A case of Turner's syndrome associated with partial anomalous pulmonary venous return complicated by dissecting aortic aneurysm and aortic regurgitation.

We report a successful surgical case with Turner's syndrome associated with partial anomalous pulmonary venous return (PAPVR) complicated by aortic dissection and aortic regurgitation without coarctation of the aorta. The patient, a 30-year-old woman, is of a short stature who was diagnosed with Turner's syndrome at the age of 12. She has suffered from dyspnea and edema of the legs since a year ago and was admitted to our hospital in June 1994 as echocardiography revealed rapid dilatation of ascending aorta and aortic regurgitation. A chest X-ray showed cardiothoracic ratio of 63% and transesophageal echocardiogram revealed that ascending aortic diameter was extended up to 60 mm at its maximum and that it was possible to distinguish true lumen from false lumen. The aortic arch was found to be normal. Also revealed by cardiac catheterization was drainage of the left upper pulmonary vein to the innominate vein. The L-R shunt ratio was 2.2. The surgery was performed by the Bentall method. The composite graft with a 21 mm St. Jude Medical prosthetic heart valve placed on the annulus of aortic valve. The ostiums of the coronary arteries were directly anastomosed to the composite graft with Carrel patch. After declamp of the aorta, the left pulmonary vein was directly anastomosed to the left atrial appendage without causing stenosis. The postoperative course was uneventful, and the cineangiogram after surgery demonstrated successful repair. Reports of cases of Turner's syndrome like this are sparse.

[Thallium-201 scintigraphy of the myocardium during exertion in the indication for aortocoronary bypass of an area in the myocardium, the site of an infarct]. / Apport de la scintigraphie du myocarde au thallium 201 à l'effort dans l'indication du pontage aorto-coronarien d'un territoire myocardique ayant été le siège d'un infarctus.

The purpose of this study is to precisely evaluate the indications and the results of direct revascularization surgery in a myocardial area previously infarcted. 35 cases were analyzed using thallium scintigraphy during stress. Before surgery, the patients were divided in two groups. Group I (18 cases) includes patients who presented initially a regional hypoperfusion and a reperfusion at the site of the infarction, on late scintigrams; group II (17 cases) also presented a regional hypoperfusion initially, but showed no reperfusion on late scintigrams. Concerning the results during stress, the thallium 201 scintigrams during exercise show alterations of the myocardial perfusion in the infarcted area, before and after surgery; in group I, a significant improvement (p less than 0.01) is noted in the entire group, i.e. 16 patients (88.9%), except in 2 cases where the graft was occluded, and group II shows an improvement in only 4 cases (NS) after surgery. Concerning the modifications of the product pressure X cardiac rhythm, there is a significant improvement (p less than 0.01) in group I (14 out of 18 patients (77.8%)); 2 out of 4 patients who were aggravated, presented occluded grafts after surgery. Group II shows an improvement in 10 out of 17 patients (58.8%) after surgery (NS). The left ventriculography demonstrates alterations in the global ejection fraction. Group I shows a significant improvement in 15 out of 18 patients (88.3%) (p 0.01); in group II there is improvement in 11 out of 17 patients (64.7%) (NS) after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ventricular septal defect with pulmonary hypertension and concomitant left atrial myxoma in elder patient: a successful surgical case report].

A 70-year-old man was admitted with syncope attack on exertion. Ventricular septal defect with pulmonary hypertension and left atrial myxoma were confirmed by ultrasonography and cardiac catheterization. Preoperative Pp/Ps was 0.95 and pulmonary vascular resistance was 16 units. Pulmonary vascular resistance decreased to 9.6 units by the administration of Isoproterenol and decreased to 8.5 units with PGE1. Patch closure of VSD and excision of left atrial myxoma were performed simultaneously. The patient recovered completely, although he suffered from pneumonia and jaundice due to liver congestion postoperatively. Cardiac catheterization before discharge revealed Pp/Ps 0.38 and PVR 10.1 units.

[Emergency coronary artery bypass grafting (CABG) in a case of coronary occlusion secondary to long segmental dissection of left anterior descending artery after percutaneous transluminal coronary angioplasty (PTCA)].

A 60-year-old man with unstable angina underwent PTCA at left anterior descending artery (LAD) #6, which had stenosis of 90%. Subsequently, a long segmental dissection formed from #6 to #7 and the patients was scheduled for CABG. On the day before the expected date of CABG, he had an angina attack and a 12 lead electrocardiogram (ECG) showed ST segment and T wave elevation in V1-3. Coronary angiograms revealed 99% stenosis in LAD #6 and immediately rePTCA was performed at the site. RePTCA improved the stenosis to 50%, but ECG showed an inverted T wave in V3,4 and emergency CABG was performed, with the saphenous vein at LAD #8 and high lateral artery. Some authors have stated that CABG is not useful for long segmental coronary dissection, but we conclude that CABG should be definitely considered in such a case, because this procedure resolves pressure gradients at before-and-after entry and the bypass grafts will be never occluded whenever anastomosis (intima-adventitia-graft) is performed.

[Surgical results of emergency coronary artery bypass grafting: effect of left main trunk lesion].

Emergency coronary artery bypass grafting has higher risk than elective surgery. Furthermore, if a lesion is located at left main coronary artery, the frequency of cardiogenic shock or high risk patient would be greater, and operative results would be worse. Between January, 1989 and December, 1995, 45 patients who underwent emergency CABG were included. Age ranged 44 to 80 years (mean 67 +/- 7.6 years; 31 men, 14 women). Of 45 cases, 12 cases were patients with LMT lesion. Results were analysed by univariate analysis and multivariate logistic analysis. Of 45 emergency cases, 5 were operative death and 3 were hospital death. Mortality rate was 17.8%, which was significantly higher than the mortality of elective CABG (2.8%) during the same period (p < 0.001). A factor that influenced the mortality was acute myocardial infarction (AMI), which was confirmed by both univariate and multivariate logistic analyses. Odds ratio (relative risk) was 12.4 for AMI. Only one patient died in 12 cases with LMT (8.3%). This case was due to complication after catheter intervention possibly caused by MOF. Thus, the relative risk of LMT was not so high (p = n.s). Other factors showed no significant correlation. Although the emergency case of LMT lesion was generally severe, we could have the same result as other emergency surgeries when patients were revascularized as soon as possible.

[A comparative study of long-term results of surgical and medical treatment for ischemic heart disease].

Left ventricular performance, survival rate and subjective symptoms were analyzed in 243 cases of angina pectoris (147 cases of A-C bypass and 96 cases of medical treatment) and 58 cases of left ventricular aneurysm (21 cases of surgical treatment and 37 cases of medical treatment). Left ventricular performance of angina pectoris were improved in surgical group 6 months after A-C bypass with the significance of p less than 0.02-0.05. However, in the medical group, it showed unchanged or aggravated tendency during average 18 months. Similar results were obtained in the patients with left ventricular aneurysm and furthermore, aggravation of EF and Max dp/dt/p in some medically treated cases was observed. Operative death by A-C bypass was seen in 4 cases (2.7%) and 5 years cumulative survival rate was 92.6% including late death cases died during average 30.1 months in the medical group and its 5 years survival rate was 77.3%. For left ventricular aneurysm, no operative death was recognized and the 5 years cumulative survival rate was 95%. Whereas during average 32.7 months in the medical group, 8 cases died and 5 years cumulative survival rate was 78.6%. Improvement of subjective symptoms after treatment for both ischemic heart diseases was also conspicuous in the surgical group.