Abstract:

Chronic leg ulceration affects about 1 to 2 % of the European population. Although the pathogenesis of venous ulceration is not completely understood, it is generally agreed that the transmission of high ambulatory pressures through incompetent perforating veins plays a major role. There are only limited data available to assess the long-term prognosis for leg ulcer patients.

Authors:

Gerald Hauer, M.D., Angelika Werner, M.D.

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Abstract:

Endoscopic surgery is not a recent development. In fact, the application of the Edison light bulb to the cystoscope in 1883 was followed by widespread use of endoscopy. In 1910, Jacobeaus proposed the diagnostic use of the cystoscope for investigation of "serous cavities," and in 1922, he reported lysis of pleural adhesions to promote artificial pneumothorax in 40 patients with pulmonary tuberculosis. For the next 30 years, the thoracoscope was widely used for pneumolysis in tuberculosis patients, but its use waned considerably after the development of effective antibiotic treatment for tuberculosis. With the advent of laparoscopy, endoscopy has become popular again and here we review the application of endoscopic techniques in cardiovascular surgery.

Authors:

Samuel S. Ahn, M.D., F.A.C.S., Cecilia K. Wieslander, B.S.

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Abstract:

In recent years mitral valve repair has gained increasing acceptance as the preferred treatment for mitral insufficiency. Mitral valve repair has many advantages. The surgical risk is lower than prosthetic valve replacement. Improved preservation of left ventricular function due to maintenance of the papillary muscle - mitral annular continuity - has been demonstrated. Thromboembolism is rare after mitral repair in patients in sinus rhythm. These patients receive no coumadin and thus are free from bleeding complications. The repaired valves have been shown to have durability comparable to or better than prosthetic valves.

Authors:

Gerald M. Lawrie, M.D., F.A.C.S.

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Abstract:

Most surgeons use a longitudinal right lateral left atrial incision behind the inter-atrial groove for the exposure of the mitral valve, even though several other surgical techniques have been described. The shortest route to the mitral valve is, however, through the roof of the left atrium, where the incision is closest to the mitral annulus. This was first described by Meyer et al., but the approach became unpopular because of its technical difficulties and inadequacies. We have modified this technique, making it safer, easier and adaptable to any type of mitral surgery. We describe our experience with 53 patients who had mitral valve surgery using this modified approach. All of the operations were performed by the same surgeon over an 18 month period with consistently satisfactory results.

Authors:

Dumbor L. Ngaage, F.R.C.S., Anil Mulpur, F.R.C.S., R. Unnikrishnan Nair, F.R.C.S.

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Abstract:

Intraoperative measurement of flow allows functional evaluation of coronary bypass grafts and may be predictive of a patient's immediate and late outcome after myocardial revascularization as it permits early detection of technical errors. Many different methods have been used to assess the quality of the anastomosis intraoperatively. Angiography is considered the gold standard technique to which all other methods should be compared. However, it is invasive, costly, time consuming, and not always readily accessible in the operating room.

Authors:

Charles C. Canver, M.D., Jyotirmay Chanda, M.D., Ph.D.

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Abstract:

The port-access technique for cardiac surgery was recently developed at Stanford University in California as a less invasive method to perform some cardiac operations. The port-access system has been described in detail elsewhere. It is based on femoral arterial and venous access for cardiopulmonary bypass (CPB) and on the adoption of a specially designed triple-lumen catheter described originally by Peters, and subsequently modified and developed in the definitive configuration called the endoaortic clamp.

Authors:

Mario Vigano, M.D., Gaetano Minzioni, M.D., Patrizio Spreafico, M.D., Mauro Rinaldi, M.D., Stefano Pasquino, M.D., Piero Ceriana, M.D., Alessandro Locatelli, M.D., I.R.C.C.S

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Abstract:

Revascularization of all significantly stenosed vessels remains the goal of coronary artery bypass surgery. Recent improvements in endoscopic instruments have resulted in the evolution of selective left anterior descending artery bypass grafting through a limited anterior small thoracotomy (LAST) incision. A major limitation of this technique is the inaccessibility for complete surgical revascularization in multivessel disease. In this article, we describe a minimally invasive technique for total coronary artery revascularization that combines conventional surgical techniques with the advantages of minimally invasive surgery. We have performed total coronary revascularization in 52 patients over a period of 16 months with consistently good results.

Authors:

R. Unnikrishnan Nair, F.R.C.S., David A. C. Sharpe, F.R.C.S., Anilkumar Mulpur, F.R.C.S.

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