Faculty Bibliography

From January 1972 to April 1982, 125 adults underwent operation for congenital heart disease at the Medical University of South Carolina. Age ranged from 18 to 73 years, with an average age of 31 years. A variety of defects were seen. Atrial septal defect (59 patients), ventricular septal defect (15 patients), patent ductus arteriosus (14 patients), tetralogy of Fallot (14 patients), and coarctation of the aorta (9 patients) were the most common. There were 48 men and 77 women in the study. Most patients presented with recent onset of dyspnea on exertion or at rest, but 16 patients were asymptomatic. Eight patients died after surgery for an overall operative mortality rate of 6 per cent. The most common postoperative complication was arrhythmia (13 patients, 10%). Despite recent advances in the diagnosis and treatment of congenital heart disease in infants, a significant number of patients apparently escape detection and first present with congenital heart disease as adults. Prompt diagnosis and surgical intervention will usually produce excellent results and relief of symptoms in these patients

The external pressure suit (MAST) is beneficial in hypovolemic shock by preventing lower extremity venous pooling. Previous data from this laboratory demonstrated that internal cardiac massage is significantly improved when combined with MAST. This study was designed to see if external massage (EM) could be similarly augmented by this device. Twenty anesthetized pigs underwent left thoracotomy and placement of a left atrial catheter for pressure determination and microsphere injection. A flow probe was placed around the aorta for measurement of cardiac output, axillary artery catheters were placed for blood pressure determination and microsphere sampling, and central venous pressure was monitored. Hemodynamic collection of microsphere injections was performed during resting conditions, during EM alone after electrically induced ventricular fibrillation, and during EM after inflation of the MAST suit. Significant increases in mean arterial pressure, systolic arterial pressure, and diastolic pressure were noted with EM and MAST suit inflation over EM alone. Left atrial pressure doubled during EM and MAST suit inflation. Cardiac output was not augmented by the inflation of the MAST. Myocardial blood flow and brain blood flow increased during EM and MAST, but renal blood flow decreased. These data suggest that unlike internal massage, cardiac output during EM and MAST is not improved by increased venous return and flow during EM may be due to a different mechanism than direct cardiac compression

Vena caval injuries are relatively rare and are associated with a high mortality before the patient arrives at a medical facility and even after initial resuscitation and operative intervention. Survival is directly related to (1) the location of the injury, (2) the amount of active bleeding, and (3) the type and number of associated injuries. To achieve maximum survival in patients with serve injury, rapid transportation to an emergency room is necessary. Resuscitation must then be aggressive, with rapid transferral to the operating room, and the surgeon must know the various techniques available for repair