Long-distance transportation of human hearts for transplantation.

This communication describes the preservation and long-distance (203 to 1,400 km) transportation of 6 human donor hearts with a hemodynamically successful short-term outcome in the recipients, all of whom were critically ill from end-stage cardiac failure. These techniques of long-distance donor heart transportation, not previously described in the human, offer prospects for markedly improving the logistics of heart transplantation in critically ill recipients who require immediate transplantation in face of limited local capability for securing an adequate donor heart. These systems may also prove of value in cardiac transplant protocols, such as rapid retransplantation during rejection and programmed protocols for recipient pre-treatment to promote enhancement of graft survival, that require obtaining a donor heart in an expedient manner.     

The organization of the endocrine pancreas: a hypothetical unifying view of the phylogenetic differences.

The comparative morphology of the endocrine pancreas is seemingly quite divergent in the vertebrate classes of bony fish, amphibians, reptiles, birds, and mammals. However, a hypothesis based on the concept of regional differences of islets unifies this apparent diversity. Such a hypothesis has several elements: (1) the splenic portion of the pancreas has a larger concentration of islet tissue than most other parts of the pancreas; (2) islets in the splenic portions are larger and contain A, B, and D cells but only few or no PP cells; (3) islets of the duodenal portion are smaller and are principally B cells with numerous D cells and occasional A cells. In an often limited area of this portion PP cells are found in greater number than elsewhere usually as a major component of the islets. This organization may have functional significance and not be just an embryological pattern. Higher nonmammalian vertebrates are readily encompassed by this hypothesis and mammals may be included as well. These concepts may have important implications for our understanding of the mammalian pancreas.     

Advantages of open mind commissurotomy using a triple-orifice technique.

Our experience over an eight-year period with the operative relief of mitral stenosis is reviewed and detailed. Of the 106 patients in the series, 80% had minimal or no calcification, 17% had moderate calcification, and 4% had severe calcium deposits in the valve. Four patients have required reoperation for recurrent stenosis, with valve replacement in 3 and a second commissurotomy in the fourth. Left atrial thrombus was encountered in 16%, and no patient with thrombus experienced embolization in the postoperative period. One postoperative death occurred within 30 days, and a single late death occured 35 days after operation. For the scarred, retracted mitral valve we have utilized a multiple-orifice technique that provides maximal flow without the risk of inducing significant mitral insufficiency.     

Efficacy of percutaneous transluminal coronary angioplasty: Technique,patient selection,salutary results,limitations and complications

Percutaneous transluminal coronary anglopiasty (PTCA) was performed in 25 patients and 29 vessels during a 12-month period. In six additional patients scheduled for PTCA, the procedure was cancelled when repeat angiography identified progression to occlusion, coronary spasm, or other adverse factors not previously apparent. PTCA was successful in 14 of 25 patients (56%) and in 18 of 29 vessels (62%); success was associated with clinical improvement in all patients by symptomatology, exercise testing and/or myocardial radionuclide imaging. Beneficial results were particularly achieved with left anterior descending artery lesions and with stenoses showing less than 90% narrowing. One peripheral arterial complication occurred and no patients required emergency surgery. While coronary dissection was detected angiographically in four patients and evidence of coronary spasm was present in three patients post-PTCA, neither was accompanied by untoward early clinical events. Multivessel dilatation in three patients was initially successful but symptoms returned in two during follow-up. Restenosis developed in 3 of 14 patients (21%) after 3 months. Our experience indicates (1) that the specific vessel attempted and lesion severity particularly influence the liklihood of success, (2) the not infrequently induced coronary dissection or spasm does not necessarily represent a serious complication, and (3) angiography repeated in preparation for PTCA identifies a significant minority of patients who are no longer candidates.     

Posttraumatic Thoracic Aortic Aneurysm Associated with a Diaphragmatic Hernia

The case of a patient with a chronic, posttraumatic descending thoracic aortic aneurysm and a large diaphragmatic hernia is presented. We repaired the diaphragm with Prolene mesh and externally grafted the aneurysm. To our knowledge, simultaneous repair of these two chronic injuries has not been reported. The merits of external grafting of aortic aneurysms are discussed.     

Securing soft latex drains: A practical method

A method to secure soft latex drains has been described that prevents both unwanted retraction and unintentional dislodgement while facilitating advancement of the drain (or drains). This technique simplifies the postoperative management of selected patients.     

Operative removal of misplaced Greenfield vena caval filters

Operative retrieval has not been necessary in our experience, though interest has been expressed by other surgeons. Specifically, during removal the hooks of the filter may become attached to adjacent structures, making manipulation and eventual extraction difficult. Because the occasion for late removal of a misplaced filter may arise, we have developed this method using readily available materials. We anticipate that this technique will be most useful for removal of filters that have been in place for more than 7 days. A method to retrieve filters in place less than 1 week has already been reported [4]. We have found the technique quite satisfactory in experimental animals.