AIDS is a syndrome caused by HIV. The virus is spread by homosexual or heterosexual transmission and by infected blood or certain body fluids. Respiratory infections are the commonest cause of death, and diagnosis may be difficult. The fiberoptic bronchoscope (FOB) plays an essential role in diagnosing respiratory infections in AIDS and is important in minimizing the need for open lung biopsies. Various problems require thoracic surgical consultation and treatment. We do not consider it ethical to deny these patients help. There can be no "double standard" in the care of patients in the hospital or in the operating room since any of our patients may have HIV without our knowledge.
Intraoperative epicardial two-dimensional and pulsed Doppler echocardiography (PDE) were performed for 44 patients undergoing open mitral valve surgery to determine the presence and severity of functional tricuspid regurgitation (TR). The findings of intraoperative epicardial PDE performed before cannulation for extracorporeal circulation were compared with those of preoperative transthoracic PDE test. The findings of intraoperative PDE after cessation of the extracorporeal circulation were compared with postoperative transthoracic PDE and clinical findings. Pansystolic pulsed Doppler signals recorded in the right atrium were defined as TR. The grade of TR was assessed transthoracically and intraoperatively on the basis of its maximum distance from the tricuspid valve orifice. To perform intraoperative echocardiography, the transducer was sterilized with ethylene oxide gas and placed directly on the right atrium. The pulsed Doppler signals were recorded from nine sample volumes set in the right atrium, and the TR was graded. There were no complications using this technique. Intraoperative PDE prior to the extracorporeal circulation was more sensitive and specific for detecting TR (100% and 80%, respectively) than was preoperative transthoracic PDE (92.8% and 46.7%, respectively). All patients without TR by intraoperative PDE before cannulation for extracorporeal circulation had the competent tricuspid valves. The patients who were diagnosed as having no TR by intraoperative PDE after cessation of the extracorporeal circulation had no significant TR during the follow-up period. It was concluded that intraoperative PDE is a practical method which allows surgeons to assess the presence and severity of TR intraoperatively and to evaluate tricuspid valve function after intracardiac procedures.
