Texas Heart Institute JournalVolume 12 Number 3 September 1985

Supported in part by grants from:

* Ethicon, Inc.Somerville, New Jersey

* Shiley IncorporatedIrvine, California

* Norton/Texas Medical ProductsHouston, Texas

* W.L. Gore & Associates, Inc.Medical Products DivisionElkton, Maryland

* Sarns, Inc.Subsidiary of the 3M CompanyAnn Arbor, Michigan

* Davis & GeckAmerican Cyanamid CompanyPearl River, New York

* St. Jude Medical, Inc.St. Paul, Minnesota

* Bio-Medicus "

Minnetonka, Minnesota

* Bard Cardiosurgery DivisionC.R. Bard, Inc.Billerica, Massachusetts

* IMPRA, Inc.Tempe, Arizona

(Please see pages 282-283 for product information.)

Volume 12, Number 3

The Texas Heart Institute Journal will be sent upon request to members of the medicaland allied health professions. Copyright© 1985 by the Texas Heart Institute ofSt. Luke's Episcopal and Texas Children's Hospitals, Houston, Texas. All rightsreserved.ISSN 0730-2347

Published in the Cardiovascular Surgical Research Laboratories, Texas Heart Institute,and printed by Baxt & Associates, 4828 Loop Central, Suite 820, Houston, Texas77081.

Cover: Artist's rendition of the internal mammary artery as used for a bypass conduit.See article on page 211.

Editor-in-Chief Senior Assistant EditorsRobert J. Hall, M.D. Arthur Garson, M.D.

Paul Gerson, M.D.Associate Editors Ali Massumi, M.D.0. Howard Frazier, M.D. Hugh A. McAllister, M.D.Virendra S. Mathur, M.D. Stephen Slogoff, M.D.William E. Walker, M.D. Robert E. Sonnemaker, M.D.

Executive EditorEvelyn Lawrence, B.A., M.B.A.

Editorial Consultants Earl F Beard, M.D.John A. Burdine, M.D. Carlos M. de Castro, M.D.Denton A. Cooley, M.D. J. Michael Duncan, M.D.Arthur S. Keats, M.D. Robert D. Leachman, M.D.Carl J. Lind, M.D. Louis Leatherman, M.D.Dan G. McNamara, M.D. James J. Livesay, M.D.John D. Milam, M.D. Edward K. Massin, M.D.Edward B. Singleton, M.D. Charles E. Mullins, M.D.H. Irving Schweppe, M.D. David A. Ott, M.D.Layne 0. Gentry, M.D. Everett C. Price, M.D.Camilo Barcenas, M.D. George J. Reul, M.D.Efrain Garcia, M.D.

Production Assistants Michael G. McGee,Bill Andrews, Art Director Research CoordinatorPhotographic Services, SLEH, TCH, and THI Susan J. Miller, SecretaryDebby Butler, Symposia Leonard W. Pechacek,Beth Cooley, Accounting EchocardiographyGerald Creager, Data Research O.U.J. Okereke, M.B., FR.C.S.Sidney K. Edelman, Ph.D., Statistics Steven N. Parnis,Jacqueline Fogle, Editorial Research AssociateJohn M. Fuqua, Biomedical George E. Pool, ResearchAssociateKen Hoge, THI Laboratory Photography Robert Preston, LaboratoryDena Houchin, R.N. B. Radovancevic, M.D.Stephen R. Igo, Physiology Robin E. Secrest, EditorialMarianne Kneipp, Editorial Cora Sharp, Laboratory

Joyce Staton, Editorial

Brief CommunicationsShort, well-documented original casereports, techniques, or research effortsare invited. They will be published underBrief Communications in future issuesof this journal. They should be limitedto approximately a thousand words,with very few figures and references.

Healing is a matter of time, butit is also a matter of opportunity.

Hippocratesc. 460-400 B.C.

Great deeds are usuallywrought at great risks.

Herodotusc. 485-425 B.C.

CorrespondenceComments and letters pertaining torecently published articles in the TexasHeart Institute Journal are welcomed.The letters should be no longer thantwo double-spaced typewritten pagesand should contain no more than fourreferences. They should be signed,with the expectation that the letters willbe published if appropriate. The rightto edit all correspondence in accordwith the Journal style is reserved by theeditors.

For extreme illnesses extremetreatments are most fitting.

Hippocrates (Precepts)c. 460-400 B.C.

