PubMed Health⌕ Search

Biomedical subjects

E R Kyger

Publications and source records attributed to E R Kyger.

At least 19 recordsLinked to original sources
PubMed1986

A method for improved exposure of the mitral valve: cannulation of innominate vein and division of superior vena cava for extended left atriotomy in mitral valve operations.

A method of improved exposure of the mitral valve and subvalvular apparatus is described. Cannulation of the left innominate vein and division of the superior vena cava allow excellent exposure of the mitral valve and subvalvular apparatus. This method is particularly useful in patients with a small left atrium or deep chest.

Brachiocephalic Veins↗
PubMed1978

Sinus venosus atrial septal defect: early and late results following closure in 109 patients.

The clinical course of 109 patients who underwent closure of a sinus venosus atrial septal defect is reviewed, with emphasis on the incidence, type, and severity of arrhythmias before and after operation. There were no operative deaths and only 1 late death. No instances of obstruction of the superior vena cava were detected clinically. One patient had a probable hemorrhagic pulmonary infarction that cleared; another may have a persistent left-to-right shunt. Excellent results were achieved in 72% of the patients, good results in 5%, and poor results in 3%. The type of arrhythmia, both before and after operation, varied with the age of the patient: younger patients had bradyarrhythmias, and older patients had tachyarrhythmias. Ten patients experienced persistent new arrhythmias postoperatively, but none were disabled, required a pacemaker, or died. The arrhythmias in all severely symptomatic patients were supraventricular tachycardias that had occurred before operation. Although functional classification after operation was clearly related to age at the time of the procedure (with younger patients having the best functional results), 19 of 21 patients over age 40 were noticeably improved after surgical closure of the sinus venosus atrial septal defect.

Adolescent↗
PubMed1977

Postoperative lobar torsion and gangrene.

Following left upper lobectomy for a pulmonary nodule, complete 180-degree torsion of the left lower lobe with haemorrhagic infarction occurred. Despite re-exploration within 24 hours of the initial procedure the patient died. Postoperative torsion requires early diagnosis and resection of the gangrenous tissue.

Aged↗
PubMed1977

Reoperation following direct myocardial revascularization.

Among the 5507 patients who underwent aortocoronary bypass between October 1969 and June 1975, 41 patients (0.007%) developed recurrent angina and required reoperation. The factors necessitating reoperation were graft thrombosis in 10 patients (24%), progression of disease in 12 (29%), graft thrombosis and critical unbypassed lesions in one (2.4%), graft failure and progression of disease in in 12 (29%), graft failure and critical unbypassed lesions in four (10%), and all three factors in two patients (4.8%). Among 10 patients with 50% lesions present but not bypassed at the initial operation, nine of these lesions progressed to significant stenosis and in five patients this was the sole reason for reoperation. At the second operation, total revascularization was achieved in 32 patients (78%). One patient (2%) experienced a perioperative myocardial infarction and one patient (2%) died. This study emphasizes the importance of "complete" revascularization at initial operation, the concept that arteries with 50% obstruction should be routinely bypassed, and the conclusion that risks of reoperation are comparable with those of initial aortocoronary bypass, but that long-term relief of angina is less favorable.

Adult↗
PubMed1976

Aortocoronary artery bypass: present indications and risk factors.

From 1969 through 1974, a total of 4,522 patients were operated on for coronary artery occlusive disease. This article is an in-depth analysis of a consecutive series of 275 of these patients, operated on during 1974. The mortality was 1.8% and perioperative myocardial infarction occurred in 3.6%. On analysis of risk factors, it was found that 24% of the patients were over the age of 60; 57% had some degree of left ventricular dysfunction; 9% had generalized hypokinesis; 24% were New York Heart Association functional class IV; 13% had left main coronary artery stenosis; and 11% had preinfarction angina. On analysis of the early mortality, the limiting factor was diffuse coronary arteriosclerosis combined with poor ventricular function. This resulted in inadequate or incomplete myocardial revascularization. Since these two risk factors are usually predictable, coronary artery bypass can be recommended not only for patients with intractable angina, but also for patients with impaired left ventricular function associated with angina, and in patients without angina who have a positive stress electrocardiogram.

