DeBAKEy CARDIOvASCuLAR JOuRNAL - Methodist Hospital

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3 Table 1. Post infarction ventricular septal defect Figure 27. Top: Post infarct VSD with patch graft repair. Bottom: Surgical exposure of post infarction. 13 11 9 7 5 3 1 0 Operative Procedure Cases Deaths Mortality VSD + LVA 11 6 55% VSD + VA + CAB 8 2 25% VSD + VA + VALVE 3 0 0% VSD + CAB 2 0 0% ALL CASES 24 8 33% 1 1 50% 1965-1975 Cases 3 Figure 28. LVA with VSD 4 2 3.3% 4 1976-1985 Cases 6 LVA with VSD = 29 OP survival = 22 OP death = 7 24% 4 50% 1986-1995 Cases 5 13 0 0% 1996-2005 Cases 4 Post Infarction Ventricular Septal Defect Mortality after post-infarction ventricular septal rupture exceeds 90% at one year if untreated. Twentyfour such defects were surgically repaired during four decades (Table 1). Acute intervention was the choice in most of the patients in this series, with outcomes better than anticipated. More than 70% of these patients were alive at 24 months. Meticulous surgical techniques minimize the likelihood of disruption of the suture line or incomplete repair, which can lead to recurrence of the defect with resulting high mortality (Figure 27 and 28). Associated procedures such as coronary revascularization (10 patients) (Figure 29) and valvular reconstruction or replacement (3 patients) greatly improved operative results (Table 1) with overall 33% mortality. Myocardial preservation techniques improved survival, especially during the last decade with no operative deaths (13 pts.). Tumors of the Heart Since the advent of echocardiography, cardiac neoplasms have become readily recognizable. And with cardiac MRI now available, tissue characterization differentiating benign and malignant cardiac tumors and thrombus is increasingly possible. This series includes 31 patients with cardiac tumors that were treated surgically. Cardiac myxoma accounted for 23 of these cases, with no surgical mortality (Figure 30). (Editor’s Note: I recall one day when there were three left atrium myxomas on Dr. Howell’s surgical schedule.) There was one benign fibroma obstructing the left ventricular outflow track that was surgically removed and seven patients operated on for primary sarcoma of the heart. Out of the 31 patients, the only mortality occurred in two cases of inoperable sarcoma. Figure 29. Left: Myocardial infarction with anterior wall aneurysm and distal ventricular septal rupture. Right: Aneurysm resection and repair with associated patch graft repair of VSD and myocardial revascularization. 10 vII (1) 2011 | MDCvJ
Figure 30. Myxoma filling the left atrial cavity with obstruction of the mitral valve. Figure 32. Left: Giant right coronary artery aneurysm and associated fistula to the right atrium. Right: Post operative reconstruction with resection of aneurysm, coronary artery, and closure of fistula to the right atrium. Miscellaneous Cardiac Operations The subset of this overall series categorized as miscellaneous cardiac operations was composed of 852 procedures (Figure 31) that included one or more of the following: repair of a congenital heart defect (atrial septal defect, ventricular septal defect, Tetralogy of Fallot), septal myomectomy for idiopathic hypertrophic subaortic stenosis (IHSS), subaortic ring, coronary artery malformation, and pacemaker insertion (Figure 32). Pacemaker insertion had the largest number of patients in this series (568), and the 12 total deaths were all associated with a myocardial infarction or stroke occurring after the pacemaker insertion. There were two deaths in the IHSS group for a mortality of 5.5%. There was no mortality associated with any of the other procedures. Isolated Coronary Endarterectomy 43 Tetrology 40 Figure 31. Miscellaneous cardiac operations Carotid Endarterectomy Coronary Artery Abnormalities Supravalvular Aortic Stenosis 3 Surgery for cerebral vascular insufficiency was first performed at this institution by Michael E. DeBakey, M.D., and has continued to evolve over time. Dr. Howell has performed operations on 3,523 patients for this condition during the past four decades. Out of those, 3,313 patients were operated on for carotid artery insufficiency and the remaining cases for vertebral artery insufficiency. During these four decades, electroencephalography (EEG) monitoring, first adopted by Dr. Howell at The <strong>Methodist</strong> <strong>Hospital</strong>, has continued as the gold standard for monitoring cerebral blood flow, thus avoiding routine carotid artery shunting. Right or left carotid endarterectomy was performed in 2,874 patients. There were 26 deaths and 2,848 survivors with a mortality rate of 0.9% over the four decades. The mortality after the first decade never exceeded 0.8%, and the last decade mortality rate was 0.3% (Figure 33). MDCvJ | vII (1) 2011 11 ASD 119 IHSS 32 VSD 29 18 Pacemaker 568
Page 1 and 2: Volume 7, Number 1 • Jan. - Mar.
Page 3 and 4: W.L. Winters Jr., M.D. EDITOR’S N
Page 5 and 6: Every generation has its heroes. Dr
Page 7 and 8: OTHER CHEST 8.96% Figure 5. Surgica
Page 9 and 10: Baxter Edwards Beall Bjork Shiley C
Page 11: mitral valve operations. In most ca
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Page 21 and 22: W.S. Henly, M.D. PRIvATE PRACTICE O
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MetHodist de Bakey Heart & VasCular
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My yEARS WITH MICHAEL E. DeBAKEy Lo
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poet’s pen WHY I AM NOT A BUDDHIS
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To the Editor: After reading Dr. Be
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6565 Fannin Street Houston, Texas 7
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