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.
Two patients with infected aortic aneurysm underwent surgical treatment. When using autologous tissue in place of the infected aorta a recurrent aneurysm was observed four months later. Extraanatomical bypass of the infected area with prosthetic material and consecutive removal of all infected tissue seems to be the only successful management. This is confirmed by another patient who was treated successfully in this way. Prolonged antibiotic therapy after resection of infected aneurysms seems to be mandatory.
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.
66 patients with 2 and 3 vessel coronary heart disease were studied before and after complete successful revascularization. Hemodynamic measurements and biplane left ventricular angiograms were obtained at rest and during supine bicycle exercise.--After operation a significant overall decrease of LVEDP with exercise was seen; exercise LVEF increased in cases with left main disease and in most cases with double vessel disease and double bypass. Inconsistant response was present in 3 vessel disease. Improvement of left ventricular dynamics with exercise in advanced coronary disease after complete revascularization can be expected mainly in 2 vessel disease and left main coronary disease.
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