Methemoglobinemia diagnosed as a consequence of cardiopulmonary bypass.

Clinically significant methemoglobinemia is rare and difficult to diagnose when other causes of cyanosis are likely. We report a patient in whom unstable angina pectoris and chronic obstructive pulmonary disease were assumed to be responsible for preoperative cyanosis. The use of cardiopulmonary bypass for aortocoronary grafting enabled the clinical diagnosis of methemoglobinemia to be made.

Aortocoronary vein graft spasm: case report with brief review.

Some reports of coronary bypass spasm recently published in the literature aroused skepticism and discussions. Our own doubts were shared by many who have been doing coronary bypass angiography without ever finding such spasms. However, we report a case of a 45-year-old woman with spasm of a vein graft inadvertently induced by catheter manipulation.

Cardiac surgery in children of Jehovah's Witnesses.

A retrospective study was done of 73 consecutive Jehovah's Witness children less than 2 years of age who were operated on for lesions of the heart and major vessels. The series was divided into three groups: (1) neonates less than 31 days old, (2) children between 31 days and 2 years, and (3) children requiring cardiopulmonary bypass. The overall mortality rate for the series was 12.

False iliac aneurysms.

Of 2,389 aortoiliac, femoral bypasses performed from 1971 to 1983 at our institution, 182 pseudoaneurysms were observed; of these, only 17 were false anastomotic iliac aneurysms (9.4%) among 13 patients. The mode of presentation varied from pain or swelling in the lower quadrant of the abdomen, or a combination of both, to acute rupture of the false aneurysm in the abdomen.

Laser coronary endarterectomy: proposed treatment for diffuse coronary atherosclerosis.

A new surgical technique with a hand-held laser is proposed as an adjunct for coronary revascularization. High intensity light energy from a carbon dioxide laser may be used to cut atherosclerotic plaques, to relieve coronary stenosis, and to reopen totally occluded arteries. The recent development of a small, portable CO(2) laser provides a practical surgical tool for treatment of diffuse coronary atherosclerosis.

Interrupted aortic arch: brief review and summary of an eighteen-year experience.

Interrupted aortic arch (IAA) is an uncommon congenital anomaly representing approximately 1% of congenital heart disease. More than 97% of the cases also have associated cardiac anomalies complicating their treatment. Because the median age at death in untreated cases is 10 days, this condition usually occurs as a complicated neonatal surgical emergency.

Rupture of the thoracic aorta: emergency treatment and management of chronic aneurysms.

Between 1957 and 1983, 58 patients were treated in our institution for traumatic rupture of the thoracic aorta. Seven patients had acute ruptures and 51 had traumatic aneurysms. Surgical correction of the lesion was obtained by means of left femoral artery bypass in 17 patients, femoral artery-femoral vein bypass in five patients, and external shunt in three patients.

Cardiac transplantation: current results at the Texas heart institute.

The first series of cardiac transplants at the Texas Heart Institute began in May of 1968 but was discontinued because of the complications of infection and rejection. A second series of cardiac transplants was initiated in July of 1982 after the introduction of the immunosuppressant drug, cyclosporine. By August of 1984, 30 patients had undergone orthotopic cardiac transplantation for end-stage cardiac disease.

Transverse sternotomy for concomitant cardiac and pulmonary surgery.

We describe a simplified surgical procedure whereby pulmonary or other intrathoracic operations can be safely and easily performed in conjunction with cardiopulmonary bypass for indicated cardiac procedures. Transsternal bilateral anterior thoracotomy can provide excellent exposure in cases requiring concomitant attention to cardiac and pulmonary pathology.

Supraceliac aorta-to-femoral artery bypass: definitive treatment for failed axillary femoral bypass.

A new operation is described for the definitive treatment of acutely occluded axillary femoral bypass grafts in patients who have previously had an infected aortofemoral prosthesis removed. An aortofemoral or aortopopliteal artery bypass is constructed by using the supraceliac aorta for the proximal anastomosis and avoiding the infrarenal retroperitoneal area. The disadvantages of other extra-anatomic bypasses are thus corrected and long-term patency enhanced.

Coronary artery revascularization without cardiopulmonary bypass.

