Effect of partial oxygen supply on mitochondrial electron transport system during complete cardiac ischemia.

During complete ischemia we assessed myocardial utilization of the small amount of oxygen available. We also determined whether blood cardioplegia has any advantage over crystalloid cardioplegia in this setting. Patients with preserved left ventricular myocardial function and without anterolateral wall infarct or aneurysm were included to the study. Intermittent cold blood and crystalloid cardioplegia were used in 10 patients (group BC) and 9 patients (group CC), respectively. From myocardial biopsies, obtained before and after ischemia, complete electron transport system (ETS) enzyme activities (NDH, SDH, NCCR, SCCR, and COX) and lactate content were analyzed. Biochemical and hemodynamic analyses also were done. Myocardial and blood temperatures were monitored. Ischemic time was longer in group CC (p < 0.05). There were no important differences in biochemical and hemodynamic variables between the two groups. In addition, there was no difference in NDH and SDH activities as well as COX/SCCR and COX/RS-NCCR ratios between the two groups before and after ischemia. After Ischemia, RS-NCCR in group CC and SCCR and COX activities in both groups were lower than the control. For all enzymes, activity change ratios were not different between groups. Myocardial lactate content was increased in both groups after ischemia. However, the increase in group BC was less (p < 0.01). Based on our findings, we believe that the superiority of blood cardioplegia over crystalloid cardioplegia does not depend on oxygen content, but on other factors such as buffering and free oxygen radical scavenger effects among others. However, with the warm and continuous blood cardioplegia technique, oxygen content might be more important.

Ultrasonic decalcification of calcified valve and annulus during heart valve replacement.

A heavily calcified heart valve annulus increases the likelihood of sequelae after prosthetic valve replacement. Such sequelae include cerebral embolism, paravalvular leakage, valvular dysfunction, rhythm disturbance, hemolysis, communication of the heart chambers, and rupture of the posterior wall of the left ventricle. From January 1991 through June 1994, we performed heart valve replacement on 30 patients, using an ultrasonic surgical aspirator to remove calcific deposits. We placed aortic valve prostheses in 12 patients, mitral valve prostheses in 13 patients, and both aortic and mitral prostheses in 5 patients, after ultrasonic débridement of calcified annuli. All patients were re-examined 6 months after surgery: echocardiographic study showed no paravalvular leakage or valve-related complications. In our experience, ultrasonic decalcification of the annulus is superior to traditional methods. We advocate the use of ultrasonic débridement as an adjunctive tool in calcified heart valve replacement.

Echinococcal cyst of the interventricular septum with right ventricular protrusion.

Although echinococcosis (echinococcal hydatidosis) is common in sheep-raising countries such as Turkey, cardiac involvement is rare; the presence of a hydatid cyst in the interventricular septum is rarer still. We report a case of hydatid cyst of the interventricular septum that was first revealed by 2-dimensional echocardiography and then confirmed by right ventricular angiography. The cyst was removed surgically under cardiopulmonary bypass. Within the context of the medical literature concerning this rare lesion, we discuss this case and 10 other cases of cardiac hydatidosis, previously unreported in the world literature, that we have treated from January 1967 through January 1987.

Surgical treatment for the type II and III truncus: complete division of the truncal root with primary repair using absorbable suture.

A simplified technique for repair of type II and III truncus arteriosus applicable in neonates is described. The method is particularly useful in those patients in whom the pulmonary artery orifices arise from the posterior wall of the truncal root. Advances in two-dimensional echocardiography have provided an accurate means of determining the exact anatomy preoperatively. At operation, isolation of the pulmonary orifices on a button of posterior truncal wall is accomplished by complete division of the main truncal root. Primary closure of the new ascending aorta is made possible by extensive mobilization of the aorta and pulmonary orifices. Early postoperative follow-up indicates that the use of a new absorbable suture for primary repair of the aortic root allows for normal growth.

Rupture of the thoracic aorta: emergency treatment and management of chronic aneurysms.

Between 1957 and 1983, 58 patients were treated in our institution for traumatic rupture of the thoracic aorta. Seven patients had acute ruptures and 51 had traumatic aneurysms. Surgical correction of the lesion was obtained by means of left femoral artery bypass in 17 patients, femoral artery-femoral vein bypass in five patients, and external shunt in three patients. After 1975, simple aortic cross-clamping was used in 33 patients. There was one death 1 week after a procedure for ventricular fibrillation. Paraplegia occurred in two patients, and both cases were correlated with hypotensive episodes. From this experience and that of others, it was determined that an aortogram should be performed in all patients suspected of having highspeed deceleration trauma, and that such patients should undergo surgical repair as soon as possible after diagnosis.

Transverse sternotomy for concomitant cardiac and pulmonary surgery.

We describe a simplified surgical procedure whereby pulmonary or other intrathoracic operations can be safely and easily performed in conjunction with cardiopulmonary bypass for indicated cardiac procedures. Transsternal bilateral anterior thoracotomy can provide excellent exposure in cases requiring concomitant attention to cardiac and pulmonary pathology.