Composite graft in annulo-aortic ectasia. Nineteen years' experience without graft inclusion.

Objective: The original Bentall procedure for the surgery of annulo-aortic ectasia (AAE) includes the risk of leakage and pseudo-aneurysm formation in the coronary anastomosis. To avoid the complications mentioned above we have used the open technique without the graft inclusion. In this study we evaluate our early and late results.

Results of cardiovascular surgery in the Marfan syndrome. A retrospective study of 49 patients.

To evaluate the outcome of cardiovascular surgery in the Marfan syndrome, the records of 49 patients (median age 35 years) who underwent 60 operations were reviewed. Primary surgery was elective in 39 patients and emergency in ten. Non-dissecting aneurysm with diameter 4-19 cm was present in 34 cases and distal, isolated aneurysm in four.

Combined cardioplegia delivery offers no advantage over antegrade cardioplegia administration in coronary surgical patients with a preserved left ventricular function.

The effects of antegrade and of combined antegrade and retrograde cardioplegia were compared in 101 patients undergoing elective coronary artery surgery. The patients were randomly allocated to two groups: antegrade cardioplegia was administered in 53 patients and combined cardioplegia in 43 patients. The patients of the two groups were similar in age, sex and left ventricular ejection fraction.

Exercise habits and physical performance during comprehensive rehabilitation after coronary artery bypass surgery.

The effects of training as part of a comprehensive rehabilitation programme on exercise capacity and habits was studied in 171 male coronary artery bypass surgery patients randomized into a rehabilitation (R) (n = 93) and a reference, hospital-based treatment (H), group (n = 78). The rehabilitation programme started with a 2-day informative course before surgery and continued with a 3-week exercise-based course 2 months after surgery followed by a 2-day refresher 8 months post-operatively. The percentages of subjects having regular exercise were 22% and 10% pre-operatively, 42% and 38% 6 months and 46% and 38% 12 months after surgery in the R and H groups, respectively.

Quality of life during rehabilitation after coronary artery bypass surgery.

The effect of a three-phase comprehensive rehabilitation programme on the quality of life during the first postoperative year after coronary artery bypass surgery was studied in 205 male patients randomly allocated into a rehabilitation (R) and a hospital-based treatment (H) group. The rehabilitation programme included physical exercise, relaxation training, psychological group sessions, dietary advice and discussions about postoperative treatment of coronary disease. There was no difference between R and H groups in the frequency of postoperative complaints, number of hospital admissions and satisfaction of sexual life.

Prosthetic valve endocarditis.

Prosthetic valve endocarditis is an infrequent but serious complication of valve surgery. It occurred in 25 (3.2%) of 772 patients who received aortic, mitral or double valve replacement in 1971-1987.

Early and late results of aortic valve replacement. A series of 510 patients.

Aortic valve replacement was performed in 510 patients (Björk-Shiley valves in 93%), with concomitant surgical procedures in 146 cases. The patients were grouped according to technique of myocardial protection: Group I (n = 98) selective coronary perfusion, group II (n = 82) topical cooling, and group III (n = 330) cold crystalloid cardioplegia and topical cooling. The early mortality rate was 5.

Comparison of somatostatin and vasopressin in bleeding esophageal varices.

Somatostatin (ST) and vasopressin (VP) infusions were compared in the treatment of actively bleeding esophageal varices. Fifty-four patients with liver cirrhosis were included in the study. Thirty-two were given ST 4.

Results of multiple valve repair. A clinical study of 81 patients.

A report is presented of 50 men and 31 women, mean age 50.3 years, who underwent surgery for multivalvular cardiac disease in 1973-1987. NYHA function class was III-IV in 88% of the patients.

Surgical treatment of active native valve endocarditis.

A report is presented of 24 patients (23 male), mean age 38 years, who underwent surgery for active native valve endocarditis of the left heart in 1975-1988. The aortic valve was affected in all patients, and also the mitral valve in five. Pre-existing aortic valve disorder was present in 17 cases (13 congenitally bicuspid 4 rheumatic affection).

Fatty acid composition of serum lipids in patients with a coronary bypass operation.

The fatty acid composition of serum phospholipids and cholesteryl esters was analysed in 71 male patients with angiographically defined three-vessel coronary artery disease (CAD) selected for a coronary bypass operation. Their 71 control subjects were matched according to age, sex, smoking, relative weight, and absence of CAD. The concentrations of fatty acids, 14:0, 16:0 and 16:1 of the serum phospholipids, were significantly (P less than 0.

