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Preservation of All Chordae Tendineae and Papillary Muscle During Mitral Valve Replacement with a Tilting Disc Valve 总被引:1,自引:0,他引:1
HAROLD L. FEIKES M.D. JAMES B. DAUGHARTHY M.D. JESSE E. PERRY M.D. JOHN H. BELL M.D. ROBERT E. HIEB M.D. GILBERT H. JOHNSON P.A.-C. 《Journal of cardiac surgery》1990,5(2):81-85
Mitral valve replacement was performed in 21 patients using a surgical technique that preserves the entire papillary muscle and chordal apparatus. With this technique, the anterior mitral leaflet is split from the center of the free edge toward the annulus. Bilateral incisions are made from the proximal end of this split to the two mitral commissures, detaching the anterior leaflet from the annulus. These two halves of the leaflet, with all chordae intact (corresponding to the anterolateral and posteromedial papillary muscles), are judiciously trimmed to remove areas of leaflet untethered by chordae tendineae and (when necessary) fibrous thickening; then swung posteriorly and sutured to the posterior mitral annulus using mattress sutures with pledgets. This surgical technique is expected to favor the preservation of left ventricular function and avoid occurrence of irreversible left ventricular dilation/dysfunction, and has been used successfully for calcific and degenerative etiologies, using both tilting disc valves and porcine bioprostheses. It is especially useful in the implantation of tilting disc and bileaflet mechanical prostheses because anterior subvalvular chordae tissue may interfere with the disc excursion and relocated to the posterior leaflet annulus. 相似文献
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The advantages of the new, safer, but more expensive iodinated contrast agents are discussed, and opinions on which patient groups should receive the agents are presented. 相似文献
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ANIS BARAKA MD FRCAnaes MUSA MUALLEM MD GILBERT CHIDIAC MD CHAKIB AYYOUB MD 《Paediatric anaesthesia》1994,4(3):169-172
Investigation was carried out in ten children aged between one month and six years, who were anaesthetized by the T-piece circuit. The volume of the reservoir tubing of the T-piece was 250 ml. Ventilation was controlled automatically by oxygen jets which were delivered via an injector attached to the reservoir tubing. The oxygen jets were regulated by an electronically-controlled solenoid valve. The children were ventilated by a tidal volume about 12 ml±kg?1 at a rate of 12-20 per min depending on their age, while the FGF varied between 3 and 6 l min?1 depending on their body weight. The resulting FIO2 ranged between 0.32 and 0.34 which was expected from the oxygen:nitrous oxide mixture (1:2), denoting no mixing of the oxygen jets with the anaesthetic mixture. The PAco2 was ventilation-dependent, and ranged between 4±6-5±3 kPa (35-41 mmHg). The results suggest that automatic jet ventilation facilitates controlled ventilation in children anaesthetized by the T-piece circuit, while maintaining the original simplicity of the T-piece.; 相似文献
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A modified technique for catheterization of the pulmonary artery was developed. It involves the passage of a tapered, movable-core, J-tipped guide wire across the right ventricle into the pulmonary artery followed by the advancement of a straightened Grollman pigtail catheter. The technique was successful in 34 of 34 pulmonary artery catheterizations. The method avoids prolonged catheter manipulation within the right ventricle. In addition, since the catheter does not cross the tricuspid valve until the guide wire has been advanced, the occasional complication of the pigtail "hooking" on a tricuspid valve leaflet or chordae tendineae during catheter withdrawal and manipulation is prevented. 相似文献