Orbital meningoencephalocele manifesting as a conjunctival mass.

Orbital meningoencephalocele is a rare congenital abnormality caused by a defect of the cranio-orbital bones that usually manifests soon after birth as a soft, cystic fullness in the superomedial canthal area with associated exophthalmos. We managed an unusual case of congenital orbital meningoencephalocele that manifested as a cystic conjunctival mass without proptosis or periorbital changes. Preoperative computed tomographic scans failed to demonstrate a bone defect. After suture ligature of the posterior stalk, excision of the lesion yielded an ependymal cyst surrounded by neuroglial and meningeal tissue and filled with cerebrospinal fluid. The patient had normal results of ophthalmic and neurologic examinations after transconjunctival resection of the lesion after three years of follow-up. An orbital approach may be appropriate for a few selected cases in which no bone defect is found on computed tomography. Orbital meningoencephalocele should be included in the differential diagnosis of isolated congenital conjunctival cystic masses.

Retrograde coronary sinus perfusion.

"Redo" operations for coronary artery disease have become commonplace. One of the major complications that occurs is perioperative infarction due to embolization of atheromatous material from diseased veins into the distal coronary arteries. Because of this, we began using retrograde coronary sinus perfusion (RCSP) for delivery of cardioplegia to prevent the embolization of grumous material. It is our belief that retrograde flow through the coronary arteries is an effective preventive measure. In addition, RCSP is a simple method of delivery in redo operations such as aortic valve replacement where the majority of coronary flow is through patent vein grafts. Sixty-five of approximately 3,100 patients in our practice in the past three years underwent a cardiac operation in which RCSP was used for cardioplegia delivery. Ventricular function in all patients was well preserved, and all survived. There were no complications associated with the use of this method.

Late stenosis of Starr-Edwards cloth-covered prostheses.

During a two-year period (August, 1971, to July, 1973) 1 Starr-Edwards Model 2400 and 135 Starr-Edwards Model 2320 aortic prostheses were inserted without postoperative antiocagulant therapy. Seven of these valves (including the Model 2400 prosthesis) have been replaced because of substantial transvalvular gradients resulting from fibrous overgrowth of the valve orifice. Symptoms associated with aortic stenosis occurred an average of nine months after the initial operation. Six patients had severe anemia (packed cell volume less than 30%) and hemolysis (serum lactic dehydrogenase greater than 900 units). Gradients across the prostheses ranged from 66 to 105 mm Hg with a mean of 87 mm Hg. One valve was size 8A, 3 were 10A, and 1 was 12A. Fibrous ingrowth was not observed in an earlier group of 23 patients receiving the Model 2310 or Model 2320 prosthesis who were placed on long-term anticoagulant therapy. These findings, coupled with a 9% incidence of thromboembolism at one year, indicate that patients having these prostheses inserted should receive long-term anticoagulant therapy.