Bilateral traumatic dislocations of Volz total wrist arthroplasties: a case report

Bilateral traumatic dislocations of Volz total wrist arthroplasties in a patient with rheumatoid arthritis occurred 7 years after the initial surgical procedures. Treatment consisted of closed manipulation and reduction of both wrists followed by temporary splinting. Good function was restored in both wrists without operative intervention. No fractures or loosening at the bone cement interface was encountered.     

Experience with the DeBakey-surgitool aortic prosthetic valve.

The DeBakey-Surgitool aortic valve differs from popular cloth-covered prostheses by having a bare metal cage and a pyrolytic carbon ball. This valve was implanted in 37 patients. There were 7 operative deaths (19%), none of which was related to the valve design. Thirty survivors have been followed up to five years with 12 late deaths. The single thromboembolic event resulted in the only valve-related death. One patient developed a periprosthetic leak and another has hemolytic anemia. The incidence of thromboembolism in small series (3%) is comparable to that with the cloth-covered valves. This and the absence of complications related to cloth wear are important considerations when selecting a prosthesis.     

Stainless Steel Markers for Aorta–Saphenous Vein Anastomosis

A stainless steel marker for tagging the proximal aorta-saphenous vein anastomosis in a bypass operation has been devised and utilized in more than 600 patients over the past 3 years. This marker has been found superior to other methods used for marking vein grafts in that it encircles the anastomosis, providing accurate marking, and can be attached after both anastomoses are complete.     

Supraclavicular thoracotomy for diagnosis of apical lung and superior mediastinal lesions.

Despite the use of mediastinoscopy, anterior mediastinotomy, transcarinal biopsy, needle biopsy, and transbronchial fluoroscopic brushing, thoracotomy is necessary to obtain tissue for diagnosis in patients suspected of having carcinoma of the lung. A technique we have employed is exploratory thoracotomy, as described for the approach to cervical and upper dorsal sympathetic ganglion, with entrance into the pleural space through a supraclavicular incision. Five patients, 3 with marginal pulmonary function and 2 with brachial plexus and upper mediastinal or vertebral involvement, had tissue diagnosis of lung carcinoma by this method without postoperative complication. Supraclavicular thoracotomy offers a safe, easy, and definitive method of tissue diagnosis of apical lung and superior mediastinal lesions.     

Constrictive pericarditis.

A patient with constrictive pericarditis following an open-heart operation without sepsis is discussed. In the absence of sepsis, it has been widely held that this complication does not develop following an open-heart procedure. The fatal outcome in this patient could have been avoided had such an association been known.     

Sparing effect of tendon injury on osteoarthritis

A case is reported in which a finger with no active flexion did not develop erosive osteoarthritis at the time that it developed in the other active digits.     

Revascularization of the heart through the coronary veins.

Fifty-six dogs were used in a study to evaluate perfusion of the left anterior descending vein by the internal mammary artery in hearts with normal coronary arteries and those with ligated desending coronary arteries. Perfusion of the myocardium with arterial blood through the cardiac veins offers minimal immediate protection from infarction, as evidenced by light and electron microscopy studies. This protection is of short duration due to intimal fibrosis and luminal stenosis or obstruction of the perfused veins. Nineteen animals in which the coronary vein was perfused and the corresponding coronary artery was not ligated died within sixty hours from the time of operation. Pathological examination revealed patent grafts in all the animals. There was marked congestion of the myocardium with petechial hemorrhages over the surface of the heart. No evidence of myocardial infarction was found.     

Insertion of the intraaortic balloon through the aortic arch.

A method for rapidly inserting the balloon catheter of the intraaortic balloon pump directly into the aortic arch in patients undergoing cardiac operations is described.     

Mitral valve replacement with viable aortic homograft valves

Forty consecutive patients underwent mitral valve replacement with viable aortic valve homografts. Viability was assessed by autoradiography in a sample of the aortic wall of the graft at the time of insertion. Sixty to 75% of the fibroblasts were found to be metabolically active.All patients were in New York Heart Association Functional Class III or IV prior to operation. Pulmonary hypertension was present in 37. One patient died in the hospital, and 1 late death occurred 9 months postoperatively. Anticoagulants were discontinued 6 weeks after operation without thromboembolic complications. Thirty-six of the patients showed marked clinical improvement, and only 3 patients were found to have a mild degree of mitral regurgitation by angiography.This experience has encouraged us to continue with this method of mitral valve replacement.     

Reoperation for aortic coarctation: techniques, results, and indications for various approaches

To define the safety and efficacy of operation for recurrent thoracic aortic coarctation, we reviewed the hospital records and subsequent courses of 53 patients who underwent such procedures over a 23-year period. Previous operations included end-to-end anastomosis, prosthetic patch or subclavian flap aortoplasty, and prosthetic interposition or bypass grafts, performed in patients ranging from 1 day to 44 years old. Several different reoperative procedures were used, including an ascending-descending aortic bypass graft in 4 patients who had had two previous repairs. There were no hospital or late deaths and only 3 relatively minor complications. Only 2 patients have hypertension requiring drug therapy at follow-up, which now averages 7 years. We conclude that operative management of severe, recurrent coarctation is both safe and effective, and that several techniques of reconstruction may have a place in such therapy.     

