Ake Senning

Correction of the transposition of the great arteries.

Inversion of the atrial flow in transposition of the great arteries is achieved in the following way: the remaining atrial septum is detached from behind, leaving it as a flap between both AV. valves. The incision is continued into the coronary sinus and the Vena magna cordis to the base of the left atrial appendage along the mitral ring. The resutling flap from the split coronary sinus is sutured to the left atrial wall in front of the left side pulmonary veins, thus forming a septum dersal to the caval veins, diverting the left pulmonary venous blood to the right side. The atrial septal flap is reattached in front of the caval vein orifices. In 50 cases a small Dacron patch was used to complete the midportion of the new septum. Six patients died and so far we have encountered one superior Vena cava stenosis and one pulmonary vein stenosis. In 16 patients completion of the midportion of the new atrial septum was done with a partially excised flap from the right atrial wall still attached to the Vena cava inferior. This method resulted in 3 operative deaths. In 42 of 58 survivors the ECG has been repeatedly controlled 3 months to 6 years postoperatively. Thirtysix of the 42 patients have sinus rhythm, 4 vary between nodal and sinus-rhythm and 2 have a total A V-dissociation.

ANESTHESIOLOGICAL EXPERIENCE FROM INTRACARDIAC SURGERY WITH THE CRAFOORD‐SENNING HEART‐LUNG MACHINE

Intracardiac procedures with the aid of cardiopulmonary bypass are nowadays common, especially in the United States. The use of extracorporeal circulation involves many branches of medicine, among which anesthesiology plays an important r81e. However, relatively few publications pertaining to this field of anesthesia have been published, and information on anesthesiological problems related to extracorporeal circulation has mostly been given in the form of personal communications or in occasional reviews (D. MENDELSOHN, T. N. MACKRELL, M. A. MACLACHLAN, F. S. CROSS and E. B. KAY (1957)27; D. E. HALE, P. MORACA and C. E. WASMUTH (1957)19; R. T. PATRICK, R. A. THEYE and E. A. MOFITT (1957y). As the clinical use of heart-lung machines was started in Stockholm in 1954 by c. CRAFOORD and A. SENNING~~, we have thought it may be of interest to give an account of our anesthetic procedures and related investigations on 52 consecutive patients operated upon from November 1957 to July 1958 at the new Thoracic Clinics. I t is also the purpose of this paper to give the results of some investigations on acid-base changes before, during and after bypass.-An important factor in the regulation of the acid-base equilibrium is the adjustment of ventilation, and as we have found controlled respiration with a mechanical, volume-cycled respirator useful during anesthesia as well as postoperatively in many patients who have had extracorporeal circulation, our technique, indications and results from this type of ventilation will also be outlined.

Persistent atrioventricular canal: Surgical experiences

Abstract Sixteen patients with common A-V canal have been operated on, the last eight by a technic of annuloplastic suture. The over-all mortality was 37.5 per cent. Of the last eight patients operated on, only one died. The factors contributing to mortality were large muscular defects of the interventricular septum, persisting mitral insufficiency and postoperative A-V heart block.

Indikatorische Probleme bei Aortenaneurysmen thorakal und abdominal aus chirurgischer Sicht

Alle sakularen, wie auch signifikanten fusiformen Bauchaorten-Aneurysmen sollten reseziert werden. Aortenaneurysmen im Bereich der Aorta ascendens sollten ebenfalls reseziert werden, wenn sie mit einer Aorteninsuffizienz kombiniert sind oder im Anschlus an eine Coarctatio auftreten.

