Intracardiac pheochromocytoma with dual coronary blood supply: case report and literature review.

An intracardiac pheochromocytoma is extremely rare. This patient first presented postpartum at age 28 with clinical signs, symptoms and biochemical evidence suspicious for the diagnosis of pheochromocytoma. Multiple radiologic studies and laparotomy failed to confirm the diagnosis.

Spectroscopy of the isolated rabbit heart: effects of perfusion with oxygenated crystalloid cardioplegia at 4 degrees C and 20 degrees C.

Factors that limit survival of explanted cardiac allografts include intracellular acidosis and loss of high energy phosphates. This study was undertaken to determine if these processes could be retarded by specific interventions during organ storage and to determine the capabilities of phosphorus-31 (31P) nuclear magnetic resonance spectroscopy to monitor these intracellular changes noninvasively. Thirty-six excised rabbit hearts were studied in six groups according to the storage temperature and conditions of their perfusion: nonperfused, aerated perfusate or oxygenated perfusate, each at 4 degrees C and 20 degrees C.

Deposits of crystalline material containing silicon in surgically excised human valves.

Ninety-seven surgically excised natural cardiac valves were examined by scanning electron microscopy and x-ray energy spectroscopy to assess the occurrence of crystalline deposits that contain the element silicon. Valves examined included 33 mitral valves, 63 aortic valves, and 1 tricuspid valve. To reduce the possibility of surface contamination, the deep layers of some valves were examined after exposure by fracture of the valve.

Role of brachytherapy in the management of pulmonary and mediastinal malignancies.

Brachytherapy, the permanent or temporary implantation of radioactive sources, has been performed in limited numbers of patients with lung cancer over the last 50 years. Because of renewed interest in this modality, we reviewed our experience with 103 patients treated over a 7-year period. The mean age of this group was 55.

Can computed tomography of the chest stage lung cancer? Yes and no.

To determine the accuracy of computed tomography (CT) of the chest in the staging of lung cancer, we studied 418 patients with primary pulmonary carcinoma between 1979 and 1986. Each had a preoperative scan performed before detailed operative staging. Each CT scan was analyzed for components of the current TNM staging system.

Bioprosthetic valve replacement of aortic valve endocarditis: Detroit experience.

Bioprosthetic valve replacement for aortic valve endocarditis was reviewed in 98 patients, 39 nonaddicts and 59 addicts, from the Henry Ford Hospital in Detroit. Multivariate analysis was carried out, and the bioprosthetic valve is a reasonable valve replacement device for both native and prosthetic valve endocarditis.

The porcine bioprosthetic heart valve: experience at 15 years.

The porcine bioprosthetic valve has been in use at Henry Ford Hospital since 1971. In this review, 980 patients with 1,081 porcine bioprosthetic valves were examined from 1 month to 16.4 years after implantation with a 99% complete follow-up.

Scanning electron microscopy of surgically excised human mitral valves in patients over 45 years of age.

Leaflets were obtained from 23 diseased mitral valves of patients over 45 years of age removed at the time of prosthetic valve insertion and the topography was studied with scanning electron microscopy. The clinical diagnosis in all cases was probable rheumatic heart disease. Filiform processes (Lambl's excrescences) were seen on 15 of 23 (65%) of these leaflets.

Prediction of post-cardiopulmonary bypass cardiac output.

The ability to predict cardiac output (CO) before termination of cardiopulmonary bypass (CPB) allows identification of potential complications once the patient is off bypass. We have previously demonstrated that CO early after CPB can be reliably predicted by a plot of venous oxygen saturation at various flow rates on CPB, based on in-line monitoring of venous oxygen saturation. In this study, we evaluated a simplified technique for predicting CO with a series of 50 patients on CPB.

Randomized clinical trial of fibrin sealant in patients undergoing resternotomy or reoperation after cardiac operations. A multicenter study.

A multicenter study was conducted to test the efficacy and safety of fibrin sealant as a topical hemostatic agent in patients undergoing either reoperative cardiac surgery (redo) or emergency resternotomy. A total of 333 patients from 11 centers in the United States were included in the study. Patients were randomly assigned to initially receive the fibrin sealant or a conventional topical hemostatic agent when such was required during an operation.

Implantable electrical left ventricular assist system: bridge to transplantation and the future.

