Thomas J. Tarnay

An Alternative Method for Repair of Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava

The surgical management of 15 patients with partial anomalous pulmonary venous connection (PAPVC) to the high superior vena cava (SVC) is described. This new technique redirects the anomalous pulmonary venous flow into the left atrium through the cardiac end of the SVC, transected and oversewn above the anomalous pulmonary vein or veins, by coaptation of the atrial septal defect (or of the surgically created septal defect in patients with an intact atrial septum) to the intracardiac orifice of the SVC. Normal SVC-right atrial flow is reconstituted by atriocavoplasty to the cephalad portion of the transected SVC. A 31-year-old woman with severe pulmonary hypertension died early in the series; this was the only death. Surviving patients enjoy full activity. Except for one symptomatic SVC obstruction due to technical error (since relieved), this technique has achieved total correction of these congenital defects with marked reduction in the undesirable postoperative sequelae often associated with other methods of repair.

The surgical experience and a one to sixteen year follow-up of 277 abdominal aortic aneurysms

Abstract Between 1960 and 1975, 277 patients with abdominal aortic aneurysms were operated on at the West Virginia University Medical Center. One hundred ninety-three aneurysms were intact lesions and eighty-four were ruptured. Operative mortality for elective resection was 8.8 per cent and for ruptured aneurysms 66.7 per cent. Mortality associated with ruptured abdominal aortic aneurysms was best related to shock and advanced age. Ninety-nine per cent of patients underwent long-term follow-up which ranged from thirteen months to thirteen years and four months (mean, 4 years and 9 months). At present 61 per cent of patients surviving elective resection and 50 per cent of those surviving operation for ruptured aneurysm are alive.

Upper limb ischemia resulting from arterial thromboembolism

Acute ischemia of the upper limb is commonly caused by trauma and embolic arterial occlusion. However, primary atherosclerotic thrombosis is found infrequently and concern regarding its incidence, recognition, and treatment prompted a review of our clinical experience. Of 36 patients with acute ischemia of the upper limb, 17 (47.2 per cent) had embolic occlusion, 9 (25 per cent) iatrogenic thrombosis in the brachial artery, and 10 (27.8 per cent) primary arterial thrombosis. Of the total group, noncardiac arterial emboli (two patients) and primary atherosclerotic thrombosis (six patients) accounted for 8 of 36 (22.2 per cent) ischemic limbs. Including 2 additional patients who had atherosclerotic thrombosis associated with trauma, the total number represented 10 of 36 (27.8 per cent). An aggressive approach to the undiagnosed patient with acute ischemia of the upper limb is warranted, including the use of arteriography in most cases. In patients with iatrogenic thrombosis in the brachial artery, we believe that the routine use of intraoperative arteriograms may improve the operative results.

The use of the isolated annulus technique for the evaluation of intracardiac thrombosis

Abstract In 35 dogs, the “isolated annulus” technique was used to assess clotting in the tricuspid and mitral areas. By means of cardiopulmonary bypass, this prosthesis was fixed to the atrial or ventricular aspect of the respective valve annulus with preservation of leaflet integrity. In addition, annular placements were performed with complete tricuspid valve excision. Simultaneous bilateral insertions were undertaken in two animals to confirm the pronounced difference in clot propensity from one valve area to the other. The technique proved useful in evaluating clot formation. Constant blood motion or shielding in some cases diminished thrombosis. Under the conditions of the experiment, the mitral valve region was more clot-prone than the tricuspid zone. Prosthetic evaluation may be carried out in the tricuspid area with advantage, for reasons of technique, tolerance to valvular insufficiency, and convenience of counting emboli trapped by the lungs.

Closed chest cardiopulmonary bypass in deep hypothermia: The use of the pulmonary vasculature as left heart vent

Abstract In the in situ arrested perfused heart left ventricular overdistention does not invariably occur. This has been shown to be the consequence of pulmonary valvular insufficiency permitting decompression by means of reverse flow from the left atrium through the pulmonary capillary bed to the right atrium. The clinical successes of closed-chest cardiopulmonary bypass in humans could in part be explained on this basis. A percutaneous method for rendering the pulmonary valve open was devised. The variations and limitations of extracorporeal circulation in closed-chest hypothermic dogs was evaluated in reference to left atrial pressure. The studies included the role of perfusion pressure and the effects of vasoactive drugs.