Traumatic transection of the hepatic artery

Complete transection of the hepatic artery following blunt abdominal trauma is rare. A case successfully treated by ligation of the vessel is described. Attempts to reconstruct the artery may be difficult and are probably unnecessary. We suggest that simple ligation is the correct management of this injury.     

Prosepctive analysis of heart biopsies in coronary artery surgery.

In a prospective analysis of 36 biopsies from human hearts performed at the time of elective coronary operation, several morphological changes were identified in the myocardium. Some of these changes (fibrosis, vacuolation, edema, and amyloid deposition) are of clinical signficance and may affect the long-term prognosis for patients undergoing revascularization procedures. It appears, therefore, that knowledge of the morphological state of the myocardium at the time of operation can prove useful in elucidating further the long-term effects of coronary artery bypass on the left ventricular myocardium.     

Anomalous origin of the left coronary artery from the pulmonary artery. Definitive surgical treatment by saphenous vein interposition in a 17-month-old child.

A 17-month-old child underwent successful operative correction of anomalous origin of the left coronary artery from the pulmonary artery by saphenous vein interposition. The clinical, hemodynamic, and angiographic features of the anomaly are presented. Three months after the operation, cardiac catheterization and angiography revealed a patent graft with good antegrade flow and improvement in left ventricular function.     

Hepatic artery ligation for exsanguinating liver injuries in children.

Selective hepatic dearterialization for exsanguinating liver injury has been performed in two young children without untoward sequelae. It appears to be a safe, simple, life-saving maneuver, as has been shown in adults. Simultaneous cholecystectomy and drainage of the extrahepatic biliary tree does not seem necessary. Postoperative studies in these two patients showed normal liver functions, normal liver scintiscans, and in one case, early rearterialization of the devascularized lobe by translobar collaterals. We would urge the use of this relatively simple procedure in place of major hepatic resection for selected severe hepatic injuries.     

Coronary artery bypass in patients with total laryngectomy

Patients who have undergone laryngectomy pose a challenge when they require coronary artery bypass grafting. The location of the tracheal stoma just above the jugular notch may interfere with the sternotomy, increase the risk of infection, and add some difficulty to the operative procedure. We describe the surgical technique used in 2 such patients.     

Elimination of venting in coronary artery surgery.

The present study is a prospective analysis of 78 consecutive patients undergoing coronary operation without venting of the left ventricle. Results indicate that with cardioplegic arrest left ventricular distention does not occur when the venous lines are positioned in the right atrium. The technique described here has simplified the pump setup, shortened the operative time, and eliminated the potential hazards associated with venting the left ventricle.     

The aorta-to-coronary radial artery bypass graft. A technique avoiding pathological changes in grafts

A technique of aorta-to-coronary artery bypass grafting using the patient's radial artery is proposed with the aim of reducing the incidence of late pathological changes in the graft. Experience with 40 radial artery grafts in 30 human patients has shown excellent short-term results and has demonstrated the primary importance of mechanical dilation of the arterial graft before implantation to counteract its spasm. Even though several advantages favor use of the radial artery over the vein for grafting (arterial structure, elasticity, regularity of the lumen) and over the mammary artery (graft size and length, resistance of the arterial wall), the ultimate fate of the radial artery graft needs a longer follow-up to be determined with certainty.     

Obstruction of the duodenum by the superior mesenteric artery — Does it exist in children?

Though well described by rokitansky in 1861, the symptoms and treatment of duodenal compression by the superior mesenteric artery have not been clearly defined in children. As a result, diagnosis and therapy may be unduly delayed. This report is of personal experience with superior mesenteric artery (SMA) syndrome in 20 children. Seven of these cases have been discussed previously.     

Combined aortocoronary bypass and intraoperative transluminal angioplasty in left main coronary artery disease

Transaortic intraluminal angioplasty of the left main coronary artery by Grüntzig's technique has been used intraoperatively in 4 patients who underwent multiple aortocoronary bypasses. Angiographic and clinical results were excellent in 3 of them. It is suggested that this combined technique be used to obtain more complete revascularization at the time of coronary artery bypass. The technique is easy to perform without x-ray facilities in the operating room, and it seems reasonable to assume that it may improve the myocardial blood supply of those areas irrigated by small arteries originating between the stenosed main trunk and other subsequent lesions.     

Resection and reconstruction of the carotid artery in metastatic squamous cell carcinoma

Although it is uncommon to consider resection of the common and internal carotid arteries for involvement by carcinoma, nevertheless, if this is the only significant finding precluding an adequate ablative procedure, this operation is worthy of consideration. Ten procedures were performed in nine such patients; the carotid bifurcation was resected and continuity reestablished using Teflon or autogenous saphenous vein grafts. In attempting to predict the efficiency of the collateral cerebral cross-flow, arteriography, oculopneumoplethysmography and intraoperative measurement of carotid stump pressure were used in some patients. There was no operative mortality. The postoperative mortality rate was 20 percent and cerebrovascular complications occurred in 20 percent of the cases. Seven patients survived 9 months to $\text{4}\text{1}\text{4}$ years. Teflon grafts appeared to have a higher patency rate than saphenous vein autogenous grafts. Although this series is very small, it is an evaluation of a procedure of last resort which appears worthwhile in carefully selected patients.     

Massive mitral regrgitation from chordal rupture and coronary artery disease

The precise mechanism that causes spontaneous rupture of chordae tendineae remains unknown. That it may occur in patients with no disease other than underlying or associated coronary artery occlusion has not been previously reported. Six patients with chordal rupture were found among 600 patients who underwent operation for mitral regurgitation in a 6-year period. All 6 patients without exception underwent simultaneous mitral valve replacement and coronary revascularization. The salient clinical features of these patients are summarized, and 1 case is reported in detail.     

Aorta-pulmonary artery shunts with expanded polytetrafluoroethylene (PTFE) tube.

Ten patients underwent an aortapulmonary artery shunt with a polytetrafluoroethylene (PTFE) tube between December, 1976, and October, 1977. Five of them were less than 1 month old. The diameter of the PTFE tube was 5 mm in 9 patients and 4 mm in 1 patient. Seven patients survived the operation. One of them had a clotted shunt, which was reoperated on successfully. Three patients died in the postoperative period, and all had a patent shunt. Overall patency was 90% (9/10). Congestive heart failure refractory to medical treatment developed in 1 patient with a patent Blalock-Taussig and PTFE shunt. In our institution, the Blalock-Taussig shunt is the procedure of choice. The PTFE shunt is used when the anatomy of a patient is unsuitable for a Blalock-Taussig shunt. A tube diameter of 5 mm is optimal for infants when further growth is considered, even if digitalization is necessary to control congestive heart failure.     

Association between operator specialty and outcomes after carotid artery revascularization

Objective

To examine the association between operator specialty and 30-day outcomes among patients undergoing carotid endarterectomy and carotid artery stenting.

Cannulation of the left main pulmonary artery for partial left heart bypass.

Cannulation of the left main pulmonary artery for partial left heart bypass is described. We have employed this method successfully in 5 patients who underwent resection of aneurysms of the descending thoracic aorta. A main advantage is that high and consistent rates of venous return are obtainable.