RESUMEN
Two cases of orthotopic ovarian transplantations were performed on patients diagnosed to have Turner's syndrome (ovarian dysgenesis) with primary amenorrhea, short stature, and absent secondary sexual characters. Chromosomal analysis showed 45XO pattern. Both transplants were living related from a sister and from a mother. In both the cases the donor and the recipient were immunologically matched by blood group, histocompatibility antigens (HLA), and lymphocyte cross-match done twice. The donor ovaries were dissected extraperitoneally to have long vascular pedicles. In the first case the donor ovarian vein was sutured end-to-side to external iliac vein and the ovarian artery was sutured to the inferior epigastric artery end-to-end using an operative microscope. The ovary was placed in the orthotopic position transperitoneally. Follow-up for 2.5 years has shown regular menstruations, documented ovulations, rise in hormonal levels, and development of secondary sexual characters. In the second case there was no large vein available for anastomosis so that an avascular orthotopic transplantation was performed. The ovarian cortex was dissected in a fan-shaped manner of 0.5-cm strips. Two grafts sutured onto surgicel were placed orthotopically in the ovarian fossa and the remaining ones were placed into the broad ligament. One month follow-up shows good take-up and follicular development on USG, power-angio, and MRI. Hormonal rise has indicated functioning graft. Immunosuppression was achieved in both cases using cyclosporine (4 mg/kg) and prednisolone (2 mg/kg).
Asunto(s)
Ovario/trasplante , Síndrome de Turner/cirugía , Adolescente , Estradiol/sangre , Femenino , Supervivencia de Injerto , Humanos , Trasplante Homólogo/métodos , Resultado del TratamientoRESUMEN
BACKGROUND AND AIM OF THE STUDY: The Chitra tilting disc valve was developed in India to meet the need for a low-cost cardiac valve. The valve has an integrally machined cobalt-based alloy cage, an ultra-high molecular-weight polyethylene disc, and a polyester suture ring. An important feature of this valve is its soft closing sound, by virtue of a plastic occluder. METHODS: Between December 1990 and January 1995, 306 patients underwent isolated aortic (AVR, n = 101) or mitral valve replacement (MVR, n = 205) at six institutions in India. The early mortality rate was 6.9% (seven after AVR; 14 after MVR). A total of 285 survivors was followed up until September 1998; total follow up was 1212 patient-years (pt-yr) (AVR, 445 pt-yr; MVR, 767 pt-yr). RESULTS: There were 52 late deaths (4.3%/pt-yr; AVR 2.2%/pt-yr; MVR 5.5%/pt-yr). Thirty-five deaths were valve-related (23 were due to unknown causes). One AVR patient (0.2%/pt-yr) and 12 MVR patients (1.6%/pt-yr) developed valve thrombosis, and embolic episodes occurred in 25 patients (seven after AVR, 1.6%/pt-yr; 18 after MVR, 2.4%/pt-yr). Bleeding events and infectious endocarditis occurred infrequently (AVR 0.9 and 0.7%/pt-yr; MVR 0.4 and 0.5%/pt-yr, respectively). There was no incidence of paravalvular leak or structural dysfunction of the valve. Actuarial survival rates at seven years were 82.4+/-4.0% for AVR and 65.2+/-5.0% for MVR. During the same interval, thrombus-free and embolism-free survival after AVR and MVR occurred in 98.9+/-1.1% and 94.1+/-1.9%, and 92.3+/-2.8% and 82.1+/-5.7% of patients, respectively. Freedom from all valve-related mortality and morbidity at seven years was 81.5+/-4.1% after AVR, and 64.2+/-5.1% after MVR. CONCLUSION: The Chitra valve appears to be safe and to have performance comparable with that of other currently used tilting disc valves. This valve costs substantially less than other valves, and is therefore within reach of a larger subset of Indian patients.
