Background-We examined predictors of early and very long-term outcome after combined mitral and tricuspid valve repair for rheumatic disease. Methods and Results-Between

The management of apical ventricular septal defects continues to be challenging because of the difficulty in achieving a complete closure without a left apical ventriculotomy. In this study, we present our innovative technique of closing multiple and/or large muscular apical ventricular septal defects through a right atriotomy. We operated three patients with multiple apical muscular trabecular ventricular septal defects ("Swiss cheese") using a technique that involved exclusion of the right ventricular apex. Their ages ranged between 2 months and 13 years. The VSDs were approached through right atriotomy. The trans right atrial approach using a 5-0 polypropylene purse-string suture or a two-patch procedure is a novel method of closing large apical ventricular septal defects. It was found to be effective with no persistent residual defects and did not have the disadvantages of a ventriculotomy.

We report a case of a patient who presented with aortic stenosis and a borderline left ventricle during foetal life. A balloon aortic valve valvuloplasty was performed in uterus, and in the postnatal period for relief of the left ventricular outflow tract obstruction followed by a Ross-Konno procedure with fibroelastosis resection. These successful interventions allowed left ventricular growth and the conversion to a biventricular circulation after a single-stage surgery.

An ultrasonographic study in a 60-year-old man incidentally detected an iliac artery aneurysm that gave rise to the renal artery of a single ectopic pelvic kidney. Renal T he surgical treatment of intra-abdominal artery aneurysms is challenging when the renal artery arises from the aneurysm. Preserving the kidney is crucial when repairing the aneurysm. In these cases, renal-preservation solution cannot be used, because it would pass through the renal vein into the general circulation. For this reason, various techniques have been proposed to preserve renal viability. We discuss our surgical correction of an iliac artery aneurysm in a man whose single ectopic pelvic kidney necessitated an alternative treatment. Case ReportIn August 2010, a 60-year-old man with hypertension and type 2 diabetes mellitus underwent abdominal ultrasonography and was incidentally found to have an iliac artery aneurysm. Results of physical examination were unrevealing. Computed tomographic angiograms disclosed a 5 × 7-cm saccular aneurysm in the right common iliac artery; this vessel gave rise to the renal artery of a single ectopic pelvic kidney (Fig. 1). Calibrated angiograms confirmed that the single renal artery originated from the iliac artery aneurysm. No other abnormalities of the cardiovascular system were detected. Because of the high risk of rupture, surgical treatment was recommended.A thermal blanket was used to prevent hypothermia in the patient, whose body temperature remained unchanged throughout the operation. The aneurysm was exposed after dissection of the involved arteries. Cold normal saline solution (8 °C) was infused through the ostium of the renal artery at a rate of 20 cc/min (total volume, 400 cc). Renal-preservation solutions were not infused, because the renal vein was not clamped and such solutions would reach the systemic circulation. Topical cooling of the kidney with normal saline solution was also performed. We performed an aortoiliac bypass with use of a 10-mm Bard ® DeBakey ® Vasculour ® Dacron graft (Bard Peripheral Vascular, Inc.; Tempe, Ariz). The renal artery, which supplied the ectopic pelvic kidney, was implanted onto the graft by means of an end-to-side anastomosis. The duration of renal ischemia was 40 minutes.The patient's postoperative recovery was uneventful, and he was released from the hospital after 13 days. His preoperative serum creatinine level of 1.2 mg/dL had increased 30% to 1.7 mg/dL, but no renal failure was observed. At that time, results of Doppler ultrasonography showed normal renal function, and the results of technetium-99 gammagraphy confirmed patency of the renal vessels. One month after the operation, the patient's serum creatinine level was 1.9 mg/dL; after one year, it was normal at 1.4 mg/dL.

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The first-stage palliation of newborns with single-ventricle anatomy and transposed great arteries can be very challenging when associated with systemic ventricular outflow obstruction and aortic arch obstruction. Often, the initial intervention is a stage I Norwood procedure. We present the case of a newborn with double inlet left ventricle, discordant ventriculoarterial connection with restrictive ventricular foramen, and severe aortic arch obstruction. A hybrid procedure was performed initially as a means of addressing hemodynamic instability. Three months later, a palliative arterial switch procedure was performed as an alternative to the combined Norwood-Glenn procedure. Palliative arterial switch combined with arch reconstruction can be an effective surgical option in these complex, challenging patients.