Correction of pectus excavatum with a self-retaining seagull wing prosthesis. Long-term follow-up.

Between June 1958 and December 1991, 315 patients (217 male and 98 female, mean age = 17.8 +/- 5.5 years) affected by pectus excavatum (PE) were surgically treated. Most of the patients required operation for aesthetic reasons only (299 patients; 95 percent). The grade of PE (Chin classification) was I in 72 patients, II in 152, and III in the remaining 91. The surgical technique consisted of a double transversal sternotomy at the level of the lowest and highest part of the depression associated with a longitudinal sternotomy. A wedge resection of the ribs was then performed and the sternum was fixed using a stainless steel strut molded into a seagull wing prosthesis. The strut was removed 12 months postoperatively. There were no operative mortalities. Four patients had sternal wound infection that was successfully treated. The mean follow-up was 15.8 years per patient and was 60 percent complete. From the aesthetic point of view, the postoperative results were excellent in 246 patients (78 percent), good in 57 (18 percent), and poor in 12 (4 percent). All subjective symptoms, when present, disappeared after surgery. The seagull wing prosthesis appears to be safe, easy to implant and to remove, and comfortable for the patient. This technique has shown good long-term results independently of type of deformity and patient age.

[Surgical cardiopathies and pregnancy (a 30-year report)]. / Cardiopatie chirurgiche e gravidanza (un consuntivo trentennale).

The advent of heart-surgery in obstetrics has been determinant, in as much as it has improved therapeutic treatment and above all it has resulted in achievement which were impossible 30 years ago. The concepts already put forward by the school of cardio-obstetric surgery of Turin on haemodynamics in pregnancy and childbirth as biologic risk factors for the patient with a bad heart continue to be upheld. The results of Actis Dato Group's in cardiac surgery are reported. Almost all types of congenital and acquired cardiopathies in their relationships to pregnancy are described. 1750 Pregnancy cases in 997 heart diseased women are analised. The cooperation with the obstetrical team is stressed.

[Our experience with cardiac electrostimulation (1964-1979: 730 implants)]. / Nostra esperienza nell'elettrostimolazione cardiaca (1964-1979: 730 impiante).

From 1964 to 1979, 446 patients were treated with pace-maker implantation for a total of 730 devices. Epicardial stimulation was employed in 263 cases, endocardial in 160, and both in 23. The results, complications, treatment and indications are reported and discussed.

[504 implantations of aortic valve prostheses]. / Su 504 impianti di protesi valvolari aortiche.

The results in 504 patients operated with aortic valve replacement are reported. In 153 patients other associated valvular diseases or complications were present. The mortality in non complicated case was 3%. The long term mortality (1--14 years) was 4%. The results and indications are discussed.

[Radical correction of the tetralogy of Fallot: 122 cases]. / Correzione radicale della tetrade di Fallot: su 122 casi.

In 122 patients with Fallot tetralogy total correction was performed. 18 were previously operated with palliative surgery. The results were the following: hospital mortality: 8,5%; very good or good improvement: 78%; satisfactory in 13,5%.

[Surgery of ventricular aneurysms and akinetic zones]. / Chirurgia degli aneurismi e delle zone acinetiche ventricolari.

Operation was performed in 180 patients with post-infarction ventricular aneurysm (12 cases) or akinesia (92 cases). Simultaneously in 2 cases mitral valve replacement was performed and in 2 cases ruptured ventricular septum was treated by patch. The results are reported and discussed.

[Malignant hyperthermia treated with refrigerant venous catheterization]. / L'ipertermia maligna trattata con catetere venoso refrigerante.

A cold water circulation heat exchanger metal probe was used in 3 patients to treat severe hyperthermia. The probe was introduced into the caval veins by way of the sephenous vein. In 40' temperature fell from 42 degrees to 37 degrees and the patients were saved. The apparatus is simple and the technique straightforward.

[Aortic subvalvular stenosis]. / Le stenosi sopravalvolari aortiche.

Six cases of supravalvular aortic stenosis with other abnormalities are presented. Their causes, anatomical, pathological, and clinical aspects are discussed and reference is made to the excellent results of treatment.

[Akinetic zones of the left ventricle in aortic insufficiency. Treatment]. / Zone acinetiche del ventricolo sinistro nell'insufficienza aortica. Trattamento

22 cases of aortic valvular insufficiency treated by prosthesis and in which the acinetic areas of the left ventricle were eliminated at the same time are reported. Only one postoperative death (ventricular fibrillation) was encountered; one after 1 year (emboly as a result of endocarditis) and one as a result of an unknown cause. Emphasis is laid upon the frequency of this associated complication, its seriously negative incidence on ventricular haemodynamics, the need for surgical treatment, and its favourable immediate and long-term results.

[Surgery of pre-valvular aortic stenosis]. / La chirurgia delle stenosi prevalvolari aortiche

An anatomic and functional classification of the malformation and its associated faults is followed by an account of its physiopathological and clinical features, with particular reference to questions of diagnosis and the indications for surgery. Surgical management is explained and a personal series is presented. Finally, an account is given of the modern approach to treatment particulary in cases of muscular-type prevalvular stenosis of the aorta.

[Plastic widening of the aorta associated with implantation of valvular prosthesis]. / Plastica ampliante dell'aorta associata all'impianto di protesi valvolare

Widening of the supravalvular aorta by means of a lozenge-shaped dacron patch was performed in 9 cases of stenosis and/or aorta insufficiency. Marked improvement was noted in the 8 patients followed up: the transvalvular gradient was not significant and neither haemolytic anaemia nor hyperhaemolysis were present. This expedient is both useful and indicated in cases where the calibre of the descending aorta is small.

[A technical procedure in the Blalock operation for Fallot's tetrad to facilitate the radical intervention]. / A ccorgimento tecnico nella operazione di Blalock per tetrade allo scopo di agevolare l'intervento radicale

It is proposed that when carrying out subclavian-pulmonary anastomosis as a palliative measure in Fallot's tetralogy, a cord or open tourniquet clamp should be left round the subclavian. When radical operation comes to be carried out, some years later, this device will enable the fistula to be closed easily and quickly.