201.100 Jahre Lungenchirurgie

SummaryThe milestones in pulmonary surgery during the last 100 years have been in 1881 the first experimental lung resection by Gluck in Berlin; in 1882 an unsuccessful pulmonary resection in man, Block, Berlin; intrapleural pneumothorax, Forlanini, Milano; 1883 first successful pulmonary resection, Krönlein, Zürich; 1886 thoracoplasty, Cerenville, Lausanne; 1887 pneumotomy, Quincke, Kiel. 1891 planned successful resection of the pulmonary apex, Tuffier, Paris; 1900 first successful lobectomy, Heidenhain, Berlin; 1902 intratracheal intubation anesthesia, Kuhn, Kassel; 1904 differential pressure chamber, Sauerbruch, Breslau; 1911 pillar thoracoplasty, Wilms, Heidelberg; 1913 thoracoscopy, Jacobaeus, Stockholm; 1929 closed drainage of pleural cavity, Brunn, San Francisco; 1931 pneumonectomy, Nissen, Berlin; 1932 tourniquet, Shenstone, Toronto; 1933 one-stage pneumonectomy for bronchial carcinoma, Graham, St. Louis; 1939 segmental resection, Churchill, Boston; 1948 anatomical correct segmental resection, Overholt, Boston.Zusammenfassung1881 tierexperimentelle Lungenresektion, Gluck, Berlin. 1882 Lungenresektion, Block, Berlin. Intraoperativer Tod der Patienten. Intrapleuraler Pneumothorax, Forlanini, Milano. 1983 erste erfolgreiche Lungenresektion, Krbnlein, Zürich. 1886 Thoracoplastik, Cerenville, Lausanne. 1887 Pneumotomie, Quincke, Kiel. 1891 geplante und erfolgreiche Lungenspitzenresektion Tuffier, Paris. 1900 Lobektomie, Heidenhain, Berlin. 1902 Intubationsnarkose, Kuhn, Kassel. 1904 Druckdifferenzverfahren, Sauerbruch, Breslau. 1911 Pfeilerthoracoplastik, Wilms, Heidelberg; Thoracoskopie, Jacobaeus, Stockholm. 1912 individuelle Unterbindung der Hilusgefäße, Davies, London. 1929 geschlossene Pleuraraum-Drainage, Brunn, San Francisco. 1931 Pneumonektomie, Nissen, Berlin. 1932 Hilustourniquet, Shenstone, Toronto. 1933 einzeitige Pneumonektomie wegen Ca., Graham, St. Louis. 1939 Segmentresektion, Churchill, Boston. 1947 anatomisch gerechte Segmentresektion, Overholt, Boston.

293. Chirurgische Behandlung des thorakalen dissezierenden Aortenaneurysmas

SummaryA total of 199 patients with dissecting aneurysm of the thoracic aorta (99 of type I, 33 of type II, 67 of type III) were treated between 1967 and 1981. Early mortality (30 days) was 40% in the 47 patients in type I who were operated on, but only 4% in the 23 type II patients. However, it was 100% in the 62 patients of types I and II who were not operated on. In type III, 39 of 67 patients underwent surgery: early mortality was 26% versus 39% in patients treated concervatively; late mortality was 10% in both groups. It is concluded that acute dissection of type I or II should be operated on immediately after angiography and in type III after 4–6 weeks of medical treatment.ZusammenfassungVon 1967–1981 wurden 199 Patienten mit dissezierendem thorakalem Aortenaneurysma (99 Typ I, 33 Typ II, 67 Typ III nach De Bakey) behandelt. Die Frühmortalität (30 T) der operierten 47 Typ I betrug 40%, der 23 Typ 11 4%, der 62 nicht operierten Typ I/II jedoch 100%. Nach 4,8 Jahren starben 15% Typ I und 9% Typ II. 39/67 Patienten mit Typ III wurden mit einer Frühmortalität von 26% versus 39%. der konservativ behandelten Patienten elektiv operiert. Die Spätletalität war 10% in beiden Gruppen.Schlußfolgerung: Nach Angiographie und antihypertensiver Stabilisierung sollen Typ I/II sofort und Typ III nach 4–6 Wochen operiert werden.

283. Aggregationshemmung durch Ticlopidine

SummaryTo study the effects of Ticlopidine (Ticlid) as a platelet inhibiting drug, dacron grafts were implanted in arteries of 18 dogs. After different times of free blood-flow (10s to 7 weeks) pieces were taken out and observed by scanning electron microscopy. Those treated with the drug showed an inhibition of aggregation and pseudopods. The occlusion rate of the implanted grafts after 7 weeks had dropped from 76% to 11% under Ticlopidine.ZusammenfassungZur in vivo-Prüfung des Thrombocytenaggregationshemmers Ticlopidine (Ticlid) wurden bei 18 Hunden Dacron-Gefäßprothesen in beiden Aa. femorales implantiert. Nach verschiedenen Zeiten freien Blutdurchflusses (10s bis 7 Wochen) wurden Stücke derselben entnommen und rasterelektronenmikroskopisch untersucht. Die mit Ticlopidine behandelten Tiere zeigten eine Hemmung der Aggregation und der Pseudopodienbildung. Die Verschlußrate der implantierten Grafts nach 7 Wochen Versuchszeit war bei der mit Ticlopidine behandelten Gruppe (11%.) gegenüber der Kontrollgruppe (76%) signifikant niedriger.

