Restenosis of the mitral valve: surgical considerations and results of operation.

Our experience over an eight-year period with 63 consecutive patients with mitral restenosis who underwent operation forms the basis for this report. Striking clinical disability was a notable finding. A majority of the patients were less than 30 years old. Embolic phenomena were rare. Closed transventricular valvotomy offers excellent low-risk palliation and good long-term results. Follow-up showed excellent or good results in 90.5% of the patients and poor results in 9.5%. Hemodynamic study of 6 patients demonstrated a pronounced decrease in the pulmonary artery pressure. Open valvotomy was performed in 6 subjects. The presence of intracardiac calcification together with mild mitral incompetence in 2 patients made valve replacement mandatory. The problem of restenosis of the mitral valve is complex, and only after further long-term results are available will the superiority of any one method be demonstrated.

Intracardiac repair of tetralogy of Fallot in adults.

This study demonstrates that total surgical correction in tetralogy of Fallot is a gratifying procedure even with advancing age especially when one reckons that a great majority of these patients showed pronounced disability at the time of surgery without the benefit of previous palliative procedures. However, there are technical difficulties in accomplishing repair in the fibrotic hearts of older patents. The early mortality and long term benefits in this age group closely parallel those in our over all experience with surgery for this anomaly. There was a 12.5% early and 10% late mortality in this series. Surviving patients have been followed up for a period ranging from 1 to 10 years (mean 18 months) and are found to be leading normal active lives.

The use of an omental pedicle flap in the closure of bronchopleural fistulae.

Two recurrent bronchopleural fistulae in patients in whom previous intercostal myoplasty had failed were successfully closed by an omental pedicle flap and a bucket-handle flap slide over the omentum. The original procedure in both was left lower lobectomy. The advantages of the procedure are its simplicity, the absence of cosmetic defect, and its suitability for left lower or lingular bronchopleural fistulae when other procedures have failed.

Surgical treatment of congenital coronary artery fistula.

Six patients with congenital coronary artery fistula underwent successful corrective surgery. Precise diagnosis was established either by retrograde aortography or more recently by selective arteriography. The left coronary artery was involved in four and the right in two cases. The fistula communicated with the right ventricle in three and the right atrium in three subjects. The operative approach is dictated by the site of entry of the vessel into the cardiac chamber. The use of cardiopulmonary bypass for intracardiac repair allows accurate closure of the fistula thereby reducing the chances of recurrence. A follow-up of one to seven years showed that all patients are asymptomatic and leading normal lives.

Pulmonary hydatid cyst: a 25-year experience.

This study reviews our experience with 102 patients operated on for pulmonary hydatid cysts during a 25-year period. The sex incidence was approximately equal. All subjects except three were symptomatic. The diagnosis was made on the radiographic findings. Early surgery is advised for complicated cysts in view of their increased postoperative morbidity and mortality. Surgical treatment included Barrett's enucleation for uncomplicated cysts and resection for complicated ones.

Experience with the surgical treatment of coarctation of the aorta in India.

Between 1961 and 1977, 51 patients underwent operations for coarctation of the aorta. The average age of presentation of these cases was higher than in other series. Only three were asymptomatic, a finding which is not seen in reports from the West. Operative procedures included resection and graft interposition, resection and end-to-end anastomosis, and bypass grafting. However, the technique of patch angioplasty, routinely performed in the last three years of this review, seemed by far the most satisfactory procedure. The overall operative mortality was 9.8%. Hypertension did not regress in some cases in spite of a successful operation. Recoarctation was not seen in this series. Associated defects influenced results adversely. The overall results of operation for coarctation of the aorta have been very satisfactory and comparable with those in other recorded series.