Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 1997
The two-patch technique for complete atrioventricular canal.
The goals for repairing complete atrioventricular canal (atrioventricular septal defect) are ventricular septation, atrial septation, mitral valve reconstruction, and tricuspid valve reconstruction. Complications to avoid are heart block, residual septal defects, and dysfunctional atrioventricular valves. The surgical repair of atrioventricular canal has undergone major advances over the past 40 years. ⋯ Perhaps more important than the applied method is that the operation be properly executed to ensure defect closure and competent valves. We review our experience in 120 patients using the two-patch technique with special reference to the technical aspects of the operation. The two-patch technique of repair with routine cleft closure as evaluated by intraoperative transesophageal echocardiography results in a low surgical mortality, a low incidence of permanent heart block, and competent atrioventricular valves.
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Semin. Thorac. Cardiovasc. Surg. · Jan 1997
Late results and reoperation after repair of complete and partial atrioventricular canal defect.
Advances in surgical technique and postoperative care have resulted in substantial improvement in the operative mortality after repair of atrioventricular canal defects. However, significant late morbidity and the need for reoperation complicate the medium and long-term results in these patients. Left atrioventricular valve regurgitation, residual or recurrent intracardiac shunting, and subaortic stenosis are the principle causes of late morbidity after repair of complete and partial atrioventricular canal defects. This article describes the incidence and etiology of these complications, as well as the methods of diagnosis and management.
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Traditionally, high technical morbidity and mortality and uncertain long-term survival have been associated with carinal surgery for bronchogenic carcinoma. However, growing evidence exists that judicious indications, meticulous surgery, and also perioperative management can decrease surgical mortality. Contraindications include patients whose tumors are so extensive that reconstruction would be under tension and those with involved precarinal and paratracheal nodes. ⋯ A limited tailored thoracoplasty and transposition of the latissimus and serratus muscles into the postpneumonectomy pleural space can mitigate anastomotic complications. If these recommendations are respected, the technical mortality rates of carinal pneumonectomy can equal those observed after conventional pneumonectomy, and 5-year survival rates in excess of 40% can be expected for NO-1 patients. Invasion of the carina by bronchogenic carcinoma should not be considered by itself a surgical contraindication because the potential for cure is not elusive.
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Semin. Thorac. Cardiovasc. Surg. · Jul 1996
Lung transplantation in children with pulmonary hypertension and congenital heart disease.
Pulmonary vascular disease with or without associated congenital heart disease is the indication for lung transplantation in 30% of all children requiring this procedure. Although many of these children will have primary pulmonary hypertension, a substantial number are children whose pulmonary vascular disease is either associated with a congenital heart lesion or secondary to it. Heart-lung transplantation has been performed in these children in the past, but because of the scarcity of availability of donor heart-lung blocks, lung transplantation with repair of associated congenital cardiac lesions has of necessity been performed more frequently. ⋯ Although the overall experience with this complex group of patients is small, the results seem similar to the prior experience with heart-lung transplantation. Thus, we remain optimistic that this will continue to be a viable form of therapy for children with pulmonary vascular disease associated with congenital heart lesions. The quality of life of the surviving patients is excellent and limited only by those factors impacting upon lung transplantation in general, such as rejection, infection, and the development of bronchiolitis obliterans.
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Semin. Thorac. Cardiovasc. Surg. · Jul 1995
Late results of pulmonary ventricle to pulmonary artery conduits.
The development of the extracardiac conduit has been one of the greatest advances in cardiac surgery. Conduits have decreased the mortality rate of several standard operations and have made possible the correction of numerous complex congenital cardiac anomalies that previously were uncorrectable. However, the ideal conduit has not yet been developed. We have reviewed the long-term (16 to 29 years) results of our early experience with this technique.