Robert D. Bloodwell

Orthotopic cardiac prosthesis for two-staged cardiac replacement

Abstract Clinical experience with cardiac transplantation has evidenced the feasibility of cardiac replacement in man but has made apparent the need for a mechanical device that will provide circulation and sustain life in emergency conditions while a suitable allograft is obtained. The cardiac prosthesis used in a 47 year old man consisted of two reciprocating pumps constructed entirely of synthetic materials and activated pneumatically in the orthotopic position by a control console connected by tubes passed through the patients chest wall. The device supported the patients circulation for 64 hours while a donor for cardiac transplantation was obtained. Death of the recipient from Pseudomonas pneumonia occurred 32 hours after the allografting. The first successful prolonged use of a total mechanical substitute for the human heart is recorded.

Human heart transplantation. Experience with twelve cases.

Abstract Transplantation of the human heart is rapidly becoming an accepted method for rehabilitation of patients with end-stage heart disease and incurable congenital defects. This report is concerned with 12 cases of human cardiac transplantation. All 11 patients receiving allografts survived operation with normal circulation provided by the transplanted heart. In 1 of these patients the lungs still attached to the heart were also transplanted. One xenograft (sheeps heart) was placed in a terminal patient in a desperate attempt to prolong life and resulted in failure from hyperacute rejection. Immunosuppressive therapy in all allograft recipients consisted of azathioprine, corticosteroids and antilymphocyte globulin (ALG). One patient died 54 hours later from pneumonia. In 1 moribund patient the transplanted heart functioned well for eight days, and death was secondary to preexisting disease. A 5 year old child had an uneventful early recovery and died suddenly eight days after operation with evidence of organ rejection. The 2 month old infant died 14 hours after transplantation of the heart and lungs. The remaining 7 patients have excellent hemodynamic function of their transplanted hearts up to four and a half months after operation. This experience confirms the feasibility of human heart transplantation.

Surgical Treatment of Muscular Subaortic Stenosis Results from Septectomy in Twenty-six Patients

The results of surgical treatment of 26 patients with muscular subaortic stenosis are presented. Left ventricular septectomy was performed in 16 patients, and septal myocardiectomy via a right ventriculotomy was employed in the last ten patients. There were five hospital deaths among these patients, yielding a mortality rate of 19%.Hemodynamic studies after operation in six patients showed relief of functional left ventricular outflow obstruction in all but one patient. This patient subsequently underwent successful right ventricular septectomy.Recently we have employed a right ventriculotomy for excision of septal myocardium during digital exploration of the left ventricular outflow tract. Freedom from serious complications and effectiveness in relieving the subaortic stenosis recommend this technique for patients with obstructive cardiomyopathy.

Partial Cardiopulmonary Bypass for Pericardiectomy and Resection of Descending Thoracic Aortic Aneurysms

xtracorporeal circulatory support during extracardiac operative procedures on the cardiovascular system may be used to augE ment cardiac output, supplement respiratory function, and protect organs distal to sites of temporary aortic occlusion from ischemic injury. Partial cardiopulmonary bypass employing peripheral venous and arterial cannulation and an oxygenator with a small priming volume may be used as an adjunctive perfusion technique in a variety of clinical situations. Preservation of functional integrity of the kidneys and spinal cord is mandatory for the successful conduct of operations for resection and graft replacement of aneurysms of the descending thoracic aorta. Partial cardiopulmonary bypass provides an alternative technique with several advantages over pump bypass from the left atrium to the femoral artery for protection against renal and spinal cord ischemia and for reduction of circulatory load on the heart during temporary aortic occlusion. Partial cardiopulmonary bypass can also provide supplementary respiratory and circulatory function during operations on the heart or lungs which temporarily interfere with their function, such as during pericardiectomy for constrictive pericarditis. This report presents the results of the use of partial cardiopulmonary bypass in 19 patients during operative correction of descending thoracic and thoracoabdominal aneurysms, repair of traumatic transection of the aorta, and pericardiectomy for constrictive pericarditis.

Rejection of the transplanted human heart.

Abstract The human heart is highly vulnerable to rejection. In 16 patients with 17 allografts rejection progressed relentlessly in histocompatibility matches of C and D grades. Only three patients ...

