Hypothermic circulatory arrest and the management of giant and large cerebral aneurysms.

The surgical adjuncts of hypothermic circulatory arrest, exsanguination, and barbiturate cerebral protection were evaluated in nine cases of cerebral aneurysms felt unapproachable by conventional surgery. These techniques were used in seven posterior circulation aneurysms, two of which were giant and two giant anterior circulation aneurysms originating at the middle cerebral artery bifurcation. Four patients had excellent outcomes, two had a fair result, one had a poor result, and two died.

The utility of a double-lumen tube for one-lung ventilation in a variety of noncardiac thoracic surgical procedures.

To determine the utility of one-lung ventilation (OLV) in a variety of noncardiac thoracic surgical procedures, 200 patients were studied to document the ease of double-lumen tube (DLT) placement, associated complications, intraoperative respiratory changes, and methods for managing hypoxic events. Most tubes could be placed, repositioned when necessary, and secured within 12 minutes. By defining tube position with fiberoptic bronchoscopy, auscultatory assessment of placement was found to be incorrect in 38.

Transthoracic and transesophageal echocardiography in the diagnosis and surgical management of right atrial myxoma.

An asymptomatic patient was discovered to have a large right atrial myxoma by transthoracic echocardiography. Preoperative considerations included the possibility of satellite lesions, left atrial origin, and a question of tricuspid valve involvement. Subsequent operative transesophageal echocardiography demonstrated single-stalk attachment in the right atrial septal wall and no satellite lesions.

Transesophageal echocardiographic features of normal and dysfunctioning bioprosthetic valves.

Transesophageal and transthoracic echocardiography and color flow Doppler were performed in patients with 42 normal and 20 dysfunctioning bioprosthetic mitral and aortic valves. Transesophageal echocardiography was superior to the transthoracic approach in delineating bioprosthetic valve cusps and the presence of valve thickening due to valve degeneration. In 27 clinically normal bioprosthetic mitral valves, regurgitation was demonstrated in three patients by the transthoracic approach and in seven by transesophageal study.