl. An external conduit containing a porcine aortic valve was positioned to lead from the right atrium to the underdeveloped right ventricle. The right ventricle was reconstructed with a large Dacron patch, thus providing a large cavity for the small hypoplastic right ventricle.

Pyopneumopericardium as a complication of oesophagogastrostomy.

A case of pyopneumopericardium 13 years following resection of a peptic stricture and oesophagogastrostomy, and treated successfully by closure of the gastric ulcer, pericardiectomy, and drainage, is reported.