Rupture of the tricuspid valve associated with disruption of De Vega's annuloplasty

A case of sudden ruptured chordae tendineae of the tricuspid valve associated with failure of De Vega's tricuspid annuloplasty, 27 months after surgery, is reported. This is the first case to our knowledge of spontaneous ruptured chordae tendineae of the tricuspid valve reported in the literature.

Surgical treatment of annulo aortic ectasia. Experience in eight consecutive patients

Eight patients with ectasia of the aortic annulus due to cystic degeneration of the media are presented. All patients were operated with a technique similar to the one described by Bentall and De Bono. Six patients had the aortic valve replaced by a bioprosthesis and two patients with a St. Jude Medical Valve Prosthesis. Manoeuvers to avoid anastomotic tension, adequate myocardial protection, and a careful control of postbypass blood pressure are described. There was no early or late mortality. Patients have been followed for a mean period of twelve months. Seven patients are in grade I of the N.Y.H.A., and one in grade II. Five patients studied postoperatively with cardiac catheterization and angiography showed normal ventricular function, normal prosthetic function and no aneurysm or pseudoaneurysm in any of the suture lines and with a good coronary anatomy.

Transaortic cannulation for balloon pumping in a "crowded aorta"

A technique for cannulating the ascending aorta or aortic arch to introduce a balloon catheter for intraortic balloon pumping is described. It is performed without the use of a partial occlusion clamp. This technique is useful when multiple anastomoses in the ascending aorta leave no room for the application of a vascular clamp. Three patients in whom this technique was used are reported.

[Use of human albumin and dextran-70 in extracorporeal circulation. Postoperative function of blood platelets (author's transl)]

Human albumin and dextran 70 were used as volume expanders in extracorporeal circulation in two homogeneous series of patients. Comparative results were statistically processed. No significant differences were observed either to early postoperative bleeding or needed volume of transfused blood. Postoperative complications neither developed in the two groups of patients. The total number of platelets showed a 50 percent decrease in relation to basal extraction figures and those after immediate heparin neutralization. Results of platelet function tests were similar in both series, except for a statistical significant decrease in ADP-induced platelet aggregation in the group with dextran 70. Such decrease, however, was not followed by an increase of postoperative bleeding. Thus, dextran 70 has showed to be a valuable substitute for human albumin in extracorporeal circulation.

Simultaneous assessment of pharyngeal wall and velar displacement for selected speech sounds

Velar and pharyngeal wall displacements were studied simultaneously by using conventional lateral-view radiography and frontal-view tomography. Twenty-five normal adult male and female subjects were utilized. Major results pertaining to lateral pharyngeal wall displacements during speech include the following. 1) At more superior levels of the pharynx, greater mesial displacements occurred for nonnasal compared to nasal speech sounds and no significant differences were noted among the nonnasal speech sounds studied. 2) At an inferior level of the pharynx, mesial displacements were greater for low vowels compared to the other speech sounds studied but some lateral (outward) movements were observed during high vowel production for some subjects. 3) Greatest mesial displacements for all subjects ad speech sounds studied occurred at the level of and just below the plane of the hard palate. Low correlations between velar and lateral pharyngeal wall displacements were obtained for most subjects. The results do not support the hypothesis that the levator veli palatini muscle is solely involved in both velar and lateral pharyngeal wall movements.

Entrapment of leaflet of St. Jude medical cardiac valve prosthesis by miniscule thrombus: report of two cases

Two patients with dysfunction of the St. Jude Medical cardiac valve prosthesis, one in the aortic and one in the mitral position, are presented. In both, one of the valve leaflets was jammed by a very small thrombus that fixed the leaflet in a semiclosed position. Neither patient received anticoagulation postoperatively. Because of the pathological findings in these 2 patients, anticoagulation for patients with a St. Jude Medical valve prosthesis is recommended for life.

Prosthetic valve endocarditis after heart catheterization

It is accepted that patients with valvular disease or valvular prosthesis should be protected against endocarditis during procedures causing bacteriemia. On the other hand it has been shown that bacteriemia occurs during catheterization. Thus, protection against endocarditis for patients undergoing catheterization deserves more consideration, specially among patients with prosthetic valves. Moved by the fatal outcome of one of our patients with postcatheterization prosthetic valve endocarditis, the authors leave an open discussion about this subject.

[Experimental cardiogenic shock (author's transl)]

An experimental model fo cardiogenic shock has been developed in anesthetized dogs. The shock was produced by injecting mercury into the second diagonal branch of the descending anterior coronary artery. Arterial and venous pressure E.C.G., aortic, renal and circumflex flow were directly measured. Other parameters such as O2 consumption and arterio-venous difference were also studied. The present model seems very useful to make therapeutic studies. Open chest surgery has been used for simplicity and economic reasons.

Isolated mitral valve replacement with the Björk-Shiley prosthesis in 100 consecutive patients. Short- and long-term results

Single mitral valve replacement with the Björk-Shiley tilting disc prosthesis was performed in 100 consecutive patients between March 1971 and December 1973. The hospital mortality was 13% and the late mortality was 6%. 74 of the patients were followed for periods ranging between 12 and 46 months (mean follow-up: 24 months): clinical improvement was noted in 92%. The incidence of postoperative embolism, including 1 case of prosthesis thrombosis, was 6.7%, and all cases occurred within the first 9 months after surgery. 6 patients required reoperation because of prosthesis dysfunction due to thrombosis (1 patient), leakage (3), and late disc entrapment (2).

Perforation of the right ventricle and cardiac tamponade caused by a venous catheter

A case is reported in which a venous catheter perforated the right ventricle and caused cardiac tamponade. Methods recommended to avoid such complications include limiting the length of the radio-opaque catheter, and modifications to the catheter tip.