Asunto(s)
Aleaciones Dentales/uso terapéutico , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Adolescente , Adulto , Anticoagulantes/uso terapéutico , Válvula Aórtica/cirugía , Niño , Protección a la Infancia , Embolia/etiología , Embolia/mortalidad , Embolia/terapia , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/mortalidad , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/terapia , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Hemorragia/etiología , Hemorragia/mortalidad , Humanos , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Diseño de Prótesis , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/mortalidad , Reoperación , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/terapia , Factores de Riesgo , Tasa de Supervivencia , Terapia Trombolítica , Trombosis/etiología , Trombosis/mortalidad , Trombosis/terapia , Factores de Tiempo , Resultado del TratamientoRESUMEN
An eight-month-old male child presented with a nonpulsatile abdominal mass, which was detected during a routine follow-up examination. After ultrasound examination a tentative diagnosis of pseudoaneurysm of the abdominal aorta was made. An umbilical artery catheterisation had been performed for procuring arterial blood gases after birth for treatment of birth hypoxia. There was a history of fever subsequent to the umbilical artery catheterisation with positive blood and catheter tip cultures for coagulase-positive Staphylococci and Klebsiella pneumoniae. He had also suffered from infectious arthritis of the left hip joint one month after the catheterisation. CT scan with enhancement and angiography confirmed the diagnosis. He was treated successfully with excision of the aneurysm and direct repair of the aorta. A false abdominal artery aneurysm has been noted very rarely as a complication of umbilical artery catheterisation. Such an aneurysm most probably develops from infected thrombi which weaken the aortic wall. Diagnosis may be delayed as the child can remain asymptomatic. CT scan with contrast enhancement can give precise diagnosis. Angiography may be done preoperatively. The safest management is early surgery with direct repair.
Asunto(s)
Aneurisma Falso/etiología , Aneurisma Infectado/etiología , Aneurisma de la Aorta Abdominal/etiología , Cateterismo Periférico/efectos adversos , Infección Hospitalaria/etiología , Infecciones Estafilocócicas/etiología , Arterias Umbilicales , Aneurisma Falso/diagnóstico por imagen , Aneurisma Infectado/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía , Humanos , Lactante , Masculino , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To evaluate and discuss etiopathology, clinical manifestations and surgical outcome of a rare subset of unruptured aneurysm of the sinus of Valsalva which erodes into the interventricular septum. METHODS: Between 1989 and 1995, seven cases of unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum underwent surgical correction at the King Edward VII Memorial Hospital, Bombay. The origin of all these aneurysms was from the right coronary sinus. The mean age of presentation was 31 years. All patients were male. Calcification of the aneurysm was seen in three. Three patients presented without aortic regurgitation; all had complete heart block. Four patients presented with aortic regurgitation and in addition, two had complete heart block. Preoperative left ventricular function was poor in patients with aortic regurgitation (Ejection fraction range; 30-42%), when compared to those without aortic regurgitation (Ejection fraction range; 48-52%). Of those without aortic regurgitation at initial presentation, one patient developed progressive aortic regurgitation after 3 years requiring surgery. While two other patients were operated at earliest for closure of aneurysm, even in the absence of aortic regurgitation. All those with aortic regurgitation required surgery for aortic valve replacement and closure of aneurysm. Aneurysm was closed by direct suturing of the ostium in two patients and by patch closure in five patients. Permanent pacemaker was implanted in five patients. RESULT: There was no operative death. Patients who underwent aortic valve replacement required postoperative ionotropic support. Two patients, who underwent surgery in absence of aortic regurgitation, remain free of aortic regurgitation at the end of 36 and 42 months of follow-up. One of the patients with calcific aneurysmal sac underwent successful re-replacement of the aortic valve for paravalvar leak after a 2 year interval. CONCLUSION: Unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum should be operated at the earliest, which makes surgery simple and prevents development of complications such as aortic regurgitation and heart block.