Coronary Artery Bypass↗
PubMed1976

Treatment of severe coronary artery disease with quadruple and quintuple saphenous vein grafts. Review of 100 consecutive patients.

In order to establish the anatomic criteria, the functional results, and the safety of complete myocardial revascularization for severe coronary artery disease, 100 consecutive patients who received four or five saphenous-vein grafts were analyzed. Ages ranged from 37 to 75 years (mean, 56 years). Men predominated by a ratio of 12:1. As an indication of the severity of multiple-vessel disease, 28 percent were in functional class 4, and left ventricular function was classified as good in 47 percent, as fair in 44 percent, and as poor in 8 percent. Coronary arterial scores ranged from 9 to 15 (average, 12.2). Fourteen patients had significant left main coronary arterial obstruction. All 100 patients had grafts to the left anterior descending coronary artery; 96 to the right coronary artery; 94 to the obtuse marginal branch of the circumflex; 78 to a diagonal branch of the left anterior descending; and 27 to the distal circumflex. Operative mortality was 5 percent. Nonfatal perioperative myocardial infarction occurred in 10 percent, and only one of these had low cardiac output. Follow-up from 5 to 23 months showed 95 percent of the patients to be improved, with 70 percent free of angina. Two late deaths occurred, for an overall mortality of 7 percent.

Adult↗
PubMed1976

Intraventricular repair of transposition complexes with ventricular septal defect.

Repair of transposition of the great arteries by the technique developed by Mustard is the method routinely used for correction of such anomalies. Intraventricular repair of transposition complexes associated with a large ventricular septal defect can prevent some of the limitations and late complications of the intra-atrial operation. A technique is described of intraventricular repair of an unusual Taussig-Bing type of anomaly with a pericardial patch as a baffle to channel left ventricular outflow to the aorta and right ventricular outflow to the pulmonary artery.

Adolescent↗
PubMed1976

Surgical treatment of aneurysms of the ascending aorta.

From January 1970 to April 1975, 132 patients underwent surgical repair of aneurysms of the ascending aorta at this institution, 24 of whom had acute dissections. In almost all cases the ascending aorta was replaced with a Dacron tube graft. Aortic valve replacement was performed in 100 patients and 23 patients underwent coronary artery revision or bypass. Fifteen hospital deaths occurred. Although chronic or nondissecting aneurysms may be dealt with on an elective basis, acute dissections require prompt surgical intervention. Symptomatology and radiographic findings are such that angiography may not be necessary to establish the diagnosis. Clinical evidence of aortic regurgitation in an acute dissecting aneurysm is sufficient indication for immediate operation. Improvements in surgical techniques, fabric grafts, and valve prostheses have all contributed to the successful surgical treatment of aneurysms of the ascending aorta.

Adult↗
PubMed1975

Dissecting aneurysm of the descending aorta. Improved surgical results in 91 patients.

Dissecting aneurysm of the descending thoraic aorta (type iii) is a specific disease process whose pathogenesis, pathologic description, surgical treatment, and prognosis is different from dissections of the ascending arota (types l and ll). From 1964 through 1974, 91 patients underwent surgical correction of type iii dissection. The operative mortality was 21% and late mortality, up to ten years follow-up, was 13%. During the past four years, operative mortality has dropped to 6.5%. Mortality was determined by extent of the aneurysm and underlying cardiac disease. Antihypertensive and negative ionotropic drugs have not been used as definitive treatment but as adjuncts in perioperative support. Based on our present mortality of 6.5%, with no late mortality, we urge early surgical treatment of acute and chronic dissecting aneurysms of the descending thoracic aorta before extension, rupture, or massive enlargement of the aneurysm occurs.

