Thirty years survival without anticoagulation after aortic valve replacement with a Björk-Shiley prosthesis.

Anticoagulation is mandatory in all mechanical valve replacements and, when well-managed, permits both embolism and valve thrombosis to be kept at low levels. Here, we report the case of a male patient who has survived 30 years without anticoagulation following aortic valve replacement with the Björk-Shiley prosthesis.

Beneficial effect of BioGlue surgical adhesive in repair of iatrogenic aortic dissection.

We report the benefits of using BioGlue surgical adhesive to repair an iatrogenic aortic rupture and dissection that resulted from cannulation of the ascending aorta during open-heart surgery.

Successful reoperation after Batista partial left ventriculectomy demonstrates patient's hemodynamic recovery.

We report an emergency reoperation due to mechanical valve thrombosis following a Batista partial left ventriculectomy and mitral valve replacement with a St. Jude prosthesis. We re-replaced the valve with an identical St. Jude device and counseled the patient on the importance of routine anticoagulation. To the best of our knowledge, this is the 1st reported case of a patient who has survived cardiac reoperation after a Batista partial left ventriculectomy. Moreover, our report demonstrates that the hemodynamic recovery achieved after a Batista operation can enable a patient to tolerate reoperation on cardiopulmonary bypass, even in the presence of acute pulmonary edema and cardiogenic shock.

Effects of dynamic cardiomyoplasty on right ventricular function.

This study was planned to document the right ventricular function immediately after cardiomyoplasty. Right ventricular volumes were calculated with the use of fast response thermistor. Right ventricular end-diastolic volume was reduced from 91 +/- 8 mL/M2 to 75 +/- 7 mL/M2 (p < 0.05) and right ventricular end-systolic volumes increased from 51 +/- 5 mL/M2 to 59 +/- 4 mL/M2 24 hours after the operation. Central venous pressure was raised from 2 +/- 1 to 9 +/- 3 mm H2O. These changes were interpreted as impairment of the right ventricular diastolic function. Cardiac index raised from 1.8 +/- 0.5 L/M2 per minute to 2.7 +/- 0.3 L/m2 per minute within a period of 7 days (p < 0.05). As a result of this study, we concluded that preoperatively normal right ventricular function deteriorates after the cardiomyoplasty. In the intensive care unit volume balance must be carefully monitored to avoid creating right ventricular dysfunction.

Beneficial effects of prostacyclin treatment on reperfusion of the myocardium.

A total of 20 patients with coronary artery disease were studied in order to assess the benefits of prostacyclin administration on reperfusion of the ischaemic myocardium after cardiopulmonary bypass. Ten received prostacyclin (25 ng/kg per min) while ten were untreated controls. There was no difference between groups with regard to age, preoperative ejection fraction and aortic cross-clamping times. There were no in-hospital deaths in either group. The administration of prostacyclin significantly altered the metabolic side effects of reperfusion followed by hypothermic cardioplegic arrest. Myocardial oxygen consumption after cardiopulmonary bypass was significantly higher in the prostacyclin-treated group than in controls (18.5 ml versus 13 ml; P < 0.01). Prostacyclin treatment significantly reduced the leucocyte activity: leukotriene B4 concentrations were 58 pmol/l in prostacyclin-treated patients compared with 93 pmol/l in controls (P < 0.01). Such recovery of metabolic status during reperfusion resulted in better haemodynamic function in patients receiving prostacyclin.

Coronary sinus retroperfusion combined with intraaortic balloon pumping to perfuse the acutely ischemic myocardium.

This study was planned to show the effect of retroperfusion and intraaortic balloon pumping (IABP) on myocardial hemodynamic recovery. Twelve dogs entered this study. Half of them received IABP and coronary sinus retroperfusion (CSPR) combination (Group II) and the remaining received IABP alone (Group I). Left anterior descending artery was occluded for a period of three hours. 15 minutes after occlusion IABP and IABP + CSRP were initiated. The average cardiac output was 1.41 +/- 0.18 L/min in the group I and 1.72 +/- 0.24 L/min in the group II (p < 0.03) after 3 hours of occlusion. Mean arterial pressure was 82.1 +/- 4.8 mmHg in the group I and 89.7 +/- 2.6 mmHg in the group II (p < 0.03). On the basis of this study it was concluded that CSRP + IABP could be an alternative treatment to IABP alone during the acutely developing ischemia.

The beneficial effects of aminophylline administration on heparin reversal with protamine.

