Early and late results of pericardiectomy for constrictive pericarditis.

Records of 231 patients (171 males, 60 females; aged 10 months to 83 years [median 45 years]) who underwent operation for constrictive pericarditis at the Mayo Clinic from 1936 through 1982 were reviewed. All had had hemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. Preoperatively, 69% were in New York Heart Association Class III or IV and 81% had peripheral edema or ascites.

Straddling atrioventricular valve: two-dimensional echocardiographic diagnosis, classification and surgical implications.

The usefulness of subclassifying the anatomic variations of straddling and overriding atrioventricular (AV) valve by 2-dimensional echocardiographic observation were evaluated. Chordae straddling into a contralateral ventricle were subdivided into type A (chordae inserting into the contralateral ventricle near the crest of the ventricular septum), type B (chordae inserting along the contralateral ventricular septum) and type C (chordae inserting into the free wall or papillary muscles of the contralateral ventricle). Overriding AV valve anulus was described as minor (less than 50% of the anulus committed to the contralateral ventricle), major (about 50% of the anulus committed to each ventricle), and double-inlet ventricle (greater than 50% of both AV valves committed to a single ventricular chamber).

Total correction of tetralogy of Fallot at age 40 years and older: long-term follow-up.

Whether total surgical correction of tetralogy of Fallot in adults aged 40 years old or older has acceptable operative risk and gratifying long-term results is unknown. The Mayo Clinic experience (June 1960 to May 1982) with 30 patients 40 to 60 years old (mean 47) who had total surgical correction of tetralogy of Fallot was reviewed. Preoperatively, 4 patients (13%) were in functional class I, 9 (30%) in class II and 17 (57%) in classes III and IV.

Results of the Damus-Stansel-Kaye procedure for transposition of the great arteries and for double-outlet right ventricle with subpulmonary ventricular septal defect.

From 1975 through 1982, the Damus-Stansel-Kaye procedure was performed on 20 patients with complete transposition of the great arteries (TGA) and on 4 with double-outlet right ventricle (DORV) and subpulmonary ventricular septal defect (VSD). The patients ranged from 6 days to 20 years old (median age, 13 months). Associated anomalies included atrial septal defect (24 patients), VSD (14), and others (25).

Surgical repair of univentricular heart (double inlet left ventricle) with obstructed anterior subaortic outlet chamber.

The results of operation in all patients with univentricular heart and an obstructed anterior subaortic outlet chamber who were operated on utilizing extracorporeal circulation at the Mayo Clinic from 1973 through 1983 were reviewed. Ten of the 18 patients died during the immediate postoperative period and there was one late death. Factors significantly related to operative and immediate postoperative mortality were age at operation, cardiothoracic ratio on X-ray examination, degree of ST depression on electrocardiogram and pressure gradient across the outlet foramen at catheterization.

Late results after Starr-Edwards valve replacement in children.

Selection of types of prosthetic heart valves for children remains controversial. The case histories of 50 children surviving valve replacement with Starr-Edwards prostheses between 1963 and 1978 were reviewed to evaluate the long-term performance of mechanical valves. The 31 boys and 19 girls ranged from 6 months to 18 years in age (mean 10.

Surgery for tricuspid regurgitation late after mitral valve replacement.

Tricuspid valve insufficiency may contribute to a poor hemodynamic result after mitral valve replacement. To determine the role of surgical treatment, we have reviewed the records of 32 adult patients who underwent tricuspid valve repair or replacement 4 months to 14 years after mitral valve replacement. Mild tricuspid valve insufficiency at the time of mitral valve replacement was present in 21 patients (66%); 26 patients (81%) had New York Heart Association class IV disability.

Reoperation for obstructed pulmonary ventricle-pulmonary artery conduits. Early and late results.

Obstruction of pulmonary ventricle-pulmonary artery conduits can result from neointimal peel formation or valvular degeneration and calcification. To determine the risks and outcome of reoperation, we reviewed the records of 100 consecutive patients who had replacement of severely stenotic pulmonary ventricle-pulmonary artery conduits. At reoperation, the 70 male and 30 female patients had a mean age of 13.

Functional single ventricle: cardiorespiratory response to exercise.

