Benson B. Roe

Total Anomalous Pulmonary Venous Drainage, Technical and Physiological Considerations

Total Anomalous Pulmonary Venous Drainage, Technical and Physiological Considerations BENSON ROE; Annals of Surgery

Noninvasive diagnosis of a false left ventricular aneurysm with radioisotope gated cardiac blood pool imaging: Differentiation from true aneurysm

Unlike the true left ventricular aneurysm, false aneurysms have recently been shown to be subject to late rupture. Rarely diagnosed before surgery or autopsy, the false aneurysm has never been identified by noninvasive techniques. We report the first such noninvasive diagnosis employing radioisotope gated cardiac blood pool imaging. Due to the unique and possibly life-threatening clinical course and potential for surgical cure of false left ventricular aneurysm, early noninvasive diagnosis by imaging techniques may be critical. The methods shown here are generally applicable, becoming widely available and may help in evaluation of false left ventricular aneurysm as a cause of sudden death.

Mechanical injury to the coronary arteries during operative cannulation

Abstract An extensive review of 18 patients who died after aortic valve surgery indicated that operative cannulation caused fatal mechanical injury in 10 of these patients. Underlying coronary arterial anomalies and atherosclerosis were present in most of these cases. It is probable that many operative deaths which have formerly been attributed to the patients heart disease are really due to iatrogenic coronary artery obstruction. Disease coronary arteries and the technical problems of cannulation present hazards which may offset those of intermittent ischemia.

Intracardiac Myxomas with Report of Two Unusual Cases and Successful Removal

A comprehensive review of the various aspects of intracardiac myxomas is presented. Two unusual cases are illustrative of many of the problems encountered. Of particular interest are the successful surgical removals of the myxomas in both cases.

Valve Replacement for Bacterial and Fungal Endocarditis A Comparative Study

Twenty-eight of 143 patients treated for infective endocarditis had replacement of one or more cardiac valves within six months after the diagnosis was made. Twenty-two patients (16%) with bacterial endocarditis had operation, and six died in hospital. All six patients with fungal endocarditis required vale replacement, and one died in hospital. Uncontrolled or progressive heart failure was the indication for operation in all patients with bacterial endocarditis. When severe heart failure was present, 5 of 11 patients with bacterial endocarditis died in hospital, and only 1 of 3 patients with associated bacteremia survived. If blood cultures were sterile, the duration of preoperative antibiotic therapy did not correlate with hospital survival. None of the patients with bacterial endocarditis developed prosthetic infections, but two developed paravalvular leak.Massive emboli or persistent mycotic septicemia were the indications for valve replacement in patients with fungal endocarditis. Viable organisms were cultured from the excised valves in all of these patients in spite of preoperative amphotericin B for 30 to 140 days and negative blood cultures. Excision of the infected valve cured the infection in all patients.Five patients died 6 weeks to 36 months after operation. At the present time 16 patients remain alive 14 to 47 months after operation. Six of nine drug addicts are alive 15 to 27 months postoperatively.

The application of radionuclide infarct scintigraphy to diagnose perioperative myocardial infarction following revascularization.

To evaluate the application of radionuclide infarct scintigraphy to diagnose myocardial infarction after revascularization, we obtained postoperative technetium 99m pyrophosphate myocardial scintigrams, serial electrocardiograms and CPK-MB isoenzymes in ten control and 51 revascularized patients. All control patients had negative electrocardiograms and scintigrams, but eight had positive isoenzymes. Eight revascularized patients had positive electrocardiograms, images and enzymes and two had positive scinti- grams and enzymes with negative electrocardiograms. Thirty-four patients with negative electrocardiograms and scintigrams had positive isoenzymes; in only seven patients were all tests negative. Our data suggest radionuclide infarct scintigraphy is a useful adjunct to the electrocardiogram in diagnosing perioperative infarction. The frequent presence of CPK-MB in postoperative patients without other evidence of infarction suggests that further studies are required to identify all factors responsible for its release.

Open mitral valvulotomy.

Abstract A five-year experience with routine open visualization of the mitral valve in 95 patients with mitral stenosis resulted in salvage of 53 valves and replacement of 42. The subvalvular structures were often thickened and fused, and meticulous dissection was necessary to produce adequate mobilization of the valve leaflets. An operative mortality of 1 death among the 53 patients undergoing commissurotomy attests to the safety of the procedure, but immediate functional results were not significantly better than with the closed method. Sufficient mobilization to produce a wide-open orifice in the relaxed state may be an important factor in the functional result.

Postintubation Tracheal Stenosis

uring the past three years, 12 patients have been treated at the University of California Medical Center, San Francisco, for D severe tracheal stenosis that followed prolonged mechanical ventilation. A retrospective analysis of the clinical material was made to determine the role of techniques, underlying disease, and coincident contributory factors in the production of this previously rare complication. The results of treatment were also evaluated.

Physiologic principles of drainage of the pleural space with special reference to high flow, high vacuum suction

Abstract Evacuation of the pleural space and apposition of tissue surfaces after pulmonary resection is promoted by measures which aid pulmonary expansion on the one hand and which maintain a constant pleural vacuum on the other. Thoracostomy tubes should be connected to a closed system which maintains a vacuum greater than peak negative pressures in the chest and a flow capacity greater than any anticipated air leak.

Tricuspid Leaflet Aortic Valve Prosthesis

The theoretical and practical advantages of the flexible-leaflet prosthetic aortic valve make it worthy of continued development. Laboratory and clinical experience with a precision-molded, single-unit, tricuspid silicone rubber prosthesis suggest that the problems of materials, construction, and performance have been overcome. The use of a suitable elastomer in a precision casting with an anticlotting surface coating has resulted in a leaflet prosthesis the long-term functional performance of which should compare favorably with any device currently in use.