An implantable left ventricular assist system (LVAS) utilizing an electromechanically driven dual pusher-plate blood pump has been employed in a multiinstitutional trial as a bridge to cardiac transplantation. Under development for permanent circulatory support in patients with end-stage heart disease, the LVAS, in this application, derives power and control from an external console via a percutaneous lead. The LVAS was implanted in 20 patients (16 men, 4 women) who were hemodynamically unstable or in refractory cardiogenic shock.

Energy expenditure of autoperfusing heart-lung preparation.

The autoperfused heart-lung preparation was developed as a method for extending the acceptable donor-to-recipient interval in clinical heart-lung transplantation. Metabolic substrate enhancement has been shown to be necessary for the survival and homeostasis of the functioning preparation. To define basic metabolic requirements and to determine the resting energy expenditure of the working canine heart-lung preparation, two groups were studied.

Minnesota ALG. Safe and effective immunosuppression for cardiac transplantation.

Fifty-six patients undergoing orthotopic cardiac transplantation were given Minnesota ALG prophylactically or therapeutically for acute cardiac rejection. During a follow-up period of 0-28 months (mean follow-up period, 11.9 months), the actuarial survival for the entire group was 96% and 86% at 30 days and 1 year, respectively.

The future of bioprosthetic valves.

The glutaraldehyde treated bioprosthetic heart valve is the most intensively studied valve in the history of heart valve replacement. The valve is examined from three aspects: hemodynamics, thromboembolism, and durability. The hemodynamic performance of the porcine bioprosthetic heart valve reveals that it performs as well as the Hall-Medtronic valve, better than the Starr-Edwards valve, but not as well as the St.

Leukocytes, platelets, and surface microstructure of spontaneously degenerated porcine bioprosthetic valves.

The microstructure of 33 spontaneously degenerated porcine bioprosthetic valves was assessed by scanning electron microscopy in order to gather insight regarding the degenerative process. Twenty-four mitral and 9 aortic valves were removed from 32 patients. The duration of insertion was 7.

Prevention of early postoperative renal dysfunction in cardiac transplantation.

Fifty six patients undergoing cardiac transplantation were immunosuppressed with a multi-drug induction regimen in which Cs administration was delayed postoperatively until satisfactory hemodynamics and renal function were achieved. The advantage of this approach is the absence of acute renal dysfunction in the early postoperative period. This immunosuppressive regimen was well tolerated and without significant detrimental effects on patient survival, graft rejection, or infection.

Infection surveillance in cardiac transplantation.

Infections are a major cause of morbidity and mortality in cardiac transplantation. There is little information describing screening and prospective surveillance of heart recipients. We describe a surveillance program that was used for 35 patients, which screens and follows recipients through serologic, virologic, and immunologic parameters.

Treatment of lung cancer metastatic to the brain. Results of combined excision.

Lung cancer with solitary metastasis to the brain has been treated by surgical resection of both lesions over a 25-year period. Survival was 55 per cent at 1 year and 31 per cent at 2 years. Mean survival was 2.

Doppler and echocardiographic features of normal and dysfunctioning bioprosthetic valves.

Echocardiographic and Doppler studies were performed on 183 clinically normal and 58 severely dysfunctioning bioprosthetic mitral, aortic and tricuspid valves. The valve dysfunction resulted from spontaneous cusp degeneration in 49 instances and from paravalvular regurgitation in 9. The pulsed Doppler study demonstrated regurgitant flow in 36 (92%) of 39 regurgitant valves and 8 (90%) of 9 paravalvular regurgitant valves.

Mixed venous oxygen saturation as a predictor of cardiac output in the postoperative cardiac surgical patient.

Mixed venous oxygen saturation (SvO2) was measured continuously with a fiberoptic pulmonary artery catheter in 25 patients during the first 24 hours after cardiac surgery and was compared with the thermodilution cardiac index (CI). The mean correlation coefficient between SvO2 and CI was 0.05 +/- 0.

Asynchronous primary valve failure in patients with porcine bioprosthetic aortic and mitral valves.

Seventy-three patients with aortic and mitral porcine bioprosthetic valves (PBV) have been followed for up to 14 1/2 years. In that time, 11 patients have undergone replacement of one or more PBVs for primary tissue failure. Three patients underwent repeat aortic and mitral valve replacement for synchronous PBV failure.