Inherent dangers of simultaneous application of microfibrillar collagen hemostat and blood-saving devices.

Microfibrillar collagen hemostat is a topically applicable hemostatic agent that has been introduced relatively recently. Because of the possibility that this substance may pass through different blood-collecting circuits and cause organ damage if reintroduced into the patient's circulation, we performed a series of in vitro and in vivo experiments. The results of these experiments suggest that such a passage may indeed occur and could cause organ damage, either by direct or by induced embolization that cannot be completely prevented even with the application of commercially used filters.

Long-range observations following two-stage occlusion of the descending thoracic aorta for type III dissection.

Clinical and angiographic observations have been presented in a patient with subacute dissecting aneurysms of the descending thoracic aorta (Type III) who underwent a two-stage operation. The first stage consisted of insertion of an ascending to lower abdominal aorta bypass graft through a midline incision, the second stage of exclusion of the dissected segment through a separate left thoracotomy a week later. The patient remained asymptomatic through the two years' observation period.

Prevention of cholesterol embolism (trash foot) during aorto-iliac reconstruction using a blood filtering device.

It is considered good surgical practice to cleanse the aorta and the vascular prosthesis of debris in aorto-iliac reconstruction by a "downward flush" through the unanastomosed end of the prosthesis, thus prevent the development "trash foot" caused by distal embolization. A method is presented which by applying a filtering device allows the flushed blood to enter the distal arterial tree instead of being discarded, thus allowing the prolongation of the maneuver and the increase of its effectiveness.

Acute methemoglobinemia during cardiopulmonary bypass caused by intravenous nitroglycerin infusion.

The case of a patient is presented who was undergoing coronary bypass grafting and who, during cardiopulmonary bypass, became severely cyanotic because of methemoglobinemia after intravenous infusion of nitroglycerin. His condition responded promptly and favorably to the withdrawal of the offending agent and to administration of methylene blue.

Patency rate of bifurcated aortic grafts: comparative analysis of woven versus knitted prostheses in the same patient.

To investigate the difference in patency rate between woven and knitted aortofemoral or aortoiliac prosthetic grafts, a special vascular prosthesis was manufactured with one limb of the graft knitted and the other, woven. The prosthesis was implanted in 143 consecutive patients with occlusive aortoiliac arteriosclerotic disease or aneurysms. Detailed statistical analysis failed to reveal any difference in the patency rate between the woven and knitted limbs of the grafts during an observation period ranging from one month to two years.

An autoperfused heart-lung-preparation: metabolism and function.

The number of heart transplantations performed in the United States is increasing, and better preservation techniques are needed for distant transport and improved organ viability. Earlier experiments demonstrated that the autoperfused heart-lung preparation maintains adequate function for six to seven hours without exogenous substrates or medications. The present study evaluated the metabolic alterations at normothermia in an autoperfused heart-lung preparation and if its longevity can be extended by satisfying metabolic requirements.

A simple test to determine the efficiency of mammary artery grafts during operation.

A simple test is presented to measure the efficiency of mammary artery-left anterior descending coronary artery anastomosis. While the aorta is still cross-clamped and a pronounced temperature gradient exists between the warm patient and the hypothermic heart, a thermoprobe is inserted into the apex of the heart and the flow through the mammary artery pedicle is released. Rapid warming of the cardiac apex indicates good function of the anastomosis.

Administration of hypothermic cardioplegia in the presence of aortic regurgitation.

Two technical maneuvers are presented to make the administration of cardioplegia feasible in the presence of moderate aortic valve incompetence. In the first maneuver, the cardioplegic solution is administered through a double-lumen balloon catheter inserted retrograde through the aortic wall and the aortic valve into the left ventricle; the inflated balloon obstructs the aortic orifice while the solution is injected through the proximal hole. In the second, after proximal anastomoses of the saphenous vein grafts are performed, the portion of the aorta from which the vein grafts rise is excluded by double cross-clamping and the cardioplegic solution is injected into this excluded segment.

Transthoracic approach to the left subclavian and vertebral arteries.

The method of simultaneous transthoracic repair of stenosis of the left subclavian artery and stricture of the origin of the left vertebral artery is presented.

Compression of the true lumen by retrograde perfusion during repair of aortic dissection.

