Biomedical subjects
Publications and source records attributed to H L Gately.
We report 2 cases of extensive atherosclerosis of the ascending aorta, arch of the aorta, innominate artery, and bilateral carotid arteries treated surgically at St. Vincent and Veterans Administration Medical Centers of Portland, Oregon.
We describe a method for performing the distal anastomosis in replacement of the ascending and the proximal arch of the aorta with specific attention to obtaining accurate length and orientation of the graft. This method reduces the incidence of both anastomotic dehiscence due to tension and obstruction caused by redundant graft.
Coronary artery bypass grafting in patients with calcified aorta presents a formidable problem in terms of cannulation and proximal anastomosis with its attending risks of cerebral and peripheral embolism. Coronary artery bypass grafting without cross-clamping and proximal anastomosis to the aorta at a soft spot under circulatory arrest may be a simple and safe alternative to a difficult clinical problem.
We describe a new technique for aortic anastomosis in the repair of acute dissection. The aorta is buttressed by inverting the adventitia without the use of Teflon or other synthetic materials. This technique provides a safe and secure anastomosis.
Aortic valve replacement (AVR) in the small aortic root has been reported to be associated with obstruction of left ventricular output. This study was designed to investigate the determinants of long-term survival after the implantation of small size prostheses. From September 1961 to December 1993, 2,977 patients underwent isolated aortic valve replacement at our institution. Of these patients, 447 who were older than 18 years received small size (21 mm or less) prostheses. Long-term survival was investigated in the 404 patients who survived operation (more than 30 days) with 92% follow-up completeness (mean +/- deviation 7.1 +/- 6.4; maximum, 31 years). The age was younger than 50 years in 62 patients, 50 to 59 years in 60, 60 to 69 years in 99, 70 to 79 years in 138, and 80 to 94 years in 45; 67% were men. Thirty patients (7%) had previous AVR. Prosthesis usage included early Starr-Edwards models in 130 (32%), current Starr-Edwards (model 1260 since 1969) in 50 (12%), Carpentier-Edwards (porcine) in 113 (28%), and other prostheses in 111 patients (27%). One hundred sixteen patients (26%) had concomitant coronary artery bypass grafting (CABG). Eleven variables (age divided as above, sex, preoperative functional class, body surface area [BSA], small BSA [less than 1.6, 1.7, 1.8, or 1.9 m2], period of operation, previous AVR, type of prosthesis, size of prosthesis, concomitant CABG, and re-replacement) were investigated with regard to the long-term survival by the Kaplan-Meier method, and age, concomitant CABG, and type of prosthesis were significant.(ABSTRACT TRUNCATED AT 250 WORDS)
A 67-year-old female was incidentally found to have an anomalous right coronary artery (RCA) arising from the pulmonary artery during evaluation of her aortic valve disease. The left main, left anterior descending, and circumflex coronary arteries were mildly dilated. Large collaterals from the left filled the RCA retrogradely. During surgery, a circumferential web was found at the ostia of the RCA. The patient underwent an aortic valve replacement, resection of the web, and translocation of the anomalous RCA into the aorta.
Inadequate left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD) was encountered in 10 of 3,076 patients between 1984 and July 1990. The mean number of bypass grafts was 2.9 per patient. All patients with inadequate LIMA grafts were stable preoperatively with normal to moderately reduced left ventricular function. No technical difficulties were encountered during surgery. All patients were weaned off cardiopulmonary bypass with minimal or no inotropic support. Each patient developed myocardial ischemia of the LAD territory and/or circulatory collapse or recurrent ventricular dysrhythmia during the first 24 h postoperatively. Six patients, who were immediately re-operated on and had an additional saphenous graft to the LAD, recovered with no infarction and good functional results. Four patients, who were medically treated, developed myocardial infarction. In cases of refractory circulatory collapse and/or ventricular dysrhythmia, inadequate LIMA flow should be suspected. We recommend urgent re-operation with additional saphenous vein graft to the LAD.
Acute thrombosis of the pulmonary vein following lobectomy or bilobectomy is a rare complication with no standard guideline for diagnosis or management. In this report, we present a case of right upper lobe vein thrombosis following a middle and lower lobectomy. Diagnosis was confirmed by ventilation-perfusion lung scan, pulmonary angiogram, and bronchoscopy. The patient was treated conservatively with no further complications and had a partial recovery of the circulation to the right upper lobe. A review of the literature is also presented along with the experimental data demonstrating the mechanisms of recovery.
A nonautopsy, retrospective analysis of severe motor-vehicle accident trauma can provide valuable information in regard to volume of trauma and quality of care. In a 6-county region surrounding a large metropolitan area trauma care, as reviewed by this method, had deficiencies at all levels of delivery. Patients were taken to the nearest hospital. Hospitals then had not been classified or designated according to capability. Twenty-five per cent of the fatalities and 16% of all outcomes were considered inappropriate for the severity of injury incurred. A regional trauma system with categorization and designation of hospitals providing trauma care would have eliminated or improved these deficiencies, resulting in improved outcomes for a significant percentage of these patients.