Aortic and mitral valve replacement in children or adults with small valvular annulus.

Two methods are described for enlarging the aortic and mitral valvular annuli. The first method is aortoventriculoplasty, the results of which are reported here in 7 patients with small aortic annulus and in 4 cases with stenotic aortic valvular prosthesis inserted previously. The second method is developed for enlargement of the mitral ring to insert larger mitral valvular prosthesis.

Enlargement of mitral valvular ring. New technique for double valve replacement in children or adults with small mitral anulus.

The technical difficulty of inserting a sufficiently large prosthesis in a small mitral ring has been overcome by a new technique based on the principle of complete division of the valvular ring and its unrestricted enlargment by reconstruction of the prosthetic valve. Th technique entails division of the aortic valvular ring into and through the mitral anulus and the left atrial wall. It provides wide exposure for easy double mitral and aortic valve replacement, which is performed with large prosthetic valves that are supported in part by the patch reconstruction of the incised structures.

Simultaneous dopamine and sodium nitroprusside therapy following open heart surgery.

Twenty post-open heart surgery patients with low output syndrome were given dopamine, sodium nitroprusside (SNP) alone and in combination. Dopamine alone (3--4 mcg/Kg/min) caused an increase of cardiac output (CO) from 3.2 to 4.

Aortoventriculoplasty for tunnel subaortic stenosis and other obstructions of the left ventricular outflow tract. Clinical and hemodynamic results.

A new therapeutic concept of enlarging the outflow tracts of both ventricles with a patch and inserting an aortic prosthesis has been developed for the treatment of tunnel subaortic stenosis. This operation has been applied clinically since June 1974 on several types of obstruction in the outflow tract of the left ventricle. Twenty-one operations have been performed on 20 patients under the age of 18 years, with an overall mortality of 24% and no late deaths.

[Fresh autologus blood transfusion during open heart surgery (author's transl)].

Hemodynamic parameters were measured in 80 unselected patients prior to cardiopulmonary bypass for a variety of a operative procedures. Isovolemic blood withdrawel up to 24.7 ml/kg or 10 gms% and 30% hematocrit during sternotomy using ACD blood storage containers was carried out prior to bypass.

[Hemodynamic results of surgery for congenital supravalvular aortic stenoses (author's transl)].

Supravalvular aortic stenosis is either a syndrome combined with typical face characteristics mental retardation and peripheral pulmonary artery stenosis or it occurs as an isolated congenital heart defect. The diagnosis was confirmed in 137 patients by means of catheterization and angiocardiography; 35 pediatric and 10 adult patients were considered to be candidates for corrective surgery because of the severity of their disease. Age varied from 3 to 32 years.

[Haemodynamic effects of acute intra-operative haemodilution in open heart surgery (author's transl)].

Haemodynamic measurements were made in 80 patients who underwent acute haemodilution (up to 40 ml/kg blood withdrawal) before cardiopulmonary bypass. Measurements of cardiac output, pulmonary arterial pressures including wedge pressure were made. Cardiac index, stroke volume and total peripheral resistance were calculated.

[Corrected transposition of the great arteries: surgical treatment of associated cardiac defects (author's transl)].

Corrected transposition of the great arteries is often associated with other cardiac anomalies. We report our experience with the correction of the associated cardiac defects in 13 cases: ventricular septal defect with pulmonary hypertension (5 cases), ventricular septal defect with obstruction of pulmonary outflow tract (5 cases), obstruction of pulmonary outflow tract (2 cases), ostium primum defect (1 case). The possible surgical approaches for repair of the cardiac anomalies are described and the results of the operative correction are communicated.

[Coarctation of the aorta: surgical management in infancy--results in 72 patients (author's transl)].

Early and late results of a total of 72 infants operated for coarctation of the aorta are reported. Operative repair included various methods (End-to-End, Vossschulte, Clagett, Shumaker, Waldhausen, Blalock). Isolated coarctation was present in 6 infants, 17 also had patent ductus arteriosus, 39 patients had additional associated cardiac anomalies, part of which were combined with PDA.

Isolated unilateral absence of the pulmonary artery. Review of the world literature and guidelines for surgical repair.

A 10-month-old boy is presented who had isolated unilateral absence of the right pulmonary artery. He suffered from hemoptysis and severe congestive heart failure. The patient underwent prosthetic anastomosis of the right to the main pulmonary artery.