Rejection of the Transplanted Human Heart

Abstract The human heart is highly vulnerable to rejection. In 16 patients with 17 allografts rejection progressed relentlessly in histocompatibility matches of C and D grades. Only three patients ...

Surgical Correction of Coarctation of the Aorta in the First Year of Life

oarctation of the thoracic aorta produces obstruction to left ventricular outflow with myocardial strain that may be intolC erable to the newborn infant, especially when combined with other anomalies such as ventricular septa1 defect and patent ductus arteriosus. The resultant cardiac failure may respond to medical therapy. If so, an elective operation can be performed when the child is several years older and a better operative risk. When response to medical treatment is inadequate or if heart failure recurs after initial improvement, operation must be performed to prevent a fatal outcome. This report describes our experience with 58 infants who required operation for coarctation of the thoracic aorta during the first year of life. CLINICAL MATERIAL During the 11-year period from 1954 through 1964, 58 infants less than one year of age were operated upon at the Texas Children’s Hospital for coarctation of the thoracic aorta. The series included 39 males and 19 females. Mox were in the first 3 months of life (Figs. 1A and 1B). The majority of infants (93%) developed symptoms during the first month of life (Fig. 2). The mean age at onset of symptoms was 21 days. Forty (70%) of these infants were brought to the physician because of congestive heart failure, the most common initial symptom complex. Other initial symptoms were cyanosis or dusky color after straining, crying, or feeding; growth failure; feeding problems; irritability and sweating; and incidental murmur. Principal physical findings were strong brachial pulses with imperceptible or nonpalpable femoral pulses. All infants had a significant difference in blood pressure between the upper and lower extremities. The mean arterial pressure was 150170 mm. Hg in the upper extremities and 89/68 mm. Hg in the lower extremities. The mean arterial pressure by flush method was 120 mm. Hg in the arm and 58 mm. Hg in the leg.

Human Cardiac Transplantation

Transplantation of the human heart may provide palliation for patients with end-stage cardiac disease for whom no other treatment is available. Cardiac transplantation was performed in 17 patients undergoing 18 heart transplants. Five early deaths occurred: three from acute cardiac rejection after one week and one each from pre-existing diseases and complications of immunosuppressive therapy. The transplanted heart provided effective cardiac function for each surviving patient. Two late deaths occurred from sepsis. Three patients died between five and nearly seven months after operation from chronic cardiac rejection. Clinical investigations of the role of histocompatibility testing, methods of immunosuppressive therapy, recognition and management of rejection, search for preformed anti-heart antibodies, physiological evaluation of the denervated transplanted heart, and causes of histological changes in the transplanted hearts are continuing. Further clinical trial is needed to determine the role of cardiac transplantation in palliating advanced myocardial insufficiency.

Correction of Double-Outlet Right Ventricle with Pulmonary Stenosis and Aortic Insufficiency in a Jehovah's Witness

Abstract Double-outlet right ventricle is a rare congenital anomaly that may go undetected or be misdiagnosed as tetralogy of Fallot or even simple ventricular septal defect. Cardiac catheterization and selective angiography are necessary for correct diagnosis. Patients with a double-outlet right ventricle and pulmonary stenosis frequently have associated aortic regurgitation as well. A 23-year-old Jehovahs Witness had a double-outlet right ventricle, pulmonary stenosis, aortic regurgitation, and an anomalous anterior descending coronary artery. Total surgical repair was successfully performed using hemodilution techniques for temporary cardiopulmonary bypass and avoiding the use of any blood, in accordance with the patients religious beliefs.

Correction of congenital cardiovascular defects in patients over fifty years of age.

Abstract Congenital cardiovascular defects are not peculiar to childhood. Individual patients with certain anomalies may survive for many years only to experience cardiac decompensation in later life. During the past decade in our institutions fifty-eight patients more than fifty years of age underwent operation for congenital cardiovascular disease. Open heart procedures were necessary in forty-four patients. Seven patients died, resulting in a 12 per cent mortality. The geriatric patients differed from the younger patients in that the elder patients had increased cardiac arrhythmias, degenerative vascular changes, pulmonary emphysema, other acquired diseases, defects permitting hemodynamic compensation for many years, and omission of congenital lesions from diagnostic considerations. Age alone should not be a deterring factor in recommending operative treatment in geriatric patients since congenital defects can be corrected with a mortality comparable to that achieved in younger patients.