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Article
November 3, 1956

VISUAL INTRACARDIAC SURGERY IN A SERIES OF ONE HUNDRED ELEVEN PATIENTS

JAMA. 1956;162(10):941-946. doi:10.1001/jama.1956.02970270001001
Abstract

• The use of general hypothermia in order to permit cardiac surgery to be performed on the open heart with a dry field under direct vision has intrinsic, unknown risks. These have been analyzed in 111 patients, the largest group being 58 patients with atrial septal defects. Of 19 fatalities, 8 were due to cardiac failure, 4 to thrombosis, 4 to hemorrhage, and 3 to other causes. The hazards both of the cardiac arrhythmias and of the disturbances of clotting can be greatly reduced by not exceeding a limit of eight minutes of circulatory occlusion, by not using this technique for procedures that cannot be readily accomplished within this time limit, and by keeping the temperature within the range from 29 to 32 C (84.2 to 89.2 F). Within these limitations, pulmonary valvular and infundibular stenosis, atrial septal defect, and aortic stenosis can be readily repaired at low risk. The risk is justified by the sometimes dramatic improvement seen after operation in patients with otherwise hopeless conditions.

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