ABSTRACT
We describe an alternative step in the transatrial approach to the repair of ventricular septal defects. We temporarily detach the chorda of the obscuring tricuspid valve from its attachment to the septum to expose the ventricular septal defect.
Subject(s)
Heart Septal Defects, Ventricular/surgery , Chordae Tendineae/surgery , Heart Atria/surgery , Humans , Prosthesis Implantation , Suture Techniques , Tetralogy of Fallot/surgery , Tricuspid Valve/surgeryABSTRACT
Video-assisted thoracoscopic surgery (VATS) was recently described as an approach to clip the patent ductus arteriosus (PDA). Between May 1994 and May 1996, we performed this procedure on 34 children below 12 years of age (mean 7 years). Thirty-two had an isolated PDA and two had associated small perimembranous ventricular septal defect (VSD), diagnosed on echocardiography and colour flow mapping. None had pulmonary arterial hypertension. The procedure was successful in 33 (97%) children confirmed by absence of residual shunt on serial echocardiography. Complications in the form of pneumothorax (1) and vocal card paralysis (2) were encountered in three children. The overall hospital stay was reduced to five days. In conclusion, the technique of PDA clipping using VATS is easy to learn and highly successful with acceptable risk of complications.
Subject(s)
Ductus Arteriosus, Patent/surgery , Endoscopy/methods , Child , Humans , Thoracoscopy , Treatment Outcome , Video RecordingABSTRACT
From 1979 to 1983, 1726 carotid endarterectomies were performed at the Cleveland Clinic. During this period, 39 men (mean age, 60 years) and 22 women (mean age, 63 years) required 65 reoperations (3.8%) for correction of recurrent carotid stenosis occurring 3 to 194 months (mean, 42 months) after previous endarterectomy at this center (N = 43) or elsewhere (N = 22). Remedial procedures were necessary because of restenosis demonstrated by routine noninvasive testing in 32 asymptomatic lesions and because of neurologic symptoms in 33 others. The mean recurrence interval was 57 postoperative months for atherosclerosis (N = 37) in comparison to 21 months (p = 0.0007) for myointimal hyperplasia (N = 28), and was 48 months for men in comparison to 31 months for women (p = NS). Hypercholesterolemia appeared to be associated with late atherosclerotic recurrence (p = 0.05), but was not a feature of myointimal hyperplasia. Patch angioplasty (N = 59) or graft replacement (N = 3) was employed during 62 of the 65 reoperations, with a total of two operative deaths (3.1%), one nonfatal stroke (1.5%), and six transient cranial nerve injuries (9.2%). Three unrelated late deaths have occurred within a mean follow-up period of 23 months, but only three patients have experienced subsequent neurologic symptoms.
