RESUMEN
From 1982 to 1992, nine patients underwent correction of vascular rings. The diagnosis was strongly suggested by symptoms of tracheoesophageal obstruction and was confirmed by barium esophagogram and angiography. Endoscopic studies were considered unnecessary and potentially harmful. Seven patients had double aortic arch, one patient right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum and one patient anomalous origin of the left pulmonary artery. The anomaly was approached through a left thoracotomy in every patient. There were no operative or late deaths. When patients are symptomatic, vascular rings should be promptly repaired. The surgical risk is minimal, and the long term results are excellent.
Asunto(s)
Aorta Torácica/anomalías , Angiografía , Aorta Torácica/diagnóstico por imagen , Enfermedades del Esófago/etiología , Humanos , Enfermedades de la Tráquea/etiologíaRESUMEN
Forty six infants with a large ventricular septal defect (VSD) underwent surgical treatment during the first 12 months of life. Forty three patients ranging in age from 3 to 12 months (mean age 10.4 months) and weighting from 3.0 to 8.2 kg (mean weight 6.8 kg) had primary surgical closure of their VSD. All infants were below the third percentile for weight preoperatively. In 40 patients (93%) the defect was closed through the right atrium. Three patients (7.0%) died in the early postoperative period. Surgically induced heart block occurred in one patient (2.3%). Late results were assessed in 29 surgical survivors (mean follow-up 26 months). There was no late mortality. Relief of congestive heart failure was prompt in all patients following closure of VSD. Right bundle branch block with left anterior hemiblock developed in 5 patients (17.2%), and right bundle branch block alone in 10 patients (34.5%). Three patients (mean age 4.3 months, mean weight 2.7 kg) underwent initial palliative pulmonary artery banding (PAB). There were no operative or late mortality. Closure of VSD and pulmonary artery debanding was performed in two of these patients, with no mortality. Prior to intracardiac correction the pulmonary artery pressure distal to the band was normal; no band related complications were found. Early primary closure is the treatment of choice for symptomatic infants with large VSDs. In particular circumstances, however, PAB may provide effective palliation.
Asunto(s)
Defectos del Tabique Interventricular/cirugía , Factores de Edad , Humanos , Lactante , Complicaciones PosoperatoriasRESUMEN
OBJECTIVE: To evaluate the medium term results of surgical closure of ventricular septal defect (VSD) performed during the first year of life, using echocardiography (echo). MATERIAL AND METHODS: We studied prospectively 29 patients aged from 17 to 68 months (mean = 37) who underwent surgical closure of perimembranous VSD during the first year of life. The postoperative follow-up time ranged from 6 to 60 months (mean = 26). Fifteen age-matched normal children were used as a control group in evaluating the left ventricular (LV) systolic function. The echo study included: 1) the assessment of LV systolic function using the shortening fraction, ejection fraction, pre-ejection to ejection time ratio (PET/ET), aortic flow acceleration time, acceleration to ejection time ratio, mean aortic flow acceleration; 2) detection and quantification of residual VSD as well as tricuspid and or aortic regurgitation; 3) determination of right ventricular systolic pressure (RVSP). The RVSP was evaluated from the maximum flow velocity from a residual VSD or tricuspid regurgitation, using the simplified Bernoulli equation. RESULTS: The LV systolic function parameters from patients versus (vs) normals showed a significantly different shortening fraction (34 +/- 5 vs 39 +/- 4; p = 0.005) and PET/ET ratio (0.34 +/- 0.04 vs 0.31 +/- 0.03; p = 0.02). None of the other studied parameters was significantly different from normal. Five (17%) patients had a small residual VSD. Two (7%) patients had mild aortic regurgitation. Tricuspid regurgitation was detected in 23 (79%) patients being trivial in 20 and mild to moderate in 3. The RVSP was quantified in 22 (76%) patients, ranging from 30 to 45 mmHg (mean +/- SD = 36 +/- 4). None of the remaining 7 patients showed changes in the end-systolic interventricular septal configuration. CONCLUSIONS: Our study shows that surgical closure of perimembranous VSD performed during the first year of life was possible without significant mobility. Furthermore, the echo allowed a complete and noninvasive cardiac evaluation of the anatomic, functional and hemodynamic status of this group of patients, thus limiting the need for postoperative control cardiac catheterization.
Asunto(s)
Ecocardiografía , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/cirugía , Femenino , Humanos , Lactante , Masculino , Complicaciones Posoperatorias , Estudios ProspectivosRESUMEN
Superior sternal cleft is a rare congenital malformation that should be repaired during the first weeks of life, while the thorax is still complaint. We report the case of a two-week-old neonate with superior sternal cleft and describe the technique used to close the defect.