Elias S. Hanna

Carotid surgery without angiography

We propose that circumstances exist in which angiography is not necessary or is unwarranted for the diagnosis and treatment of carotid arterial disease. High quality real-time B-mode ultrasonographic imaging, combined with both pulsed gated, and continuous wave Doppler analysis, shows a remarkably close correlation with the pathologic abnormality identified at operation. Scanning in the vascular laboratory not only provides quick, noninvasive, accurate assessment of the atherosclerotic disease, it can also provide plaque and blood flow detail not previously attainable. Carotid surgery can be effectively and safely performed in selected patients with the aid of ultrasonography and Doppler analysis without the need for invasive angiographic imaging.

A Modified Sternal Retractor for Exposure of the Internal Mammary Artery

Abstract This report describes the use of a modified chest wall rake retractor used to provide better exposure of the internal mammary artery (IMA). The instrument is easy to use and has been associated with minimal complications. It facilitates the harvesting of the IMA for use in coronary artery bypass grafting and provides better visualization of the retrosternal area for control of hemostasis.

Argon laser radiation of human clots: differential photoabsorption in red cell rich and red cell poor clots

Since argon laser radiation (454-514 nm) can vaporize human clots, we determined whether the absorption of laser energies can differ among different types of blood clots. Thus we performed spectrophotometric studies and examined the ability of this laser to penetrate red cell rich and red cell poor clots. Fifty-four red cell rich and red cell poor clot samples, varying in depth from 1.8 to 5.0 mm, were subjected to 3, 5 and 7 watts from an argon laser beam. At a given power intensity, the deeper the red cell rich clot, the longer was the time needed to penetrate the clot. The higher the power used, the shorter was the red clot penetration time. In contrast, all power levels used up to 5 minutes did not penetrate any of the varying depths of red cell poor clots. Spectrophotometrically, the red cell rich clot had an absorption curve typical of hemoglobin pigment while the red cell poor clot, in the absence of hemoglobin, had poor absorption between 350 and 600 nm and was unable to absorb argon laser energies. Thus, the argon laser provides a therapeutic modality for human red cell rich clot dissolution but the present approach does not appear to be effective against red cell poor clots.

Primary repair of ascending aortic dissection: Experience with 20 cases

A primary repair technique was used to treat 20 cases of dissection of the ascending aorta. The group consisted of 13 men and 7 women with an average age of 65 years. Dissection complicated cardiac surgery in 13, was spontaneous in 6, and was traumatic in 1. The repair included a noncircumferential aortotomy at the site of the primary tear sparing the posterior wall, followed by Teflon felt-supported repair of the dissected layers, and wrapping of the aorta with a Teflon felt pad. Concomitant procedures included coronary bypass grafts in 12, valve surgery in 3, and closure of infarction-related ventricular septal defect in 1. Two patients died (mortality 10%). Postoperative complications were relatively frequent in the remaining 18 patients. All survivors were stable for an average follow-up period of 2 years. Compared with replacement grafting, this procedure is less time-consuming and probably provides better stability of the ascending aorta.

Laser Treatment of Coronary Artery Disease

Extension of the principle of microwave amplification by stimulated emission of radiation (maser) [1] afforded the development of laser (light amplification by stimulated emission of radiation) from devices that emit energized light within the visible spectrum [2]. Initial medical application of such photoradiation included retinal coagulation [3], tumor ablation [4], dermal surgery [5], and gastric hemostasis [6]. These advances have led to progress in the dissolution of obstructive atherosclerotic vascular disease with laser radiation [7]. In experiments carried out in our laboratories in the late 1970s performing balloon angioplasty in human cadaver coronary arteries [8], we found that balloon catheters could not traverse many subtotal coronary stenoses. Our initial concept of using lasers was to create a large enough channel through the obstructive lesion to allow the passage of a balloon catheter for coronary angioplasty. The application of laser as it has evolved during the past few years into the clinical treatment of coronary artery disease is described in the present report.

Pulmonic valvular stenosis: clinical-hemodynamic correlation and surgical results

Sixty-six patients with pulmonic valvular stenosis were evaluated by cardiac catheterization and cine-angiography over the past four years in a recently established cardiovascular center in Syria. Patients were divided according to severity of pressure gradient across the pulmonic valve into three groups: Group I (25 patients) had gradients below 50 mm. Hg, Group II (14 patients) had gradients between 50 and 100 mm. Hg, and Group III (27 patients) had gradients exceeding 100 mm. Hg. Clinical symptoms and signs including dyspnea on exertion, palpitation, cyanosis, and characteristics of the murmur and the pulmonic second sound were correlated with severity and grouping along with electrocardiographic and radiographic findings. Valvulotomy was carried out in 23 patients (35%). Short term clinical results were excellent in 19 patients, but long term course of the non-operated and post-operative cases is yet to be established.

An Unusual Case of Systemic Embolism During Cardio-Pulmonary Bypass

An unusual case of systemic arterial embolism of a plastic ring that got detached from an aortic cannula at the completion of an aorto-coronary bypass procedure is presented. The patient was successfully managed with aortic embolectomy.