Internal temporary aortic shunt for managing lesions of the descending thoracic aorta.

An intraaortic shunt was used to maintain distal organ perfusion during experimental descending aortic cross-clamping and graft interposition in the descending aorta. None of the dogs in which this form of shunt was employed developed paraplegia, whereas 60% of the dogs in which no adjunct was used during aortic cross-clamping became paraplegic.

Aortic-left ventricular discontinuity and aortic regurgitation from acute endocarditis.

During the past 14 years, eight patients have had surgical intervention for acute aortic endocarditis and aortic-left ventricular discontinuity at our institution. Repair of the defect between the aorta and left ventricle was accomplished in two patients with interrupted horizontal pledgeted sutures placed through the left ventricular and aortic walls and through the ring of a valve prosthesis. In the remaining six patients the repair was done with the interposition of a Dacron patch graft between the left ventricle and the aorta, and then the valve prosthesis was sutured to the graft and to the remaining native aortic annulus.

Acute endocarditis: surgical treatment of aortic regurgitation and aortico--left ventricular discontinuity.

The clinical course of five patients with acute endocarditis resulting in aortic regurgitation and aortico--left ventricular discontinuity was reviewed. All five patients were operated upon less than 6 weeks after the onset of the antibiotic therapy. Aortic valve replacement and repair of the left ventricular discontinuity were done successfully in all five patients.

Immediate and long-term outlook for valve replacement in acute bacterial endocarditis.

The clinical course of 22 patients with acute endocarditis treated surgically less than six weeks after the onset of antibiotic therapy was reviewed. The aortic valve was infected in 13 patients, the mitral in six, the tricuspid in two, and one patient had both aortic and mitral valve involvement. The indications for surgical intervention before the completion of adequate antibacterial therapy included uncontrollable congestive heart failure, persistent sepsis, systemic embolization, and multiple septic pulmonary embolizations.