Open Intracardiac Operations Research Articles

The Tetralogy of Fallot: From a Surgical Viewpoint

This excellent monograph is a much needed contribution in the field of cardiovascular surgery. Moreover, it is written by authors who possess impressive qualifications to present this important subject. The introduction provides a concise and yet complete discussion of the historical development of the surgical correction of the tetralogy of Fallot. The first chapter defines the tetralogy in a meaningful and understandable manner, a fact of considerable importance in current cardiovascular surgery. The anatomy of the various types of malformation which can occur is beautifully described and illustrated in appropriate angiocardiograms and specimens. Especial emphasis is placed upon the hemodynamics with tracings of the pressure curves and oximetry records. The clinical features and diagnosis, presented in detail, are most commendable. The major aspect of this monograph is quite properly devoted to both the principles and details of open intracardiac operation for correction of the tetralogy. Both the description and illustrations

Distribution volume, equilibration time, and exponential analysis of 82Br after open intracardiac operations.

Distribution volume, equilibration time, and exponential analysis of 82Br after open intracardiac operations.

Acute alterations of body composition after open intracardiac operations.

The body composition of patients with heart disease is acutely altered by surgical intervention. Interrelations and causes of the alterations have not been clear. Twenty patients were studied preoperatively and again 2 to 4 days after open intracardiac operations. In nine, measurements were made of the volumes of total body water, extracellular water, plasma, and red cells, and of the amounts of total exchangeable sodium and potassium. In an additional four patients total exchangeable sodium and potassium were measured, and in another seven only exchangeable sodium was measured. Calculations were made of the intracellular and extracellular distribution of water and potassium. The significant changes ( P < 0.05) occurring during the interval between studies were increase in extracellular water (7%), interstitial water (12.5%), and exchangeable sodium (9.4%), decrease in total exchangeable potassium (8.5%) and amount (8.7%), and concentration (6.9%) of calculated intracellular potassium. Uptake of sodium and water by the patient during cardiopulmonary bypass and postoperative loss of intracellular potassium with its secondary renal excretion are postulated as being etiologic. These findings imply that sodium intake in the early postoperative period should be low, water intake no more than urinary and insensible losses, and that potassium should be administered.

Surgical intervention in chronic postinfarction cardiac failure.

Seven patients with severe, chronic postmyocardial infarction cardiac failure underwent open intracardiac operation following catheterization and quantitative biplane angiocardiographic studies. Four patients with mitral incompetence had valve replacements; three had dilated mitral rings and did not survive the immediate postoperative period. In contrast, the single surviving patient had papillary muscle dysfunction evident at surgery and had less severe myocardial impairment as indicated preoperatively by a lower end-diastole volume and higher ejection fraction. Three patients demonstrated significant clinical and hemodynamic improvement after resection of a sccared akinetic area of left ventricular myocardium. Although two of the three patients died within the first year of operation, neither died in congestive failure. The results of this study indicate that certain patients with chronic postinfarction heart failure may benefit from surgery.

Effect of intracardiac operations upon congestive heart failure and body composition

Patients with heart disease have under some circumstances marked abnormalities of body composition. These may be the result of many factors, including the tendency to retain sodium and to lose body cell mass when there is chronic reduction of cardiac output. Abnormalities of body composition are increased in the first 24 hours after open intracardiac operation. Patients without a history of chronic congestive heart failure usually recover normal body composition within a few weeks of operation. Patients with a history of chronic congestive heart failure usually require a longer period for resolution of their compositional abnormalities and in a few instances do not resolve them. The circumstances under which this last unfortunate result occurs have not been completely defined.

Late changes in body fluid and blood volume after intracardiac surgery

Summary Various fluid volumes in 23 patients were studied before and 2 weeks after open intracardiac operations. Two patients, studied prior to intensive preoperative medical treatment, had abnormally large volumes of plasma, blood, extracellular fluid, interstitial fluid, and total body water; 1, with chronic congestive heart failure, had an abnormally large erythrocyte mass whereas the other, with acute congestive heart failure, did not. After intensive medical treatment of congestive heart failure, erythrocyte mass remained significantly larger than calculated normal for the group as a whole but other volumes were not. Patients with acquired valvular heart disease or left-to-right shunts without congestive heart failure did not have any abnormally large volumes preoperatively. In patients who had been in congestive failure preoperatively, extracellular and interstitial fluid volumes at 2 weeks after operation were significantly larger than they were preoperatively. Total body water and plasma volumes were not significantly larger than preoperatively, but erythrocyte mass was smaller. In patients who had not been in congestive failure preoperatively, extracellular and interstitial fluid volumes 2 weeks after operation were not significantly different from those found preoperatively. Blood volume was slightly decreased in these patients although the significant reduction was that of erythrocyte mass in patients operated upon for valvular heart disease.

Low cardiac output after open intracardiac operations

Low cardiac output after open intracardiac operations

Postoperative care after whole-body perfusion and open intracardiac operations: use of Mayo-Gibbon pump-oxygenator and Browns-Emmons heat exchanger.

Open intracardiac operations, at the present time, can be done with a low risk and a minimum of complications. When complications do occur, they are related primarily to a reduction in cardiac output. Metabolic acidosis or the presence of complete heart block, although rare, can aggravate these states of low cardiac output. To combat such complications when they occur, accurate postoperative care is important. Maintenance of the patient's blood volume at proper levels, treatment of metabolic acidosis when it occurs, and the judicious use of digitalis are the cornerstones of such therapy. In general, every effort should be made to prevent complications by improving the quality and conduct of the operation itself.

Hypothermia for open heart surgery ∗

1. (1) For open intracardiac operations to repair atrial septal defects under hypothermia the patient's body temperature has been lowered by surface cooling to approximately 29 °C (84.5 ° F). Sixty-five patients with atrial septal defects have been operated upon by the technic described and five minutes of cardiac inflow occlusion has been sufficient to repair most of the defects. 2. (2) Hypothermia also provides an effective method for operating on a few other intracardiac defects such as isolated pulmonary stenosis and aortic stenosis under direct vision. 3. (3) Some of the advantages and disadvantages of hypothermia are discussed.

The electro-encephalogram in patients undergoing open intracardiac operations with the aid of extracorporeal circulation

The electro-encephalogram in patients undergoing open intracardiac operations with the aid of extracorporeal circulation