Mesocaval shunt for bleeding oesophageal varices.

A total of 43 patients underwent end to side mesocaval (25 patients) or interposition shunts (18 patients) for bleeding oesophageal varices in 1970-1985. Alcoholic cirrhosis was the aetiology in 30 patients. The operation was elective in 26 and urgent or as emergencies in 17 instances.

Serum group I pepsinogens during insulin and pentagastrin tests in unoperated and vagotomized duodenal ulcer patients.

The level of serum group I pepsinogens (PG I) has been studied during the conventional insulin-pentagastrin test in 29 duodenal ulcer (DU) patients before and 2 months after proximal selective vagotomy (PSV) and in 31 unoperated DU patients. The mean basal serum PG I level was 191.6 +/- 15.

Vagotomy and gastroenterostomy for stenosing duodenal ulcer.

Vagotomy and gastroenterostomy (V-GE) was performed in 41 patients with chronic stenosing duodenal ulcer and gastric retention in the years 1965-84. There was no mortality and no severe complication occurred. One patient was reoperated for dysfunction of an antecolic stoma.

Clinical results after mitral valve replacement with the Björk-Shiley disc prosthesis.

Between September 1971 and June 1985, 230 Björk-Shiley valves were implanted for mitral valve disease at the Department of Surgery, University of Turku. Concomitant cardiac surgical procedures were performed in 35.2% of the cases.

Levels of serum lipids, apolipoproteins A-I and B and pseudocholinesterase activity and their discriminative values in patients with coronary by-pass operation.

Serum lipids and apoproteins A-I and B were measured in 115 male patients and serum pseudocholinesterase activity (PChE) was determined in 83 patients with 3 vessel coronary artery disease (CAD). The control subjects were matched according to sex, smoking, relative weight and age and were free from heart disease. The CAD patients had significantly higher serum VLDL cholesterol and triglyceride levels and lower HDL cholesterol and apo A-I levels and lower HDL to total cholesterol ratio than the controls.

Parietal cell vagotomy for duodenal and pyloric ulcer: clinical and secretory results.

Unlabelled: In the Department of Surgery, University of Turku, 310 patients underwent parietal cell vagotomy for duodenal (268 patients) or pyloric-prepyloric ulcer (42 patients) in the years 1973-82. The male/female ratio was 4/1 and mean age 43 years. There was no mortality.

Results of five standard operations for elective surgery of duodenal ulcer.

459 patients who were operated on electively for duodenal ulcer in the Surgical Department, University of Turku, in 1965-1976 are reviewed. The operations were: Billroth II resection (B II) 95, truncal vagotomy and antral resection (TV-A) 61, selective gastric vagotomy and antral resection (SV-A) 159, vagotomy and pyloroplasty (V-P) 70, and parietal cell vagotomy (PCV) 110 patients. Operative mortality was 0 in B II, 4.

Early results and complications of coronary artery bypass surgery. A consecutive series of 441 patients.

The mortality rate and early complications of coronary artery bypass surgery were assessed for the first 441 consecutive patients operated on at Turku University Hospital. The overall hospital mortality rate was 2.5%.

Morphology and function of the parietal cells after proximal selective vagotomy in duodenal ulcer patients.

The effects of proximal selective vagotomy (PSV) on parietal cell morphology and the degree of gastric inflammation were investigated and correlated with changes in gastric acid secretion and serum gastrin concentrations in 17 duodenal ulcer patients. Endoscopy, acid secretion tests, and blood sampling were performed preoperatively and 2 months, 1 year, and 3 years postoperatively. The mucosal biopsy specimens obtained at endoscopy were analyzed both light- and electron-microscopically.

Surgical repair of annulo-aortic ectasia in children.

Results of total repair of annulo-aortic ectasia in three children are presented. The operations were performed on vital indications. All the children survived.

Myocardial oxygen balance during hemodilution in patients undergoing coronary artery bypass grafting.

The myocardial (arterial-coronary sinus) balance of oxygen and lactate was studied before a cardiopulmonary bypass and during the first 5 min of a normothermic bypass in two patient groups undergoing coronary revascularization for multiple coronary artery disease. The hemodilution (HD) group was hemodiluted before the bypass with dextran 70 (15 ml/kg; resulting mean hematocrit 32%) and further at the beginning of the bypass due to nonhemic priming of the oxygenator (mean hematocrit 15%). The control (C) group was not diluted before the bypass, and four units of red blood cells were included in the oxygenator priming (mean hematocrit 27% after the beginning of the bypass).