The Current Status of Cardiac Surgery

This book consists of an edited report of the proceedings of the Fifth Cardiac Surgical Course run by the Royal Post-Graduate Medical School, The Institute of Cardiology, The Institute of Diseases of the Chest, The Institute of Child Health, The National Heart Hospital, The Brompton Hospital, The Hammersmith Hospital and Great Ormond Street Children's Hospital. These organisations encompass most of the major London hospitals associated with cardiac surgery. The course has been run annually, its aim being to help young men and women who are training in the specialised field of cardiac surgery. Thus this book consists of the proceedings of a teaching course rather than of a symposium, the 60 authors having been charged with the task of teaching rather than displaying their results or discussing their latest ideas and the proceedings reflect an interesting appraisal of the current status of cardiac surgery. The speakers were chosen from all over the world, because they were leaders in their field or because they have access to up to date and reliable information, and I am grateful to all the lecturers for their cooperation in the production of this volume. Ten thousand surgical cases are reported. These figures are drawn from experience in the United Kingdom, France, Germany, Switzerland, the United States of America, Australia and New Zealand. The reader may be surprised to find that only a handful of experiments are described.

1 Cardiac Transplantation.- 1. Introduction.- 2. Transplantation of other organs.- 3. Logistics of organ acquisition.- 4. The significance of tissue typing and matching in cardiac transplantation.- 5. Vascular lesions in experimental transplantation.- 6. Cardiac transplantation today.- 7. The place of transplantation.- 2 Fallot’s Tetralogy.- 8. The surgical anatomy of Fallot’s tetralogy.- 9. Angiographic aspects of Fallot’s tetralogy in infants.- 10. The present indications of palliation in Fallot’s tetralogy.- 11. Total correction after previous Blalock-Taussig shunt.- 12. Total correction after the Brock procedure.- 13. Radical corrective surgery after Waterston shunts.- 14. Current concepts in the management of Fallot’s tetralogy.- 15. Primary total correction of Fallot’s tetralogy under the age of two years.- 16. Correction of tetralogy of Fallot.- 17. Revaluation after total correction of Fallot’s tetralogy.- 18. The need for homograft reconstruction of the right ventricular outflow tract in Fallot’s tetralogy.- 3 Prosthetic Valves.- 19. The design characteristics of heart valves.- 20. Echocardiographic studies following mitral valve replacement.- 21. Myocardial preservation during aortic valve replacement.- 22. The cage ball prosthesis.- 23. Five years experience with the Björk-Shiley disc valve in aortic, mitral and tricuspid valvular disease.- 24. The Australian experience with prosthetic valves.- 25. The use of Starr-Edwards composite seat valves (models 2320 and 6320) in the aortic and mitral positions.- 26. Mitral valve replacement.- 27. The use of Starr-Edwards valves (model 1260).- 28. The use of Braunwald Cutter valves: Part 1.- 29. Experience with the Björk-Shiley prosthesis: Part I.- 30. Experience with the Björk-Shiley prosthesis: Part II.- 31. The use of the Braunwald Cutter valve: Part II.- 4 Tissue Valve Replacement and Repair.- 32. Viability of homografts and problems of long-term storage.- 33. Problems of sterilisation in homograft preparation.- 34 Tissue valve preparation.- 35. Mechanical characteristics of vena cava and a technique for its use, unsupported, for mitral valve replacement.- 36. Homograft and autograft replacement of the aortic valve.- 37. Experience with heterografts.- 38. Homograft replacement of the mitral valve.- 39. Experience with tissue heart valves.- 40. Late results of cardiac valve replacement with autologous fascia lata.- 41. Reconstructive valve surgery.- 5 Open-Heart Surgery under One Year of Age.- 42. Open-heart surgery in the first year of life.- 43. Experience with infant perfusions.- 44. Management of ventricular septal defects in infants.- 45. Total surgical correction of total anomalous pulmonary venous drainage in infants.- 46. Operative treatment of patients with transposition of the great arteries in infancy.- 47. Treatment of valvar stenosis.- 6 Post-Operative Care following Cardio-thoracic Surgery.- 48. Osmolar balance after open-intracardiac operations in children.- 49. Peripheral temperature measurement as an aid to postoperative care.- 50. Atrial pressure measurement after open-heart surgery.- 51. Assessment of left ventricular function and simultaneous measurements of pressure and dimension.- 52. Measurement of cardiac output in infants and young children using thermodilution.- 53. Cardiac output and its derivatives using an implantable electromagnetic flow probe and intra-cardiac manometers.- 54. The place of the computer and automation in postoperative care.- 7 Ischaemic Heart Disease.- 55. Selection of patients for coronary artery surgery.- 56. Pre and postoperative investigation.- 57. Problems of technique in aorto-coronary bypass operations.- 58. The coronary bypass operation.- 59. Coronary endarterectomy.- 60. Postoperative blood flow in auto-coronary saphenous vein bypass grafts.- 61. Pathological aspects of ischaemic heart disease.- 62. The intra-aortic balloon pump.- 63. Infarctectomy.- 64. Surgical treatment of left ventricular aneurysm.- 65. Management of postinfarction mitral regurgitation.- 66. The treatment of postinfarction VSD.- 8 Results of Surgery in Rare Congenital Heart Disease.- 67. Results of surgery in rare congenital heart disease.- 9 Discussion.