Cid Nogueira

Correction of Mitral Insufficiency under Direct Vision

The incompetent valves in the majority of patients with mitral regurgitation can be surgically corrected by the technics described above. The ease and effectiveness of the correction are largely dependent upon the severity of the pathologic process. The roles of chronic myocarditis, myocardial failure, pulmonary vascular sclerosis, and the presence of other valvular defects are important factors in the eventual result. Fortunately, the abnormality in the majority of valves can be corrected, and the myocardial reserve is usually sufficient to provide satisfactory function. With continued progress in this field, earlier surgical intervention, and probably less severe disease from improved treatment, better results can be anticipated in the future.

Corrective Surgery for Tetralogy of Fallot Evaluation of Results

Fifty patients with tetralogy of Fallot have had surgical correction of their complex defects made possible by the open technic during the past 5 years. The overall 5-year operative mortality was 18 per cent. This was reduced to 15 per cent during the past 2 years in 20 patients. Forty-one of the patients are alive, asymptomatic, and have normal physical activity. Ffteen patients have had cardiac evaluation studies including cardiac catheterization from 1½ to 3 years postoperatively. Thirteen patients had normal cardiac hemodynamics. In only two patients was there evidence of incomplete hemodynamic improvement even though marked clinical improvement was gained.

Results of surgery for ventricular septal defects

Abstract The surgical correction of ventricular septal defects can be accomplished today by teams experienced in extracorporeal perfusion technics with a minimum of risk and a maximum of effectiveness. There has been no operative mortality during the past two years in the series reported, regardless of the degree of pulmonary hypertension. With this degree of success it is believed that patients with significant shunt flows (40 per cent or more) should have the shunts closed without waiting for the development of enlarged hearts, increased pulmonary vascularity and pulmonary hypertension. Operative intervention is delayed in infants less than one year of age or less than 20 pounds in weight because of the increased risk.

Isolated ventricular septal defects: An anatomic-hemodynamic correlation∗

Previous associations between size and location of ventricular septal defects and hemo-dynamics have been based on antemortem physiologic and postmortem anatomic observations. The present study is based on pre-operative and operative observations in vivo in twenty-six patients. Size of defect is shown to be the major determinant of hemodynamic abnormality. The index of relative size (measured diameter of defect/maximum cardiac diameter) shows a good correlation with right ventricular systolic pressure; the regression of this correlation enables approximate prediction of defect size. Relative shunt flow (shunt fraction of pulmonary blood flow) distributes parabolically in relation to right ventricular systolic pressure. A plot of this distribution can be divided into five segments. These demonstrate correspondence of clinical and anatomic findings: 1. Segment 1 (shunt flow < 50 per cent; right ventricular systolic pressure < 60 mm. Hg): diameter of defect 1 cm. or less; corresponds to “maladie de Roger.” 2. Segment 2 (shunt flow > 50 per cent; right ventricular systolic pressure < 60 mm. Hg): defects 1 to 1.5 cm. in diameter; increased pulmonary flow with left ventricular overload. 3. Segment 3 (shunt flow > 50 per cent; right ventricular systolic pressure 60 to 90 mm. Hg): defects 2 cm. or more in diameter; pulmonary congestion and combined ventricular overloading. 4. Segment 4 (shunt flow > 50 per cent; right ventricular systolic pressure > 90 mm. Hg): defects 2 cm. or more in diameter; clinically compensated but with right ventricular overloading. 5. Segment 5 (shunt flow 90 mm. Hg): defects 2 cm. or more in diameter; imminent cardiac failure with severe right ventricular hypertrophy. Surgical repair is indicated for patients in segments 2, 3 and 4. The data clarify suggested mechanisms in ventricular septal defects and provide a basis for predictions of defect size and operability.

ANESTHESIA for open-heart surgery: acquired valvular diseases

Q INCE THE mitral valvulotomy was EXTRACORPOREAL APPARATUd \3 first used successfully to correct mitral stenosis,l there has been a steady advance in cardiac surgery. Direct-vision intracardiac surgery has become a reality. The development of safe and efficient pump-oxygenators plus improvements in perf usion technique have made all chambers of the heart accessible to the cardiac surgeon. This reDort emDhaThe extracorporeal apparatus used in this series was the Kay Cross pumpoxygenator (fig. 1).* It consists of a rotating disk-type oxygenator and suitable arterial and venous pumps. More efficient oxygenation and perfusion have been obtained by modifications of the originally described pump-oxygenator.

Surgical treatment of mitral insufficiency; direct vision correction with use of mechanical pump oxygenator and extracorporeal perfusion.

Abstract We have described our experiences during the past year with the direct vision surgical correction of mitral regurgitation in 30 patients operated on by the extracorporeal circulation technic with the heart beating. It is felt that with the use of a mechanical pump oxygenator, direct vision correction of mitral regurgitation will now be a realization in the majority of such patients. The valves in a few patients are so destroyed that nothing short of valve replacement will suffice. The operative mortality and morbidity during the developmental phase has been low. Some of the technical factors contributing to this mortality and morbidity are correctable. Others, such as extensively destroyed valves, pulmonary vascular changes, and poor myocardial reserve, may be largely avoided by earlier surgical intervention.

Wolff-Parkinson-White syndrome and tetralogy of fallot∗: Report of a case

Abstract A case of tetralogy of Fallot proven at operation and autopsy presented the classic electrocardiographic findings of Wolff-Parkinson-White syndrome. An additional anatomic finding of interest was the presence of marked endocardial sclerosis involving the upper part of the interventricular septum. It is postulated that abnormal activation of this zone could have been responsible for the abnormal interventricular conduction.