During the first two years of clinical cardiac transplantation 20 patients had the operation at Stanford. Operative techniques were successfully translated from extensive laboratory experience to clinical application. Operative indications and contraindications were defined. The diagnosis and treatment of acute cardiac rejection were successful in most cases. Infection, unremitting acute rejection, and chronic rejection remain the major problems in clinical cardiac transplantation. In 20 patients operated upon, survival at six months was 42 percent. At one year it was 35 percent and at 18 months still 35 percent. These figures contrast with those for patients who were accepted as transplantation recipients but died before a suitable donor became available. In this group the 30-day survival was 50 percent, and the 90-day survival was zero. For patients with severe myocardial insufficiency for which alternative methods of therapy are not available, cardiac transplantation results in significantly increased survival and offers an opportunity for return to productive activity.

Adult↗

PubMed1970

Subclavian-axillary vein thrombosis following implantation of a pacemaker catheter in the internal jugular vein.

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Aged↗

PubMedDate not supplied

Malignant wide complex tachycardia after adenosine administration to a postoperative pediatric patient with congenital heart disease.

Adenosine has become the treatment of choice for paroxysmal supraventricular tachycardia because of its safety and efficacy. There have been no reports of malignant arrhythmias occurring after adenosine administration. This case report presents the occurrence of a malignant wide complex tachycardia after intravenous adenosine administration in a 10-year-old boy 2 days after a Fontan procedure. Thus the administration of adenosine in a critically ill postoperative patient can have morbidity or potential mortality and must be monitored closely.

Adenosine↗

PubMedDate not supplied

Juxtaposition of the atrial appendages: a clinical series of 22 patients.

Because the outcome of a large clinical series of patients with juxtaposition of the atrial appendages (JAA) has not previously been reported, a retrospective study was performed on patients diagnosed with JAA at a tertiary medical center. Patients with JAA were identified through a computerized database search, and echocardiograms and medical records of patients with JAA were reviewed. Twenty-two patients with JAA were identified, with an overall incidence of 0.28%. All but 2 patients were diagnosed prospectively with JAA by echocardiography. The lesion-specific incidences and associated lesions were similar to those of large autopsy and surgical series. Abnormal conotruncal anatomy was more frequently seen with juxtaposition of the right atrial appendage (JRAA) vs juxtaposition of the left atrial appendage (JLAA) (14/15 vs 4/7), as was atrial outlet obstruction (6/15 vs 2/7). JLAA was more frequently associated with complex atrioventricular anatomy (3/7 vs 1/15). Patients with JAA underwent single ventricle palliation in 11/22 cases with 6 deaths; biventricular repair was performed in 8/22 cases with no deaths. Surgical outcomes for patients with JRAA and JLAA were similar, and survival was predominantly influenced by suitability for biventricular repair.

Adolescent↗

PubMedDate not supplied

Delayed chronic type A dissection following CABG: implications for evolving techniques of revascularization.

BACKGROUND: Postoperative dissection in some patients is related to manipulation of the aorta and accounts for 3% to 5% of deaths after cardiac surgery. METHODS: Between 1987 and 1999, 109 patients with previous cardiac operations were treated for chronic type A dissection. In 31 of the patients, the etiology was related to aortic manipulation. Twenty-one patients (17 men, 4 women; 67+/-13 years of age) had isolated coronary artery bypass grafting (CABG) as their first operation and were reviewed. The interval between operations was 52.9+/-47.3 months. RESULTS: Reoperation was elective in 11 patients, urgent in 10 patients. Median maximal aortic diameter was 6.8+/-2.1 cm; 9 patients had major aortic insufficiency. The intimal tear was at the partial occlusion clamp site in 12 patients (57.1%), at the cross-clamping site in 4 patients (19.1%), and at the proximal anastomosis in 1 patient (4.8%); 4 patients (19.1%) had multiple tears at several sites. Cystic media necrosis was present in 9.5% of the patients, severe atherosclerosis in 47.6% of the patients, and 42.9% of the patients had both. Nine patients (42.9%) underwent a modified Bentall procedure, 12 patients (57.1%) underwent a supracoronary anastomosis, and all had open distal anastomosis. There were two (9.5%) hospital deaths and three (14.3%) postoperative strokes. Freedom from cardiac or aorta-related mortality was 85.7% at a mean follow-up of 49.3 months. CONCLUSIONS: In patients who develop type A dissection of the aorta after previous CABG, the intimal tear most often is at partial occlusion clamp site. This complication is associated with morbidity and mortality. It remains to be seen whether the use of partial occlusion clamps on the pulsating and often diseased aorta during off-pump coronary artery bypass (OPCAB) will increase the risk of delayed iatrogenic dissections.

Aged↗

PubMedDate not supplied

Cardiac transplantation at Stanford.

Increasing survival of cardiac allograft recipients has been noted with each year of the Stanford cardiac transplantation program. Current 1 year survival is 67%, compared with 22% 1 year survival in the first year of our program. Five factors are felt to be important in improving survival: 1 degree stringent recipient selection criteria, 2 degrees routine use of serial endomyocardial biopsies for the diagnosis of acute graft rejection, 3 degrees administration of rabbit antithymocyte globulin for the treatment of rejection, 4 degrees aggressive diagnosis and treatment of infectious complications, and 5 degrees reduction of the incidence of accelerated graft arteriosclerosis by appropriate prophylaxis.

Biopsy↗