[Surgical treatment of total anomalous drainage of pulmonary veins into the right superior vena cava]. / Tratamento cirúrgico de drenagem anômala total de veias pulmonares em veia cava superior direita.

This report describes a 2-month-old boy with diagnosis of total anomalous pulmonary venous obstruction and marked hypertension established by cross-sectioned echocardiography and catheterization with angiography. Successful surgical correction was performed with profound hypothermia and circulatory arrest. The risk factors and the high operative mortality associated with this type of anomaly are analyzed.

Double-outlet left ventricle. Echocardiographic diagnosis.

This is a case report of a double-outlet left ventricle associated with tricuspid atresia and hypoplasia of the right ventricle, diagnosed during echocardiography with color-flow imaging, in a three-month-old child who presented with fatigue and cyanosis. The child underwent palliative pulmonary arterial banding without an invasive procedure, and showed sustained improvement during follow-up.

[Surgical treatment of tetralogy of Fallot associated with an anomalous coronary vessel]. / Tratamento cirúrgico da tétrade de Fallot associada a coronária anômala.

Anomalous coronary arteries crossing the outflow tract of the right ventricle in tetralogy of Fallot have a prominent surgical importance in total correction. The unintentional section of these arteries is followed by a high mortality. In the period between 1977 and 1987, 475 patients with tetralogy of Fallot were operated on. Fourteen of these patients had anomalous coronaries crossing the right ventricle. Three of the patients were less than one year of age. Eleven patients were male. Diagnosis was performed in the operating room in 13 patients. Twelve patients had the anterior descending artery originating from the right coronary, and two presented single left coronary arteries. During the surgical procedure two patients had the anomalous coronary artery divided; in one a saphenous vein bypass graft was used and in the second and end-to-end anastomosis was performed. In the remaining 12 cases, a transverse ventriculotomy (one case), extensive dissection of the anomalous coronary artery (two cases), a palliative procedure (one case), a valved conduit between the right ventricle and the pulmonary artery (one case) and total correction through the atriopulmonary approach (seven cases) were performed. No immediate mortality was observed and there was one late death. The authors suggest that, whenever anatomical conditions permit, the atriopulmonary approach should be preferred in the repair of tetralogy of Fallot associated to anomalous coronary arteries.

[Supravalvar and valvar aortic stenosis associated with valvar and subvalvar pulmonary stenosis. Coexistence of two clinical syndromes]. / Estenose supravalvar e valvar aórtica associada à estenose infundíbulo valvar pulmonar. Coexistência de duas síndromes clínicas.

A 4 year old patient with congenital rubella syndrome, confirmed serologically, presents with neurosensorial deafness and a rare association of cardiac anomalies: supravalvar and valvar aortic stenosis and subvalvar pulmonary stenosis. Bidimensional echocardiography and angiography confirmed the diagnosis and the surgical treatment was successful. Due to the presence of somatic characteristics of Williams's syndrome, mental retardation and supraortic stenosis, the authors postulate that there is a coexistence of clinical syndromes responsible for the malformations of this case. This fact is rare on clinical settings, requiring accurate diagnosis and treatment.

[Ruptura of the thoracic esophagus due to closed abdominal trauma]. / Rotura de esôfago torácico por trauma abdominal fechado.

The authors present a rare case of closed abdominal trauma in a five year old girl resulting from a washtub fall on her causing three lacerations in the middle third of the esophagus, identified 48 hours after the trauma. The stitcher surgical treatment of the lacerations associated with gastrostomy and lengthy parenteral nutrition did not prevent the recurrence of the esophagus-pleural fistula, and an esophagectomy plus cervical esophagostomy was required. After a 10-month follow-up, the digestive passage was reconstructed by an esophagocoloplasty. At present, after 5 years of follow-up, the patient is cured. The authors discuss the causes of esophagus rupture in children and its etiopathogeny. They propose that preservativement the esophagus is the best initial treatment, in spite of the foot that this procedure was ineffective in the present case.

Hemodinamica do enxerto femoro-femoral cruzado. Estudo experimental. / Hemodynamics of the cross-over femoro-femoral graft.Experimental study

As alteracoes hemodinamicas que ocorrem na arteria iliaca doadora, apos realizacao de derivacao femoro-femoral cruzada, foram, experimentalmente, avaliadas, utilizando-se o efeito Doppler ultrassom. Apesar de empregado como metodo semi-quantitativo, houve consonancia com os achados obtidos em estudos semelhantes, nos quais se usaram metodos quantitativos para determinacao de fluxo sanguineo.Observou-se, em vigencia de arvore arterial distal normal, tendencia para duplicacao do fluxo pela arteria iliaca, doadora, quando ocluida sua homonima contra-lateral apos instalacao de derivacao cruzada. A importancia desta duplicacao de fluxo e notavel por ser responsavel pela alteracao da chamada "estenose critica" da arteria iliaca. Em condicoes hemodinamicas normais, seu valor se situa em torno de 52% de comprometimento da liz arterial, diminuindo para 40% quando ocorre duplicacao de velocidade do sangue. Tal fato exige, alem da apreciacao anatomica de eventuais lesoes arterioscleroticas que possam comprometer a arteria iliaca doadora, avaliacao funcional desse vaso em condicoes de fluxo aumentado