Does coronary artery bypass surgery prolong life? Results of a five-year followup study.
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Biomedical subjects
Publications and source records attributed to G C Dacumos.
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Although the occurrence of an arterial embolus is usually a cataclysmic event prompting emergency presentationand early diagnosis, we have managed 22 patients who presented more than 48 hours after the onset of symptoms. The diagnosis was apparent in only six patients. The remainder had subacute limb ischemia, and arteriography was used to help delineate the diagnosis in 14 of these patients. In most instances arteriograms were atypical of chronic occlusive disease, rather than diagnostic of arterial emboli. Embolectomy was performed a mean of 13 days after the onset of symptoms, with retrieval of thromboembolic material in all instances. Two patients died (mortality rate of 9%), and the limb salvage rate for the 25 limbs explored was 88%. Among 22 lower extremity embolectomies, foot pulses were restored in 13 patients (59%), and four patients (18%) had viable extremities without pulses. Adjunctive arterial reconstruction was required in three patients.
A technique is presented to eliminate the residual gradient more completely after removing the main pulmonary band at the time of primary repair of ventricular septal defect. The band and underlying pulmonary artery are circumferentially excised, except for a small posterior part, and pulmonary artery is reanastomosed.
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Tweleve patients with the complete form of persistent atrioventricular (AV) canal were operated upon at the University of Wisconsin between May, 1972, and November, 1975. The technique originally described by Rastelli and his associates was used. All 12 patients are asymptomatic and well, with no hospital or late deaths. Postoperative cardiac catheterization in 8 patients showed a return to near normal dynamics, with minimal residual mitral insufficiency. Half of these children had type A and half type C malformations; both types could be repaired without the need for valve replacement. Since 3 of these patients were less than 2 years of age, we now feel that complete repair of the AV canal can be undertaken in children between 12 and 18 months of age for optimal management.
From 1971 to 1975, 17 consecutive patients aged 1 day to 4 years underwent Blalock-Taussig shunts for severe tetralogy of Fallot. Three infants were under 6 weeks of age and 7 (41%) under 1 year. There were no hospital deaths. Modification of the shunt technique adapts it to any size infant. The subclavian artery is divided at its major branches and the end spatulated to enlarge it. The artery is occluded while the shunt is constructed. No intraoperative complications were encountered; all patients have a shunt murmur with no early or late closure. No child has had heart failure or hypoxic spells. Flows measured at operation equaled one-quarter to one-half of the child's normal cardiac output. Ligation of the shunt at subsequent repair is uncomplicated. One child died three years later at correction from causes unrelated to the shunt. With appropriate modifications in technique, the Blalock-Taussig shunt is the operation of choice, at any age, for palliation of severe tetralogy of Fallot.
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This study evaluated the mixed leukocyte culture (MLC) technique to quantitate differences in kidney allograft survival between unrelated animals. Each of five beagles received two heterotopic kidney allografts, one from a mongrel dog showing high MLC stimulation and one from a second mongrel dog showing a low MLC stimulation. Low or high stimulators were defined by the amount of radioactive thymidine incorporated by lymphocytes when the recipient was tested against a number of potential donors in one way MLC TESTS. Low and high stimulators usually differed by a factor of up to ten in the stimulation index. Recipients were given a standard treatment of asathioprine and prednisone. No special treatment was given for rejection episodes. Creatine clearances and periodic biopsies were used to determine rejection. Creatine clearances and biopsies showed the high stimulating kidneys to be rejected completely by the end of 2 weeks in all animals. All of the low stimulating kidneys maintained normal function for 3 weeks and then developed progressive deterioration and rejection over the next 3 to 6 weeks. These studies suggest that quantitation of the MLC may be predictive of kidney allograft survival in unrelated dogs.
Femoral artery grafts were anastomosed end-to-end to the left internal mammary artery proximally and end-to-side to the circumflex coronary artery distally in 21 adult mongrel dogs. Fourteen dogs received allografts and seven received autografts. All autografts studied from one to 11 months were patent. Eleven of the fourteen homografts studied from one to thirteen months were occluded. Histologically, extensive interstitial edema and leukocytic infiltration with subintimal fibrosis and thrombotic occlusion were seen. This study shows that fresh arterial autografts have excellent long term patency, but that most arterial allografts have early thrombotic occlusion.