A case of neonatal intrapericardial teratoma. Clinical and pathological findings.

AIM: It is of general agreement that complete surgical removal after birth of intrapericardial fetal teratomas is needed, because of the risk of severe cardiovascular and respiratory distress, related to the mass size, location and secondary pericardial effusion. Histological examination generally shows mature aspect of cells and tissues. METHODS: We present a case of grade II immature pericardial teratoma, diagnosed in utero and completely removed after birth. RESULTS: Even surgical removal was complete, histological aspects raised the need of long follow-up with serial alpha-fetoprotein determinations. CONCLUSION: A neonatal grade II immature pericardial teratoma was completely removed after birth. The follow-up of the patient, until 10 months of life, was good with no recurrence of the disease.

[Anatomical correction of transposition of the great arteries associated with a large interventricular defect]. / La correzione anatomica della trasposizione delle grandi arterie associata ad ampio difetto interventricolare.

Between December 1975 and February 1984 five patients with Transposition of the great arteries and large ventricular septal defect underwent repair by arterial switching with reimplantation of the coronary arteries. They ranged in age from 2 to 28 months and weighted between 3.2 and 10 kg. The oldest patient had underwent banding of the pulmonary artery together with a Blalock-Hanlon septectomy at 6 months of age. Direct reconstruction of the "new" pulmonary artery was achieved in 4 patients. The first of these patients operated upon on December 1975 died of acute left ventricular ischemia due to compression of the main left coronary artery caused by the newly reconstructed pulmonary artery. This death appears to be technically avoidable by using the method recently reported by Lecompte. One patient who was in good hemodynamic status died of mediastinitis 2 months after the repair. At necropsy the repair was found intact and the woven dacron conduit used to reestablish the continuity to pulmonary artery was found grossly infected. The remaining three patients continue to be asymptomatic 48, 40 and two months respectively after repair. Our small experience supports the anatomic correction as the procedure of choice for the surgical treatment of most of the patients with Transposition of the great arteries and large ventricular septal defect.

[Surgical treatment of the tetralogy of Fallot with a single pulmonary artery]. / Trattamento chirurgico della Tetralogia di Fallot con una sola arteria polmonare.

Eleven patients with Tetralogy of Fallot and congenital or acquired absence of one pulmonary artery (PA) have been operated upon at the Department of Cardiac Surgery of Ospedali Riuniti-Bergamo-Italy. Eight children had agenesis of the left PA, one of the right PA and two had complete occlusion of the right PA after a palliative operation. Four patients had only a palliative procedure (one Blalock-Taussig, two Waterston, three PTFE shunts) with one operative death. Two patients underwent a two-staged procedure, that is an initial shunt (one Blalock and one PTFE shunt) followed by subsequent total correction. Five patients underwent primary total correction. No operative death occurred among the patients who had total correction. Right ventricular outflow reconstruction has been accomplished with an infundibular patch in one patient, an external valved conduit in two patients, and a transanular patch plus orthotopic bioprosthesis in 4 patients. One patient with a valved conduit died one year postoperatively in right heart failure caused by pulmonary hypertension. The pulmonary vascular disease was probably due to pulmonary microembolization following the severe hemolysis that lasted for twenty days in the early postoperative period. The nine surgical survivors are in good general condition with maximum follow-up of 7 years. The surgical approach either in case of palliation or in case of corrective surgery is finally discussed. In our experience TOF with unilateral absence of a PA is a congenital anomaly that can be corrected with results comparable to those of uncomplicated TOF.

Systemic-pulmonary artery shunt using PTFE prosthesis (Gore-Tex). Early results and long-term follow-up on 105 consecutive cases.

One hundred-five patients (median age 14 months) in whom a PTFE prosthesis was used to create a systemic-pulmonary artery shunt were studied between 1978 and 1980. The prosthesis was mainly used to create a modified Blalock-Taussig anastomosis. Nine patients died in hospital (8.5%, 70% confidence limits: 5.7% to 12.3%). The clinical condition did not appear to be an incremental risk factor, while the young age and the underlying type of disease accounted for the hospital mortality to a large extent. All 96 survivals were available for follow-up information. One graft, which was damaged intraoperatively, occluded 3 months later. The remaining patients have a patent graft 3 months to 36 months (mean 24 months) postoperatively. In 6 patients the patency was assessed angiographically and no damages of the pulmonary artery were observed, therefore this type of palliation is advisable for any patient, particularly in the first year of life.

Mitral insufficiency and aortic valve stenosis in infancy associated with endocardial fibroelastosis, surgical treatment and long-term results.

Surgical treatment of mitral insufficiency and aortic valve stenosis associated with endocardial fibroelastosis has not been well documented. We treated 2 infants with this complex lesion: in one case it was possible to repair the mitral valve. The long-term results are quite encouraging and emphasize that this lesion should be treated early to avoid the risk of compromising the left ventricular function, although the chance of a valve replacement in an infant can be high.

[The current role of palliative operations in the surgical treatment of tetralogy of Fallot. A report on 172 operated cases (author's transl)]. / Ruolo attuale degli interventi palliativi nel trattamento chirurgico della tetralogia di Fallot. A proposito di 172 casi operati

172 consecutive palliative operations in patients with Fallot's tetralogy are presented. 19% of the patients were aged less than 6 and 45% less than 12 months. The overall mortality was 5.8%, but has been recently reduced with the improvement of anaesthesiologic and technical experience. In fact, during the last two years, 69 Waterston shunts (33 under 12, and 17 under 6 months of life) were performed with no deaths. On the grounds of this experience, indications of the different types of systemic to-pulmonary artery shunts are discussed, as well as problems related to the choice between one-stage and two-stages surgical correction. The authors' opinion is that palliative procedures still play an important role in the treatment of Fallot's tetralogy, although the future approach may well be early total correction. In their experience, the last approach is restricted to children over 18-24 months of life with favorable anatomy, and to all patients over 4 years of age.