Thomas E. Bowen

Open-heart surgery in patients with hematologic disorders

Open-heart surgical correction of congenital or acquired cardiac lesions in patients with hematologic disease, although infrequent,lv8 presents potential management problems during the perioperative period. Intraoperative use of the cardiopulmonary bypass pump causes some unavoidable hemolysis, platelet destruction, acidosis, and protein denaturation. These deleterious effects of cardiopulmonary bypass, when coupled with preexisting hematologic disorders, can result in fatal hemorrhaging unless appropriate preoperative diagnosis and timely therapeutic intervention are accomplished. The perioperative course of this type of patient should be managed by a team consisting of a cardiologist, a hematologist, and a cardiovascular surgeon. We report nine illustrative cases of patients with eight different hematologic disorders who successfully underwent open-heart operations; also presented is a literature review on the subject.

Ultrastructure of A cardiac rhadomyoma

Abstract Electron microscopic study of a cardiac rhabdomyoma removed at open heart operation revealed large rounded or polygonal cells that contained large amounts of monoparticulate glycogen. Myofibrils in these cells were few and located either subjacent to the plasma membranes or radiating from central areas. Leptofibrils and masses of anomalous Z band material were abundant. Shallow tubular sarcolemmal invaginations and elements of free and junctional sarcoplasmic reticulum were associated with the myofibrils. Desmosomes and nexuses were evident in intercellular junctions, which were extensive and randomly distributed throughout the cell surfaces. It is concluded that cardiac rhabdomyomas probably are hamartomas.

Treatment of Refractory Atelectasis

Abstract Atelectasis sometimes fails to respond to the classic conservative forms of therapy. The therapeutic approach to atelectasis with respect to physical laws (Laplaces theorem) and the surfactant system are reviewed. With loss of surfactant activity atelectasis supervenes, necessitating the delivery of a critical opening pressure to overcome the process. Immediate resolution of atelectasis that had been refractory to the usual therapeutic modalities was achieved postoperatively in 15 patients by creating a closed system for selective delivery of critical opening pressure. This is done by fitting the ordinary ventilating bronchoscope with a balloon cuff at its distal end and an anesthesia bag for generation of pressure at the other end. Pressures as high as 100 cm. H 2 O were delivered for as long as 5 seconds with no complications.

Björk-Shiley mitral valvular dehiscence: Documented by radiography, echocardiography, fluoroscopy, and cineangiography

This case report presents combined radiographic, echocardiographic, fluoroscopic, and cineangiographic findings of the dehiscence of a Bjork-Shiley mitral prosthetic valve. The valvular dehiscence was confirmed at surgery. A distinct rounding of the opening phase of the valve was recorded on the echocardiogram. Other clinical evidence, documenting the severe valvular dehiscence, is reported in detail. Non-invasive procedures are therefore invaluable in recording prosthetic valvular dysfunction.

Thoracic traction for median sternotomy dehiscence.

Standard management of median sternotomy dehiscence sometimes fails to achieve lasting reduction and fixation of the sternal halves. An effective method of external thoracic traction that augments internal fixation of the sternal fracture is presented.