TUESDAY AFTERNOON, APRIL 27, 1971

2:00 P.M. Executive Session (Limited to Active and Senior Members)

Phoenix Ballroom

3:30 P.M. Scientific Session: REGULAR PROGRAM

Phoenix Ballroom

Address by the President

Thomas H. Burford

St. Louis, Missouri

"FROM WHENCE TO WHITHER -

Some Reflections on Surgical Specialty Training"

Address by the Honored Speaker

Roger O. Egeberg, Assistant Secretary

for Health and Scientific Affairs,

Department of Health, Education and Welfare

Washington, D.C.

31. Operative Management of Thoracic Aortic Aneurysms Due to Cystic Medial Necrosis

Harris B Shumacker, Jr., Indianapolis, Indiana

This is a study of the author's personal experience during the past eight years. Eleven had operations upon the ascending aorta with cardio-pulmonary by-pass, three of them for unruptured aneurysms with aortic insufficiency, eight for ruptured aneurysms. Two of the former had ball-valve protheses inserted, one a fascia-lata graft. Several of the latter had valve suspensions. All patients survived. One with a prothesis died six years later of cerebral embolic episodes. The other has had a fascia lata replacement of the valve for more minor embolic difficulties. Of the group with rupture all have done well save one who died later from rupture of an arteriosclerotic abdominal aortic aneurysm. Twelve had operations upon the descending aorta, using an atrial-femoral by-pass in eleven, arch-femoral by-pass in one. One with an unruptured aneurysm did well. Three of eleven with rupture died in the hospital. Two died later. Possible reasons why there were no hospital deaths in all eleven with operations upon the ascending aorta while three of twelve with operations upon the descending died will be discussed as will the puzzling and fortunately uncommon case in which the dissection involves the entire thoracic aorta and arteriograms fail to disclose site of aortic tear.

32. Left Ventricular Approach for the Repair of Ventricular Septal Perforation and Infarctectomy

Hushang Javid,* James A. Hunter, Hassan Najafi,

William S. Dye* and Ormand C. Julian,

Chicago, Illinois

Emergency repair of ruptured ventricular septum was undertaken within six weeks following myocardial infarction in four patients. Profound cardiogenic shock six days following infarct in one patient and non-remitting congestive failure in the other three patients prompted surgical treatment. A review of the literature indicates that 40% of patients with post infarction ventricular septa! ‘ defects also have a left ventricular aneurysm. In our series of four, repair of septal rupture and excision of the infarct concomitantly would have been justified in three patients. The only operative death in this group occurred in a patient whose septal defect was repaired through the right ventricle six days after myocardial infarction. This patient died in the operating room because of inadequately functioning left ventricle. The late death three months after surgery was due to congestive failure caused by a large left ventricular aneurysm in another patient whose obvious infarct was not excised. The ease of ventricular septal repair through the opening in the left ventricle after excision of the infarct and the uneventful postoperative course prompted this report. The mere presence of a dyskinetic or akinetic left ventricular wall should justify excision of the infarct as well as the repair of the septal defect.

*By Invitation

TUESDAY EVENING, APRIL 27, 1971

7:00 P.M. Reception

Phoenix Ballroom

8:00 P.M. Dinner and Dancing

Phoenix Ballroom

Attendance limited to Members of the Association and their ladies, Invited Speakers and their ladies, Invited Guests and their ladies.

Dinner dress preferred