The aim of this study was to demonstrate the beneficial effects of aminophylline on protamine cardiotoxicity. Thirty-four patients were examined, 17 of whom received aminophylline 3 mg/kg before protamine administration, being the study group, while the other 17, being the control group, did not. All cardiac output and biochemical measurements were evaluated 5 min following protamine administration. The cAMP level was 43.4 +/- 3.51 pmol/ml in the study group and 18.7 +/- 2.98 in the control group (P < 0.0001) before protamine administration, while the oxygen extraction rate decreased from 49% to 44 +/- 2% in the control group, and from 51.2% to 47 +/- 3% in the study group (P < 0.03). The N-acetyl glucosaminidase value was 16.9 +/- 13.9 pmol/ml in the study group and 27.8 +/- 1.47 pmol/ml in the control group (P < 0.01), and myocardial lactate extraction was -0.20 +/- 0.03 in the control group and -0.07 +/- 0.07 in the study group (P < 0.001). The left ventricular stroke work index was 28.6 +/- 3.14 gm/m2 in the control group and 37 +/- 6.77 gm/m2 in the study group (P < 0.002). The findings of this study led us to conclude that the adverse effects of heparin neutralization using protamine can be relieved by aminophylline.

Hypertrophic obstructive cardiomyopathy in combination with anomalous insertion of papillary muscle directly into anterior mitral leaflet and "sawfish" systolic narrowing of the left anterior descending coronary artery.

This report describes an unusual case of subaortic stenosis in which hypertrophic obstructive cardiomyopathy was found in combination with both anomalous insertion of papillary muscle directly into the anterior mitral leaflet and "sawfish" systolic narrowing of the left anterior descending coronary artery. Definitive diagnosis was made on operation. We freed the left anterior descending coronary artery by incising the muscular bridge, resected both papillary muscles, and replaced the mitral valve.

Warm blood cardioplegia: ultrastructural and hemodynamic study.

Forty patients with coronary artery disease were included in this study. Half of them received cold crystalloid and cold blood cardioplegia (group 1), and half received normothermic blood cardioplegia (group 2). In group 1, left ventricular stroke work index was 24 +/- 3 g.m/m2 1 hour after the operation, 29 +/- 8 g.m/m2 12 hours after the operation, and 33 +/- 6 g.m/m2 24 hours after the operation. In group 2, left ventricular stroke work index was 37 +/- 4 g.m/m2 1 hour after the operation, 37 +/- 4 g.m/m2 12 hours after the operation, and 44 +/- 7 g.m/m2 24 hours after the operation. Myocardial oxygen extraction 20 minutes after the termination of cardiopulmonary bypass was 0.28 +/- 0.03 in group 1 and 0.44 +/- 0.08 in group 2. Myocardial lactate extraction at the same time was -0.09 +/- 0.02 in patients receiving cold blood cardioplegia and 0.17 +/- 0.07 in patients receiving normothermic blood cardioplegia. Electron microscopic study revealed no calcium accumulation in the mitochondria in group 2 patients, whereas calcium accumulation was present in the other group.

Effects of prostacyclin on spinal cord ischemia: an experimental study.

BACKGROUND: Paraplegia after thoracic aortic aneurysm has an incidence of 2.2% to 24%. This study was planned to show the beneficial effects of prostacyclin on spinal cord ischemia. METHODS: Twelve rabbits underwent 30 minutes of aortic occlusion. Six rabbits received prostacyclin, whereas the remaining rabbits did not. Prostacyclin administration was started with a rate of 5 ng/kg/min 5 minutes before aortic occlusion. This dosage was increased to 25 ng/kg/min during aortic occlusion. Prostacyclin administration after aortic occlusion was maintained for a period of 5 minutes. During this period, prostacyclin dosage was 5 ng/kg/min. RESULTS: One rabbit in the prostacyclin group and five rabbits in the control group were paraplegic. Arterial pressure proximal to the clamp was 65 +/- 7 mm Hg before aortic occlusion and 78 +/- 10 mm Hg during aortic occlusion in the control group and 68 +/- 12 mm Hg before aortic occlusion and 65 +/- 6 mm Hg during aortic occlusion in the prostacyclin group. Arterial pressure distal to the clamp was 11 +/- 4 mm Hg during aortic occlusion in the control group and 18 +/- 5 mm Hg during aortic occlusion in the prostacyclin group (p = 0.02). CONCLUSIONS: Intravenous prostacyclin reduced the neurologic injury caused by spinal cord ischemia and reperfusion after 30 minutes of aortic occlusion in the rabbit model.