RESUMEN
A 24-day-old male with interrupted aortic arch (type B), ventricular septal defect, and tunnel-like subaortic stenosis underwent a one-stage surgical treatment. The operative procedure comprised reconstruction of the aortic arch, transatrial excision of the subaortic fibromuscular tissue via the ventricular sepatal defect, and patch closure of the defect. The patient tolerated the procedure well and the postoperative echocardiography demonstrated a residual pressure gradient across the left ventricular outflow tract of 20 mmHg. Our result suggests that the transatrial surgical management of subaortic stenosis via the ventricular sepatal defect produces a safe and promising surgical option.
Asunto(s)
Síndromes del Arco Aórtico/cirugía , Estenosis Aórtica Subvalvular/cirugía , Defectos del Tabique Interventricular/cirugía , Síndromes del Arco Aórtico/complicaciones , Síndromes del Arco Aórtico/diagnóstico por imagen , Estenosis Aórtica Subvalvular/complicaciones , Estenosis Aórtica Subvalvular/diagnóstico por imagen , Ecocardiografía , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/diagnóstico por imagen , Humanos , Recién Nacido , MasculinoRESUMEN
A one-year-old boy without congenital cardiac anomaly suffered from meningitis and subsequent acute infective endocarditis that resulted in mitral regurgitation. During antibiotic therapy and management of congestive heart failure, he suddenly developed an acute subdural hematoma, and an aneurysm of the cerebral artery was detected by brain computed tomography. Clipping of the aneurysm was performed by neurosurgery, and 9 days after clipping, we performed mitral valve repair. Kay-Reed annuloplasty was performed and annulus size was reduced from 20 to 16 mm, and edge to edge repair of anterior and posterior leaflets near the commissure to reconstruct ruptured anterior leaflet chordae. This method is easy and useful to control mitral regurgitation when mitral chordae are detached from near commissure especially in child case.
Asunto(s)
Endocarditis Bacteriana/cirugía , Aneurisma Intracraneal/cirugía , Meningitis/complicaciones , Insuficiencia de la Válvula Mitral/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Endocarditis Bacteriana/etiología , Humanos , Lactante , Aneurisma Intracraneal/etiología , Masculino , Insuficiencia de la Válvula Mitral/etiología , Procedimientos Neuroquirúrgicos/métodos , Resultado del TratamientoRESUMEN
Since the residual mitral regurgitation after the Dor procedure contributes to increasing postoperative mortality, repair of mitral regurgitation has become one of the essential surgical approaches. We describe two cases of transventricular posterior annuloplasty using a trimmed Duran ring for surgical management of ischemic mitral regurgitation performed with the Dor procedure. This procedure is easy to perform and provides secure annuloplasty because the mitral annulus can be easily exposed through the same ventriculotomy incision.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cardiomiopatías/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Isquemia Miocárdica/complicaciones , Cardiomiopatías/etiología , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/etiología , Resultado del TratamientoRESUMEN
OBJECTIVE: Reoperative coronary bypass grafting is at high risk. Particularly in redo cases where the patent graft is running near the midline of the sternum, the graft may be exposed to injury by a median sternotomy and subsequent dissection. Whereas, off-pump bypass grafting from the left axillary artery or descending thoracic artery by a left thoracotomy approach is safe for preventing graft damage. METHODS: From March 1998 to February 2002, we performed off-pump coronary artery bypass grafting by a left thoracotomy approach in 9 patients. The left axillary artery was used as the inflow vessel in 4 cases, and the descending thoracic aorta in 5. RESULTS: The radial artery was anastomosed proximally to the axillary artery in 4 cases and the descending thoracic aorta in one case. The saphenous vein graft was anastomosed proximally to the descending thoracic aorta in 4 cases. Transdiaphragmatic minimally invasive bypass grafting for the right coronary artery was simultaneously performed in 3 cases. Postoperative cardiac events were ventricular arrhythmia in 6 cases and supraventricular arrhythmia in 3 cases. There was no damage to the patent grafts. Postoperative coronary angiography performed in 8 cases revealed all the grafts to be patent without stenosis. Cardiac symptoms were not found after the operation in any of the cases. CONCLUSIONS: These procedures can prevent the injury to patent grafts caused by a median sternotomy, and will be one of the useful strategies for reoperative off-pump coronary artery bypass grafting.