Résumé
We report a case of an 8 years and 11 month-old male patient who had developed severe tricuspid insufficiency(TI) after correction of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA). Transthoracic echocardiogram and coronary angiography confirmed ALCAPA, ischemic mitral regurgitation and trivial TI. He underwent direct reimplantation of the left coronary artery to the aortic root by using additional cannulation at the main pulmonary artery for arterial inflow and cardioplegia delivery to the left coronary artery. After the correction of ALCAPA, transesophageal echocardiogram(TEE) revealed good antegrade flow at the aortic implantation site of the left coronary artery and severe TI(Gr III-IV/IV). Cardiopulmonary bypass was reestablished and tricuspid valve was repaired with Kay-type annuloplasty, artificial chordae formation and chordal shortening plasty. The postrepair TEE revealed trivial to mild TI.
Sujets)
Humains , Nourrisson , Mâle , Syndrome de Bland-White-Garland , Pontage cardiopulmonaire , Cathétérisme , Coronarographie , Vaisseaux coronaires , Arrêt cardiaque provoqué , Insuffisance mitrale , Artère pulmonaire , Réimplantation , Valve atrioventriculaire droite , Insuffisance tricuspideRésumé
The effects of deep hypothermia and circulatory arrest during aortic arch reconstruction are associated with potential neurologic and myocardial injury. We describe a surgical technique that two patients underwent a modified Norwood procedure without circulatory arrest and myocardial ischemia. One was 13-day-old female patient, weighing 3.1kg, having a variant of hypoplastic left heart syndrome and another was 38-day-old male patient, weighing 3.4 kg, diagnosed Taussig-Bing anomaly with severe aortic arch hypoplasia, coarctation of the aorta, and subaortic stenosis. The arterial cannula was inserted in innominate artery directly. During Norwood reconstruction, regional high-flow perfusion into the inominate artery and coronary perfusion were maintained and there were no neurologic, cardiac, and renal complications in two patients. This technique may help protect the brain and myocardium from ischemic injury in patients with hypoplastic left heart syndrome or other arch anomalies including coarctation or interruption.
Sujets)
Femelle , Humains , Mâle , Aorte thoracique , Coarctation aortique , Artères , Tronc brachiocéphalique , Encéphale , Cathétérisme périphérique , Cathéters , Sténose pathologique , Ventricule droit à double issue , Hypoplasie du coeur gauche , Hypothermie , Ischémie myocardique , Myocarde , Procédures de Norwood , PerfusionRésumé
Mesenchymal chondrosarcoma arising in soft tissue of mediastinum is a very rare tumor. This paper reports an extraskeletal mesenchymal chondrosarcoma occuring in the posterior mediastinum.