Charles P. Bailey

Re-Establishment of the Continuity of the Anomalous Right Subclavian Artery After Operation for Dysphagia Lusoria

Dysphagia lusoria is a condition in which hesitancy or difficulty in swallowing occurs because of pressure on the esophagus by an anomalous right subclavian artery. Bayfordl in 1794, described the symptoms produced by this anomaly and coined the term &dquo;dysphagia lusoria,&dquo; which meant difficulty in swallowing due to a quirk of nature. Kommerell2 described the roentgenologic findings in 1936. In these patients the right subclavian artery instead of arising in normal fashion from the innominate artery takes origin from the left side of the aortic arch so that the vessel must course upward and to the right, crossing the midline to reach its normal pathway. In 1946, Gross3 ligated and divided the anomalous subclavian artery in a child. Since that time this has become

Extending Operability in Lung Cancer Involving the Heart and Great Vessels

Abstract Despite new developments in radiotherapy technique and the increasing effectiveness of various cancericidal drugs, up to the present time these modalities have remained essentially palliative. Only by resection can the potential for cure of bronchogenic carcinoma be realized. We submit that extracorporeal bypass, in the hands of those experienced in its use, may be applied for excision of certain pulmonary lesions hitherto considered inoperable. Trained bypass teams currently are available at many hospitals, as is extracorporeal apparatus that can be prepared quickly and primed without large quantities of compatible blood, suggesting that this equipment might be kept sterile and available to be brought into the operating room whenever a pulmonary resection for malignancy is scheduled. Available on a standby basis to be used only for patients who are considered fit to withstand an extended operation for lung disease, cardiopulmonary bypass furnishes a valuable means for accomplishing difficult surgical maneuvers in an unhurried and technically enhanced setting. Two cases are documented in which extracorporeal bypass was used to facilitate excision of bronchogenic carcinoma extending into the heart and great vessels. The chief difficulty encountered was an increase in problems of hemostasis. Since one ordinarily is able to handle these hemostatic problems effectively during the performance of various types of open-heart procedures, it is thought that they can similarly be overcome when they occur in conjunction with pulmonary resection.

Reconstruction of the Mitral Valve with Autologous Tissue

uring the past seven years a collaborative program directed at development of a technique or techniques for the reconstrucD tion of the diseased mitral valve with the patient’s own tissues has been in progress at St. Barnabas Hospital, Bronx, N.Y. This program has comprised fundamental investigations of the anatomy of the “fibrous skeleton” of the heart and the structure of the cardiac valves [33-37], long-term studies of the fate of various types of autogenous tissue utilized as free grafts in experimental reconstruction of the heart valves, development of a new type of oxygenator more suitable for the somewhat more prolonged periods of extracorporeal bypass that may be required [18, 22, 231, and trial of various surgical reparative techniques, at first in animals, later in human patients. The surgical approaches have passed through several developmental phases, gradually evolving into a number of highly reliable techniques that appear specifically and variably to be indicated, depending upon certain anatomical and pathological considerations in the individual clinical case. In a very real sense this work has been the logical continuation of the earliest surgical efforts at valvulotomy, valvuloplasty, valvotomy, and commissurotomy [l, 2, 9, 11, 12, 19, 20, 29, 311, subsequently modified to the term neostrophingic mobilization [3,4,6-81, and early efforts at patching perforations of the mitral valve and elongation of the shrunken mural leaflet [lo, 16, 17, 301.

Absolute hemodilution cardiopulmonary bypass: Free water distribution and protein mobilization in body compartments

Abstract Water retention in the body compartments was studied in patients who underwent cardiopulmonary bypass with absolute hemodilution and blood replacement exclusively with nonhemic solutions. During operation, 3 1 2 volumes of fluid had to be administered for each volume of blood lost in order to maintain cardiovascular stability. Of this amount, 1 volume was excreted as urine and insensible water loss, 2 1 2 volumes were held in the body, 1 2 volume of it in the blood stream. The extravascular to intravascular partition ratio of retained water varied from 1 : 3 to 1 : 9. These figures are higher than those usually cited for compartmental equilibration of retained fluid following resuscitative therapy for hemorrhage. It is suggested that water distribution in patients subjected to open-heart surgery is influenced to an appreciable extent by ill-defined effects on the circulation by the mechanics of the bypass procedure itself.

Direct Right Internal Mammary-Right Coronary Arterial Anastomosis: a Six-Year Follow-Up Study

On February 8, 1968 the first reported successful direct anastomosis between the internal mammary artery and the right coronary artery using a minivascular suturing technique was performed at St. Barnabas Hospital. This case has been restudied several times, most recently on January 14, 1974. A cineangiogram demonstrated that the graft was still patent after six years. The writer believes that this case clearly illustrates the validity of the direct anastomotic technique using the internal mammary artery in coronary arterial