Early Postoperative Evaluation Research Articles

Color Doppler imaging of modified Blalock-Taussig shunts during infancy

To assess the role of color Doppler echocardiography in the early postoperative evaluation of patients with a Blalock-Taussig shunt we examined 13 consecutive infants who underwent insertion of either a modified right (6 patients) or a modified left (7 patients) Blalock-Taussig shunt (age range 7 days to 6 months, mean age 8 weeks). Examination of the patients in a high parasternal right or left long axis was able to determine patency of the shunt in 12 patients. In the remaining patient, who did not show flow in the shunt, complete occlusion of the shunt was confirmed by angiography. From subcostal views we were able to demonstrate patency of the shunt in 75% of the infants and in all patients younger than 4 weeks of age. In our experience color Doppler echocardiography is a highly reliable method for early postoperative evaluation of infants with a Blalock-Taussig shunt.

Early postoperative angiographic findings after carotid endarterectomy.

This report reviews the early postoperative evaluation of 70 patients who underwent carotid bifurcation endarterectomy within our department (before patients' releasing). Angiography was performed by femoral catheterization or the retrograde brachial route; three times only digital venous techniques were employed. No complications due to radiological procedures occurred. Postoperative angiographic findings include asymptomatic occlusion of ICA, occlusion of ECA, the presence of mural thrombi, diffuse surface roughness, intimal flaps and kink of ICA. Dilatation of the arteriotomized segment was detected with a high rate of frequency. Postoperative vascular changes are then analyzed in relation to surgical techniques, to early postoperative clinical course and to the occurrence of late re-stenoses.

Resection of Scarred Papillary Muscles Improves Outcome after Surgery for Ventricular Tachycardia

Papillary muscle scarring is encountered frequently during operations for sustained ventricular tachycardia (VT). Indications for excision of the papillary muscle scar and mitral valve replacement (MVR) are controversial. The findings in 46 consecutive patients undergoing operative electrophysiologic map-directed endocardial resections for VT were reviewed. There was papillary muscle scarring in 15 patients (average age: 59 years; sex: 11 male, 4 female; average ejection fraction: 31 +/- 14%). Eleven patients had a VT with the site of origin on a scarred papillary muscle; four had another VT site of origin. Six patients underwent papillary muscle scar resection (5 with MVR); six underwent papillary muscle cryotherapy (-60 C X 2 min); and three had neither papillary muscle resection nor MVR. All six patients with papillary muscle resection +/- MVR are alive and free of arrhythmia after 14.3 +/- 7.6 months of follow-up. Five of six patients treated by papillary muscle cryotherapy alone manifested spontaneous (4 patients) or inducible (1 patient) VT during early postoperative evaluation. Two of the three patients with untreated papillary muscle scarring developed late complications requiring reoperation. One patient developed mitral regurgitation requiring MVR 5 months later. The other developed a previously undocumented VT 2 years after operation. Significant papillary muscle scarring visualized at the time of operation for arrhythmia is an indication for resection of the scar and the papillary muscle, even if this necessitates MVR. In this series, attempts to preserve the papillary muscle, by incomplete resection of the scar or by cryotherapy, resulted in a high failure rate owing to recurrent VT or mitral regurgitation.

Atrial septal defect--echocardiographic assessment before and after surgical repair.

Twenty-two patients with atrial septal defect (ostium secundum type and sinus venosus) were studied by echocardiography before and after surgery. The sizes of the various heart chambers - right and left ventricles, left atrium and aortic root - and the interventricular septum and the left ventricular posterior free wall (motion and thickness) were analysed and compared in the pre and postoperative period. A significant reduction in size of the right ventricle and a normalization of the left ventricular dimension in the early postoperative evaluation was found. The paradoxical motion of the interventricular septum seen in the preoperative period showed an early trend toward normalization. The changes before and after surgery are discussed, particularly for the interventricular septum.

Aortocoronary bypass grafts. Early postoperative angiographic evaluation and reexploration for stenosis or thrombosis of the vein graft.

In a group of 200 patients who underwent aortocoronary bypass grafts at the Montreal Heart Institute, 33 were found to have stenosis or thrombosis of the vein graft in the early postoperative angiographic evaluation.