Use of the Batista procedure to discontinue bypass following aortic reimplantation of an anomalous left coronary artery.

A four-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery developed severe left ventricular failure after aortic reimplantation, despite prolonged supportive cardiopulmonary bypass with high level inotropic support and several abortive attempts for discontinuation. The Batista procedure was performed and the patient was successfully weaned from bypass. Postoperative recovery was uneventful, and at one-year follow-up she remains asymptomatic.

Rhabdomyoma of the heart: surgical treatment.

Rhabdomyoma of the heart may cause severe hemodynamic obstruction specially in infants. Medical treatment carries a 100% mortality, but there are no clear surgical indications for these patients. Accordingly we reviewed the world literature (30 operated patients) adding our own experience (1 successfully operated patient) Based on our data and that of other we conclude: (1) Severely ill patients with rhabdomyoma should be operated upon. Age or associated tuberous sclerosis are not surgical contraindications. (2) Removal of the hemodynamic obstruction should be the main surgical goal. Radical resection of the tumor is not necessary and may be dangerous. (3) Surgical mortality is acceptable and it is becoming lower with time. (4) Long-term outcome for successfully operated patients is unknown.

[Reabsorbable banding. Our initial experience]. / Banding reabsorbible. Experiencia preliminar.

Since May 1989 we have been using a reabsorbable 3 mm, polidioxanona band for pulmonary banding instead of the dacron one. This procedure was performed in 5 patients with ages between 33 to 230 days. The diagnoses were atrioventricular canal in one case and ventricular septal defect in the other 4 cases. One of them also had vascular ring with right aortic arch, left patent ductus arterious and aberrant subclavian artery. All the patients were in a poor condition. Subsequent reoperations performed in short, medium, and long term were uncomplicated, and the technique had the added benefit of avoiding the need for pulmonary reconstruction. A close ECO Doppler follow-up is necessary to determine the best moment for definitive correction. We think that this new technique makes the banding a reliable and complications free procedure and its place should be reevaluated in the light of the current tendency for early complete correction.

[Asymptomatic aortic dissection in a patient with aortic valve prosthesis]. / Disección aórtica asintomática en paciente con prótesis valvular aórtica.

The occurrence of iatrogenic aortic dissection after aortic valve replacement is uncommon, usually late, and exceptionally asymptomatic. We present here a case of dissecting aneurysm suspected by excessive mediastinal dilatation observed in the routine annual roentgenogram exam of a patient who has had an aortic valve prosthesis for thirteen years. The confirmation with other diagnostic methods and its successful surgical treatment are also described.

[Transesophageal echocardiography follow-up of patients operated on using the Bono-Bentall technique in aneurysms or dissection of the ascending aorta]. / Seguimiento con ecocardiografía transesofágica de pacientes intervenidos con técnica de Bono-Bentall por aneurisma o disección de la aorta ascendente.

INTRODUCTION: Increasingly patients are surviving after reconstructive surgery of the ascending aorta. These patients require follow-up to detect postoperative prognostic markers, such as persistence of the flow in a false lumen, intimal rupture, or graft complications. We conducted a study with transthoracic and transesophageal echocardiography in order to detect residual abnormalities and establish the usefulness of this technique in a group of patients after Bono-Bentall surgery for ascending aorta pathology. PATIENTS AND METHODS: Twelve patients were studied with transthoracic and transesophageal echocardiography, four after surgery for annulo-aortic ectasia with severe aortic insufficiency and eight for type A aortic dissection. The Bono-Bentall surgical procedure was used in all the patients with Cabrol's modification being added in three. RESULTS: Seven of the eight (87%) patients with aortic dissection had residual abnormalities: five persistence of the distal dissection, one pseudo-aneurysm, and one peritubular haematoma. A residual lesion (pseudo-aneurysm) was found in just one of the four patients (25%) who underwent surgery for annulo-aortic ectasia. The ejection fraction was normal in those patients who had been operated on for aortic dissection and depressed in those who had annulo-aortic ectasia (60 +/- 9 vs 40 +/- 10; p = 0.005). CONCLUSIONS: In patients undergoing surgery with the Bono-Bentall procedure there is a high incidence of residual aortic abnormalities, especially when the operation is for aortic dissection. Transesophageal echocardiography is an ideal diagnostic method for the detection and follow up of residual abnormalities after ascending aorta surgery. We believe this technique should be included in the periodic follow up of these patients.

Se debe indicar la cirugía en la rotura traumática de la aorta torácica? / Is surgery indicated in traumatic rupture of the thoracic aorta?

Objetivo: El momento ideal para indicar la cirugía en un paciente con rotura traumática de aorta torácica sigue siendo controvertido. Parece, a tenor de las últimas publicaciones, que existe una opinión favorable a demorar en lo posible dicha indicación. Revisamos con este objetivo nuestra experiencia. Material y métodos: Nuestra casuística es de 13 pacientes. Once fueron operados, 8 de ellos con carácter emergente y 3 programados a los 4, 15 y 120 días. Dos pacientes recibieron sólo tratamiento médico. Resultados: Cinco pacientes fallecieron (mortalidad operatoria del 38 por ciento). Tres de estos fallecidos fueron por fracaso multiorgánico a los 3, 10 y 40 días respectivamente. Estos tres pacientes fueron dos de ellos los que siguieron tratamiento médico y el tercero uno de los operados emergentemente. Los otros dos exitus fueron por shock hemorrágico. La mortalidad de los pacientes operados programadamente fue del 0 por ciento y la de los operados emergentemente del 37 por ciento. Conclusiones: Aunque en la mortalidad hospitalaria intervienen diversos factores, como grado e importancia de las lesiones asociadas, técnica quirúrgica, etc., consideramos que el tiempo ideal de indicación quirúrgica debe ser lo más precoz posible si no existen lesiones cerebrales o abdominales graves y el paciente está estabilizado metabólica y hemodinámicamente. Aunque existen diversas posibilidades de corrección, nos inclinamos por usar by pass parcial izquierdo lo que permite mejor protección medular y desarrollo de la técnica quirúrgica. Generalmente hemos usado la interposición de un injerto protésico