Simultaneous treatment of aortic stenosis and coarctation by left thoracotomy with apical aortic conduit.

Acute monilial esophagitis generally responds well to oral nystatin therapy, and long-term sequelae of this condition have not been well recognized. Nor is it generally appreciated that Candida infections of the esophagus may occur in subacute or chronic form. Four men, 34, 40, 41, and 49 years old, have been treated for esophageal stenoses resulting from different types of chronic monilial esophageal involvement. All were seen with painless dysphagia and strictures of the upper half of the thoracic esophagus. In 2 patients, an associated roentgenographic pattern of “intramural esophageal pseudodiverticulosis” was present. Two patients have been treated successfully with esophageal dilation, 1 required substernal colonic bypass of the stenotic, perforated esophagus, and 1 is being evaluated for esophageal bypass. Esophageal moniliasis must be considered in the differential diagnosis of benign esophageal strictures, particularly those involving the upper half of the thoracic esophagus.     

Reoperation after insertion of aortic homograft as a right ventricular outflow tract

Three patients who developed pseudoaneurysm or stenosis of the right ventricular outflow tract after insertion of an aortic homograft between the right ventricle and the pulmonary artery presented the technical problems at reoperation of intimate adherence of the homograft to the sternum. Successful replacement of the defective aortic homograft was accomplished by sequentially employing peripheral venous and arterial cannulation, heart-lung bypass, hypothermia, circulatory arrest, sternotomy, right atrial cannulation, and resumption of bypass.     

The prosthetic (Teflon) central aortopulmonary shunt for cyanotic infants less than three weeks old: results and long-term follow-up

The expanded microporous polytetrafluoroethylene (PTFE) 4 mm vascular prosthesis has been used to create a central aortopulmonary shunt in 20 critically ill infants less than 3 weeks old. The infants ranged from 1 to 18 days old (5.25 days), and from 1.5 to 4.0 kg (2.9 kg). Conduit length ranged from 2 to 6 cm (4 cm). Sixteen patients had atresia of the tricuspid or pulmonary valve. There were 6 early deaths (30%), only 1 of which was shunt related. The mean preoperative arterial oxygen saturation was 62% (range, 33 to 80%), and mean postoperative saturation was 87% (range, 78 to 90%). There were 5 late deaths, 1 probably caused by shunt failure. Nine long-term survivors have done well. Follow-up ranges from 1 to 36 months (18 months). Factors influencing conduit function are length, technical considerations, and pulmonary vascular resistance. Late restudy in 5 of 9 survivors confirms patency and demonstrates bidirectional pulmonary blood flow. Since PTFE shunt flow capability is fixed, the infant may require repair or a second shunt within 24 months of the initial procedure.     

Aortic and mitral valve replacement with cloth-covered Braunwald-Cutter prosthesis. A three-year follow-up.

From February, 1971, through February, 1974, heart valves of 510 patients were replaced with cloth-covered Braunwald-Cutter prostheses. The data indicate that cloth encapsulation of the prosthetic cage is associated with a reduction in thromboembolic complications, particularly for mitral valves. Cloth wear on the distal strut, however, is not prevented by use of a Silastic poppet and appears to be a typical finding in aortic valves recovered or inspected after 3 months. Excessive poppet wear has also been noted in the aortic position; poppet embolization has occurred on 2 occasions, and a third patient was found, at the time of reoperation for periprosthetic leak, to have opppet wear sufficient to permit embolization. Although there have been no reports of clinical malfunction of the mitral prosthesis at the time of this writing, further long-term observation of these patients appears warranted.     

Volz total wrist arthroplasty in rheumatoid arthritis: a preliminary report

The results of 20 Volz design total wrist arthroplasties in 19 patients with stages III and IV rheumatoid arthritis are presented. Follow-up averaged 18 months. Using a 100-point evaluation form, there were 75% excellent or good results and 10% poor results. An effective extensor carpi radialis brevis tendon and the presence of volar and ulnar contractures were the most important factors influencing the results. This operation is recommended in patients with painful stage III or IV rheumatoid wrist disease, and in whom the extensor carpi radialis brevis is functioning where preservation of motion is desired.     

The determinants of survival following reoperation on prosthetic cardiac valves

In an effort to identify the determinants of survival following reoperation on patients with prosthetic cardiac valves, the experience with a group of 33 patients at the University of Rochester Medical Center was reviewed. The survival rate was 58% (19/33). Survival was not related to the valve involved, the age of the patient, or the technical hazards of a second cardiac operation. Ten (77%) of the 13 patients in New York Heart Association (NYHA) Functional Class II survived compared with 8 (40%) of the 20 in Class III or IV. The survival rate for patients with a paravalvular fistula was 79% (11/14); with valve dysfunction, 50% (6/12); and with prosthetic valve infection, 29% (2/7). The determinants of survival seem to be similar to those for primary operation (i. e., NYHA patient classification and indication for operation) and less related to the potential operative complications of a reoperation.     

Spontaneous embolization of a St. Jude prosthetic mitral valve leaflet

A patient with left ventricular failure as a result of leaflet embolization from a St. Jude valve implanted 20 months earlier is described.