188. Percutane transluminale Dilatation chronischer Coronarstenosen

SummarySince September 1977 67 patients with disabling angina pectoris have been treated with percutaneous transluminal coronary angioplasty (PTCA) using a double-lumen dilatation catheter. In 54 patients we were able to complete the procedure, of whom 47 (70%) were anatomically and clinically improved. In the follow-up period there were recurrences in 6 patients, of whom 3 had a second PTCA. Seven of the 54 patients needed coronary operation, 6 within 24 h, due to deterioration of symptoms. Therefore, standby of the cardiac surgeon during PTCA is mandantory. Coronary lesions most suitable for the procedure are subtotal, discrete, noncalcified and proximal stenoses in patients with a short history of angina (less than 1 year).ZusammenfassungSeit September 1977 wurden 67 Patienten mit der percutanen transluminalen Coronar-Angioplastie (PTCA) behandelt. In 54 Patienten konnte der Katheter durch die Stenose gebracht und diese dilatiert werden. In 47 (70%) wurde ein anatomischer und klinischer Primärerfolg verzeichnet. In der Kontrollperiode kam es zu 6 Rezidiven, wobei bei 3 die Dilatationsbehandlung wiederholt wurde. Sieben der 54 Patienten mußten sich einer Coronaroperation unterziehen, 6 innerhalb von 24h, weil sich die Symptome nach der Dilatation akut verschlechterten. Die Operationsbereitschaft des Herzchirurgen ist daher während der Dilatation unbedingt nötig. Für diese Therapie geeignet sind subtotale, kurzstreckige, nicht calcifizierte proximale Stenosen bei Patienten mit Ein-Gefäß-Erkrankung und kurzer Anamnese der Angina pectoris (kürzer als 1 Jahr).

146. Langzeitresultate nach Rekonstruktion der proximalen Arteria subclavia

Summary80 patients had been operated on for 70 occlusions or stenosis, 7 aneurysm, 2 aplasia and 2 injuries of the prox. subclavian artery. 67 pat. were endarterectomized. 1 pat. died in hospital. 72 pat. had a follow-up after 5.5 years. 92 % were symptom-free. 94.5 % had an anterograde flow in the vertebral artery. The endarterectomy of the prox. subclavian artery is in our hands the method of choice. The mortality is very low and the long-term results are excellent.Zusammenfassung80 Patienten wurden wegen 70 Verschlüssen oder Stenosen, 7 Aneurysmen, 2 Aplasien und 2 Verletzungen der prox. A. subclavia operiert. Bei 67 Patienten war die Endarterektomie die Operation der Wahl. 1 Patient verstarb postoperativ. 72 Patienten wurden 5,5 Jahre nach der Operation nachkontrolliert. 92% waren beschwerdefrei, 94,5 % zeigten einen anterograden Vertebralisfluß. Die Endarterektomie ist in geübten Händen eine einfache und wirksame Operation. Die Mortalität ist gering und die Langzeitresultate sind außerordentlich gut.

Paracorporeal artificial heart: early and late results

Pneumatically driven artificial heart was used for 2–5 days in 6 patients with refractory postoperative heart failure. The ventricles were fixed on the patients chest in paracorporeal position. In 4 patients the ventricles could be removed after recovery of the natural heart; 2 died of bleeding complications. Only 2 patients left the hospital; one of them died 3 months later due to sudden arrhythmia and there is one single survivor at 19 months after the operation. Postoperative heart failure is becoming very rare: The artificial heart was not used in the last 10 months. Massive postoperative heart failure is reversible when the natural heart is mechanically unloaded for 2–3 days, but long-term success is rare.SummaryPneumatically driven artificial heart was used for 2–5 days in 6 patients with refractory postoperative heart failure. The ventricles were fixed on the patients chest in paracorporeal position. In 4 patients the ventricles could be removed after recovery of the natural heart; 2 died of bleeding complications. Only 2 patients left the hospital; one of them died 3 months later due to sudden arrhythmia and there is one single survivor at 19 months after the operation. Postoperative heart failure is becoming very rare: The artificial heart was not used in the last 10 months. Massive postoperative heart failure is reversible when the natural heart is mechanically unloaded for 2–3 days, but long-term success is rare.ZusammenfassungDas pneumatisch angetriebene künstliche Herz wurde bei 6 Patienten mit therapeutisch refraktärem postoperativem Herzversagen für die Dauer von 2–5 Tagen eingesetzt. Die Ventrikel wurden parakorporal am Brustkorb des Patienten fixiert. Bei 4 Patienten konnten die Ventrikel nach Erholung der Herzfunktion entfernt werden; 2 Patienten verstarben während des Pumpens an Blutungskomplikationen. Nur 2 Patienten haben das Spital verlassen; einer verstarb nach 3 Monaten an einer plötzlichen Rhythmusstörung, so daß nur 1 Patientin nach 19 Monaten einen Langzeiterfolg zeigt. Postoperatives Herzversagen wird immer seltener (keine Anwendung des künstlichen Herzens in den letzten 10 Monaten). Die schwerste postoperative Herzinsuffizienz ist reversibel, wenn das eigene Herz für die Dauer von 2–3 Tagen mechanisch entlastet wird; die Langzeiterfolge sind jedoch selten.