The anatomic situation is described in which during repair of DeBakey Type I dissecting aneurysms blood flow may be directed into the false lumen by a large intimal flap at the distal reentry site in spite of seemingly properly placed femoral arterial perfusion cannula. An illustrative clinical case is presented and measures are recommended by which this serious complication may be recognized in time and be properly corrected before irreversible changes occur.

The value of thermography in the early diagnosis of postoperative sternal wound infections.

Peristernal skin temperatures were recorded postoperatively by infrared thermography in 150 patients. Persistent elevation of peristernal skin temperature during the 3rd and 4th post-operative week was found in 5 patients, all of whom developed sternal wound infection. A further group of 18 patients, all suspected to have occult wound infection, showed persistent temperature elevation in 7 patients, 6 of these patients were proven later to have manifest infection and needed treatment.

Dye-enhanced fluoroscopy-directed catheter embolectomy.

A method is presented that uses a double-lumen balloon catheter to perform embolectomy under contrast-enhanced fluoroscopy control. The technique has the advantage of localization of the thrombi before removal; it permits the individual arterial branches to be entered during embolectomy and allows confirmation of the patency of the arterial tree after completion of the embolectomy.

Massive chest trauma due to impalement.

It is concluded in cases of thoracic impalement after arrival to the hospital the chances of survival are high because the probability is dominant that organ injury is most probably limited to severe contusion of the lung and that the cardiovascular system is largely spared by the penetrating object. The case histories of two patients surviving massive thoracic impalement are presented. Factors influencing initial survival and principles of surgical management are discussed.

The control of bleeding after cardiopulmonary bypass by the intrapericardial instillation of fresh frozen plasma and platelets with microfibrillar collagen.

A technique of, and the results obtained with, the intraoperative and postoperative intrapericardial instillation of microfibrillar collagen and fresh frozen plasma and platelet mixture are presented. Intraoperatively, the mixture was instilled into the exposed mediastinum in the course of open-heart operations in 31 patients in whom diffuse oozing of blood persisted following the termination of cardiopulmonary bypass and the neutralization of circulating heparin. Immediate clot formation and decrease of blood loss were observed in all instances.

Ascending-distal abdominal aorta bypass for treatment of hypoplastic aortic arch and atypical coarctation in the adult.

Repair of aortic coarctation is usually an easy operation. However, it can be very difficult under certain circumstances. These include operating on an adult or operating when specific anatomical variations, such as hypoplasia of the transverse aortic arch or calcification of the coarctation area, are present.

Diffuse dilatation of autogenous saphenous vein grafts used to replace the renal and superior mesenteric arteries. A case report.

Of the many different materials used to replace diseased arteries, autogenous saphenous vein grafts are among the most favored. This view is also explicitly expressed regarding patients who suffer from occlusive arterial disease of the abdominal viscera, particularly the renal vessels. There is, however, recent information which suggests that for reasons unknown saphenous vein grafts in the renal position are likely to be subject to both diffuse and aneurysmatic dilatation, a complication seen only seldom in the femoral and practically never in the coronary position.

Long-term observations on a crimped Dacron aortic bypass graft in the growing child.

Nineteen years of clinical and angiographic observations are presented on a patient with congenital stricture of the upper abdominal aorta who underwent thoracic-to-abdominal aorta bypass grafting using a woven crimped Dacron vascular prosthesis. These observations indicate that if such a prosthesis is properly applied, i.e.

Biochemical termination of sustained fibrillation occurring after artificially induced ischemic arrest.

A method of biochemical termination of persistent ventricular fibrillation is presented. The technique consists of re-cross-clamping the ascending aorta while the patient is still on cardiopulmonary bypass, infusing 37 degrees C buffered potassium cardioplegic solution into the coronary system, and, after having achieved flaccid standstill, pacing the heart by the ventricular mode.

Conservatism in the management of aortic aneurysms.

The authors discuss in general, conservative surgical therapy in the management of thoracic aneurysms and the principle that the purpose of such surgery is to prevent rupture and not "extirpation of a tumor". As an illustrative example, they present a case in which a large thoracoabdominal aneurysm was managed by bypass exclusion and individual grafting of the visceral arteries and-in the same patient-two aneurysms of the ascending aorta and aortic regurgitation caused by dissection were handled by valve suspension, limited resection, and external grafting. They promote the usage of conservative procedures versus radical resection in selected cases of aortic aneurysms as an effective alternate.