New PDF release: Cardiac Reconstructions

Nonfiction 8

By P. K. Ghosh (auth.), Probal K. Ghosh MD, MS, MCh, FRCSE, Felix Unger (eds.)

Attempts to reconstruct quite a few elements of the guts all started even earlier than the start of open cardiac surgical procedure. through the past due Nineteen Fifties and early 1960 s numerous closed and open systems had already been defined. In that period, numerous surgeons in Europe and the Americas have been relatively caused to improve a number of concepts of valve re­ development as a result loss of applicable valve prostheses and conduits that have turn into on hand consequently. at the moment, numerous congenital lesions nonetheless defied definitive correction, and medical makes an attempt at left ventricular wall alternative had now not but acquired lower than manner. A renaissance in several cardiac reconstructive approaches all started before everything of the Eighties. because the difficulties in terms of valve prostheses grew to become extra often liked and the significance of chamber volumes and geometry (atrial or ventricular) used to be accorded due significance within the long term follow-up, there has been a resurgence of surgical makes an attempt at reconstruction in congenital and bought cardiac lesions as a way to approximate the typical country. even as a number of features of this reconstructive "discipline" grew to become obvious. First, cardiac reconstructive surgical procedure has remained a surgical "art" with a steadily expanding variety of cardiac surgeons.

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Wigle ED (1957) Duplication of the mitral valve. Br Heart J 19:296-300 4. Di Segni E, Lew S, Shapira H, Kaplinsky E (1986) Double mitral valve orifice. Pediatr CardioI6:215-217 5. Wakai CS, Edwards JE (1958) Pathologic study of persistent common atrioventricular canal. Am Heart J 56:779-794 6. Studer M, Blackstone EH, Kirklin JW, Pacifico AD, Soto B, Chung GKT, Kirklin JK, Bargeron LM (1982) Determinants of early and late results of repair of atrioventricular septal (canal) defects. J Thorac Cardiovasc Surg 84:523-542 7.

Obstruction resulted from isolated valvular degeneration (n = 14), isolated neo-intimal peel formation (n = 6), or a combination (n = 5); stenosis of distal pulmonary arterial anastomoses was present in two cases, and proximal right ventricular anastomoses in three cases. The mean transconduit pressure gradient decreased from 81 mmHg preoperatively to 20 mmHg postoperatively. During operation the first conduit was replaced with valved (n = 8) or non valved (n = 23) protheses; concomitant cardiac valve replacement was performed in two patients, and residual ventricular septal defect closure was achieved in ten patients.

Particularly interesting is one former premature infant who needed mechanical ventilation for the first 6 months of life due to respiratory distress. Total static lung compliance was reduced to 17% of normal, and the pulmonary vascular resistance index was up to 12 units/m 2 • The infant could be extubated 14 days postoperatively. One year later recatheterization revealed pUlmonary hypertension of two-thirds of the aortic pressure. Catecholamines and other vasoactive drugs were necessary in only three patients.

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