ABSTRACT
We report the case of a heart transplant in which the recipient patient had a total congenital absence of the pericardium. Associated with this, we found a major disproportion between the size of the recipient's mediastinal cavity and the size of the donor's heart. To prevent twisting of the great arteries, we placed the graft on the left diaphragm muscle and beneath the left lung, which resulted in an uneventful early and late postoperative course.
Subject(s)
Heart Transplantation/methods , Pericardium/abnormalities , Adult , Cardiomegaly/surgery , Humans , MaleABSTRACT
A patient with tertiary syphilis presenting with bilateral coronary ostial lesions and aortic regurgitation underwent surgical reconstruction of the coronary ostia by the anterior approach with autogenous saphenous vein grafting and substitution of the aortic valve with a bovine bioprosthesis. The procedure was easily performed and had good outcomes both early and late. The rarity of the association of a lesion in both coronary ostia with aortic regurgitation in syphilis and the surgical technique employed are discussed.
Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve/surgery , Coronary Disease/surgery , Saphenous Vein/transplantation , Syphilis, Cardiovascular/surgery , Bioprosthesis , Coronary Disease/etiology , Humans , Male , Middle Aged , Syphilis, Cardiovascular/complicationsABSTRACT
BACKGROUND: A new technique is suggested for the reconstructive surgical treatment of mitral regurgitation. It involves partial transfer of the tricuspid valve of the patient to the mitral valve, in order to provide chordae to correct anterior leaflet prolapse of the mitral valve, secondary to rupture of the chordae tendineae. METHODS: From January 1991 to May 1997, 20 patients with mitral insufficiency due to rupture of the chordae were operated on. The prevailing cause was myxomatous degeneration (70%). Patients were in New York Heart Association functional class III and IV. RESULTS: There were no hospital deaths. Two patients were reoperated on. Eighteen patients (90%) are alive with their own valves (class I and II). Doppler echocardiogram mean values were: ejection fraction, 0.65; left atrial diameter, 4.2 cm; mitral area, 2.4 cm2; mitral transvalvular gradient, 3.3 mm Hg. No regurgitation or mild regurgitation was observed in 16 (94.1%) of the 17 cases evaluated. Mean tricuspid valvular area was 3.3 cm2. In all cases, no tricuspid regurgitation was present or it was mild. CONCLUSIONS: Partial transfer of the tricuspid valve to the mitral valve is an effective procedure for the surgical treatment of mitral valve insufficiency secondary to ruptured chordae tendineae of the anterior leaflet.
Subject(s)
Chordae Tendineae , Mitral Valve Insufficiency/surgery , Tricuspid Valve/transplantation , Adolescent , Adult , Aged , Blood Pressure/physiology , Child , Echocardiography, Doppler , Female , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnostic imaging , Postoperative Complications/diagnostic imaging , Postoperative Complications/surgery , Reoperation , Retrospective Studies , Rupture, Spontaneous , Stroke Volume/physiology , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/surgeryABSTRACT
A new technique is proposed for mitral incompetence due to elongated chordae tendineae of the anterior leaflet. It consists in shortening the chordae tendineae of the leaflet level. First, we make a longitudinal orifice in the anterior leaflet just near its free edge and the elongated chordae tendineae. Through the orifice and with the help of a micro nerve hook we pull the elongated chordae the necessary to keep the anterior leaflet in the same level of the posterior leaflet. The orifice is then closed with a polipropilene 5-0 suture. The mitral annuloplasty was performed with a Gregori IMC prosthetic ring. The excellent clinical and laboratorial data suggest that mitral insufficiency due to elongated chordae tendineae can be corrected by this technique.