The St. Jude medical valve: early clinical results in 253 patients.

The St. Jude Medical cardiac valve is a low-profile, bileaflet, central-flow prosthesis made entirely of pyrolytic carbon. A total of 261 St.

Resection of the aortic arch with moderate hypothermia and temporary circulatory arrest.

Resection of the aortic arch with the use of moderate hypothermia and temporary circulatory arrest was performed in a 63-year-old woman. The simplified technique is described, along with a brief review of the literature. The patient recovered uneventfully.

Improved cardiac function following left ventricular aneurysm resection: pre- and postoperative performance studies in 150 patients.

One hundred fifty patients underwent radionuclide left ventricular performance studies before and one week after resection of a left ventricular aneurysm. The patients were classified according to pre-and postoperative ejection fraction into five classes as follows: Class I > 50%, Class II = 41%-50%, Class III = 31%-40%, Class IV = 21%-30%, and Class V = < 21%. They were also classified into groups according to the size of the aneurysm and wall thickness.

Atrial pacing via the subxyphoid approach.

A new method is described whereby atrial epicardial pacing is accomplished with a newly designed lead and a modification of the standard subxyphoid approach. This technique has not been previously reported.

Acute limb ischemia from sudden thrombosis of an abdominal aortic aneurysm: a case report.

Thrombosis of a previously undiagnosed aneurysm of the abdominal aorta in a 64-year-old woman resulted in acute and severe ischemia in both legs. Prompt surgical resection of the aneurysm and restoration of aortic continuity with a fabric graft brought about complete resolution of her symptoms, with excellent functional results one year after the operation.

Early degeneration of porcine xenograft valves in pediatric patients who have undergone apico-aortic bypass.

The glutaraldehyde-preserved stented porcine xenograft valve has been durable in adult patients with a low incidence of valve-related complications. In children, however, early degeneration and calcification of this valve is now being reported. The etiology of the early degeneration is still unclear but may be related to calcium metabolism, tissue fatigue, and host rejection.

Clinical experience in 1040 patients with double-velour knitted Dacron vascular prostheses: With particular reference to dilatation and aneurysm formation.

Recent reports of dilatation and aneurysm formation in Dacron fabric grafts have prompted us to review our experience with 1040 patients who received Meadox-Cooley double-velour knitted grafts over a 47-month period. Bifurcation grafts were used in 398 patients with aorto-femoral occlusive disease and in 203 patients with aortoiliac occlusive disease. Straight tube grafts were implanted in 310 patients with abdominal aortic aneurysms.

Left ventricular aneurysm: Twenty-year surgical experience with 1572 patients at the Texas Heart Institute.

From January 1958 through December 1979, 1572 patients underwent surgery for left ventricular aneurysm (LVA) in our institution. The series included 1365 men and 207 women, with a ratio of 6.5:1.

A method of intraoperative right ventricular assistance following the Fontan procedure for tricuspid atresia.

A method of temporary intraoperative right ventricular assistance following the Fontan procedure is described in this case report. The multiple etiologic factors and avenues of treatment for postoperative right ventricular failure are discussed.

Variations in coronary artery anatomy: Normal versus abnormal.

We offer a comprehensive classification of coronary artery anomalies, together with angiographic examples of each entity. Minimal requirements for normality include the following criteria: (1) the dual aortic origin is from right and left coronary ostia; (2) the course of the right coronary artery follows the right atrioventricular groove; (3) the course of the left coronary artery follows the left atrioventricular groove and anterior interventricular groove; (4) the posterior descending branch originates from either the right or left coronary artery; (5) the major coronary branches flow epicardially; and (6) the coronary arteries terminate at the myocardial capillary level. This conception of "normal" coronary arteries has determined the classification of abnormalities presented here.

Transascending aortic intraaortic balloon insertion with delayed sternal closure: A retrospective analysis.

Intraaortic balloon pumping (IABP) is an established therapeutic adjunct in the treatment of postcardiotomy/infarction low cardiac output states. Although the common femoral or iliac arteries are the preferred sites for balloon insertion, severe arterial occlusive disease may preclude entry by these methods. To circumvent this problem, alternative methods of insertion utilizing transthoracic approaches have evolved.

