Heterotopic hindgut duplication: a cloacal remnant associated with exstrophy of the bladder.

Lower hindgut duplications, although very rare, usually present as a cystic mass located posterior to the rectum and confined to the pelvis. Hindgut duplications are often associated with genitourinary or spinal anomalies. We describe a neonate with a previously unreported heterotopic colonic duplication presenting as an exophytic perineal mass associated with classic bladder exstrophy. The embryonic significance of these anomalies is discussed.

Treatment of bulboventricular foramen stenosis by ventricle-ascending aorta valved-conduit bypass.

An 8-year-old girl with single ventricle and 1-transposition developed severe stenosis of the bulboventricular foramen. This became critical subsequent to pulmonary banding and a modified Fontan operation. Successful relief of the obstruction was achieved by placing a valved conduit between the ventricle and ascending aorta, thus bypassing the obstruction.

Surgical correction of complete tracheoesophageal cleft.

Laryngotracheal esophageal cleft is a rare congenital anomaly that should be considered in the differential diagnosis of any neonatal respiratory distress aggravated by feeding. Diagnosis is difficult and repeat endoscopic examinations may be necessary. In complete clefts, immediate surgical repair is indicated with combined approach through the chest and neck and incorporation of part of the esophageal wall into the repair. Because the cleft may be associated with esophageal atresia and/or tracheal esophageal fistula, it should be suspected in patients who have persistent symptoms after successful repair.

Graft hemostasis: an alternative to preclotting.

An alternative to preclotting prosthetic grafts has proved to be simple, safe, and effective in the already heparinized patient. The prosthetic graft or patch is soaked in the patient's blood obtained after systemic heparinization, autoclaved for three minutes at 131 degrees C (270 degrees F), and then inserted.

Renovascular hypertension following surgical repair of dissecting aneurysm of the thoracic aorta.

A critically ill patient with refractory renovascular hypertension following successful intrathoracic repair of a type I aortic dissection was treated successfully with gelfoam embolization of the left kidney. Renal artery stenosis secondary to aortic dissection can exacerbate pre-existent hypertension in the preoperative or postoperative periods and can be diagnosed angiographically. Unilateral renal artery embolization may provide a safe alternative to nephrectomy for renovascular hypertension in cases where surgery is not feasible.

A simplified approach to hepatic vein injuries.

Hepatic vein injuries continue to be difficult and frustrating problems, presenting any surgeon with a formidable challenge. However, this simplified approach can be used successfully in many patients. It does not require extensive dissection and cannulation of the inferior vena cava, and it is more applicable for surgeons with limited vascular experience, who occasionally encounter an injury of this magnitude. Obviously, it is not suitable for all patients with hepatic vein trauma, especially those with extensive caval involvement which does require shunting and exclusion procedures. However, one should evaluate thoroughly the magnitude of the injury and strongly consider this simplified approach before selecting a technically more difficult method which may not be required and which may result in a fatal complication if not executed properly.