The cardiorespiratory response to exercise was measured in 27 children with functional single ventricle. All 27 patients had a significant reduction in exercise time, work performed, maximal exercise heart rate, maximal oxygen uptake and systemic arterial blood oxygen saturation. The reduction in exercise performance increased with increasing age of the patients.

Clinical and therapeutic aspects of Haemophilus influenzae pericarditis in pediatric patients.

Two cases of Haemophilus influenzae type B pericarditis are presented which demonstrate the major clinical features and sequelae of this serious illness. These cases are analyzed together with 77 others from the literature to characterize the clinical features, natural history, and optimal therapy. H.

Complete atrioventricular canal associated with tetralogy of Fallot. Morphologic and surgical considerations.

Between 1962 and 1979, 14 patients with complete atrioventricular canal and tetralogy of Fallot underwent repair of both anomalies. The ages of the patients ranged from 1 to 12 years. Six patients had Down's syndrome.

Intracellular calcium transients in human working myocardium as detected with aequorin.

The calcium transients associated with contraction in human working myocardium were recorded by use of the bioluminescent protein, aequorin, a substance that emits light when it combines with calcium ion (Ca++). Small amounts of aequorin were microinjected into superficial cells of human atrial and ventricular muscle obtained from tissue routinely excised and discarded at the time of cardiac surgery. Light output, an index of intracellular Ca++, and isometric tension development were recorded at 37.

Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations.

To study the prevention of occlusion of aortocoronary-artery bypass grafts, we concluded a prospective, randomized, double-blind trial comparing long-term administration of dipyridamole (begun two days before operation) plus aspirin (begun seven hours after operation) with placebo in 407 patients. Results at one month showed a reduction in the rate of graft occlusion in patients receiving dipyridamole and aspirin. At vein-graft angiography performed in 343 patients (84 per cent) 11 to 18 months (median, 12 months) after operation, 11 per cent of 478 vein-graft distal anastomoses were occluded in the treated group, and 25 per cent of 486 were occluded in the placebo group.

Clinical features and long-term natural history of the postpericardiotomy syndrome.

We followed 34 consecutive patients with the postpericardiotomy syndrome for a median of 7 years. In each patient, the syndrome was documented by the occurrence of: (1) a pericardial type of pain or pericardial rub (or both); and (2) fever or an elevated erythrocyte sedimentation rate. The postpericardiotomy syndrome occurred at a median postoperative time of 4 weeks (range, 2 to 52 weeks).

Septal artery revascularization.

Recurrent angina after coronary artery bypass grafting is due to several factors: graft occlusion, progression of disease, and incomplete revascularization. Of these, incomplete revascularization of diseased but graftable secondary branches of the three major coronary arteries is most amendable to primary surgical treatment. Current operative methods permit endarterectomy or direct bypass grafting (or both) of these smaller vessels.

Reoperation on prosthetic heart valves. An analysis of risk factors in 552 patients.

Five hundred fifty-two patients underwent a total of 617 reoperations for repair or replacement of a prosthetic heart valve. Operative mortality for first reoperation (530 patients) was 5.9% for the aortic position and 19.

Enlargement of the aortic root or anulus with autogenous pericardial patch during aortic valve replacement. Long-term follow-up.

Patch enlargement of the aortic root or anulus is a widely accepted technique when restrictive anatomy is encountered during aortic valve replacement. Patches made of prosthetic material have been used almost exclusively, and patches of autogenous pericardium have not received wide acceptance. Although pericardium is advantageous because of its low cost, ready availability, and ease of handling, its long-term durability has not been fully established.

Surgical pathology of obstructed, right-sided, porcine-valved extracardiac conduits.

Thirty-seven specimens were available from 39 children and adolescents with congenital heart disease who have had operations at the Mayo Clinic (Rochester, Minn) to replace obstructed Hancock conduits that had been implanted 17 to 93 months (mean, 62 months). Stenosis affected the porcine valve alone in 17 (46%), the synthetic graft alone in 11 (30%), both the valve and the graft in six (16%), and other sites in three (8%). Valvular stenosis resulted from degenerative changes with secondary thrombosis and calcification, whereas insufficiency resulted from cuspid tears, thrombotic adhesions, and endocarditis.

Results of reoperation for periprosthetic leakage.

Between 1961 and 1978, 6,602 valves were replaced in 5,660 patients. Reoperation for periprosthetic leakage was performed in 105 patients (1.6% of the valves); early mortality was 5.