Muscle flap reconstruction for the treatment of major sternal wound infections after cardiac surgery: a 10-year analysis.

Infection of a median sternotomy wound is a rare though potentially fatal complication. Despite early diagnosis and proper treatment, prognosis is poor because of the chance of mediastinal spread of the infection and the poor physical state of these patients. Muscle repair is superior to more conservative surgical options such as sternal resuturing with mediastinal irrigation. During the last 10 years, complications--including sternal infections and dehiscences--have been encountered in 172/4725 median sternotomy wounds after cardiac surgery procedures (4%). Thirty-four patients (of whom 30 had acute sternal infections and four chronical sternal infections) underwent aggressive sternal debridement followed by muscle flap closure. Seventy-two muscle flaps were carried out, a pectoralis major bilateral muscle flap being the most common either alone or in combination with a rectus abdominis muscle flap. Five perioperative deaths (15%) were recorded. Of the 29 surviving patients, 25 patients (74%) were free of infection and four (12%) developed recurrence of the infection after a mean follow up of 3 years (range 49 days-8 years). We conclude that although muscle repair is not free of complications, it is reliable in reducing mediastinitis-related morbidity and mortality.

Successful surgical management of rupture of the left ventricle and interventricular septum due to blunt chest trauma. Case report.

In a 35-year-old man blunt chest trauma caused rupture of the free wall of the left ventricle and the interventricular septum. Emergency pulse Doppler-2D echocardiography confirmed the clinical suspicion and immediate surgical repair was successfully undertaken. This appears to be the first reported case of survival after surgery for such combined cardiac rupture.

[A sinus of Valsalva aneurysm ruptured into the right atrium secondary to aortic endocarditis. The usefulness of transthoracic and transesophageal echocardiography]. / Aneurisma de seno de Valsalva roto en aurícula derecha secundario a endocarditis aórtica. Utilidad de la ecocardiografía transtorácica y transesofágica.

We present a case of a sinus of Valsalva aneurysm ruptured into right atrium secondary to aortic endocarditis. Early surgical procedure was indicated bases on transthoracic echocardiography. This technique demonstrated a abscess image enlarged into the right atrium and color Doppler showed a turbulent flow from aortic valve to right atrium. Cardiac surgery was performed with transesophageal echocardiography monitoring. This technique allowed anatomical and functional aortic valve evaluation and the abscess location and extension. This case shows the value of transthoracic and transesophageal color Doppler echocardiography in the diagnosis and management of patients with complications secondary to infective endocarditis.

[Rupture of the intraventricular septum and free wall of the left ventricle secondary to non-penetrating thoracic injury. Doppler echocardiography diagnosis]. / Rotura de septo interventricular y pared libre de ventrículo izquierdo secundaria a traumatismo torácico no penetrante. Diagnóstico por ecocardiografía Doppler.

The heart is often injured in the setting of blunt chest trauma with a broad spectrum of cardiac lesions. We present a twenty-nine years old man with interventricular septal and rupture and left ventricular free wall rupture following chest trauma. Doppler echocardiography was essential in the diagnostic and therapeutic procedure. We concluded that Doppler-echocardiography must be performed in all patients with suspicion of cardiac affectation after blunt chest trauma.

Myocardial bridging and hypertrophic cardiomyopathy: relief of ischemia by surgery.

We describe a case of myocardial bridging of the anterior descending coronary artery associated with a non-obstructive hypertrophic cardiomyopathy which was corrected by surgery because of a poor response to standard drug therapy. The clinical significance of the association is discussed. The possibility of repair by surgery should be considered when an area of ischemia supplied by the affected vessel is detected and previous medical treatment has been ineffective.

Vectocardiography in tetralogy of Fallot before and after operation (palliative and corrective surgery).

Vectorcardiograms from 55 patients with diagnosed tetralogy of Fallot were studied and divided into the following three groups: A, 35 nonoperated cases; B, 23 with systemic-pulmonary shunt (nine studied preoperatively and also in A); and C, ten after total correction. In group A, two different types of QRS loop occurred in the horizontal plane (HP); 23 clinically and hemodynamically severe cases had right anterior position with clockwise (C) rotation, and 12 less severe cases had right posterior position with counterclockwise (CC) rotation or figure-8 morphology. In the frontal plane the QRS loop was located inferiorly and to the right, with C rotation (80 percent); two cases had the left anterior hemiblock (LAHB) pattern, and another two severe cases had CC rotation and right superior position. Group B had an evident increase of left ventricular forces in the HP, compared with group A; group-B rotation was preferentially CC or figure-8 morphology. Group C had a pattern of right bundle-branch block in nine cases (classic in one and uncharacteristic in eight); four cases also had LAHB.