Hushang Javid

Left Ventricular Hemorrhagic Necrosis

ince the introduction of total cardiopulmonary bypass and the utilization of prosthetic heart valves, numerous reports have apS peared in the literature describing the clinical and hemodynamic results of their application in patients with valvular heart disease. It seems of paramount importance to review the inherent complications associated with this type of surgical intervention in hopes of determining their pathogenesis and prevention. This report is based on the review of the cardiac findings at necropsy in 31 patients who died in the early postoperative period following single or multiple valve replacement at the Presbyterian-&. Luke’s Hospital in Chicago. CLINICAL MATERIALS

Mitral valve replacement. Review of seven years' experience.

Abstract The clinical experience with mitral valve replacement at the Presbyterian-St. Lukes Hospital in Chicago since August 1961 is reviewed. The over-all operative mortality was 20 per cent with an additional 11 per cent late deaths during a mean follow-up period of 20 months. In reviewing the factors influencing the results of surgery, a direct correlation was found between the operative mortality and the level of pulmonary vascular resistance, the preoperative functional classification of the patients and whether or not a previous mitral operation had been performed. Sixty-nine per cent of the patients are still alive; of these, 90 per cent have benefited greatly from the operation. Disabling late complications have been rare. It is concluded that this modality of treatment should be utilized only in patients whose progressive cardiac decompensation indicates poor prognosis without surgery. Likewise, patients in New York Heart Association functional classification III should not be permitted to progress into class IV before valve replacement is offered since cumulative mortality doubles when this occurs.

Apical Left Ventriculotomy in Subaortic Stenosis due to a Fibromuscular Hypertrophy

A total of five patients were operated upon for subaortic stenosis due to fibromuscular hypertrophy, using a generous left ventriculotomy centered on the apex. There were no deaths or serious complications, and all patients showed a completely satisfactory functional result in the postoperative periods of 19, 17, 11, 8, and 7 months. Three patients recatheterized 16, 11, and 7 months after surgery were found to have a virtual abolition of the gradient. Pressure measurements made at the completion of surgery in all patients, indicated satisfactory removal of the obstruction. The excellent exposure afforded by this ventriculotomy and the absence of complications arising from its use, recommend it for continued trial. It must, however, stand comparison with other techniques on the basis of the durability of the relief of obstruction.

A System for Synchronized Pulsed Perfusion of the Coronary Arteries During Cardiopulmonary Bypass

A system for providing near-physiologic flow patterns in the coronary arteries during cardiac surgery is described. Results in 40 dogs demonstrate the effectiveness of the method.