Successful repair of post-infarction heart rupture. Case report and review of the literature.

Left ventricular rupture secondary to acute myocardial infarction (AMI) if untreated, is invariably fatal. Successful surgical correction reported in the reviewed literature amounts to twenty cases. This is the case presentation of a 53 year old Caucasian woman admitted urgently to our Institution 6 hours after acute chest pain with a presumptive diagnosis of intrapericardial aortic rupture secondary to acute ascending aortic dissection. A cross-sectional echocardiogram demonstrated a posterior left ventricular rupture secondary to myocardial infarction. Emergency repair was carried out with the aid of cardiopulmonary bypass (CPB) and the patient was discharged after an uneventful recovery. However, five months later she was reoperated on for resection of a large pseudoaneurysm presumably secondary to incomplete resection of nonviable myocardium at the first operation. The patient made an uneventful recovery and remains asymptomatic and well. On the basis of this experience and review of the literature the authors propose a more aggressive approach in an attempt to improve the salvage rate of this not so rare complication of AMI.

[Isolated straddling tricuspid valve. Presentation of 2 cases operated on successfully]. / Valvola tricuspide a cavaliere isolata. Presentazione di due casi operati con successo.

During the period May 1977-September 1983 in the Department of Cardiac Surgery of Massa Hospital two patients with isolated straddling tricuspid valve were studied with cardiac catheterization and selective angiocardiography and subsequently underwent surgical correction. The first patient, a 38-month-old white boy presented with "complete straddling" according to Bharati and Lev classification; the second, a 39-month-old white boy presented with "peripheral straddling". In both cases at surgery the ventricular septal defect was closed with a Teflon patch, sparing the chordae tendinae and the "straddling" papillary muscle. Both patients survived operation. The first one developed a complete atrioventricular (A-V) block with a ventricular rate which never was below 80 beats/min, during the 30 days of in-hospital observation. No permanent pacemaker was therefore inserted. The follow-up controls (39 and 79 months respectively) shows both patients to be hemodynamically and functionally well.

Posterior enlargement of the small annulus during aortic valve replacement versus implantation of a small prosthesis.

Twenty-two patients with a small aortic annulus were identified among 196 consecutive patients undergoing aortic valve replacement (AVR). The 11 patients in Group 1 underwent posterior enlargement aortic annuloplasty, and the 11 in Group 2 received a small aortic prosthesis (less than or equal to 21 mm). The two groups were unselected. Core hypothermia, cardioplegia, and local cooling were employed for all operations. Isolated AVR was performed in 3 patients in each group. In Group 1, the mean increase in diameter of the annulus was 4.82 mm, which resulted in a mean area increase of 169.91 mm2 (51.7%). Mean aortic cross-clamp times were 140.4 minutes and 93.5 minutes in Groups 1 and 2, respectively. There were 2 operative deaths in Group 1, and 1 operative and 1 late death in Group 2. Mean follow-up was 26.5 months for Group 1 and 43.4 months for Group 2. No thomboembolic or bleeding episodes have been recorded. Considerations and conclusions are offered from the study of this small series of patients.

Correction versus palliation of congenital heart diseases in the first year of life.

In the period 1971-1981 220 children below 1 year of age have been operated upon in our Hospital for Congenital Heart Diseases (CHD). Among them, 125 children were selected, in whom, because of the type of CHD present, either a palliation or a correction could have been chosen as the surgical approach. The first three common malformation treated are presented.

Absent right superior vena cava and persistent left superior vena cava. Clinical and surgical considerations.

From 4,100 patients who had cardiac catheterization for congenital heart disease and " normocardia ", 6 were found to have a persistent left superior vena cava ( PLSVC ) and an absence of right superior vena cava ( RSVC ). Because of the rarity of this finding (1.46%) the clinical and surgical implications are considered. Four of them were successfully operated upon.

Isolated chylopericardium after successful correction of total anomalous pulmonary venous drainage.

A rare case of chylopericardium following correction of Total Anomalous Pulmonary Venous Drainage (TAPVD) in a 10 month old female child is presented. Conservative treatment was successfully adopted. The Authors review the English Literature concerning this unusual complication.

Total pericardiectomy for chronic constrictive pericarditis using femoro-femoral bypass.

A technique of total pericardiectomy for chronic constrictive pericarditis is presented. The authors have used a femoro-femoral cardiopulmonary bypass in nine cases of constrictive pericarditis to prevent the complications of the traditional approach. The advantages of this technique in comparison to the performance of pericardiectomy without the use of extracorporeal circulation (ECC) or with standard ECC are discussed.

Successful repair of delayed rupture of the left ventricular wall after mitral valve replacement. Report of two cases.

Rupture of left ventricular wall (LVWR) following mitral replacement (MVR) is rare (0.5 to 7.3% of all MVR). Two "types" of LVWR have been recognized and attributed to technical errors during MVR and/or to co-existing unfavourable conditions. The two types are precisely located, and appear "early" during operation, at discontinuation of cardiopulmonary bypass (CPB). Miller et al. have described a "third type" LVWR which depends primarily on local conditions, is located between the other two and occurs "late". Successful repair is rare. The outcome is favourably influenced by intraoperative recognition. This paper reports two LVWRs "type III" which occurred among 282 MVR (0.7%) done in our Department since 1977. Both were successfully repaired respectively 12 (and again 48) and 15 hours after MVRs. To the best of our knowledge these are the only cases of successful repair of a "type III" LVWR reported in the literature. On the basis of this experience some considerations are presented.

Chylothorax following cardiac surgery in children.

Eleven cases of chylothorax following cardiac surgery in children are described. Conservative treatment was carried out with success in all patients but one, who died because of the underlying cardiac pathology, with the chylothorax still present. Our results indicate that conservative treatment is effective in children, although surgery has been previously considered by some authors as the treatment of choice in this age group.

The syndrome of congenital absence of the pulmonary valve: pathological, clinical and surgical considerations.

Four cases of congenital absence of the pulmonary valve are described. Three of them underwent successful operation. The fourth case, operated on in the first days of life, died because of severe respiratory distress. After examining the embryological aspects of this malformation, its treatment is discussed in relation to particular respiratory problems in infants and to the possibility of inserting prosthetic valves in children undergoing elective surgical treatment.