Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2013
Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants.
Anatomical repair seems an ideal method for the surgical treatment of the anomalous left coronary artery arising from the pulmonary artery (ALCAPA) in infancy. The medium-term outcome has been investigated for infants with ALCAPA following the restoration of a dual-coronary arterial circulation. ⋯ Aortic reimplantation is an effective surgical treatment for ALCAPA in infants burdened with a low risk of reoperation due to coronary artery stenosis. There was good potential for myocardial recovery within the first year after surgery. Restoration of the anatomical coronary circulation did not improve mitral valve function in infants with severe preoperative mitral incompetence.
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Interact Cardiovasc Thorac Surg · Jun 2013
Liberal use of axillary artery cannulation for aortic and complex cardiac surgery.
Axillary artery cannulation for cardiopulmonary bypass has been described previously as a safe and reliable technique, with a low risk of atheroemboli, avoidance of malperfusion in aortic dissection and facilitation of selective antegrade cerebral perfusion during hypothermic circulatory arrest. The aim of this study was to document the broad applicability of axillary cannulation and its associated morbidity and identify where it was not possible to use planned axillary cannulation. ⋯ Axillary artery cannulation is an ideal arterial inflow site in cases where the ascending aorta is unsuitable as it is safe, reliable and reduces the risks of atheroembolization and malperfusion. Major complications are rare with this meticulous technique and it is our standard practice in complex cardiac and aortic surgery.
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Interact Cardiovasc Thorac Surg · Jun 2013
Technical modification enabling pulmonary valve-sparing repair of a severely hypoplastic pulmonary annulus in patients with tetralogy of Fallot.
Although pulmonary valve-sparing repair is preferable for patients with tetralogy of Fallot, the repair of very small pulmonary valves is challenging. The present study evaluates our modification for preserving severely hypoplastic pulmonary valves in patients with tetralogy of Fallot. ⋯ Although our modification of valve-sparing repair for severely hypoplastic pulmonary valves in patients with tetralogy of Fallot could not be applied in all patients, this strategy enabled acceptable growth of the valve annulus, with only mild stenosis during the early to mid-term follow-up. This modification seems to be an option, even for a very small pulmonary valve.
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Interact Cardiovasc Thorac Surg · Jun 2013
Case ReportsType A aortic dissection complicated with fistulization into the right atrium and right-to-left shunt.
Fistulization between the aorta and the right atrium is a rare complication of ascending aortic dissection. Because of the typical haemodynamic unstability, the diagnosis is often made by bedside or intraoperative transoesophageal echocardiography. ⋯ We describe a case of type A aortic dissection complicated with shock and fistulization into the right atrium with the right-to-left shunt through a patent foramen ovale. Surgical repair was successful.
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Interact Cardiovasc Thorac Surg · Jun 2013
Case ReportsPrimary repair of sternal cleft in infancy using combined periosteal flap and sliding osteochondroplasty.
Sternal clefts are rare congenital malformations of the chest wall. Immediate correction in neonates or in infancy is beneficial in terms of providing skeletal cover with little or no need for any prosthetic material for reconstruction. In the absence of internal midline defects, one should aim to provide complete correction when the chest wall is still compliant, and cardiorespiratory compromise is expected to be least after correction. We report on 2 children who underwent primary sternal-cleft repair using a periosteal advancement flap along with mobilization of lateral sternal bars after sliding osteotomy of corresponding ribs.