Factors associated with recurrence of varicose veins after thermal ablation: results of the recurrent veins after thermal ablation study.

Background: The goal of this retrospective cohort study (REVATA) was to determine the site, source, and contributory factors of varicose vein recurrence after radiofrequency (RF) and laser ablation.

Methods: Seven centers enrolled patients into the study over a 1-year period. All patients underwent previous thermal ablation of the great saphenous vein (GSV), small saphenous vein (SSV), or anterior accessory great saphenous vein (AAGSV).

Surgical management of esophageal perforation: role of esophageal conservation in delayed perforation.

Definitive repair of esophageal perforation is considered the preferred treatment for patients presenting early (<24 hours). However, the optimal management of delayed presentation (>24 hours) has not been well defined. This study examined the management of esophageal perforation and compared the outcomes of early versus delayed presentation.

Apico-aortic conduits in children with severe left ventricular outflow tract obstruction.

Background: Infrequently, congenital heart defects are complicated by left ventricular outflow tract obstruction (LVOTO) not amenable to conventional reconstruction. Apico-aortic conduits provide a means of palliating such patients until definitive repair is possible. The purpose of this study was to review a single institution's current experience with apico-aortic conduits.

The use of methylene blue as an extravascular surgical marker impairs vascular responses of human saphenous veins.

Methylene blue is occasionally applied to the adventitia of blood vessels during coronary artery bypass and other vascular procedures to assist in the orientation of the vessel. Inherent in this method is the assumption that extravascular application of methylene blue is innocuous with regard to vascular function. In the first part of this study, the in vitro vascular reactivity of methylene blue-labeled saphenous veins was compared with that of veins that were not marked with methylene blue.

Mechanical assistance for cardiogenic shock following cardiac surgery, myocardial infarction, and cardiac transplantation.

From January, 1982, to October, 1986, 33 patients were treated with either the Pierce-Donachy prosthetic ventricle or the Bio-Medicus ventricular assist device for cardiogenic shock following a cardiac operation, myocardial infarction, or cardiac transplantation. Twenty-five patients required the assistance for postcardiotomy shock and 8, for a variety of conditions including myocardial infarction shock and myocarditis, and as a bridge to cardiac transplantation. Complications were frequent and usually secondary to prolonged cardiopulmonary bypass.

Mechanical assistance for biventricular failure following coronary bypass operation and heart transplantation.

From September 1983 to March 1985, five patients who could not be weaned from extracorporeal circulation or who deteriorated in the recovery room have been treated with biventricular mechanical support using two vortex pumps, standard cannulas and tubing. One patient was supported for six hours following heart transplantation and acute graft failure until another donor heart could be found. Intraaortic balloon pumping was utilized in each patient to augment the circulation and produce pulsatile flow.

A prospective evaluation of the pulsatile assist device.

Conversion of roller pump flow to pulsatile flow by the pulsatile assist device (PAD) is said to result in improved myocardial preservation and a decrease in the incidence of perioperative myocardial infarction. The clinical advantages of the PAD were evaluated in a prospective randomized study of 100 consecutive coronary artery bypass operations. Serial electrocardiograms, creatine phosphokinase isoenzyme studies, and myocardial scans with technetium-labeled pyrophosphate failed to demonstrate any signficiant difference between patients with the PAD and those receiving nonpulsatile flow.

Multiple coronary bypass grafting: current mortality and morbidity.

Although coronary artery bypass surgery has become increasingly popular in recent years, recent critical reports have cast doubt on its efficacy in certain groups of patients. Our report reviews a recent experience with multiple coronary bypass grafting for triple vessel disease. From March 1976 to October 1978, 276 patients received from three to nine coronary bypass grafts.

Celestin tube intubation for advanced esophageal carcinoma.

Nine patients with advanced esophageal carcinoma underwent intubation with Celestin tubes between July 1973 and May 1975. Our indications for intubation were inability to swallow liquids or handle secretions and tracheoesophageal fistula resulting from advanced carcinoma involving the esophagus. Eight patients received adequate palliation; one died of continuing aspiration from a tracheoesophageal fistula.

A comparison between propranolol and hypothermia in preventing ischemic contracture of the left ventricle (stone heart).

Ischemic contracture of the left ventricle ("stone heart") was studied utilizing a previously described stone heart model. Our studies suggest that beta-adrenergic blockade is not quantitatively as important as hypothermia in protecting ischemic myocardium. On the basis of reduced fibrillatory activity and a slight protective effect shown by electron microscopy, it would appear that combining propranolol with hypothermia may be superior to either used singly.

Bronchogenic cysts: problems in diagnosis and management.

Bronchogenic cysts usually are easily recognized and treated. On occasion they can present problems in diagnosis or management. We have experienced four such cases.

Strut fracture in De Bakey valve. Successful reoperation and valve replacement.

Strut fracture in a De Bakey aortic valve is reported. The theoretical disadvantage of a Pyrolite carbon--coated ball and titanium struts is mentioned. Periodic cinefluoroscopy is recommended in all patients with a De Bakey aortic valve to avoid the complications associated with strut wear or fracture.

A simple and effective left ventricular vent tube.

We have devised a simple, cheap, left ventricular vent that is relatively free from malfunction. It has further use in that it serves as a means of cooling the endocardium when hypothermic techniques are utilized.

Pulmonary sequestration. A broad spectrum of bronchopulmonary foregut abnormalities.

We believe the broad clinical, embryological, and radiological spectrum of pulmonary sequestration has not been adequately emphasized. In order to gain clearer understanding of these foregut abnormalities, all cases from the files of three Army Medical Centers were reviewed. Thirty-two patients, the largest single series in the literature, met the criteria for a diagnosis of bronchopulmonary sequestration.

Saccular aneurysm of ascending aorta caused by granulomatous aortitis in a child.

This report describes a 7-year-old boy who underwent successful surgical excision of a saccular aneurysm of the ascending aorta caused by giant cell aortitis. The aneurysm was removed by lateral aortorrhaphy without cardiopulmonary bypass. The clinical manifestations and appropriate surgical therapy of granulomatous aortitis in childhood are discussed.