From 1985 to 1995, 12 patients with native valve endocarditis underwent valve repair instead of replacement. Mean age was 41.9 years (range from 5 to 79 years). Eight patients had active and 4 patients inactive infection. The mitral valve was involved in 6 patients, the aortic valve in 1, both valves in 2, the tricuspid valve in 2, and the mitral and pulmonary valves in 1. The pathological findings were as follows: leaflet perforation in 2 patients, chordal rupture in 3, and vegetations in 10. Valve sparing procedures were carried out an the mitral valve in 8 patients, an the aortic valve in 1, an the tricuspid valve in 2, and an the pulmonary valve in 1. The following repair techniques were used: vegetectomy in 10 patients, leaflet patching in 2, posterior mitral leaflet resection in 3, mitral annuloplasty in 4, and pulmonary valve repair in 1. Uncontrolled sepsis, progressive heart failure, peripheral embolism, and echocardiographically demonstrated vegetations were the indications for surgery. There was no operative er late mortality and all infections were cured with no recurrences. One patient required valve replacement following aortic valve repair because of progressive aortic regurgitation. Postoperative Doppler echocardiography showed trivial to no regurgitation in 11 patients after valve repair. The overall outcome was favorable during the mean follow-up period of 39.3 months (range from 1 to 120 months). Reparative er reconstructive approaches for native valve endocarditis should be considered and can be successfully performed. Their advantages include (1) improved hemodynamics, (2) no recurrence, (3) no mortality, and (4) favorable long-term results.
The authors present three patients who had either coronary artery disease or severe aortic stenosis or both along with congenital coarction of the aorta. The use of a heterotopic bypass (Dacron tube implanted between the ascending and descending aorta) allowed the surgeons to correct the coarction through a median sternotomy and perform the coronary artery bypass grafting and valve replacement at the same time. The authors are convinced that the scarcely mentioned heterotopic bypassing of the coarcted aorta should be added to the armamentarium of the surgeons who operate on patients with coarctation or recoarctation of the aorta in adulthood or with coarctation that is associated with cardiac lesions.
A case of enormous Chiari's network in a 7-year-old girl is described. It formed a parachute or spinnaker-like sack which moved freely into the pulmonary artery causing mild pulmonic stenosis. The preoperative diagnosis was believed to be myxoma of the right ventricle. The real condition was recognized during the operation. This is the seventh reported case of correction of so-called cor triatriatum dextrum.
We report on two patients who had systemic-to-pulmonary artery shunts created by the use of the internal mammary artery (IMA). The first patients was operated on more then 30 years ago (the case has never been published) and the second one move recently. We give a brief summary of the ten cases of the same operation published so far, and emphasize the usefulness of the IMA that stays open despite the initially poor run-off and is capable of supplying increasing amounts of blood to the growing pulmonary arteries.
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