Results after surgical repair of Ebstein's anomaly.

Background: Ebstein's anomaly of the tricuspid valve is a complex malformation. Various operations have been undertaken with varying results. Because valve replacement yielded poor results, surgical treatment has focused on valvuloplasties.

Open mitral commissurotomy. A new plea for an old operation.

From April 1974 through December 1982, 673 patients underwent surgery for isolated mitral valvular disease. Valve replacement was mandatory in 507 patients; of these, 255 received low-profile mechanical (mainly Björk-Shiley) prostheses and 252 bioprostheses. In 166 patients the mitral valve was amenable to reconstructive repair.

[Surgically correctable complications of myocardial infarct].

Coronary artery bypass grafting is a straightforward solution to the problem of myocardial ischemia secondary to coronary artery disease. More recently, the complexities of complications following myocardial infarction have been elucidated with respect to various aspects. Disastrous sequelae, such as rupture of the ventricular septum, the left ventricular wall and the papillary muscle, impose many intricacies on the inevitable surgical treatment; this form of cardiac surgery is still a tour de force.

[Heart transplantation: successful treatment of postoperative complications. Case report with 19 months' follow-up].

In March, 1981, a 37-year old patient underwent cardiac transplantation, the first to be performed in Germany since 1969. Subsequent to the successful procedure, the patient has now been followed for more than 19 months. The indication for the intervention was established on the basis of endstage coronary artery disease.

Fibrin seal application. Clinical experience.

Clinical experience with fibrin gluing in cardiovascular surgery now extends over 4 years. The adhesive has been employed prophylactically for preclotting of prostheses or sealing of various suture lines including those of the bronchial system of infants. Together with collagen fleece it has turned out to be most effective for control of superficial bleeding due to adhesions or sources of bleeding difficult to reach.

Results of valvuloplasty for Ebstein's anomaly.

Sixteen patients, 8 males and 8 females were referred for surgery with the diagnosis of Ebstein's malformation of the tricuspid valve. The intervention was necessary because of deterioration of the clinical status. The age of the patients at the time of surgery ranged from 4 to 51 years.

Surgical treatment of transposition of the great arteries.

Between 1974 and 1979 171 patients with d-TGA were treated surgically, 109 had correcting operations. 77 patients with simple TGA had hemodynamic correction by atrial inversion techniques. 30 day survival rate was 96%.

[Three years experience with biological heart valve prostheses (author's transl)].

Increasing clinical experience has led to a world wide expansion of glutaraldehyde fixed aortic heterografts for valve replacement in patients. The distinct advantage of this valve is a very low rate of thrombembolic complications during the postoperative course. In our hospital 324 such prostheses of the types Hancock and Carpentier have been implanted in 290 patients.

[Surgery in newborns and infants with cyanotic cardiac malformations: indication and technique of emergency operations and urgent early surgical interventions (author's transl)].

Between April 1974 and September 1977, 368 infants underwent surgery at the German Heart Center. 287 were less than 1 year of age, and 81 were between the ages of one and two years. In 90 patients (= 24.

[Intraoperative control of revascularisation and indication for reintervention (author's transl)].

Among the procedures of intraoperative control of revascularisation the simple method of probe passage for determination of technical mistakes during anastomoses is very valuable. More informative is the measurement of bypass-flow using an electromagnetic flowmeter. We compared this method with the results of intraoperative angiography, which is performed in our hospital routinely for immediate control of revascularisation.

[Open-heart surgery during deep hypothermia in infancy].

A total of 47 infants (2,7 to 9,6 kg in weight, 3 days to 21 months of age, 89% under one year) underwent early total correction of severe congenital heart defects in profound hypothermia of about 22degreesC and circulatory arrest (11 to 64 minutes). 8 patients were operated upon without extracorporeal circulation (ECC) (mortality 63%). 37 infants were additionally cooled and rewarmed with ECC (mortality 22%).

[Instantaneous blood flow velocity profiles before and after aortic valve replacement (author's transl)].

In 17 patients the instantaneous velocity profile was recorded before and after aortic valve replacement (Starr-Edwards, Björk-Shiley, Lillehei-Kaster). A single gated pulsed Doppler Ultrasonic flownmeter was used for analysis. Distal of these valves a flat flow profile was recorded showing high velocity gradients near the walls.