Adult↗
PubMed1975

Long-term survival following coronary artery bypass. Analysis of 4,522 consecutive patients.

A consecutive series of 4,522 patients who received aortocoronary bypass (ACB) from October 1969 through December 1974 has been analyzed with respect to cumulative (actuarial) survival, cause of late death, and late postoperative complications. Through December 1973, 2,676 patients received ACB alone. Cumulative survival was 85.9% for five years. Late cumulative mortality averaged 2.7% per year. Causes of death were myocardial in origin in only 60.4% of the patients. Late complications of nonfatal myocardial infarction occurred in 4.1% of the patients, and congestive heart failure occurred in 10.2%. However, preoperative congestive heart failure was present in 25% of these subjects. Mortality in 1974 was 3.4% in patients who underwent ACB only, and 4.2% for all patients who received ACB procedures (1,478 patients). Comparison to previous medical data makes it appear that this surgery increased the actuarial survival over long-term follow-up.

Adult↗
PubMed1975

Conduit reconstruction of right ventricular outflow tract. Experience with 17 patients.

Evaluation was made of 17 patients who underwent conduit reconstruction of the right ventricular outflow tract (for anomalies other than truncus arteriosus) at the Texas Heart Institute between December, 1965, and June, 1974. Fifteen patients survived the operation and have shown substantial clinical improvement. Several different conduits were used, principally an allograft aorta with the aortic valve and mitral leaflet attached, a woven Dacron prosthesis containing a xenograft (porcine) valve, and a valveless Dacron tube graft. Allograft conduits are sometimes difficult to procure and keep and tend to calcify with passage of time. Woven Dacron prostheses are favored because they are readily available in a wide range of sizes. We believe it is not necessary for the conduit to contain a valve unless the patient has pulmonary hypertension, in which case we use a xenograft (porcine) valve because this valve does not require the long-term use of anticoagulants, a difficult regimen to manage in children. The largest possible prosthesis must be used; otherwise right ventricular hypertension will persist. Indications for conduit reconstruction include anomalous coronary arteries crossing the right ventricular outflow tract, discontinuity of the pulmonary arteries, and pulmonary atresia with a ventricular septal defect. Our current method of managing pulmonary atresia with ventricular septal defect (pseudotruncus arteriosus) includes palliative shunting to relieve hypoxemia during infancy and to permit full development of the pulmonary arteries for eventual total correction at a more optimal age when a larger conduit may be used.

Adolescent↗
PubMed1975

Surgical palliation of tricuspid atresia.

In the 20-year period ending December 31, 1973 we operated on 105 patients for palliation of tricuspid atresia (TA) with reduced pulmonary blood flow. Pott's anastomosis (85), Blalock-Taussig anastomosis (19), intrapericardial aorta (Ao)-to-right pulmonary artery (RPA) (18), Glenn procedure (3) and miscellaneous shunts (2) have been used. Of patients undergoing operation more than 15 years ago, 45% (9/20) are still alive. The over-all operative mortality was 9%. It was highest in patients less than one month of age (7/23, 30%). There were no operative deaths in patients older than 12 months. The median age at first operation for the entire series was five months. Our results indicate the Pott's anastomosis and Ao-to-RPA anastomosis are superior to the Blalock-Taussig anastomosis (BT) for palliation of TA. Of patients surviving BT, 69% (11/16) required reoperation, compared to 22% (17/78) surviving Pott's anastomosis and 13% (2/16) surviving Ao-to-RPA shunts. All three patients undergoing Glenn procedures (superior vena cava-to-RPA anastomosis) required reoperation or died without significant benefit. Ballon atrial septosomy and Pott's anastomosis appear to be indicated for infants less than six months of age, and Ao-to-RPA shunt with simultaneous atrial septectomy (if indicated) for older children.

Adolescent↗