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Special procedures in cardiac transplantation

Left thoracotomy In contemporary practice, cardiac transplantation is occasionally undertaken in patients who have undergone previous cardiac procedures that render reentry by midsternal incision impractical or inadvisable. Prior sternal wound infection is an obvious case in which a midline incision is best avoided. In these patients, cardiac transplantation can be performed through a left anterior thoracotomy. The procedure is technically more demanding than a midline approach,…

Cardiac transplantation

Improved means of controlling tissue rejection have made transplantation of the human heart a useful clinical procedure that is widely applied in cardiovascular centers throughout the world. Cooperative organizations for the sharing of facilities and long-distance transportation of cryopreserved tissue for transplantation have made this procedure available to many individuals who otherwise might have died of congestive cardiac failure. All these organizational and immunological advances make…

Aortic aneurysm

Aneurysm of the aorta in one of its segments or in its entirety may require replacement of the aorta. The need for operation is determined by the size of the aneurysm and the accompanying risk of rupture, occlusion of the aorta or its branches, thromboemboli originating from the aortic wall, or infection. Morphology Cannulation strategies for aortic operations Multiple cannulation techniques are available for cardiopulmonary bypass…

Ventricular aneurysm

Anterior left ventricular aneurysm One of the most common sequelae of severe transmural myocardial infarction is development of an aneurysm of the left ventricle. Acquired ventricular septal defect occurs as a consequence of myocardial infarction with necrosis of the septal myocardium and perforation of the ventricular septum. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If…

Coronary artery bypass graft

Coronary artery bypass graft operations are effective in the treatment of ischemic heart disease. Although these operations have become quite standard, there seems to be an infinite variety of presentations of atherosclerotic disease and combinations of operations to revascularize the ischemic myocardium. Figure 36-1 Combinations for Saphenous Vein Bypass Grafts A Sequential grafts conserve the amount of saphenous vein required for complete revascularization. A number of…

Mitral valve replacement

Mitral valve replacement is performed when the mitral leaflet tissues are thickened or calcified to the point that repair is impossible, likely to result in inadequate hemodynamic performance of the valve, or unlikely to be long lasting. Morphology Valves that do not qualify for repair and must be replaced have often been damaged by the rheumatic process. This manifests as marked thickening and scarring of leaflet…

Mitral valve reconstruction

Mitral valve reconstruction is desirable for patients with normal sinus rhythm because there is no need for anticoagulation, and hemodynamic performance is enhanced after surgery. Morphology Introduction to mitral valve reconstructive techniques You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Aortic valve replacement

Aortic valve replacement is usually required when operative intervention is performed for aortic valve stenosis or incompetence in older patients. Several replacement devices are available, but all operations share a common approach and principles. Morphology Valve excision and débridement Continuous suture technique Continuous suture technique for aortic valve replacement has some distinct advantages over the more standard pledget-reinforced mattress suture technique. A larger prosthesis can be…

Palliative operations

Operations have been devised to improve hemodynamics and balance blood flow in complex congenital cardiac anomalies. These operations are performed in a staged manner, to allow intervention for complete repair at a later time when the patient’s age and size and the clinical situation are more conducive to a successful outcome. Subclavian artery–pulmonary artery anastomosis Prior to the landmark work of Alfred Blalock, MD, surgery for…

Vascular ring and sling

Abnormal development of the aortic arch may result in vascular abnormalities that compress the trachea and esophagus. These anomalies, commonly known as vascular rings, cause airway obstruction, dysphagia, or both. The diagnosis is made by clinical symptoms confirmed by barium esophagram, which shows posterior compression of the esophagus by the abnormal aortic arch of the branch artery as it courses behind the esophagus and trachea. Computed…

Coronary artery anomaly

Anomalies of the coronary arteries include anomalous origin of the left or right coronary artery and abnormal course of the coronary arteries from the aorta to the surface of the heart. Here we discuss anomalous origin of the left coronary artery from the pulmonary artery. Congenital coronary arteriovenous fistula is a direct connection of the coronary artery to a cardiac chamber or to one of the…

Transposition of the great arteries

Transposition of the great arteries is a congenital cardiac anomaly defined by origin of the aorta from the right ventricle and origin of the pulmonary trunk from the left ventricle. The ventricular septum may be intact (simple transposition of the great arteries), or there may be a defect in the ventricular septum (transposition with ventricular septal defect). Morphology You’re Reading a Preview Become a Clinical Tree…