Cardiothoracic surgery at the Mount Sinai Hospital.

Beginning in the early years of the twentieth century, there has been a continuing record of significant contribution made by Mount Sinai physicians to the surgical management of thoracic and cardiovascular pathology. The availability of intratracheal anesthesia, a method developed at this institution, was the sine qua non which made it possible for surgeons to perform thoracic, and later, cardiac procedures. Of great importance to medicine in general, and surgery in particular, were the investigations of two Mount Sinai physicians that made the transfusion of blood safe, and the modern blood bank a reality.

Historical vignettes concerning cardiopulmonary bypass without homologous blood and perfusion hypothermia.

The development of a predictable means of carrying out CPB employing a nonhemic prime with the potential for performance of the entire cardiac operation devoid of HB and, second, the extraordinary advantage of perfusion hypothermia in establishing conditions permitting a safe period of circulatory arrest are two important components of contemporary perfusion methodology. These advances--and others yet to be--represent a continuum of the vision and accomplishments of John Gibbon who--with his lovely wife, Mary, and distinguished colleagues--made clinical CPB a reality 50 years ago.

Reoperation, emergency and urgent open cardiac surgery in Jehovah's Witnesses.

Progressive advances in perfusion technology and perioperative supportive management have made it possible for members of the Jehovah's Witnesses religious group to undergo open cardiac operations with remarkable safety. However, hospital mortality remains high in (1) patients requiring reoperation (in whom both technical and bleeding problems tend to be more frequent) and (2) patients with significantly compromised cardiac performance requiring urgent or emergency operation. Employing a number of perioperative measures designed to minimize blood loss and maintain hematocrit levels (including use of the recently available recombinant human erythropoietin in two patients whose cases are reported herein), 13 reoperations and five urgent or emergency operations were performed.

Poloxamer 188 improves neurologic outcome after hypothermic circulatory arrest.

Poloxamer 188, an amphipathic copolymer with cytoprotective properties, was investigated as a means of improving neurologic outcome after a prolonged period (150 minutes) of deep hypothermic circulatory arrest. Dogs were perfusion cooled and surface cooled to 10 degrees C, the heart was arrested for 150 minutes, and then the dogs were rewarmed and weaned from bypass. Seven dogs were treated with poloxamer 188 before and after deep hypothermic circulatory arrest.

Open heart surgery in patients in the eighth and ninth decades of life.

One hundred fifty-one patients aged 70-89 years underwent a variety of open heart surgical procedures during a period of 1 year. We divided these patients into two groups: Group A was comprised of 127 patients between 70 and 79 years of age. In group B, 24 patients were between 80 and 89 years of age.

Nine-month evaluation of dogs after open-heart surgical removal of heartworms.

Adult heartworms were surgically removed from 4 infected dogs by use of intracardiac techniques during cardiopulmonary bypass. The number of worms removed ranged from 12 to 14 per dog. Observation for 9 months after surgery gave no clinical evidence of active adult heartworm infection, in spite of the consistent finding of circulating microfilariae during the follow-up period.

Effect of labetalol on limb haemodynamics in patients following coronary artery bypass graft surgery.

Labetalol is a competitive inhibitor of alpha- and beta-adrenergic receptors and has an antihypertensive action. To determine limb haemodynamic effects, we measured calf blood flow and venous capacitance by venous occlusion plethysmography before and after oral labetalol in 10 patients 3-7 days following coronary bypass surgery. Vascular resistance was calculated as the ratio of mean arterial pressure to arterial flow.

Improved intraoperative evaluation of mitral valve operations utilizing two-dimensional contrast echocardiography.

Whenever possible, precise mitral valve repair is preferable to valve replacement. Present methods for intraoperative detection of mitral regurgitation, primarily hemodynamic measurements and direct palpation, may underestimate or not detect the presence and severity of regurgitation. We have investigated two-dimensional contrast echocardiography as a means of improving our intraoperative assessment of mitral valve function both before and after repair or replacement.

Management of postcardiotomy hypertension by microcomputer-controlled administration of sodium nitroprusside.

Manual administration of sodium nitroprusside in patients who have undergone cardiac operations can be associated with wide swings in mean systemic arterial pressure. Moreover, it is necessary for constant attention to be paid in order to minimize these potentially catastrophic arterial pressure changes. A microcomputer-based controller was constructed in the belief that it might improve the accuracy of systemic arterial pressure control as well as relieve the clinical staff of a time-consuming task.

Acute effects of oral labetalol on myocardial conduction after coronary artery bypass grafting.

Cardiac electrophysiologic effects of a single oral dose of labetalol were determined in seven patients 4 to 9 days after a coronary artery bypass graft. Surface ECG and bipolar electrograms recorded from temporary pacing wires affixed to the normal right ventricle and abnormal left ventricle at the time of surgery were used to determine conduction intervals. Electrophysiologic parameters were recorded during fixed-rate atrial pacing.

Long-term study of the ultrastructural changes of myocardium in patients undergoing cardiac surgery, with more than 10 years follow-up.

The myocardium from 44 patients undergoing open cardiac surgery was studied to determine if alterations demonstrable with the electron microscope could be related to prognosis. Planimetric methods were used to evaluate myofibrils, Golgi, mitochondria, myelin figures, other organelles, and intracellular space in order to achieve as objective a measurement as possible. Morphologic changes were graded and correlated with clinical findings and results after long-term follow-up.

Use of nonblood priming for open-heart surgery in dogs.

Three electrolyte solutions were used as priming perfusates for 1 hour of cardiopulmonary bypass in 9 dogs. Arterial blood pressure was maintained at a satisfactory level during perfusion and returned to the original ranges shortly after bypass. Measurement of various blood constituents indicated that they were constantly maintained in the normal range during the procedure.

Stability of procaine hydrochloride in a buffered cardioplegia formulation.

The stability of procaine hydrochloride in a buffered cardioplegia solution was studied. The formulation of Ringer's injection with added increments of potassium and magnesium plus procaine hydrochloride was buffered to a pH of 7.3-7.

Quantification of valve regurgitation by radionuclide angiography before and after valve replacement surgery.

Radionuclide gated cardiac blood pool imaging was used to quantify the severity of valve regurgitation in 20 patients, by calculating the ratio of left ventricular to right ventricular stroke counts (end-diastolic minus end-systolic counts in right and left ventricular regions of interest). This ratio (the stroke index ratio) was substantially higher in patients with aortic and mitral regurgitation (3.91 +/- 1.

Administering cold cardioplegia in patients undergoing coronary artery bypass grafting.

In patients undergoing coronary artery bypass grafting (CABG), use of hypothermic cardioplegia for myocardial protection may not always achieve even cooling in the areas distal to a severely obstructed artery. Employing simultaneous myocardial temperature measurements, we documented "warm" areas in some patients having CABG. We then devised a technique of combined aortic root and intracoronary cardioplegic infusion.

Superficial accessory pathway in the Wolff-Parkinson-White syndrome--electrophysiological, surgical and histologic demonstration.

A superficial accessory pathway was demonstrated by electrophysiologic techniques and surgical histopathology in 30-year-old male with Wolff-Parkinson-White syndrome, severe mitral valve disease and medically uncontrollable arrhythmias. In this patient, electrode catheter studies in the cardiac catheterization laboratory revealed antegrade and retrograde function of an accessory pathway between the anterior right atrium and the right ventricle. During surgery, electrophysiologic mapping confirmed the anterior location of this pathway.