Operative treatment of tetralogy of Fallot with concomitant correction of anomalous origin of the left pulmonary artery from Kommerell's diverticulum.

Anomalies in development of the pulmonary valve, pulmonary trunk and peripheral pulmonary arteries are typical accompanying pathologies in patients with tetralogy of Fallot (ToF). Demanding for diagnostics and borderline for treatment is a condition colloquially called "discontinuous pulmonary arteries", while the main branches are supplied with systemic blood from the ascending aorta, aortic arch or descending thoracic aorta. We present a case of a one-year-old girl with ToF and anomalous origin of the left pulmonary artery (LPA) from Kommerell's diverticulum who underwent two-stage surgical therapy with the support of interventional cardiology. We conclude that early diagnosis of discontinuous pulmonary artery is crucial for choosing the optimal operative strategy. In our opinion, simultaneous anatomic intracardiac correction with direct pulmonary reconstruction seems reasonable and effective, particularly when the result is achieved after joint efforts of cardiac surgery and interventional cardiology.

Superficial femoral vein and superficial femoral artery as replacement for infected axillofemoral graft.

We report successful replacement of infected axillofemoral bypass with a combined femoral vein and superficial femoral artery graft. The new graft was transferred through the tunnel left after infected prosthesis removal. Good early and long-term results indicate that this may be a sufficient procedure.

[Surgical treatment and adjunct hyperbaric therapy to improve healing of wound infection complications after sterno-mediastinitis]. / Leczenie chirurgiczne skojarzone z tlenoterapia hiperbaryczna powiklanego gojenia sie rany z zapaleniem sródpiersia i kosci mostka.

UNLABELLED: Although the incidence of wound complications after median sternotomy is less than 1%, it remains a serious complication in patients undergoing cardiac procedures. We suggest that the combination of hyperbaric oxygen therapy and aggressive surgical approach improves clinical outcomes in these patients. Between August 1997 and May 2002, 55 patients with postoperative sternal wound infection and/or mediastinitis were qualified for hyperbaric oxygen treatment in connection to surgical management. Surgical procedure included wound debridment and/or sternum rewiring, omental pedicle flap plasty or sternectomy. Hyperbaric oxygen therapy consisted of 20 to 40 expositions per patient and was carried before and after the surgery. RESULTS: There was no in-hospital death. The total time between the admission and discharge from the hospital varied from 2 to 24 weeks (average 8 weeks). The infection has been cured in all patients treated for postoperative sternal wound infection. That has been confirmed by negative bacteriological tests, stabilization of the sternum and complete wound healing. CONCLUSIONS: The combination of surgical treatment and hyperbaric oxygen therapy may improve clinical outcome in patients with sterno-mediastinis and poststernotomy wound infection after cardiac surgery.