Product InformationEthicon, Inc.Route #22Somerville, New Jersey 08876 USATelephone: (201) 524-0400Customer Service: (201) 524-3614TELEX: 833-487Manufacturers of Sutures/Needles, Meshes, SkinTapes and Mechanical Wound Closure

Sutures:ETMHBOND® (with pledgets), ETIHFLEX® (withpledgets), PROLENE®, Coated VICRYL®,ETHILON®, MERSILENE®, NUROLON®,PERMA-HAND® SILK, CONTROL RELEASE®

Mechanical:PROXIMATE® (skin and ILS internal staplers)LIGACLIP® (ligating clips)

Miscellaneous:CLEARON®, ETHISTRIP®

Shiley Incorporated17600 Gillette AvenueIrvine, California 92714-5751, USATelephone: (714) 250-0500Toll-free: (800) 854-3683TELEX: 68-5585Manufacturers of Cardiovascular Products:Bjork-Shiley Spherical Disc ValvesBjork-Shiley 60® Convexo-Concave Disc ValvesBjork-Shiley Monostrut Valves(not available in the U.S.A.)

Bjork-Shiley Aortic Graft Valve ProsthesesBjork-Shiley Pulmonic Graft Valve ProsthesesPuig Massana-Shiley Annuloplasty RingsIonescu-Shiley Pericardial Xenograft - AorticIonescu-Shiley Pericardial Xenograft - MitralIonescu-Shiley Low Profile Pericardial Xenografts(Not available in the U.S.A.)

Ionescu-Shiley Aortic Graft Valve ProsthesisIonescu-Shiley Composite Conduits- PulmonicIonescu-Shiley Pericardial PatchBonchek-Shiley Vein Distention SystemCardiac Insulation PadsBonchek-Shiley Cardiac Jacket

Cardiopulmonary Products:Stockert-Shiley Heart Lung Machine ProductsM-2000 Adult Membrane OxygenatorS-IOOA Adult Blood OxygenatorS-70 Infant/Pediatric Blood OxygenatorCardiotomy ReservoirsHardshell/Softshell Venous ReservoirsPerfusion Tubing SetsBuckberg-Shiley Blood CardioplegiaSolution Delivery Sets

Cardioplegia Solution Delivery SetArterial/Prebypass/Gas FiltersSterile ConnectorsTemperature Monitor Instrument

Surgical Products:Complete line of adult and pediatrictracheostomy tubes

Adult and pediatric endotracheal tubesInfant and Neonatal Oxygen HoodsEmbolectomy CathetersIrrigation CathetersVein Irrigation CannulaShiley Vas-Cath Subclavian Cannulae

Norton/1exas Medical ProductsSubsidiary of Norton Health Care Products10940 S. Wilcrest DriveHouston, Texas 77099 USATelephone: (713) 933-7766Toll free: (800) 231-9871TWX: 910 880-4055

Custom Perfusion SetsCardioplegic Sets (Custom & Standard)Custom CV. Nurse PacksNorton/TMP Products Designed forCardiovascular Surgeons and PerfusionistsTygon® S 50 HL Tubing

Distributed Products:Oxygenators & Reservoirs

Norton Health Care Products Include:Custom Cath Lab PacksDisposable Monitoring DevicesCustom Monitoring KitsIntroducer TraysDiagnostic CathetersDisposable Transducers

Bio-Medicus"15306 Industrial RoadMinnetonka, Minnesota 55343Telephone: (612) 938-7600Manufacturers of perfusion equipmentBIO-PUMPO (the blood delivery system forbypass perfusion)

BIO-PROBE" (disposable blood flowmonitoring system)

BIO-CONSOLE® Model 520 Series(companion to the Bio-Medicusblood delivery system for perfusion)

W.L.Gore & Associates Inc.Flagstaff, AZ(800) 528-8763

Huntington Beach, CA(714) 895-6666

Naperville, IL(312) 961-2809

Elkton, MD(800) 638-4804

Vol. 12, No. 3, September, 1985282

W.L. Gore & Associates, Inc.Wakefield, MA(617)246-1818

Midlothian, VA(804) 794-9340

GORE-TEXO Vascular GraftsGORE-TEX® PatchesGORE-TEX® Catheters

Sarns, Inc.Subsidiary of the 3M Company6200 Jackson RoadAnn Arbor, Michigan 48103 USATelephone: (313) 663-4145Toll free: (800) 521-2818TELEX: 23-0508CABLE: SarnsequipManufacturers of Equipment forCardiovascular Surgery:7000 MDX Modular Pump System withABLD level and air detection insafety system

7400 Pulsatile Roller Pump3000 & 5000 Heart-Lung Console withABLD Blood Level and Air Detectionin safety system

Heater/CoolerICDS Cardioplegia Delivery SystemH.E.L.P. Emergency Power SystemSternal SawSurgical and Perfusion AccessoriesDisposables for CardiovascularSurgery

MP-4 Cardioplegia Delivery SetArterial CannulaeVenous Return CathetersTwo-Stage Venous Return CathetersSuction Devices and Vent Catheter

Davis & GeckAmerican Cyanamid CompanyOne Cyanamid PlazaWayne, New Jersey 07476Telephone: (201) 831-2140Customer Service: (203) 743-4451Manufacturers of Sutures/Needles,Temporary Pacing Wires, Dacron +Tape, Skin Staplers, Skin Tape, andDisposable Ligating Clip Devices

