Right coronary artery—Pulmonary artery arteriovenous fistula secondary to open heart surgery

A patient is described who underwent atrial septal defect repair at age 12 and presented 16 years later with angina. Coronary angiography revealed a right coronary artery to pulmonary artery fistula that had developed at the site of the previous thoracotomy. This is the first report of an acquired fistula of this type developing secondary to trauma associated with open heart surgery. Diagnosis, shunt quantification and treatment are discussed

Recent Clinical Experience With Left Heart Bypass Using a Centrifugal Pump for Repair of Traumatic Aortic Transection

OBJECTIVE: To analyze the indications, results, and limitations of using left atrial to femoral artery (LA-FA) bypass to provide distal perfusion during repair of traumatic aortic injuries. SUMMARY BACKGROUND DATA: There is no consensus about the best method for repair of traumatic aortic transection. Distal aortic perfusion with LA-FA bypass and a centrifugal pump has been the authors’ preferred technique for injuries to the aortic isthmus and descending thoracic aorta. METHODS: From 1988 to 1998, the authors operated on 30 patients with traumatic aortic transection using LA-FA bypass. The mean age of the group was 36 ± 2 years. The mechanism of injury was from a motor vehicle accident in 97% of the cases. Distal aortic perfusion was maintained at 50 to 75 mm Hg with flow rates of 1.5 and 3 L/min. The mean aortic cross-clamp time was 38 ± 2 minutes, and the mean bypass time was 49 ± 2 minutes. RESULTS: No complications related to cannulation, arterial thromboembolism, renal failure, mesenteric ischemia, or hepatic insufficiency occurred. There were no cases of postoperative paraplegia and no deaths. CONCLUSION: Left atrial to femoral artery bypass is a safe, simple, and effective adjunct to the repair of traumatic injuries to the thoracic aorta. Active distal aortic perfusion preserves spinal cord, mesenteric, and renal blood flow and eliminates the potential catastrophic consequence of spinal cord ischemia from an unexpectedly prolonged aortic cross-clamp time

Aortic valve replacement in patients with systemic mastocytosis.

Systemic mastocytosis is a hematologic disorder with important perioperative implications. A variety of stimuli and medications can cause severe anaphylaxis in these patients. We report successful preoperative, intraoperative, and postoperative management of a patient with systemic mastocytosis who underwent an aortic valve replacement and review the literature pertaining to cardiac surgery in these patients

901-12 Long-term Results of Right Latissimus Cardiomyoplasty

Initial experimental and clinical studies have shown that cardiomyoplasty using the right latissimus dorsi can improve left ventricular (LV) function early after operation. This study presents the long-term results of clinical application of this procedure. Between March 1991 and November 1992, 16 patients (12 men, 4 women; mean age 57; range 33-77 years) underwent operation. Survivors have now been followed for 18 months with serial right heart catheterization and radionuclide angiography at 6 month intervals. The operative mortality was 6% (1/16), but 3 additional patients experienced sudden death within 6 months of operation. Survival was 62.5% (10/16) at 12 months and 56.3% (9/16) at 18 months. The LV stroke work index (LVSWI) was improved at each postoperative interval, but the differences were not statistically significant. Left ventricular ejection fraction (LVEF) significantly increased from 26.1 ± 5.3 to 33.4 ± 10.3 (p< 0.05), 6 weeks after operation and was not different from baseline thereafter. The LV end-diastolic volume decreased significantly at 6 months from 306.1 ± 71 to 249.4 ± 69 mL (p< 0.01), and remained lower than the preoperative value in subsequent follow-up. Comparison of preoperative LVEF in 24 month survivors (51 and non-survivors (8) revealed that survivors had an LVEF of 30.2 ± 4.38 and nonsurvivors were 22.7 ± 2.58 (p< 0.05). Preoperative LVSWI was also significantly greater in survivors 36.4 ± 6.91 gm-cm/m2vs 20.1 ± 8.26 gm-cm/m2, (p< 0.05). Overall survival was limited by the occurrence of sudden death, but survivors had improved functional capacity and stabilization of cardiac size and function. We conclude that careful selection of patients with better preserved, preoperative LV function may yield improved long-term survival in right latissimus cardiomyoplasty

Left Ventricular Assist with the New Bio-Pump 80

Six male mongrel dogs were studied on left ventricular bypass (left atrium to femoral artery) for twenty-four hours without anti-coagulation. The circuit consisted of standard perfusion cannulae, polyvinylchloride tubing, polycarbonate connectors, and the new Bio-Pump 80. Bypass flows averaged 2.2 1/m. Hematologic and biochemical parameters were measured according to protocol. The coagulation profile during the 24 hours remained normal. The prothrombin time, partial thromboplastin time, and fibrinogen values were not statistically different from preoperative control values. Fibrin split products were consistently negative and hemoglobin, hematocrit, and platelets were stable over the 24 hour period. Serum hemoglobin levels were negligible over the course of the experiment. The biochemical results also remained at normal levels, with the exception of creatinine, which was significantly lower. All dogs were electively sacrificed at the end of the 24 hour assist period. Autopsy revealed minor renal infarcts in two animals; all other organs were found to be grossly intact. There were no technical problems with the Bio-Pump 80. Thrombi were seen at approximately twenty per cent of the connector/tubing junctions. Four of the Bio-Pumps had no thrombus accumulation in any part of the pump, while two pumps had small amounts of thrombus present around the center shaft

Contemporary incidence and risk factors for carotid artery disease in patients referred for coronary artery bypass surgery

Abstract Background In the past decade, there has been an increase in the amount of patients with medical co-morbidities referred for coronary artery bypass surgery (CABG). Significant carotid artery disease in patients undergoing CABG procedures increases the risk of neurological complications. We review the results of routine carotid screening in patients undergoing CABG to determine the contemporary incidence and risk factors for carotid artery disease. Methods Between 2008 through 2010, 673 patients were referred for isolated coronary artery bypass surgery at a single institution. Patients were identified through a systematic review of The Department of Cardiothoracic Surgery Society of Thoracic Surgery Outcomes Database. A retrospective analysis of prospectively collected demographic, clinical data and outcomes were performed. All patients with screening preoperative carotid duplex were reviewed. We defined the degree of carotid disease as: none to mild stenosis ( Results 559 (83%) patients underwent screening preoperative carotid ultrasonography prior to CABG. The incidence of carotid artery disease (>50% stenosis) was 36% with 18% unilateral moderate disease, 10% bilateral moderate and 8% severe disease. Risk factors associated with carotid artery disease included: advanced age, renal failure, previous stroke, peripheral vascular disease, left main coronary artery disease, and previous myocardial infarction. Conclusions There is a significant incidence of carotid artery stenosis in patients referred for CABG. Routine screening will identify patients with carotid artery disease and may reduce the risk of postoperative stroke.</p