Results of aortoventriculoplasty in 21 consecutive patients with left ventricular outflow tract obstruction.

Results of aortoventriculoplasty (AVP) are reported in 21 patients with various types of left ventricular outflow tract obstruction (LVOTO). The concept of AVP is based on creating a surgical aortoseptal defect which is patched to provide the largest possible outflow tract to the left ventricle. Lesions consisted of isolated diffuse fibromuscular subaortic stenosis in six patients, diffuse subaortic stenosis and associated other cardiovascular anomalies in five, hypoplastic aortic anulus in two, idiopathic hypertrophic subaortic stenosis (IHSS) in two, and stenosis of a previously implanted aortic valvular prosthesis in three patients.

[A simple method for tricuspid annuloplasty (author's transl)].

A new operative method for tricuspid annuloplasty is reported. In this method the antero-posterior portion of the tricuspid annulus is sutured to a semi-circular nonelastic strip of teflon by double needle sutures. Since the radius of this strip is shorter than the radius of the valve ring, the tricuspid annulus will be narrowed after the sutures are tied.

[Surgical considerations on levo-atrial systemic vein (author's transl)].

The levo-atrial systemic vein is a special type of persistent left superior vena cava and is associated with other intracardiac lesions most often. Hemodynamically there is a right to left shunt. The operative procedure may consist in a ligature in relation to the anatomic situation.

Aortoventriculoplasty: a new technique for the treatment of left ventricular outflow tract obstruction.

Aortoventriculoplasty is a new method of treatment for left ventricular outflow tract obstructions. The concept is based on creating a surgical defect which is patched in such a way as to provide the largest possible outflow to the left ventricle. The incision of the aorta continues down as far as necessary, with the right ventricular wall, the aortic ring, and the septum being cut.

Aorta-circumflex coronary artery bypass through the transverse sinus. A new technique.

Aorta-circumflex coronary artery bypass using a saphenous vein graft may present technical inadequacies with angulation, kinking, compression, tension and finally thrombosis and occlusion of the graft. As these problems are mainly secondary to incorrect length and direction of the vein graft, a new technique is described which allows the placement of a shorter graft in a more parallel direction to the physiologic aortocoronary flow. The transverse sinus of the heart is used as a natural protected channel whereby the graft passes behind the great vessels from the right posterior wall of the aorta to the circumflex coronary artery.

[Interruption of the aortic arch with tetralogy of Fallot. Report of a successful one-stage correction of both anomalies, and review of the literature (author's transl)].

In a ten year old girl, a combination of interruption of the aortic arch (IAA) and tetralogy of Fallot was corrected simultaneously using cardiopulmonary bypass. The interruption was bypassed by implantation of the proximal end of the left subclavian artery into the ascending aorta. The simultaneous correction of both malformations was possible by a left anterolateral transsternal thoracotomy.

[Plastic enlargement of the left ventricular outflow tract. A new operative method (author's transl)].

A new operative technic for widening the stenotic left ventricular outflow ("left ventricular tunnel") is described and a clinical case is reported. A vertical incision along the anterior aspect of the aorta descends with a slight angle across the outflow tract of the right ventricle. After aortic valvectomy the ventricular septum is cut between the left and right coronary commissure through its full thickness and the incision extended inferiorly across the stenotic area.

Palliative treatment of complete transposition of the great vessels: First clinical results of closed atrial septectomy with new septectome.

Our initial method of closed atrial septectomy, used in the palliative therapy of transposition of the great arteries (TGA), failed to produce a technical success in 1 of 5 patients. Subsequently, we modified the technique by securing the septum on traction sutures and simplifying the introduction of the septectome. With the new method, we achieved technical success in all 13 patients so treated.

[Rastelli operation for complete transposition of the great vessels, ventricle septum defect and pulmonary atresis].

We report about a 6 year old patient with complete transpositon of the great arteries, a ventiricle septum defect, and pulmonary atresia, who was operated using Rastellis technique. A Hancock-prothesis of of 20 mm diameter was used for reconstruction of the outflow tract of the right ventricle and anastomosed distal with the pulmonary artery on the left side of the aorta. The proximal anastomosis was performed with the right ventricle after a longitudinal ventriculotomy.