Instantaneous left ventricular dynamics were measured from cineradiographs utilizing implanted tantalum coils as myocardial site markers in the orthotopically transplanted canine heart. Four parameters of myocardial synergy were obtained: mean shortening, anisotropy of contraction, mean time to half shortening, and asynchrony of contraction. Estimates of end diastolic volume, end systolic volume, stroke volume, ejection fraction, and cardiac output were obtained. Heart rate was altered by pacing the left atrium of the donor heart. Of the nine parameters, only cardiac output was significantly changed by alterations in heart rate. The invariance of stroke volume with rate resulted in a proportional increase in cardiac output with cardioacceleration.
The pathophysiological basis of the increase in pulmonary vascular resistance associated to lung transplantation has not been indisputably clarified. The purpose of the present work was to study the effect of lung transplantation on the pulmonary circulation at the ar-teriolar level. Autotransplantation of the left lung was performed on 9 mongrel dogs. Pulmonary arteriolar pulsation was measured by cinédensitography before and after autotransplantation. The aortic, pulmonary arterial and venous and left atrial pressures, as well as ECG, were recorded simultaneously. A comparison was made between the simultaneous arteriolar pulsation curves of the transplanted left and intact right lungs. The operation produced a fall in the aortic and pulmonary arterial pressures and an increase in the pulse rate due to blood loss during the operation, but no notable pressure gradients in pulmonary arterial or venous anastomoses. The autotransplantation caused a slight, but not significant, decrease in the arteriolar pulsation of the transplanted lung as compared with the intact contra-lateral lung. It was, therefore, concluded that the increase in pulmonary vascular resistance observed in earlier investigations could not be explained on the basis of an impaired distensibility of the pulmonary arterioles.
AbstractA rare case of a male pterygium colli syndrome associated with an extralobar pulmonary sequestration is reported. The patient had webbed neck, low-set ears, low-set hair line, aplasia of the left kidney and hypoplastic mesenterial vessels referring to Turner's syndrome, but a normal XY sex chromosome constitution. The pulmonary sequestration was resected and the patient made an uneventful recovery.
This report describes a series of 20 patients operated on for a primary cardiac tumour. The majority of the tumours (16) were benign myxomas; 12 of them were located in the left atrium, two in the right atrium and two were biatrial. Two lipomas were found; one was epicardial and the other was located in the left atrium. The only intraventricular tumour was a malignant left ventricular myosarcoma. The propensity of intracardiac tumours to embolize was distinctive. Nine of the 16 myxomas presented with peripheral embolization, and in two patients surgery was complicated by fatal perioperative cerebral embolization of myxomatous tissue. Furthermore, in one patient embolization of a left atrial lipoma necessitated amputation of her left arm before cardiac surgery. Late postoperative recurrences were found in two patients with atrial myxomas. In one of them, reoperation showed that the tumour had grown at that site in the interatrial septum where the original pedicle had been excised. One patient developed severe mitral valve regurgitation and underwent replacement with a prosthetic valve at reoperation. Otherwise our late follow-up study showed that the results of surgery were usually excellent even though mild echocardiographic abnormalities were not uncommon. Our experience emphasizes the embolic potential of intracardiac myxomas and suggests, furthermore, that to avoid recurrences excisions with wide margins should be preferred. Echocardiography is an optimal method for the follow-up of these patients.
Fifty consecutive coronary artery bypass grafting (Group I) and 50 single valve replacement (Group II) procedures were compared with 50 coronary artery bypass grafting with valve replacement (Group III) procedures and 50 multi-valve procedures (Group IV) to determine the frequency of neurological complications after cardiopulmonary bypass (CPB). The possible risks and aetiological implications were studied. The overall surgical mortality rate was 7.5%, being 0%, 4%, 6% and 20%, respectively for the different groups. The neurological event was not the primary cause of death in any of the patients. After CPB, neurological manifestations occurred in 4% of the patients in Gr. I, in 6% in Gr. II, in 4% in Gr. III, and in 8% in Gr. IV. Three patients had peripheral nerve paresis. The age of the patients and the duration of the CPB operation were not factors in the risk of neurological complications. Previous neurological events seemed to increase the frequency of postoperative neurological disorders, whereas combined procedures were no more dangerous in this respect.
A current problem after single lung transplantation is the evaluation of graft function during various pathologic conditions of the transplanted lung. In 10 single lung recipients, of which six had a parenchymal lung disease, and four pulmonary hypertension, relative perfusion of the transplanted lung (Qtx) was determined with multidetector 133-Xe radiospirometry. The determinations were performed seven times during acute rejection, nine times during infection, and four times during simultaneous rejection and infection. In the patients with a follow-up period over 5 months, the effect of bronchiolitis obliterans syndrome on perfusion was assessed as well. Statistically significant decrease in the Qtx was observed during acute rejection, whereas the perfusion change during infection was not significant. The Qtx tended to decrease during long-term follow-up, and the decrease was more prominent in the patients who developed bronchiolitis obliterans syndrome. The assessment of the Qtx with radiospirometry distinguishes acute rejection from infection and can be used for differential diagnostic aid after single lung transplantation.
Fourteen patients suffering from abdominal angina have been operated on with different revascularization techniques. Preoperatively all of them had classical symptoms: postprandial pain and all except two had remarkable weight loss. There were six patients with isolated coeliac axis stenosis and in eight cases there were two or three diseased vessels. Liberation and reconstruction of the coeliac axis were carried out in six cases. Aorto-hepatic by pass graft was performed in three patients. Reinsertion of SMA was done in four and reinsertion of IMA in one case. Reconstruction of SMA with a by pass graft was carried out also in one case. There was no operative mortality. One of the patients died five weeks postoperatively at home from myocardial infarction. Another patient operated on in 1965 died seven years later at the age of 78 from myocardial infarction. He had had no further symptoms of abdominal angina postoperatively. The remaining 12 patients were relieved of their symptoms after the operation. They have been followed up for a mean of 5.5 years. The good long term results of arterial reconstructions in contrast to the poor prognosis without operation, favours early operation. The importance of early diagnosis and the importance of early operative treatment are emphasized.
Between 1966 and 1981, 58 patients underwent operation for nondissecting aneurysm of the descending thoracic aorta at the University Central Hospital in Helsinki. The cause of the aneurysm was atherosclerotic in 38 cases. Nine aneurysms were post-traumatic and 11 had developed after correction of aortic coarctation with a Dacron patch. Rupture of the aneurysm with hypotension and haemothorax were present on admission in three patients (5.2%). Six operations were performed without use of shunt or bypass. In the other patients the circulation to the spinal cord and viscera was protected during the aortic resection and reconstruction. Left atrial-to-femoral artery bypass was used in 43 patients, femoral vein-to-femoral artery bypass in five, heparinized TDMAC shunt in three patients and total perfusion in one case. Transient paraparesis and irreversible paraplegia each occurred in one case in which some form of circulatory protection had been used. In the latter patient there was aneurysm rupture and hypotension on admission to hospital, and resection (greater than 10 cm) was done with TDMAC shunt. The patient died postoperatively of pulmonary complications. The total operative mortality was 12.1%. The mortality in the follow-up period (range 1-14 years, mean 5 years) was 13.8%. The conclusion from the study was that, when adequate technique of aneurysm resection is combined with shunt or bypass, an acceptable operative mortality and low incidence of paraplegia are obtainable.
