Light reflected from the human heart surface was used to determine mixed hemoglobin and myoglobin oxygen saturations (O2SAT) in the cardiac tissue. The measurements were performed in 8 patients with coronary heart disease including stenosis of left anterior descending coronary artery (LAD) who underwent aorto-coronary bypass surgery. At the end of the operation the O2SAT was measured in the supply area of the LAD either with patent or occluded coronary bypass. In 13 experiments occlusion of the bypass resulted in a decrease of O2SAT from 74 +/- 16% to 61 +/- 24% (p less than 0.02). A new technique is introduced and its limitations are discussed. Preliminary results of application in coronary bypass surgery demonstrate an increase in tissue oxygenation following myocardial revascularization.

Delay in myocardial cooling during an infusion of cold cardioplegic solution may occur in patients with coronary artery disease. Forty patients with significant stenosis of the left anterior descending coronary artery (LAD) were divided into 3 groups according to the extent of the LAD stenosis. Group A consisted of 12 patients with 70% stenosis. Group B included 23 patients with 90% stenosis, and in group C there were 5 patients with LAD occlusion. Myocardial temperature was measured with a thermocamera during infusion of 2000 ml 8 to 10 degrees C cold Bretschneider's cardioplegic solution and compared to 10 other patients without coronary artery disease undergoing mitral valve replacement (group D). In group A the myocardium cooled to 15 degrees C after 4 1/2 minutes and to 12 degrees C after 10 minutes. In group B the myocardial temperature was 15 degrees C after 5 minutes and 12 degrees C after 10 minutes. In group C the temperature reached 18 degrees C after 5 minutes and 14 degrees C after 10 minutes. In group D the myocardial temperature was 12 degrees C after 3 minutes and 10 degrees C after 7 minutes. This study shows far better myocardial cooling rates in patients with unobstructed coronary arteries.

A 36-year old woman was presented to our hospital with congenital ventricular septal defect and one-vessel coronary artery disease (75% proximal left main coronary artery) for CABG and repair of the VSD. After induction, a transesophageal echocardiographic (TEE) baseline examination was performed, showing a severely dilated coronary sinus (CS) measuring approximately 3 cm (abnormal >1 cm). We suggested a persistent left superior vena cava (PLSVC) draining into the CS. PLSVC is a common venous congenital anomaly, with a reported incidence of 0.5% in general population and in 3-5 % of patients with congenital heart defect. Injection of echo-contrast solution in a left arm vein, visualizing microbubbles passing through the PLSVC into the CS confirmed our suspicion. The diagnosis of a PLSVC and dilated CS is a contraindication for retrograde cardioplegia because of the loss of cardioplegia into the PLSVC resulting in a inadequate myocardial protection. It may be difficult to pass a pulmonary artery catheter (PAC) through a left internal or left subclavian vein and it may be associated with arrhythmias. A chest radiograph shows the anomalous course of the PAC along the left heart.

Sixteen children with transposition of the great arteries (TGA), ventricular septal defect (VSD), and left ventricular outflow obstruction (LVOO) underwent intracardiac correc tion. The atrio-ventricular relationship was concordant in all instances. The VSD was single in 1 3 and multiple in 2 patients. In one child a common ventricle was found. LVOO presented as valvular stenosis in 2 cases, subvalvular stenosis in 9 cases, and combined valvular and subvalvular stenosis in one case. Three patients had previously undergone band ing of the pulmonary artery.

A case of sternal fistula after left ventricular aneurvsmectcmv ls p resented. The cause of the fistula was an lnfected Teflon pledget used in the closure of the ventr iculotomy. T he tnerapeutlc management ls dlscussed. We recommend an aggressive approach to remove the infected pledgets.

From 1976 to 1977 308 patients were treated with multiple aorto-coronary vein-bypass. Fiftytwo patients receiving sequential bypasses were compared with 256 patients in whom conventional multiple anastomoses were performed. The rate of postoperative bypass failure did not differ significantly in the two types of anastomoses: 16 per cent in sequential as compared to 18 per cent in conventional bypass. In both cases the circumflex-system was afflicted by bypass failure more frequently (20 per cent each). The practical and theoretical advantages and disadvantages of the two procedures are discussed. Sequential aortocoronary vein-bypass is considered the method of choice for certain combinations of coronary stenoses and also if an adequate length of vein can not be obtained.

For the dissection of the internal mammary artery (IMA), we use a new sternal retraction technique. The retractor is an angled stainless steel device with a slotted face and two sternal arresting hooks. The method is simple and the device acts as a unit with a standard sternal spreader. The time period between mounting and the exposure of the IMA is only a few seconds. The entire procedure takes place in the sterile operative field. By utilizing this method, we dissected nearly 300 IMAs without any complications or serious sternal injuries.

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