Interrupted aortic arch in adulthood.

Interrupted aortic arch is one of the rarest anomalies among the congenital cardiac defects. Patients must be treated early in life, otherwise death is inevitable. Reports on adult patients with aortic interruption are very rare in the literature. In this report, we present a 21-year-old patient with type A interrupted aortic arch. The patient underwent successful anatomical reconstruction of the descending aorta.

Sequential use of internal thoracic artery in myocardial revascularization: mid- and long-term results of 430 patients(1).

BACKGROUND: There is still controversy about early and late results of sequenital use of internal thoracic artery (ITA) in coronary artery bypass (CAB) operations. METHODS: In this study, we report on a series of 430 consecutive patients who underwent CAB operations between 1986 and 1998, with the use of at least one sequential ITA graft. The patients, 379 men and 51 women had a mean age of 56.4 years (range 29-80 years). Both ITA grafts were used in 227 (52.8%) patients. A total of 1744 (mean 4.05 per patient) distal coronary anastomoses were performed: 1172 of which (mean 2.72) were arterial and 980 (mean 2.28) were sequential ITA anastomoses. RESULTS: Thirty-day mortality was 1.8% (n=8 patients). Perioperative myocardial infarction occurred in 12 patients (2.8%) and five of them (1.2%) were confined to the sequential ITA grafted area. Follow-up ranged from 1 month to 13 years (mean 63+/-37.7 months) for 372 patients (86.5%). Nine patients died during follow-up period. According to Kaplan-Meier method, 5 and 10 year survival rates were 95.6 and 93.4%, respectively. Coronary angiography was performed in 64 patients (17.2%) after a mean of 33 months. In 31 of these patients angiography was performed due to return of symptoms. Overall patency rate of sequential ITA anastomoses was 91.7% (111/121). Two patients underwent repeat CAB operations. CONCLUSION: Sequential use of ITA grafts was not associated with the increased perioperative mortality and morbidity and has the potential to improve the long-term results of CAB surgery because of excellent patency rates of sequential ITA anastomoses.

Anomalous origin of circumflex coronary artery from the right pulmonary artery associated with subaortic stenosis and coarctation of the aorta.

Anomalous origin of the circumflex coronary artery is extremely rare and may cause acute cardiac decompensation associated with correction of coexisting congenital malformations. We describe a 10-year-old female patient who underwent surgical repair of the aortic coarctation at 4 years of age. Six years later, she presented with chest pain during exercise. Cardiac catheterization demonstrated 25 mmHg subaortic systolic gradient and retrograde filling of the circumflex coronary artery from the left anterior descending and right coronary artery, with drainage into the right pulmonary artery. Reimplantation of the anomalous circumflex coronary artery to the aorta and resection of subaortic fibrous membrane was performed. Her postoperative course was uneventful, with complete relief of symptoms.

A rare case of mixed type total anomalous pulmonary venous connection and its surgical treatment.

In the mixed types of total anomalous pulmonary venous connection, pulmonary veins frequently show an opening at the supracardiac and cardiac level. Rarely, some other combinations of mixed type cases have been reported in the literature. In the present case the right and left pulmonary veins formed two distinct venous chambers and showed supracardiac and infracardiac openings. Anastomosis of each of these common venous chambers was performed to the left atrium, separate from each other, by extracardiac approach. The patient had no hemodynamic problems in the postoperative period and showed no pulmonary venous obstruction in a control angiography performed after 9 months. He has not needed medication and has shown no limitation of activity during a follow-up of 5 years.

Early and moderate long-term results of a new surgical technique for repair of aortic coarctation.

OBJECTIVE: From June 1987 to September 1995, 53 patients underwent a new technique of coarctation repair. This technique consists of complete mobilization of the left subclavian artery so that it can be pulled down as far as possible. METHOD: After all the necessary clamping, the anterior wall of the aorta is incised longitudinally beginning on the anterior wall of the left subclavian artery and extending distally to the descending aorta 1-2 cm past the coarctation. The left subclavian artery is pulled down so that the proximal end of the incision can reach the distal end. Then, this longitudinal incision is sutured transversely with 5/0 or 6/0 polydioxanone and continuous technique, enlarging the coarctation site and also preserving the blood flow to the left upper limb. The ages of the patients ranged from 16 days to 20 years (mean 3.7 years). Thirty patients were younger than 1 year old. One patient (1.9%) died postoperatively due to persistent pulmonary hypertension. RESULTS: There was no pressure gradient perioperatively through the coarctation site after the repair. The mean follow-up was 34.4 +/- 27.5 months (range 1-99 months). All patients but one were in class I effort capacity (NYHA). Doppler echocardiographic studies were performed in 45 patients postoperatively. There was no restenosis or aneurysm formation at the coarctation site and the mean pressure gradients were between 19.8 +/- 16.2 mmHg. CONCLUSION: The authors experience indicates that this technique could be a good alternative to the subclavian flap aortoplasty because of the preservation of blood flow to the left arm.