At the Texas Heart Institute between October 1969 and August 1983, there were 191 single bypass procedures performed without pump oxygenator support. These cases have been divided into two groups: Group I (160 patients) represents the time period from October 1969 through December 1981 and includes our experience with single vessel left anterior descending (LAD) coronary artery bypass without pump oxygenator support; Group II (31 patients) represents the period between January 1982 and August 1983 and includes our initial operative experience in patients with failed percutaneous transluminal coronary angioplasty (PTCA). Of 145 primary operations in Group I patients, 113 were single bypasses to the right coronary artery with a postoperative infarction rate of 3.

Evolution of the Texas Heart Institute Distant Organ Procurement Program.

Between August and December 1983, the Texas Heart Institute Transplantation Service performed 10 cardiac transplants. All hearts were removed at outside hospitals and transported to the Heart Institute. Adequate return of cardiac function occurred in all groups after ischemic times of 58.

Infection after cardiac transplantation: treatment and prognosis.

Since July 1982, 18 patients have undergone orthotopic cardiac transplantation at the Texas Heart Institute with steroid and cyclosporine immunosuppression. There have been no deaths from infection despite 15 bacterial, 8 viral, 6 fungal and 1 protozoal infection episodes. With a total follow-up of 90 patient months (mean follow-up, 5.

Aortic and mitral valve replacement through a single transverse aortotomy: a useful approach in difficult mitral valve exposure.

Replacement of the mitral valve through a standard vertical left atriotomy in patients requiring both aortic and mitral valve replacement can be very difficult. This is especially true in patients who have undergone previous median sternotomy. Replacement of the mitral valve through the aortic root after excision of the aortic valve is described in two case reports.

Streptokinase thrombolysis in acute myocardial infarction: a turning point.

The initial anatomic findings of angiography during acute myocardial infarction, as well as the techniques used for selective coronary streptokinase infusion, are presented in this report. Preliminary evaluation of streptokinase infusion studies seems to indicate that revascularization of coronary arteries occluded during myocardial infarction is quickly and easily achievable and could constitute the treatment of choice; however, critical questions still remain to be answered. Recanalization rates vary from 75 to 90% in the different, usually small, series.

Surgical considerations in aortitis. Part III: Syphilitic and other forms of aortitis.

The majority of cases involving clinically significant aortitis result from Takayasu's disease, syphilis, and mycotic aneurysms, although aortitis may occur as a part of the clinical manifestation in other diseases of known and unknown etiology. Syphilitic aortitis can be treated successfully if an accurate diagnosis is made early and if appropriate antibiotic therapy is instituted. Untreated or treated inadequately, late cardiovascular complications can occur, namely, aortic aneurysm, aortic valvular insufficiency and coronary osteal stenosis.

Surgical considerations in aortitis. Part II: Mycotic aneurysms.

Mycotic aneurysms were first described as the result of nonsyphilitic bacterial infection of the arterial wall. They were often caused by septic emboli from bacterial endocarditis and were much more common prior to the era of antibiotics. Although the aorta is most often affected, such aneurysms may arise in any artery.

Femorofemoral bypass: prognostic factors.

During a 17-year period, femorofemoral bypass grafting was performed on 85 patients as the primary operation for unilateral iliac artery disease. Of these patients, 53 (62%) were operated on for claudication and 32 (38%) for limb salvage. There were two operative deaths (2.

Surgical considerations in aortitis with special emphasis on Takayasu's arteritis.

Aortitis may result in an injury to the aorta or its branches. The inflammatory process that occurs in response to the injury may ultimately result in stenosis or occlusion from fibrosis and dilatation or aneurysm formation from destruction and weakening of the arterial wall. As a result of antibiotics, some diseases known to cause arteritis have declined over the years (most notably syphilis and rheumatic fever).

Recurrent malignant pleural mesothelioma: case report.

A 42-year-old woman with malignant pleural mesothelioma was admitted initially to the Texas Heart Institute in 1967 for removal of a chest wall tumor. She subsequently underwent 17 additional thoracotomies for removal of recurrent localized tumor during a 15-year period. She died in 1982 at age 56 from cardiopulmonary failure secondary to extensive recurrent mesothelioma.

The surgical treatment of aortopulmonary window.

From 1956 through July 1981, 15 patients, ranging in age from 9 days to 20 years, underwent surgical correction of aortopulmonary (AP) window. Surface hypothermia and venous inflow occlusion were used in the first patient. In four patients, the technique for closure of AP window was similar to that for patent ductus arteriosus: in one, the AP window was ligated; and in three, clamping, division and suture were performed.