SummaryObjective: To evaluate the repair of congenital heart defects through minithoracotomies.Methods: Between January 1998 and March 2005, 98 patients underwent minithoracotomies for simple congenital heart defect repairs at our institution. All patients were female between the ages of 14 months and 16 years (mean 4.6) with weights ranging from 8 to 58 Kg (mean 20). Diagnoses included 78 cases of atrial septal defects (ASD) (six with associated partial anomalous pulmonary venous drainage and four with pulmonary valve stenosis) and 20 cases of perimembranous ventricular septal defects (PVSD). All diagnoses were confirmed with an echocardiogram; therefore, cardiac catheterization was not required. A right submammary minithoracotomy was performed on 10 patients and a minithoracotomy with a partial median sternotomy was performed on 88 patients.Results: All defects were corrected successfully with satisfactory exposure. Cardiopulmonary bypass times ranged from 8 to 30 min (mean 10) and aortic clamping times ranged from 5 to 22 min (mean 12). All patients were extubated in the operating room and hospital stays ranged from 3 to 7 days (mean 5). There were no deaths during the operation or severe postoperative complications. No residual shunts were observed.Conclusions: Our study demonstrated that the minithoracotomy is a safe effective and technically viable alternative to a median sternotomy to correct selected simple congenital heart defects. The advantages of this approach include less trauma, partial or complete preservation of sternum continuity and integrity, and elimination of postoperative deformities such as pectus carinatum. The cosmetic outcome was superior to a median sternotomy.
Surgical correction was adequate in the immediate follow-up of operated patients, and mortality was higher in patients with higher functional class.
RESUMO: É relatada a retirada cirúrgica de trombos em próteses mecânicas em dois pacientes, manobra rara e inédita em nossa Instituição. O primeiro paciente, do sexo masculino, de 19 anos de idade, com história de doença reumática na infância, tendo sido submetido a duas duplas trocas mitro-aórticas, com duas próteses metálicas na última operação, realizada em 1988. Tendo descontinuado o uso de anticoagulantes por conta própria, deu entrada no pronto-socorro em edema agudo dos pulmões, com diagnóstico de trombose nas próteses. Foi levado ao centro cirúrgico, optando-se pela limpeza cirúrgica das próteses, diminuindo, desta forma, o tempo de circulação extracorpórea em paciente de extrema gravidade. Outra paciente, de 2 anos e 6 meses de idade, com diagnóstico de insuficiência mitral por degeneração mixomatosa, foi submetida a troca da valva mitral por prótese mecânica em 13/10/92. Apesar de bem anticoagulada, apresentou trombose da prótese e, no dia 12/1/93, foi submetida a trombectomia cirúrgica. Os dois pacientes apresentaram boa evolução pós-operatória, sendo que a segunda paciente, 3 meses após a trombectomia, apresentou nova trombose aguda, sendo administrada estreptoquinase, com sucesso. A trombectomia cirúrgica pode ser uma boa opção em pacientes com alto risco e portadores de trombose de próteses metálicas. DESCRITORES: próteses valvulares cardíacas, trombectomia; próteses valvulares cardíacas, cirurgia. INTRODUÇÃOO ecocardiograma confirma o mau funcionamento das próteses em 90% dos casos.A obstrução trombótica é uma rara, porém, geralmente fatal complicação nas próteses valvulares mecânicas, ocorrendo mais freqüentemente nas pró-teses de disco 11 ,23. O diagnóstico e o tratamento cirúrg ico neste tipo de complicação continuam sendo um desafio 15.As características clínicas pré -operatórias incluem: dispnéia, estertores e o desaparecimento do ·clic· metálico característico das próteses mecâ-nicas. O quadro pode ser rapidamente progressivo , com insuficiência cardíaca rebelde a tratamento , ou edema agudo dos pulmões. KARP et alii 13 relataram o risco cumulativo de trombose nas válvulas de disco, sendo de 3% em aórticos, 13% em mitrais e 13% em mitro-aórticos, até 5 anos após a troca valvular. O total de risco cumulativo relatado é de 8,6% .
Purpose -There is, today, a global tendency towards a surgical approach privileging very small incisions, the socalled minimally invasive intervention, which results in a less aggressive action. The introduction of this new technique makes it possible to dissect the left internal thoracic artery (LITA) and to perform in the anastomosis with the anterior interventricular artery (AIA) through a left minithoracotomy.Methods
ObjectiveTo analyze the initial results of the use of an organic tubular graft for systemic-pulmonary anastomoses. MethodsFrom March 2002 to April 2003, 10 patients underwent systemic-pulmonary shunt of the modified Blalock-Taussig type, using a new type of biological graft originating from the bovine mesenteric artery treated with polyglycol, the so-called L-D-Hydro. The patients' ages ranged from 3 days to 7 years, and 60% of them were of the male sex. The diagnoses of heart disease were determined on echocardiography. All patients had clinical signs of severe hypoxia (cyanosis). The heart diseases were as follows: tetralogy of Fallot (40%), tricuspid atresia (50%), and atrioventricular septal defect (10%). ResultsOne patient died due to sepsis and 9 had an immediate improvement in O 2 saturation on pulse oximetry and in the partial oxygen pressure on arterial blood gas analysis. The intensive care unit length of stay ranged from 2 to 6 days. No patient had obstruction of the shunt on the immediate postoperative period or any other complication. All patients had a patent shunt on the echocardiographic studies performed in the immediate postoperative period and later, in the third postoperative month. No bleeding occurred during surgery or in the postoperative period. ConclusionThe tubular L-D-Hydro graft proved to be promising for performing systemic-pulmonary shunt as an alternative for the inorganic products available in the market, however, we need a greater number of implantations and late follow-up for definitive assessment. Key wordssystemic-pulmonary anastomosis, modified Blalock-Taussig The systemic-pulmonary shunt using blood flow from the subclavian artery to the ipsilateral pulmonary artery was clinically introduced by Blalock and Taussig 1. Potts et al 2 have reported the performance of a shunt between the descending aorta and the pulmonary artery, Waterston 3 has created a shunt between the ascending aorta and the pulmonary artery, and Redo and Ecker 4 have introduced the use of a prosthesis for performing a systemic-pulmonary shunt.We present the initial analysis of the results with 10 patients undergoing systemic-pulmonary shunt with a new type of organic graft (L-D-Hydro) originating from the bovine mesenteric artery treated with polyglycol.
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