A surgeon's view of extracorporeal circulation.

Because this lecture series is named after Dr. John Gibbon, an examination of the remarkable developments that were set in motion by John and Maly Gibbon's work on extracorporeal circulation is not only appropriate to this forum but is, in fact, long overdue. Although John Gibbon and his wife have been honored in many countries for their basic contribution to medicine, it is my belief that the work was of Nobel stature, and I am sure that if the rules for selecting a Nobel prize winner had been different, John Gibbon would have certainly been the recipient.

Risk-benefit analysis of warfarin therapy in Hancock mitral valve replacement.

The purpose of this investigation was to analyze the thromboembolic and/or major bleeding complications of 124 consecutive but nonrandomized patients who had only mitral valve replacement with the Hancock porcine xenograft between September, 1974 and June, 1979. These patients were treated either with or without anticoagulants. Four basic study groups were created: Group 1, warfarin; Group 2, aspirin; Group 3, no anticoagulants; and Group 4, warfarin and aspirin.

Effects of different filter positions and combinations in extracorporeal circulation.

This study has demonstrated that best results are achieved when the arterial line filter and the coronary suction line filter and combined. The arterial line filter should not be used alone, as it does not replace the coronary suction line filter. Different flow patterns enable the coronary suction line filter to hold most of the very small particles, while those pass the arterial line filter easily.

[Mitral regurgitation following myocardial infarction (author's transl)].

Incompetence of the mitral valve may occur within days or weeks following myocardial infarction. The etiology most often encountered is rupture of a papillary muscle or one or more chordae tendineae. Since echocardiography is available, dysfunction of the papillary muscle with resulting incompetence of the valve is diagnosed more frequently.

Thrombosis and degeneration of Hancock valves: clinical and pathological findings.

Of 415 Hancock valves implanted in 370 patients, 26 valve specimens were recovered at postmortem examination and 8 at reoperation. In 9 of these 34, thrombosis had formed without apparent alteration of the heterograft tissue (Group A). All were mitral prostheses, and the thrombi were attached to the sewing ring.

Thromboembolic complications after mitral valve replacement with Hancock xenograft.

Case histories of 140 patients who had mitral valve replacement with the Hancock xenograft were reviewed according to the incidence of thromboembolic complications. There were 16 patients with preoperative and/or postoperative low-output syndrome (Group A.) Eight of these patients died, and six had autopsies which showed major thrombi on the heterograft valve.

A simple test to identify coarctation of the aorta.

Despite the widespread recognition of coartation of the aorta there are still many patients in whome the diagnosis is not made. A simple clinical test which is useful in making the diagnosis in infants and adults, is described. It depends upon the differential color changes between fingers and toes after releasing a manual compression of feet and hands in the elevated position.

Successful surgical correction of an embolized prosthetic valve poppet: case report.

Embolization of a prosthetic valve poppet, a rare complication following valve replacement, has been, until recently, generally fatal. Immediate recognition followed by replacement of the poppet or valve and extraction of the embolized poppet is the only feasible approach. Recently, a patient was seen was seen shortly after the onset of acute pulmonary edema with wide-open mitral regurgitation.

Leiomyosarcoma of the pulmonary artery diagnosed preoperatively by angiocardiography. Replacement with composite graft.

In a patient with rapidly progressive congestive heart failure and syncope, primary leiomyosarcoma was diagnosed by angiocardiography. The pulmonary artery was resected and replaced with a composite graft. The patient died 12 days later from myofibrillar degeneration of the right ventricle and marked pulmonary disease secondary to pre-existing bronchiectasis.

The surgical management of bacterial endocarditis: a review.

A total of 239 surgically treated patients with primary endocarditis were reviewed both from the literature and from our own experience. The age range was 10 to 74 years with a male to female ratio of 3:1. A wide variety of organisms was found.

Acquired ventricular septal defects. Evolution of an operation, surgical technique, and results.

The pathology and treatment of 19 patients with acquired ventricular septal defects (VSD's) secondary to myocardial infarction are presented. A new method of repair is described: suturing the free right ventricular wall against the VSD to support the friable septum on the right side in continuity with the patch on the left side of the septum. This removes the force of the left ventricle contraction from the patch and septum to the healthy right ventricle wall.

Protection from lung damage by blood filtration during deep hypothermia in puppies.

Ten puppies underwent deep hypothermia with surface cooling and bypass cooling. They were subjected to circulatory arrest for 30 minutes and then were rewarmed by means of bypass. There were 5 control puppies and 5 for which a Swank filter was placed in the arterial perfusion line.

Blood platelets and extracorporeal circulation; kinetic studies on dogs on cardiopulmonary bypass.

Platelet kinetics and functions were studied in dogs during extracorporeal circulation. A transient platelet sequestration in the liver occurs during the bypass. This reversible disappearance is accompanied by a loss of the ability of platelets to adhere or aggregate.

Elective operations for left ventricular asynergy.

, , 282-286. Operative results in 45 patients with symptomatic left ventricular asynergy are reviewed. The main symptoms were congestive heart failure in 77·7%, angina in 31·1%, arrhythmias in 11·1%, and systemic thromboembolism in 2·2% of the patients.