The Lugones Procedure for Scimitar Syndrome Repair Through Right Axillary Thoracotomy: Not Only a Cosmetically Superior Approach.

Several surgical strategies to deal with scimitar syndrome have been described over the years. Among them, the technique described by Lugones and coworkers in 2014 has gained attention due to its simplicity, reproducibility and excellent results. Following the original report of the procedure, the defect is usually repaired through a midline sternotomy. Here, we describe an alternative approach using a right axillary thoracotomy, which not only exhibits superior cosmetic results but allows for an excellent view of all relevant anatomic structures.

Outcomes of the Non-fenestrated Fontan Procedure at High Altitude.

BACKGROUND: Although high altitude has been considered a risk factor for the Fontan operation, and an indication for fenestration, there is a paucity of data to support its routine use. Fenestration, with its necessary right to left induced shunt, together with the lower partial pressure of oxygen found with progressive altitude, can significantly decrease hemoglobin oxygen saturation, and therefore, it would be desirable to avoid it. OBJECTIVE: To analyze immediate and medium-term results of the non-fenestrated, extracardiac, Fontan procedure at high altitude. METHODS: Retrospective analysis of data from consecutive patients who underwent non-fenestrated, extracardiac, Fontan procedure at two institutions located in Mexico City at 2,312 m (7,585 ft) and 2,691 m (8,828 ft) above sea level. High altitude was not considered a risk factor. RESULTS: Thirty-nine patients were included, with a mean age of 6.7 years. Mean preoperative indexed pulmonary vascular resistance was 1.7 Wood units. Seventy-nine percent of the patients extubated in the operating room. There was one in-hospital death (2.56%) and one at follow-up. Median chest tube drainage time was 6.5 and 6 days for the right and left pleural spaces. Median oxygen saturation at discharge was 90%. At a median follow-up of six months, all survivors, except one, had good tolerance to daily life activities. CONCLUSIONS: The present study shows good short- and medium-term results for the non-fenestrated, extracardiac, Fontan operation at altitudes between 2,300 and 2,700 m and might favor this strategy over fenestration to improve postoperative oxygen saturation. Further studies to examine the long-term outcomes of this approach need to be considered.

Supravalvular aortic stenosis associated to infectious endocarditis and cerebral vascular disease in a patient with Williams-Beuren Syndrome.

The Williams-Beuren syndrome is a rare genetic disease characterized by: (a) typical facial features; (b) psychomotor retardation with a specific neurocognitive profile; (c) cardiovascular condition and (d) likely transient hypocalcemia in infancy. The objective of this study was to describe the clinic evolution and diagnosis of patient with this syndrome that was associated with endocarditis caused by Streptococcus parasanguis in the ascending aorta and an aneurism located in the fronto-temporal area, which produced a parenchymal hematoma in the left lobe, and subarachnoid hemorrhage. He was treated with ceftriaxone and dicloxacillin. Then we proceeded to correct the aneurysm and perform vegetation resection in aortic arteries with supravalvular aortic stenosis correction. The evolution after one year has been favorable and is currently without neurologic sequelae. A 5-year-old male patient presented a diagnosis of supravalvular aortic stenosis. After cardiac catheterization was performed, he presented a fever and right side paresis. The echocardiogram showed multiple vegetations in the ascendant aortic arch and the supraortic arteries. The blood cultures reported S. parasanguis. The magnetic resonance showed a subarachnoid hemorrhage with an aneurysm and a hematoma.

[Aortic arch advancement surgery as treatment for aortic coarctation with hypoplastic aortic arch in children]. / Avance de arco aórtico en el manejo de la coartación de aorta con hipoplasia del arco aórtico en niños.

INTRODUCTION: Treatment of aortic coarctation with hypoplastic aortic arch is still a surgical challenge. The aortic arch advancement surgery has shown less re-coarctation frequency. OBJECTIVE: To determine the re-coarctation frequency in patients who underwent aortic arch advancement technique for aortic coarctation with hypoplastic aortic arch and analyze the results. MATERIAL AND METHODS: Retrospective and observational study of 38 patients who underwent aortic arch advancement in a third level Institution from 2002 to 2010. RESULTS: Twenty four males and 14 females all with aortic arch Z index diameter of < or = -2 were found. The median age was 2.6 months and the median weight was 3.8 kg. Twelve patients (31.5%) did not show post operative complications. Eighteen (47%) had only one complication; one patient (2.6%) had 2 complications and 2 (5.2%) had 3 complications. After a follow up of 3.7 years the frequency of re-coarctation was O%. DISCUSSION: With the previously mentioned technique the recoarctation frequency on medium and long term basis was 0%. From the anatomical and functional point of view, we believe this technique offers the best possible results.

Bases para la reformulacion del plan director urbano del Municipio de Colcapirhua / sss

Existe un indebido control del mercado de la tierra por parte de las instituciones del Estado y la Alcaldia. Existe un marcado desfase entre la planificacion del territorio urbano-urbanizable y la realidad fisico-espacial. El Plan Director del eje de Cochabamba-Quillacollo es una propuesta carente de un estudio y diagnostico de los problemas de territorio,lo cual es ajeno a la realidad fisico-espacial de Colcapirhua. La actual tendencia de la expancion urbana de Colcapirhua pone en riesgo las tierras de vocacion agricola y pecuaria de la zona norte y zona sud. Existe una debilidad institucional de la Municipalidad de Colcapirhua, tanto politica y tecnica, no es capaz de enfrentar los procesos de asentamientos ilegales por grupos sociales de esacasos recursos y otros de poder economico que provocana la conversion de areas agricolas y/o verdes a usos urbanos...

Proceso de periurbanizacion urbano-rural en el Valle Central de Cochabamba: caso Municipio de Colcapirhua / sss

Colcapirhua es un municipio que no acaba de consolidar su rol economico dentro de la microregion en general y dentro del area metropolitana en particular. Es un municipio artificial que su existencia o su desaparcion como seccion municipal no cambiaria la conformacion del area metropolitana en el eje de conurbacion Cochabamba-Quillacollo. La planificacion debe enmarcarse en el objetivo central de alcanzar territorio organizado segun criterios de sostenibilidad y de cohesion social, para esto el gobierno municipal debe adquirir protagonismo como actor social clave en el desarrollo local hacia el municipio productivo. Al hablar de sostenibilidad es en el entendio de la posibilidad de mantener en el tiempo tasa de crecimiento economico y de evolucion social sin dañar irreversiblemente el medio ambiente urbano-rural y los recursos naturales...