Hypertrophic obstructive cardiomyopathy. Late follow-up after ventricular myotomy-myectomy.

A series of 25 patients with hypertrophic obstructive cardiomyopathy, isolated or associated with minor anomalies, were operated upon using a modified Morrow's procedure. The indication for operation was based on either the presence of severe symptoms despite treatment with beta-blocking agents, or a significant peak gradient of over 50 mmHg even in asymptomatic patients. All patients survived and none was lost to follow-up. Long-term results were evaluated with 2-dimensional echocardiography. Surgical versus pharmacological treatment is discussed, with particular consideration given to paediatric patients.

Posterior enlargement of the small annulus during aortic valve replacement versus implantation of a small prosthesis.

Twenty-two patients with a small aortic annulus were identified among 196 consecutive patients undergoing aortic valve replacement (AVR). The 11 patients in Group 1 underwent posterior enlargement aortic annuloplasty, and the 11 in Group 2 received a small aortic prosthesis (less than or equal to 21 mm). The two groups were unselected. Core hypothermia, cardioplegia, and local cooling were employed for all operations. Isolated AVR was performed in 3 patients in each group. In Group 1, the mean increase in diameter of the annulus was 4.82 mm, which resulted in a mean area increase of 169.91 mm2 (51.7%). Mean aortic cross-clamp times were 140.4 minutes and 93.5 minutes in Groups 1 and 2, respectively. There were 2 operative deaths in Group 1, and 1 operative and 1 late death in Group 2. Mean follow-up was 26.5 months for Group 1 and 43.4 months for Group 2. No thomboembolic or bleeding episodes have been recorded. Considerations and conclusions are offered from the study of this small series of patients.

Quadricuspid aortic valve.

A case of quadricuspid aortic valve is described. The anomaly was unexpectedly found during operation for aortic valve replacement in a 70-year-old woman. Macroscopic and histological examinations of the valve showed no sign of previous inflammatory disease. Quadricuspid aortic valve must be considered, therefore, a malformation capable of leading to severe valve failure in later life.

Double outlet right ventricle, non-committed ventricular septal defect and pulmonic stenosis. Anatomical and surgical considerations.

A case of double outlet right ventricle with pulmonary stenosis, a non-committed muscular ventricular septal defect occupying the sinus and trabecular portions of the ventricular septum, an additional small subtricuspid ventricular septal defect, situs solitus, atrioventricular concordance and aortic d-position is described. Atrioventricular valvular canal type malformations, splenic, systemic or pulmonary venous anomalies, all frequently seen in double outlet right ventricle with uncommitted VSD, were not present.

[Evaluation of K-canrenoate in post-surgical treatment of open heart paediatric surgery (author's transl)]. / Valutazione del "canrenoato di potassio" nel trattamento post-operatorio in chirurgia pediatrica a cuore aperto.

The variation of Aldosterone and its consequences on urinary Sodium and Potassium after cardiac surgical trauma are well known. We made a study on 2- pediatric patients operated by extracorporeal circulation (ECC). Ten patients were given an Aldosterone inhibitor (K-canrenoate), ten patients were the control group. The efficacy of treatment with the Aldosterone inhibitor drug is proved by: 1) progressive, significant drop of Natremia; 2) considerable heightening of Kaliemia; 3) significant higher ratio between Natriuria and Kaliuria. The importance of antialdosteronic treatment is demonstrated by: 1) diminished sodium retention implies a lessened water retention; 2) increased potassium retention protects from dangerous hypokaliemia in the early postoperative period; 3) possible inotropic and extrarenal activity. It's important to modify the dose of K-canrenoate in relation to the level of electrolytes. High levels of potassium may follow a dosage of 2,5 mg/Kg/24 h. In other cases higher dosage may be necessary.