ABSTRACT
A 41 year old man with a left subclavian artery aneurysm was presented to the hospital with clinical symptom of recurrent hemoptysis. CT scan and angiography confirmed the diagnosis. Surgical treatment consisted of femoro-femoral cardiopulmonary bypass and left thoracotomy, aneurysm resection and descending aortico-subclavian vein bypass grafting. The incidental two small saccular aneurysms of the lower descending thoracic aorta were excised and directly repaired. The pathologic study revealed typical atherosclerotic changes. The patient had postoperative persistent chyle leakage and required rethoracotomy and supradiaphragmatic ligation of the thoracic duct. The patient was able to resume his usaul activity after two months of surgery.
ABSTRACT
Pulmonary stenosis with intact interventricular septum (PS, IVS) is one of the five most common congenital heart diseases to have required surgery at Siriraj Hospital during the past 17 years. It represents 4.5% of all congenital heart diseases operated upon. We reviewed 166 patients who received open-heart surgical treatment for PS, IVS at Siriraj Hospital from 1979 to 1995. Female predominated in neonates. Overall operative mortality was 2.4% with a failure rate of 0.6%. Infundibular plus valvar stenosis was the most common morphology founded at surgery (46%). There was no difference in operative mortality relevance to the level of obstruction. Operative mortality was higher (22%) in infant age group than in the neonate and childhood groups. Since 1992, there has been no operative mortality in any of the age groups. It can be concluded that, the result of surgical treatment for PS, IVS in Siriraj Hospital is excellent with a very low failure rate.
ABSTRACT
Between 1979 and 1990, 163 patients underwent open mitral valvulotomy for pure or predominant mitral stenosi at Siriraj Hospital. There were 114 females (69.94%) and 49 males (30.06%), ranging in age from 7 to 71 years (mean, 30.69 years). Pre-operatively, 13 patients (7.98%) were in New York Heart Association (NYHA) functional class II, 138 patients (84.66%) in functional class III and 12 patients (7.36%) in functional class IV. The follow-up period ranged from 14 days to 11.33 years (mean, 3.27 years). Operative mortality was low (0.61%). Improvement in NYHA classification was found in 98 percent of these patients. At 12 years, the overall cumulative proportion surviving was 74; 59 percent of the patients survived without re-operation. In the analysis of factors affecting long-term results, there was no significant difference in any of the variable; sex, age, cardiac rhythm, mobility of cusps and subvalvular changes. This study clearly demonstrates the advantages of open mitral valvulotomy, which resulted in safe, effective and excellent long-term results.