Research Articles (Cardiothoracic Surgery)

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Browsing Research Articles (Cardiothoracic Surgery) by Author "Przybojewski, J. Z."

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    Penetrating wounds of the heart and great vessels : a new therapeutic approach
    (Health and Medical Publishing Group -- HMPG, 1982-08) Knott-Craig, C. J.; Przybojewski, J. Z.; Barnard, P. M.
    A series of 36 Black and Coloured patients, presenting during a 1-year period with life-endangering intrathoracic trauma secondary to assault, is presented. Penetrating wounds of the heart were documented in 32 of these patients, 6 of whom died almost immediately after having been brought into the Resuscitation Unit of Tygerberg Hospital, Parowvallei, CP. The remaining 26 patients had clinical features of cardiac tamponade and circulatory collapse, and in 4 of these patients an emergency thoracotomy was performed in the Resuscitation Unit as it was considered inadvisable to delay surgery until theatre had been arranged. Three of the latter 4 were discharged home completely recovered. Total peri-operative mortality was 13.3%, most deaths being due to lacerations of the left ventricle. Penetrating wounds of the ventricles accounted for some 85% of the total cardiac lacerations; other lacerations affected the pulmonary artery and its branches, the aorta, left atrium and internal thoracic artery. The incision most frequently employed at surgery was a median sternotomy (53%), followed by left thoracotomy (40%) and right thoracotomy (7%). Pre-operative emergency management based on pathophysiological principles is discussed. The fact that relatively inexperienced surgical registrars performed many of these operations with good results emphasizes the need for the establishment of resuscitation units in more peripheral hospitals where many of these patients could primarily be treated. These units would then be able to manage many of these patients, probably at an earlier stage than if they were referred to a teaching hospital such as Tygerberg.
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    Post-infarction ventricular septal defect and aneurysm formation : a case presentation with successful surgical correction and review of the literature
    (HMPG, 1981-02) Przybojewski, J. Z.; Barnard, P. M.
    A fairly young man suddenly developed a large ventricular septal defect (VSD) after an extensive anterolateral and anteroseptal myocardial infarction. Because of congestive cardiac failure refractory to medical treatment he underwent simultaneous closure of the VSD and left ventricular aneurysmectomy 6 weeks after the myocardial infarction. Some 14 months after operation the patient is completely asymptomatic on the minimum of medical therapy and is able to live normally. The literature on these two combined lesions complicating acute myocardial infarction and their surgical correction is reviewed. It is postulated that this patient's infarction was caused by coronary spasm of the Prinzmetal variety with underlying normal coronary arteries.
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    Severe isolated left mainstem coronary artery stenosis : a case report
    (Health and Medical Publishing Group (HMPG), 1986-01) Przybojewski, J. Z.; Rossouw, J.
    A 33-year-old white man had exertional angina pectoris, followed by angina pectoris at rest, and then episodes of ischaemic acute pulmonary oedema associated with angina pectoris. Selective coronary angiography delineated an isolated long-segment stenosis of the left brainstem coronary artery with no other lesions. We believe that the mainstem obstruction was due to coronary artery fibromuscular hyperplasia, a condition rarely affecting the coronary artery circulation. At operation three coronary artery bypass grafts were inserted, one to the left anterior descending artery and two to the left circumflex coronary artery, with a most successful result. The patient's recurrent acute pulmonary oedema was due to severe myocardial ischaemia; the possibility of superadded coronary vasospasm aggravating the obstruction cannot be entirely discounted.