[Surgery on the wrong side: implication for the patient and the professional. Experience in a Major Ambulatory Surgery of the Foot Unit]. / Cirugía del lado erróneo: implicación del paciente y los profesionales. Experiencia en la Cirugía Mayor Ambulatoria de la Unidad del Pie.

Surgery of the wrong side is a very uncommon complication in orthopaedic surgery, but with serious consequences for the patient, the surgeon and the health institution, having to put all the necessary measures in place to prevent this occurring. We have conducted a prospective study on the introduction of a protocol to prevent surgery of the wrong side in 101 patients operated on for any foot disease in the Major Surgery Ambulatory Unit, performing three independent controls to verify the side: by the patient, by the nurse and by the anaesthetist. We review the information available of the side in the medical records and their correlation with the side operated on. Almost a quarter of the patients, 24.8%, were not informed that they had to make a mark on the foot to be operated on. No mark was made by 18.4% of the patients informed to do so, with no relationship between age, gender, education level, to live alone or previous foot operations. There was a lack of noting the side in the documentation, with this omission being more frequent in the Orthopaedic and Traumatology and Anaesthesiology medical records. Nine cases of inconsistency in the surgical side were detected, all in patients who had previous surgery in any foot. Marking of the side has been incorporated as routine practice in foot surgery, being beneficial for the safety of the patient, and should become normal practice in all surgical areas in the near future.

Complete atrioventricular canal. Anatomic study and presentation of a new technique for total correction.

A new surgical technique for total correction of complete common atrioventricular canal was evolved from study of 34 specimens from affected infants who had died in the first year of life. An interventricular patch was fashioned to reconstruct the interventricular septum and the atrioventricular valves. The patch had two distinct components, one superior or atrial and the other inferior or ventricular. The division was made by inserting a lateral support at different levels on either face of the patch, to which the anterior and posterior atrioventricular cusps were sutured. The interatrial defect was closed with a patch that, together with the atrial component of the interventricular patch, produced a foramen ovale type closure mechanism. The authors present the pathologic observations which served as a basis for development of the surgical technique.

Extraatrial interatrial duct and reestablishment of aortopulmonary communication by enlarging the aortic arch. Experimental development of two surgical techniques for hypoplastic left heart syndrome palliation without extracorporeal circulation.

A new surgical procedure is presented for palliation of hypoplastic left heart syndrome. The first palliative technique consists of creation of an extraatrial interatrial duct and the second, reestablishment of the aortopulmonary communication by enlarging the aortic arch with a "conduit patch". Both procedures avoid having to clamp small systemic vessels and pulmonary veins and extracorporeal circulation is not needed. Extraatrial interatrial ducts were created in 10 dogs and the effectiveness of the procedure was evaluated. Reestablishment of the aorto-pulmonary communication and enlargement of the aortic arch was done in 7 specimens from patients with hypoplastic left heart syndrome who had died in the first hours of life and in 8 dogs. The surgical procedures, their advantages and the results obtained are described.

[Beuren-Williams syndrome: study of 20 cases]. / Síndrome de Beuren-Williams: estudio de 20 casos.

Beuren-Williams syndrome is characterized by elfin face, mental retardation in addition to cardiovascular lesions, which consist in supravalvular aortic stenosis and peripheral pulmonary stenosis. Twenty patients having this syndrome are reported with special emphasis on their cardiovascular abnormalities.

A new surgical technique for orthoterminal correction: experimental development.

A new technique is presented for surgical correction of tricuspid atresia, univentricular heart, pulmonary atresia with intact ventricular septum and hypoplastic ventricle, and hypoplastic left heart syndrome. The procedure consists of an angled right atriotomy, creation of an interatrial septal defect and a right neoatrium that is anastomosed to the pulmonary artery, and creation of a left neoatrium communicating with the left atrium through the interatrial septal defect. The technique was evaluated in 28 mongrel dogs. In 15 of these experimental procedures, the objective was to acquire skill in performing the technique. In the remaining 13, the procedure was executed with cardiopulmonary bypass. Hemodynamic studies were made at 30, 60, 120, and 180 minutes after operation. The results and advantages of the procedure are discussed. We consider it feasible for clinical application.

Double-outlet right atrium with two atrioventricular valves and left atrial outlet atresia.

In double-outlet atrium either the right or the left atrium empties into both ventricles while the other atrium remains disconnected from the ventricular cavities. Cases of double-outlet atrium with a single atrioventricular (AV) valve have been reported but no cases of double-outlet left atrium and only two of double-outlet right atrium (one with three valves) have been reported. A description of the second case of double-outlet right atrium with two AV valves and a review of the other reported case are presented. Common anatomic characteristics were: two AV valves in the right atrium that connected with two normal ventricles; disconnection of the left atrium from the ventricular cavities; an atrial septal defect in a malpositioned atrial septum; and drainage of a left superior vena cava into the left atrium. Mitral incompetence was found in both cases. Clinical findings were similar to those seen in ostium primum atrial septal defect. Two-dimensional echocardiography and angiocardiography are able to accurately demonstrate this entity. Successful surgical correction was performed in both cases. Two morphogenetic hypotheses are proposed: abnormal development of the septum primum or primitive malposition of the common atrioventricular canal.

Surgical repair of double-outlet right atrium.

The case of a patient with abnormal position of the atrial septum resulting in a right atrium with two atrioventricular valves and a disconnected left atrium is presented. The left superior vena cava drained into the left atrium; the right superior vena cava and the coronary sinus were absent. The surgical technique for repair of this anomaly is described. A possible explanation of the embryopathogenesis of double-outlet right atrium is given. To our knowledge, this is the second case of double-outlet right atrium to be reported in the thoracic surgical literature.

Ebstein's anomaly of the left-sided atrioventricular (AV) valve in AV discordance.

Prosthetic valve replacement of the left-sided atrioventricular (AV) valve was performed in a patient with AV discordance and Ebstein's anomaly of the left-sided AV valve without other associated anomalies. An anatomical study of 22 specimens with AV discordance did not show a case with similar anatomy; 5 hearts had mild degrees of downward displacement of the attachment of the left-sided AV valve leaflets, with marked dysplastic changes and variable degrees of hypoplasia. The surgical implications are different according to the degree of downward displacement of the leaflets. This feature and the size of the annulus and the morphologically right ventricle should be considered in preoperative evaluation, along with the operative approach, possible presence of atrialization of the wall of the proximal chamber and the relation of the left AV valve to the conduction system. Preoperative diagnosis of the anomaly is possible by angiocardiography and other methods.

[Echocardiographic aspects of the aortopulmonary window. Report of a case with angiocardiographic correlations]. / Aspectos ecocardiográficos de la ventana aortopulmonar. Presentación de un caso, con correlaciones angiográficas.

A case of complex congenital heart disease is presented with diagnosis of; ventricular septal defect, interrupt aortic arch, patent ductus arteriosus and aorticopulmonary window. The latter condition was studied by means of M mode and two-dimensional echocardiographic techniques. The heart was scanned perpendicular to its long axis at the origin of the great arteries. This scan revealed an image of two adjacent circular structures which has been previously described as suggestive of dTGA or Double-outlet right ventricle. The clinical picture discarded the possibility of dTGA, and the atrioventricular relationship established by the cross-sectional echocardiography invalidated the diagnosis of Double-outlet right ventricle. The cause of the echocardiographic morphologies observed are discussed.