Complete obstruction of the left main coronary artery associated with congenital pulmonary valvular stenosis.

The surgical treatment of the completely obstructed left main coronary artery is aortocoronary saphenous-vein bypass to the left coronary artery system. Without surgical intervention, this lesion has an exceedingly poor prognosis. This report describes a patient with atherosclerotic obstruction of the left main coronary artery and congenital pulmonary valvular stenosis, an unusual combination of lesions not previously documented together. The patient remains asymptomatic 22 months after aortocoronary saphenous-vein bypass and pulmonary valvotomy.

Postoperative chest wound infections in patients requiring coronary bypass. A controlled study evaluating prophylactic antibiotics.

A controlled study investigating clean chest wound infections in 904 patients undergoing myocardial revascularization was performed. Four hundred fifty-one patients received systemic antibiotics before and after the operation, and 453 patients received no prophylactic systemic antibiotics. The infection rate was 1.10 per cent and 1.76 per cent, respectively, indicating no statistical difference between the two groups. Preoperative skin preparation and subsequent local antibiotic wound irrigation may be the most important factors in preventing clean wound infection.

Coronary arterial bypass operations without antibiotic coverage.

In this study, six of 693 consecutive patients in 29 months who underwent only myocardial revascularization, without prophylactic systemic therapy with antibiotics, experienced infection of a clean wound. This incidence of infection (0.86 percent) in such patients is the lowest reported in the literature. Prevention of infection of clean mediastinal wounds in patients undergoing only myocardial revascularization is related to preoperative preparation of the skin and local antibiotic irrigation of the wound, rather than to prophylactic systemic therapy with antibiotics.

Excessive strut wear allowing ball-poppet embolization in a DeBakey-Surgitool aortic valve prosthesis.

Excessive cage strut wear allowing ball-poppet embolization caused the sudden death of a 47 year old lady in whom a DeBakey-Surgitool aortic prosthesis had been implanted nine years earlier. Patients with this type of prosthesis should have periodic valvular cine fluoroscopy with image intensification to allow visualization of significant strut wear or fracture, and appropriate prosthetic valve replacement.

A rapid, secure method of sternal closure.

In 1977 Robicsek(1) described a method of sternal closure that involved a double wire on each side of the sternum, with appropriate circumferential wires. Shortly thereafter, we modified that procedure, as shown in Figure 1. Only one wire is used on each side of the sternum, and fewer circumferential wires are needed. This type of sternal closure can be performed as rapidly as the usual closure of simple circumferential wire sutures and is much more secure, because the circumferential wires cannot cut through the parasternal wire. After using this method in about 100 patients with either poor sternal bone or chronic lung disease, we have encountered no subsequent sternal separation.

Bilateral renal vein and inferior vena cava thrombosis with nephrotic syndrome treated by thrombectomy: case report with 3-year followup.

A previously healthy 19-year-old woman taking anovulatory medication presented with symptoms of the nephrotic syndrome and lupus erythematosus. Diagnosis of inferior vena cava and bilateral renal vein thrombosis was made angiographically. The patient was treated successfully by thrombectomy and anticoagulation, and remains well 3 years later. Laboratory data indicate normal renal function and only mild proteinuria. This is the longest followup of a patient with this entity reported in the literature.