Ligating Clips:MULTICLIP® Disposable Ligating ClipDevice

Skin Tapes:APPOSE® Skin Strips

St. Jude Medical, Inc.One Lillehei PlazaSt. Paul, Minnesota 55117 USATelephone: (612) 483-2000Toll free: (800) 328-9634Product Information:St. Jude Medicalg Heart Valve ProsthesesSt. Jude Medicalg Aortic Expanded CuffHeart Valve Prostheses

St. Jude Medical® Aortic Valved GraftProstheses

St. Jude Medical® Pulmonic Valved GraftProstheses

BioPolyMericTM Vascular Graft Prostheses

Bard Cardiosurgery DivisionC.R. Bard, Inc.129 Concord Road, P.O. Box MBillerica, Massachusetts 01821Telephone: (617) 663-5353Toll-free (800) 225-0211 (outside of Massachusetts)TELEX: 951-894William Harvey® Perfusion Products:Adult Hybrid OxygenatorsInfant/Pediatric Hybrid OxygenatorHollow-Fiber Membrane OxygenatorCardiotomy ReservoirsCardiotomy Reservoirs with FilterArterial FiltersCustom Tubing Packs and Perfusion SetsHemo-ConcentratorsExtracorporeal Cannulae

IMPRA, Inc.2445 West 10th PlaceTempe, Arizona 85281Telephone: (602) 894-9515Toll-free: (800) 321-4254TWX: 910/950-0122Manufacturers ofExpanded PTFE Vascular Grafts:IMPRA Straight GraftsIMPRA Flex GraftsIMPRA Tapered GraftsIMPRA Stepped GraftsIMPRA Femoral Artery Access CuffIMPRA Patch Grafts

IMPRA Kelly-Wick TunnelerSubclavian/Femoral CathetersTrach-Mate Endotracheal Tube Holder

TExas Heart Institute Journal 283

Information for Authors

Ol Published quarterly with an occasional sup-plementary issue. Articles are acceptable frominside and outside of these institutions.O The first page of the manuscript should pre-sent the title of the paper, name ofauthor(s), including first names and highestacademic degree, and the name of departmentand institution in which the work was done.O An abstract or summary should precede thefirst page of the text. It should be no more than200 words, except in very technical papers toclarify the presentation.o Submit one original and one copy of themanuscript, including text pages, legends,tables and references. Type double-spaced on81/2½ by 11" typewriter paper with margins of1 ½2" or more. Two glossy prints of each figureshould be included when the article is to beillustrated. Legends should be typed double-spaced on a separate page.

O References should be numbered consecu-tively as they appear in the text, and the namesof all authors are requested. The authors areresponsible for submitting correct references.Reference examples:

Article:Sobel M, Salzman EW, Davies GC, HandinRI, Sweeny J, Ploetz J, Kurland G. Circula-tion platelet products in unstable angina pec-toris. Circulation 1981; 63:100.

Book:Cooley, DA. Techniques in Cardiac Surgery,Philadelphia, W.B. Saunders, 1984; 391 pp.

Chapterfrom Book:Blakely JA, Gent M. Platelets, drugs andlongevity in a geriatric population. In Hirsh J,Cade JF, Gollus AS (eds): Platelets, Drugs,and Thrombosis. Basel, S. Karger 1975; pp284-291.

o Reprints: Authors may order reprints oftheir articles from Ms. Vicki D. Miller, ReprintManager, The Sheridan Press, Fame Avenue,Hanover, PA 17331. Telephone (717) 632-3535.

Individual reprints of an article must beobtained directly from the author of correspon-dence.

El Abbreviations: Standard abbreviationsshould be used consistently throughout thearticle. Unusual or coined abbreviationsshould be spelled out the first time they appearin the text, with the abbreviations following inparentheses.

Ol Tables should be numbered with Romannumerals and typed on separate pages. A brieftitle should follow the Table number. Allunusual units of measurement, acronyms andabbreviations should be explained in a legendat the bottom of the table.

El The right to edit all manuscripts in accordwith the Journal style is reserved by theeditors.

Ol Address inquiries and manuscripts to theExecutive Editor, Texas Heart Institute Jour-nal, PO. Box 20269, Houston, Texas 77225.Telephone (713) 791-4209.

Vol. 12, No. 3, September, 1985284

Information for SubscribersThe Texas Heart Institute Journal is a quarterly designed to meet the needs of the physician,

clinical investigator, and laboratory scientist. Now serving over 24,000 subscribers, includingthose in the United States and 93 foreign countries, the Journal is sent upon request. Subscribersmay help defray the costs of printing and distribution by taking out a voluntary paid subscriptionat an annual rate of $25.00. Please mail check with order, as we do not send invoices.

Available back issues will be sent upon request, but many issues of the Journal are no longerin stock. Please send check for $5.00 per copy with your order.

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