Randolph M. Ferlic

Partial anomalous pulmonary venous connections

Abstract Fifty-seven cases of partial anomalous pulmonary venous connections treated surgically at the University of Minnesota Medical Center are reviewed. There was no hospital nor late mortality. The electrocardiographic features seen in partial anomalous pulmonary venous connections are similar to those in isolated secundum type atrial defects and include right axis deviation, incomplete right bundle branch block and right ventricular hypertrophy. The roentgenologic features are also similar in these two conditions, with increase in the central and peripheral pulmonary vasculature, prominence of the hilar vessels and right ventricular enlargement. Occasionally the anomalously connected vessels may be visualized on planigrams or routine roentgenograms. Identification of anomalous pulmonary venous connections during right heart catheterization is frequently possible. This depends on the catheter entering a pulmonary vein from the venae cavae, increase in oxygen content in the venae cavae, angiocardiographic demonstration of the vein, or differential dye-dilution technics. Surgical correction of partial anomalous pulmonary venous connections directs the drainage from these veins through the atrial septal defect. A prosthetic patch is usually used for this purpose except in the rare instance of drainage into the infradiaphragmatic inferior vena cava. In the 6 patients without an atrial septal defect, a defect was created, and a prosthetic patch used to correct the drainage from the anomalous pulmonary venous connections in 5, and the sixth patient had the vein transposed to the left atrium (the scimitar defect).

Cor Triatriatum Review of the Surgical Aspects with a Follow-up Report on the First Patient Successfully Treated with Surgery

A follow-up report on the first patient with cor triatriatum to undergo successful surgical treatment is presented. A second procedure was necessary 9½ years later because of stenosis of the initial surgically created orifice in the anomalous diaphragm. A review and ananalysis have been made of 17 cases from the literature reporting successful operations for this lesion. Total excision of the accessory septum utilizing cardiopulmonary bypass is presently the appropriate surgical treatment of this entity. Preoperative and postoperative hemodynamic data are discussed. Recognition and correction of this defect are emphasized in order to avoid permanent pulmonary vascular changes attended by a relatively fixed cardiac output.

The precise management of heparin therapy

Abstract A modification of the whole blood activated partial thromboplastin time has been developed for use at the bedside in managing heparinized patients. Called the BaSon test, it has been found to correlate well with the Lee-White whole blood clotting time and to be more sensitive an indicator than either the clotting time or the activated partial thromboplastin time. It has become the preferred method at our institution for monitoring those patients in whom anticoagulation is achieved with heparin.

Cardioversion as an adjunct to cardiac surgery.

and accepted method for conversion of atrial fibrillation or flutter.1, 2> 3 Although many comiiiunicationS4,5 halve dealt with cardioversion in the management of patients with chronic atrial fibrillation, few have commented on the impact of this technique upon surgical practice. The purpose of this paper is to relate the experience with d.c. cardioversion in the preoperative and postoperative management of patients undergoing cardiac surgery at the University of Minnesota Medical Center during the past 2 years.