European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2009
Functional single ventricle with extracardiac total anomalous pulmonary venous connection.
The purpose of this study is to evaluate the surgical repair of functional single ventricle and extracardiac total anomalous pulmonary venous connection (TAPVC). ⋯ The mid-term results of the surgical repair of functional single ventricle with supracardiac or infracardiac TAPVC are acceptable. The surgical treatment of patients with mixed TAPVC and with severe atrioventricular valve regurgitation is not promising, but can be improved.
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Eur J Cardiothorac Surg · Jul 2009
ReviewChronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention.
Chronic pain complaints after thoracic surgery represent a significant clinical problem in 25-60% of patients. Results from thoracic and other surgical procedures suggest multiple pathogenic mechanisms that include pre-, intra-, and postoperative factors. This review attempts to analyse the methodology and systematics of the studies on the post-thoracotomy pain syndrome (PTPS) after lung cancer surgery in adults, in order to clarify the relative role of possible pathogenic factors and to define future strategies for prevention. ⋯ The available data have major inconsistencies in collection of pre-, intra- and postoperative data that may influence PTPS, thereby hindering precise conclusions as well as preventive and treatment strategies. However, intercostal nerve injury seems to be the most important pathogenic factor. Since there is a general agreement on the clinical relevance of PTPS, a proposal for design of future trials is presented.
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Eur J Cardiothorac Surg · Jul 2009
ReviewThe current role of hybrid procedures in the stage 1 palliation of patients with hypoplastic left heart syndrome.
Hypoplastic left heart syndrome is a relatively common cardiac malformation, accounting for 4-9% of children born with congenital heart disease. Since 1981 the mainstay of treatment has been the Norwood series of operations which have been variously modified, most recently using an RV-PA conduit (Sano shunt). With these surgical modifications and with increased experience in perioperative care survival for the surgical approach to completion of stage 2 palliation has improved to 70-80%. ⋯ Poor initial results caused many to discontinue this approach but some persevered, and with increasing experience survival to completion of stage 2 following hybrid palliation is now 50-80%. Although these results may superficially appear to be poorer than for surgery, it must be observed that increasingly the hybrid approach has been used by many groups as palliation for the highest risk cases (particularly small size and adverse cardiac factors). This review therefore considers what is the optimal management of children with hypoplastic left heart syndrome currently, and, specifically, what is the role for the hybrid approach in palliation of patients with hypoplastic left heart syndrome?
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Eur J Cardiothorac Surg · Jul 2009
Predictors of impaired neurodevelopmental outcomes at one year of age after infant cardiac surgery.
For most newborns, congenital heart defects (CHD) appear to be isolated anomalies and the brain is presumed to have normal developmental potential. Most studies of neurodevelopmental outcomes have focused on operative management strategies. ⋯ Patient factors (birth weight and preoperative status) are significant determinants of neurodevelopmental outcomes as opposed to operative management strategies. In this cohort, genetic syndromes unsuspected at birth were surprisingly common and correlate with poor neurodevelopmental outcomes. Without multiple congenital anomalies, syndromes may be missed in infancy. Genetic evaluation should be considered in all infants with CHD.
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Eur J Cardiothorac Surg · Jul 2009
A modification of the Ross procedure to prevent pulmonary autograft dilatation.
We present our initial experience in 10 patients operated on using a modified Ross operation. In our modification of the Ross operation the pulmonary autograft root was inserted in the Gelweave Valsalva graft to prevent dilatation of the neoaortic root. This type of graft was selected to match the discrepancy between diameters of the annulus and the sinotubular junction of the autograft and to preserve the characteristic configuration of the native root. In our group of 10 patients operated consecutively by this technique there was no change in the geometry of the neoaortic root in the follow-up 3-19 months (mean 14.6 months).