Use of a composite Biomer-butyl rubber/Biomer material to prevent transdiaphragmatic water permeation during long-term, electrically-actuated left ventricular assist device (LVAD) pumping.

The pumping diaphragm of the Texas Heart Institute (THI) E-Type ALVAD must perform the dual functions of providing a flexible blood interface and isolating the electrical actuator from adjacent fluids. Thus, protection is required against fluid leakage and moisture diffusion to prevent corrosion and damage to electrical actuator components. Average diffusion rates up to 1 ml per day through currently used elastomeric diaphragm materials have been measured during static in-vitro and in-vivo tests.

Combined replacement of the ascending aorta and the aortic valve in 42 consecutive patients: A comparison of composite graft techniques and conventional techniques over one year.

During 1978, 42 consecutive patients underwent simultaneous aortic valve and ascending aorta replacement in our institution. Seventy-one percent were at low risk despite a high incidence of dissection. Twenty-nine percent were high-risk patients requiring repeat or concomitant cardiac procedures, mostly on an emergency basis.

Treatment of aortic insufficiency with a descending aortic valvular homograft: 19-year follow-up and historical perspective.

This case report and 19-year follow-up concerns a patient with aortic insufficiency who was one of the first to undergo surgical treatment with a descending aortic valvular homograft. The historical perspective afforded here may stimulate ideas concerning advances in future methods and materials to be used in cardiac surgery.

Cervical aortic arch with mediocystic necrosis.

The case of a 21-year-old woman with symptomatic cervical aortic arch is discussed. Rapid enlargement of an aneurysm at the level of the abnormal arch caused symptoms that prompted the patient to undergo angiographic diagnosis and surgical repair. Histologic examination of the aneurysm revealed mediocystic necrosis, which contributed to the malignant course of the congenital disease.

Ionescu-Shiley pericardial xenograft valve: Hemodynamic evaluation and early clinical follow-up of 326 patients.

Dissatisfaction with the hemodynamic characteristics of available porcine valves prompted a clinical trial of the Ionescu-Shiley percardial xenograft (ISPX) valve. Three hundred fifty-six ISPX valves were implanted consecutively in 326 patients. Operative mortality was 2.

Iatrogenic ascending aortic dissection following cannulation for arterial return and for infusion of cardioplegic solution: Prevention and repair.

Two patients are presented in whom dissection of the ascending aorta resulted from cannulation for arterial return and from the infusion of cardioplegic solution. The dissections were recognized promptly. Following dissection in the first patient, the femoral artery was used to reestablish systemic perfusion.

Late ventricular fibrillation following successful resuscitation from postinfarction cardiogenic shock with intraaortic balloon pumping.

Early ventricular fibrillation occurs in approximately 5% of patients admitted for acute myocardial infarction. Although late ventricular fibrillation (> 48 hours postinfarction) may occur in stable patients, it occurs more commonly when severe left ventricular power failure is present. We have encountered late ventricular fibrillation in three of 42 (7%) patients treated with intraaortic balloon pumping (IABP) for profound cardiogenic shock secondary to myocardial infarction.

SUCCESSFUL CLOSURE OF POST-TRAUMATIC CAROTID-JUGULAR ARTERIOVENOUS FISTULA COMPLICATED BY CONGESTIVE HEART FAILURE AND CEREBROVASCULAR INSUFFICIENCY.

This report describes a patient who received a traumatic injury of the neck 28 years prior to admission to this institution. He had required multiple hospitalizations, along with medications for congestive heart failure. After ligation of a large arteriovenous fistula and replacement of a 3 cm segment of the left common carotid artery with an 8 mm double-velour graft, the patient was greatly improved.

POST-TRAUMATIC APICAL LEFT VENTRICULAR ANEURYSM IN A PATIENT WITH LEFT VENTRICULAR APICAL-ABDOMINAL AORTIC CONDUIT: CASE PRESENTATION.

A patient with a small aortic annulus had an apico-aortic conduit implanted for aortic stenosis approximately three years before being admitted to our institution. Four months after sustaining a steering wheel injury to the chest, he developed chest pain and palpitations. X-ray films and left ventriculograms revealed a large apical aneurysm of unknown duration.