[Ross operation in Chile]. / Operación de Ross en Chile.

BACKGROUND: Donald Ross introduced the pulmonary autograft for aortic valve replacement with reconstruction of the right ventricular outflow tract with a homograft. Despite its advantages over conventional valve prostheses, the Ross Operation is performed in a minority of patients who need an aortic valve replacement throughout the world. AIM: To report the operative and long term results of a series of patients subjected to Ross operation in Chile. PATIENTS AND METHODS: Between 1996 and 2006, 131 patients aged 35+/-11 years (62% males) were subjected to an aortic root replacement with a pulmonary autograft and reconstruction of the right ventricular outflow tract with a pulmonary homograft. Seventy percent had congenital valve disease. Associated procedures were done in 39%. Patients were followed for a mean of 56+/-30 months. RESULTS: Operative mortality was 2.3%. Two patients had the autografts replaced intraoperatively because of tears in the proximal suture line and one within a month of the operation after suffering autograft endocarditis. At last follow up all patients are in functional class 1 or 2. Autograft reoperations were done in two patients who developed dilation with valve regurgitation (both had aortic regurgitation as primary indication for aortic valve replacement). Three patients required reoperation for pulmonary homograft dysfunction. Another three patients had uneventful pregnancies with normal newborns. Actuarial freedom from any reoperation at 10 years is 93%. CONCLUSIONS: The Ross Operation has low operative morbidity and mortality with excellent long term results. Reoperations have been rare within 10 years of follow up both for the autograft or the homograft.

Nefritis aguda focal: caso clínico / Focal acute nephritis: a case report

Focal acute nephritis (FAN) or acute lobar nephronia is a rare clinical picture characterized by an infection localized in the kidney, with an inflammatory mass without liquefaction. Of variable clinical manifestations, diagnosis is achieved through CT scanning. Histologically, unlike acute pyelonephritis, it does not present a diffuse infíltrate. Objective: Case report of FAN in a pediatric patient. Case Report: Ten year old male complaining of abdominal pain, presents painful percussion in the right lumbar fossa. Urinary analysis and culture were negative, renal sonogram was negative. Abdominal CT sean showed múltiple hypodense renal foci. He responded well to cephotaxim, being discharged in the third day of hospitalization with completion of treatment as outpatient. Differential diagnosis with Acute Pyelonephritis is very important, as it requires controlled and opportune treatment to prevent renal absceses. Diagnosis of this pathology must be pursued despite a normal UA.

La nefritis aguda focal o nefronia lobar aguda constituye un cuadro poco común caracterizado por una infección localizada en el riñon, la que corresponde a una masa inflamatoria sin licuefacción. Posee una clínica variable, siendo la tomograña computada (TAC) la prueba más sensible y específica para el diagnóstico de esta enfermedad. Esta patología se diferencia histológicamente de la pielonefritis aguda por no presentar un infiltrado inflamatorio difuso. Objetivo: presentar un caso de nefronia aguda multifocal en un paciente pediátrico. Caso clínico: Escolar de 10 años que consultó por dolor abdominal, al examen destacaba la presencia de percusión dolorosa en fosa lumbar. Los exámenes de orina y urocultivo fueron negativos. Al ingreso no se detectó cambios renales ecográficamente evidenciables. Se realizó un TAC de abdomen que mostraba múltiples focos renales hipodensos. Respondió favorablemente a terapia antibiótica con cefotaxima siendo dado de alta al tercer día, completando terapia en forma ambulatoria. La diferenciación de este cuadro de otros procesos renales como la pielonefritis aguda (PNA) es muy importante, ya que precisa un tratamiento oportuno y controlado por el riesgo de evolucionar a absceso renal. El diagnóstico de esta patología debe ser buscado a pesar de contar con exámenes de orina negativos.

Operación de Ross en Chile / Ross operation in Chile

Background: Donald Ross introduced the pulmonary autografit for aortic valve replacement with reconstruction of the right ventricular outfow tract with a homografit. Despite its advantages over conventional valve prostheses, the Ross Operation is performed in a minority of patients who need an aortic valve replacement throughout the world. Aim: To report the operative and long term results of a series of patients subjected to Ross operation in Chile. Patients and Methods: Between 1996 and 2006, 131 patients aged 35 ± 11 years (62 percent males) were subjected to an aortic root replacement with a pulmonary autografit and reconstruction of the right ventricular outfow tract with a pulmonary homografit. Seventy percent had congenital valve disease. Associated procedures were done in 39 percent. Patients were followed for a mean of 56 ± 30 months. Results: Operative mortality was 2.3 percent. Two patients had the autografits replaced intraoperatively because of tears in the proximal suture line and one within a month of the operation after suffering autografit endocarditis. At last follow up all patients are in functional class 1 or 2. Autografit reoperations were done in two patients who developed dilation with valve regurgitation (both had aortic regurgitation as primary indication for aortic valve replacement). Three patients required reoperation for pulmonary homografit dysfunction. Another three patients had uneventful pregnancies with normal newborns. Actuarial freedom from any reoperation at 10 years is 93 percent. Conclusions: The Ross Operation has low operative morbidity and mortality with excellent long term results. Reoperations have been rare within 10 years of follow up both for the autografit or the homografit.