Surgery For Valvular Heart Disease Research Articles

Rehabilitation and functional status after surgery for valvular heart disease

Rehabilitation and functional status after surgery for valvular heart disease

Changes in whole body venous tone and distribution of blood after open intracardiac surgery

After intracardiac surgery for valvular heart disease, blood volume was lower and right atrial pressure was the same as, or higher than, preoperative values. A value for “venous blood volume” was derived by subtracting central blood volume (including, in this study, cardiopulmonary blood volume and blood in the aorta and central large arteries) from total blood volume. “Venous blood volume” was decreased proportionally more than central blood volume after operation.It is concluded that whole body venous tone is increased early after intracardiac operations and that there is some redistribution of blood in favor of the central blood volume.

Selection of patients and results of surgery for acquired valvular disease

Summary The clinical findings and the course of the disease of patients with mitral and with aortic valvular lesions have been described, as well as laboratory methods useful in assessing the severity of the valvular lesions. The indications for surgery for the various valvular lesions have been discussed, together with certain general remarks about cardiac surgery. Extensive experience with closed valvuloplasty in mitral stenosis has been such that the results can be judged by statistically valid criteria, and the factors affecting early and late results can be assessed. Closed mitral valvuloplasty is still the operation of choice in properly selected patients. The experience with open cardiac surgery for valvular heart disease has been too brief, the numbers of operated patients too few and the diversity of operative technics, with and without valve replacement, too great to permit of valid, statistically significant answers as to the immediate and late results of such surgery. Such operations must be considered still in the developmental stage, and palliative, but not curative procedures. The numerous late complications of valve replacement have been discussed. Brief mention has been made of bivalvular and trivalvular surgery.

ASSISTED CIRCULATION FOR CARDIAC FAILURE FOLLOWING INTRACARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

SUMMARY 1. Pour patients with cardiac failure following intracardiac surgery for valvular heart disease were treated with assisted circulation. One was treated with a peripheral veno-arterial bypass, one with a peripheral veno-arterial bypass followed by a left atrial-femoral bypass, and 2 by left atrial-femoral bypass. All were moribund when assisted circulation was used. Three subsequently died, but 1 fully recovered. 2. Severe left ventricular failure was found to be the main indication for assisted circulation. Pulmonary hypertension was not helped. The best guides to the severity of the left ventricular failure were the left atrial pressure and the oxygen saturation of blood in the pulmonary artery, which is a function of cardiac output. When the cardiac output is decreased to where the oxygen saturation of pulmonary artery blood remains below 40 per cent, death usually occurs within a few hours. Assisted circulation should be considered for a patient in whom the left atrial pressure remains elevated and the pulmonary artery oxygen saturation remains less than 40 per cent. 3. A peripheral veno-arterial bypass was not found useful. It increased peripheral blood flow with signs of improved metabolic function of vital organs, such as brain, heart, and kidneys, during perfusion, but left atrial pressure and pulmonary vascular obstruction were not decreased. In 1 patient the pulmonary vascular resistance was greater after bypass than before. 4. Left atrial-femoral bypass was found to be most effective. It not only decompressed the left heart but also avoided the difficulties of prolonged mechanical blood oxygenation. It has the disadvantage of requiring a thoracotomy to cannulate the left atrium. 5. The mechanism of benefit is not completely clear. The increased blood flow obviously improved organ function. It is uncertain whether it resulted in beneficial changes in myocardial oxygen consumption. None of the 4 patients showed any immediate improvement in cardiac function following bypass. The 1 patient who recovered had a low cardiac output for 3 days following assisted circulation before returning to normal levels. Although the mode of improvement is not certain, the assisted circulation was undoubtedly lifesaving for this patient.