Surgical correction of cor triatriatum sinister in the paediatric population: mid-term results in 15 cases.

OBJECTIVES: Cor triatriatum sinister (CTS) is a rare developmental cardiac abnormality resulting in left ventricular inflow obstruction. In this report, we aimed to present our mid-term results of early childhood patients operated for CTS and associated cardiac abnormalities. METHODS: We enrolled 15 patients with CTS who were operated by a single surgeon between 2001 and 2013. A retrospective analysis was performed in order to determine the demographics, operative and postoperative results of the patients. The median age was 14 months and the median body weight was 8.2 kg at the time of operation. RESULTS: Fourteen patients had concomitant cardiac pathology. Three of the patients had atrial septal defect and 1 of the patients had partial abnormal pulmonary venous connection, whereas 4 of the patients had both. In 2 cases of complete atrioventricular septal defect, 1 case with ventricular septal defect, 1 case with patent ductus arteriosus, 1 case with double outlet right ventricle and another case with tetralogy of Fallot, complete repair was performed together with membrane resection in the left atrium (LA). The mean preoperative left atrial gradient was 13.3 mmHg, whereas the mean LA pressure at the first postoperative year was 4.2 mmHg. There was 1 case with early mortality due to septic multiorgan failure secondary to pneumonia. CONCLUSIONS: CTS is a rare congenital cardiac anomaly in which the results of the corrective surgery are encouraging. Early and long-term outcomes may be variable according to the associated congenital heart defects.

Restoration of pulmonary compliance after laparoscopic surgery using a simple alveolar recruitment maneuver.

STUDY OBJECTIVE: To test the hypothesis that a pulmonary maneuver designed to recruit additional alveoli (thereby decreasing atelectasis) applied before extubation can restore pulmonary compliance to baseline values. DESIGN: Cohort study. SETTING: Operating room of a university hospital. PATIENTS: 20 ASA physical status I and II patients scheduled to undergo laparoscopic radical nephrectomy. INTERVENTIONS: Participants received a balanced general anesthesia using intermittent positive pressure ventilation. A pulmonary recruitment maneuver was performed as a single manual inflation of the lungs to 40 cm H(2)O, maintained for 10 seconds after release of pneumoperitoneum. MEASUREMENTS: Respiratory mechanics including dynamic compliance were measured continuously using the VenTrak respiratory mechanics monitor (VenTrak; Novametrix, Wallingford, CT, USA). Respiratory measures were recorded together with arterial blood gases after induction (T1), with the patient placed in the lateral "jackknife" position (T2), 10 and 120 minutes after CO(2) insufflation (T3 and T4), immediately after desufflation in the lateral and supine positions (T5 and T6), and 10 minutes after a pulmonary recruitment maneuver at the conclusion of surgery (T7). Outcome data were analyzed using analysis of variance for repeated measures; P < 0.05 was defined as statistically significant. MAIN RESULTS: On average, compliance decreased from an initial value of 63.5 to 52.6 mL/cm H(2)O when patients were turned from the supine to the lateral position (T1 vs. T2; P < 0.001), and decreased further to 31.07 mL/cm H(2)O after CO(2) insufflation (T2 vs. T3; P < 0.001). Compliance increased to 50.8 mL/cm H(2)O after desufflation and 54.4 mL/cm H(2)O after turning the patient to the supine position, but did not return to baseline levels until after performance of the pulmonary recruitment maneuver, 64.3 mL/cm H(2)O (T6 vs. T7; P < 0.001, and T1 vs. T7; P = 0.73). CONCLUSIONS: Respiratory mechanics do not fully return to baseline levels after desufflation following laparoscopy; however, lung compliance can be fully restored using a simple alveolar recruitment maneuver.

Effect of pneumoperitoneum on the level of plasma potassium.

The purpose of this study was to find out the impact of acute respiratory acidosis on serum potassium level during laparoscopy. The study was performed on ninety patients who underwent laparoscopic surgery. Ventilation parameters were kept constant throughout the study. Samples for assessment of blood gases were collected in the following sequence: before pneumoperitoneum, a the 20th minute of pneumoperitoneum, at the 60th minute of pneumoperitoneum, and after extubation. The systolic, diastolic pressures and heart rate were recorded simultaneously. Before pneumoperitoneum, heart rate, systolic and diastolic pressures were reduced according to baseline values. With the induction of pneumoperitoneum, both systolic and diastolic pressures returned to the baseline levels except the heart rate. There was a statistically significant increase in potassium level (Control: 3.49 mEq.L(-1), determined high level: 3.75 mEq.L(-1)). Electrolytes, especially potassium, should be monitored during laparoscopy utilizing CO2 pneumoperitoneum and when necessary, ventilatory parameters should be adjusted.