Asunto(s)
Aneurisma de la Aorta/patología , Aneurisma de la Aorta/cirugía , Seno Aórtico , Adulto , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/etiología , Insuficiencia de la Válvula Aórtica/etiología , Calcinosis/patología , Bloqueo Cardíaco/etiología , Tabiques Cardíacos/patología , Implantación de Prótesis de Válvulas Cardíacas , Ventrículos Cardíacos , Humanos , Masculino , Reoperación , Volumen Sistólico , Resultado del TratamientoAsunto(s)
Conflicto de Intereses/economía , Congresos como Asunto/economía , Apoyo Financiero/ética , Industrias/economía , Industrias/ética , Médicos/economía , Médicos/ética , Congresos como Asunto/ética , Humanos , India , Edición/economía , Edición/ética , Sociedades Médicas/economía , Sociedades Médicas/éticaRESUMEN
Repair of the mitral valve should be the primary goal in the surgical management of acute mitral regurgitation following valvotomy. The earlier the repair is done, the better it is because the preoperative haemodynamics affect the overall outcome. The disadvantages and anticoagulation of prosthetic valves are avoided. Besides, it is economical to avoid the high cost of the prosthetic valves in a poor socio-economic group of patients. With good patient selection and additional effort by the surgeon to acquire the necessary expertise to reproduce the techniques of mitral valve repair, a superior quality of life can be offered to these patients. The present study is a retrospective analysis of 14 patients who required emergency open heart surgery following balloon or closed mitral valvotomy. The valve was successfully repaired in 8 patients. The medium term follow-up indicates that repair is reproducible, safe, reliable, and a stable procedure free of complications.
Asunto(s)
Cateterismo/efectos adversos , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/terapia , Enfermedad Aguda , Adulto , Urgencias Médicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/fisiopatología , Selección de Paciente , Calidad de Vida , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Anomalous pulmonary venous connection of the entire left lung into the left innominate vein is very rare. 5 patients with this anomaly were managed in the authors' institution over the last 12 years. Clinically they were diagnosed as cases of pretricuspid left-to-right shunt at atrial level. Cardiac catheterisation and angiography demonstrated the anomalous drainage of the entire left lung into the left innominate vein. Anastomosis between the vertical vein and the left atrium was established using conventional cardiopulmonary bypass, hypothermia, and cold cardioplegic diastolic arrest of the heart. Postoperative course was uneventful. 4 of the 5 patients presented for follow-up during 1-12 years (mean 6.5 years). All are asymptomatic and have been studied with echocardiography, angiography, and magnetic resonance imaging techniques. The anastomatic site was found to be non obstructive in all the patients.
Asunto(s)
Venas Pulmonares/anomalías , Venas Pulmonares/cirugía , Adolescente , Adulto , Venas Braquiocefálicas/anomalías , Puente Cardiopulmonar , Preescolar , Ecocardiografía , Femenino , Paro Cardíaco Inducido , Atrios Cardíacos/cirugía , Humanos , Hipotermia Inducida , Imagen por Resonancia Magnética , MasculinoRESUMEN
Cardiac myxomas are fascinating tumours because of the protean manifestations associated with them. The complex association of cardiac myxomas, with cutaneous lesions and endocrine overactivity has been recognized. We report two such interesting cases.
Asunto(s)
Neoplasias Cardíacas/complicaciones , Mixoma/complicaciones , Enfermedades de la Piel/complicaciones , Adolescente , Niño , Síndrome de Cushing/complicaciones , Femenino , Humanos , Masculino , Síndromes Paraneoplásicos Endocrinos , SíndromeRESUMEN
A case of right superior vena cava draining to both atria, predominantly to the left atrium, with anomalous right pulmonary venous connection to the lower right superior vena cava is reported. The haemodynamic significance of these anomalies is discussed, and the technique of surgical repair is described. The literature on this rare but interesting clinical entity is briefly reviewed.
