Derward Lepley

Congenital heart disease in adults

Abstract A series of forty-one patients who have attained adulthood despite significant hemodynamic congenital heart defects is presented. Thirty-four have undergone open heart methods and seven, closed heart procedures. Only one death occurred in the series, a mortality of 2.4 per cent. Two patients had complications but survived. All patients but one have returned to full occupation and are asymptomatic. We believe that every patient with hemodynamically significant heart disease should undergo repair regardless of age.

ENDOBRONCHIAL HAMARTOMA: A DIFFICULT DIAGNOSTIC PROBLEM.

Abstract A case of a thirty-seven year old white man with an endobronchial hamartoma has been reviewed. This case is unique in that extensive diagnostic workup and thoracotomy had previously failed to find or eradicate the pathology. The undoubted growth of this lesion led to its eventual diagnosis. Review of the English literature shows that to date a total of fifty cases of endobronchial hamartomas have been reported; this one case makes a total of fifty-one cases. (Table 1.)

The spectrum of clinical manifestations of anomalous origin of the left coronary artery and surgical management

Intercoronary collaterals play a major role in determining whether patients with the symptoms of anomalous left coronary artery will suffer infarction early in life with resultant complications or will survive to an older age before becoming symptomatic with angina. We believe that the definitive surgical treatment should be performed at the earliest age possible to avoid further damage to myocardial muscle.

An electronic device for accurate identification of the cardiac conduction system: Its development and use in open heart surgery☆

I N THE REPAIR of certain groups of congenita1 heart Iesions, the incidence of surgicaI1y induced complete heart bIock has been reported to J,e IO to 15 per cent. These incIude ventricular defect, tetraIogy of FaIIot, atrioventricuIaris communis and primum type atria1 septa1 defects. No good method has been avaiIabIe to consistentig, accurateI?identify the conduction system in order to avoid trauma to it in open heart surgery for repair of these defects. This report describes the deveIopment and use of an electronic device which can accurateI!, locate the conduction system in the beating, arrested, or coId heart so that this dread compIication of open heart surgery might be avoided. In February I 96 I [I] we reported the research deveIopment of a conduction system locator hased on the principIe of comparative differences in impedance between myocardium and conduction system. This device, developed through extensive anima1 experimentation, was designed as foJIows: a bipoIar detector probe was designed using copper eIectrodes 1.0 mm. apart, which were insulated throughout except at the tip of the probe. This probe was connected to a I kc. impedance bridge. A speaker was added which emitted an audibJe tone which changed in volume when changes in impedance vverc encountered by the detector probe. A transistorized unit was then deveIoped to repIace this original equipment, and extensive animal experiments were designed to test the accuracy of the device. These incIuded: (I) detection and division of the right bundIe branch and bundIe of His, (2) pIacement of sutures near the right bundle branch (2 mm. apart and parallel to it), and (3) detection of the atrioventricular node and placement of sutures around it. Additionally, studies were done in which the atrioventricuIar node and right bundIe branch were found and stimulated extensively in an attempt to determine whether the output current of the device was harmful to the conduction system. The resuJts of these experiments in fifty-two dogs showed: (I) the right bundIe branch could be readiIy detected with an accuracy of 1.0 mm. in a11 instances, (2) the atrioventricuIar node and bundIe of His couId be identified with accuracy in onIy 50 per cent of the experiments, and (3) no trauma to the conduction system occurred with prolonged stimulation with the probe. These findings together with mapping of eJectrica1 field plots Ied us to the foIIowing concIusions as to our Iimitations in the use of the device in its present form : Depth oj Detection. The atrioventricuJar node and bundle of His, after many microdissections were found to Iie at a level from I to 3 mm. beneath the endocardium in dogs and man. FieJd pIots and anatogue studies

Selection of patients for coronary bypass surgery.

We have tried to present a rational approach to selection of patients for coronary bypass surgery. An evaluation of both the anatomic and the clinical status of a patient in whom coronary arteriography has been performed, along with consideration of known results of medical and surgical forms of treatment of coronary artery disease in large series, determines which therapy is preferable. In all instances, the goal of treatment is threefold: relief of pain, preservation of myocardium and prolongation of life. In properly selected patients, pain can be relieved by surgery 90% of the time. Preservation of myocardium is a reality in some groups of patients treated surgically. Current data indicate that prolongation of life by coronary bypass surgery occurs in patients with left main coronary or triple-vessel disease, and as more data are collected, other subgroups may be included.

Arteriovenous oxygenation for respiratory support

Abstract Arteriovenous oxygenation is reported as a method of respiratory support in dogs. Animals were put in severe respiratory distress by ventilation with a 5 per cent oxygen mixture. Oxygenation was effected by connecting a disposable oxygenator between the femoral artery and vein, and blood gases were analyzed. Five of six experimental animals survived with no apparent ill effects; all control animals (5 per cent oxygen ventilation, no oxygenator) died. This experiment represents a most severe respiratory distress which was abated by means of minimal extracorporeal support.