Asunto(s)
Atrios Cardíacos/anomalías , Venas Pulmonares/anomalías , Vena Cava Superior/anomalías , Procedimientos Quirúrgicos Cardíacos/métodos , Niño , Atrios Cardíacos/cirugía , Hemodinámica , Humanos , Masculino , Venas Pulmonares/cirugía , Vena Cava Superior/cirugíaRESUMEN
Nineteen patients of Thoraco-abdominal aortic aneurysm were operated during a nine year period. All were larger than 10 cm. in size. Four were operated in emergency. Seven underwent patch aortoplasty while eleven required tube inlay aortoplasty with visceral vessel reimplantation. One patient continued to be paraplegic postoperatively. Two (10.52%) had acute renal failure and there were two (10.52%) deaths. A sincere effort to keep the aortic and renal occlusion times to minimum and successful reimplantation of lower intercoastals and visceral branches appear to offer significant help in accomplishing successful repair with justifiable expectancy.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Femenino , Humanos , Masculino , Métodos , Complicaciones Posoperatorias , Resultado del TratamientoRESUMEN
Twenty two cases of aneurysm of sinus of Valsalva managed during a 12 year period are analysed. The right coronary sinus was involved in 14 and the non-coronary sinus in eight cases. It had ruptured in 20 patients while in the other two it had produced right ventricular outflow tract (RVOT) obstruction. Six patients had associated ventricular septal defect (VSD), and eight had aortic regurgitation (AR), five of these requiring aortic valve replacement (AVR). Aortocameral approach was preferred and was used in 18 patients. Recurrence had occurred in one. Surgical management and results are discussed.
Asunto(s)
Aneurisma de la Aorta/cirugía , Seno Aórtico/cirugía , Adolescente , Adulto , Aneurisma de la Aorta/complicaciones , Rotura de la Aorta/cirugía , Insuficiencia de la Válvula Aórtica/complicaciones , Femenino , Defectos del Tabique Interventricular/complicaciones , Humanos , Masculino , Persona de Mediana EdadRESUMEN
An interesting case of congenital intrapericardial aneurysm of the left-atrial appendage is reported. The patient presented with recurrent supraventricular arrhythmias and progressive exercise intolerance and fatigue. Computerised axial tomography aided in the diagnosis by excluding the presence of any thrombus in the sac. The aneurysm could be safely excised via a left thoracotomy without cardiopulmonary bypass. The relevant literature on this problem is briefly discussed.
Asunto(s)
Aneurisma Cardíaco/congénito , Adulto , Femenino , Aneurisma Cardíaco/diagnóstico , Atrios Cardíacos/patología , Humanos , PericardioRESUMEN
Polyvinylchloride (PVC) disposable endotracheal suction catheters were successfully used as temporary intravascular shunts in 5 patients of popliteal artery trauma. These simple shunts should be used routinely in such conditions to immediately re-establish blood supply to the ischaemic limb particularly in patients of polytrauma where systemic anticoagulation is contraindicated. This avoids the inherent delay prior to vascular repair and reduces the incidence of irreversible ischemia.
Asunto(s)
Prótesis Vascular/normas , Intubación Intratraqueal/instrumentación , Arteria Poplítea/lesiones , Heridas y Lesiones/cirugía , Accidentes de Tránsito , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Resultado del Tratamiento , Heridas y Lesiones/etiologíaRESUMEN
A case of successful surgical repair of tetralogy of Fallot with complete atrioventricular canal in 4 year old female child is reported. Double patch technique and combined right atrial and right ventricular (RV) approach were used to repair this defect. The ventricular patch was tailored wide and redundant anteriorly in the form of a sail to prevent subaortic obstruction. Right ventricular outflow tract obstruction was relieved through an infundibular incision with subsequent use of subannular pericardial patch. The relevant literature on the management of this rare anomaly is briefly reviewed.
Asunto(s)
Defectos de la Almohadilla Endocárdica/cirugía , Tetralogía de Fallot/cirugía , Preescolar , Defectos de la Almohadilla Endocárdica/complicaciones , Femenino , Ventrículos Cardíacos/cirugía , Humanos , Politetrafluoroetileno , Prótesis e Implantes , Tetralogía de Fallot/complicacionesRESUMEN
Of the 4170 open intracardiac operations performed at our hospital in the last 6 years, 55 (1.3%) were reoperations. Of these failed valve repairs or valve substitutes formed the major group (58%) and the interval between first and second operation ranged from 6 months to 8 years. There were 4 deaths on table and another 6 patients died during their hospital stay giving an early mortality rate of 18 per cent. There was one late death during a follow-up period of 1 month to 3 years. There was no death due to perioperative bleeding complications. We conclude that it should now be possible to perform reoperations with an acceptable mortality and good late functional results.