Surgery for aortic insufficiency associated with ventricular septal defect.

Aortic valve repair in children is a challenge. We have adopted a technique of single aortic cusp extension with an autologous pericardial strip in patients diagnosed with severe aortic insufficiency (AI) associated with a ventricular septal defect (VSD). The purpose of this study was to report the short-term outcomes. Seven patients were operated on between January 2002 and December 2003. The mean age was 11.28 +/- 2.1 years (range 8-14 years). The VSD was closed with a synthetic patch. Aortic cusp extension was performed at the right coronary cusp in 6 patients and the remainder had a non-coronary cusp extension. The mean diastolic arterial pressure increased from 35.71 +/- 6.09 to 74.28 +/- 7.31 mm Hg after the operation ( p < 0.001). The postoperative grade of AI was trivial in 4 patients, mild in 1 patient and non-existent in 2 patients. The mean follow-up period was 12.85 +/- 6.12 months (range 2-20 months). This technique is very effective in patients with severe AI associated with a VSD. However, long-term durability will need to be carefully followed.

Surgical management of pulmonary cavity associated with fungus ball.

Surgery for pulmonary cavity associated with fungus ball is challenged by chronic lung disease. The purpose of this report was to review patient data, operative procedures and results of surgery. This was a retrospective study. Twenty patients were operated on between January 1997 and December 2002. Fourteen (70%) patients were male and the mean age was 46.30 +/- 13.10 years (range, 24 to 76 years). The most common underlying pulmonary disorder was tuberculosis (70%). Ninety five percent of the patients had a history of hemoptysis, and 35% presented with massive hemoptysis. Lobectomy was performed in 11 (55%) patients and 6 (30%) patients were operated on by cavernostomy with transposition of muscle flap technique. There was no operative mortality and 8 complications (3 prolonged airleaks, 2 wound infections, 1 postoperative bleeding, 1 seroma and 1 empyema). It was also found that emergency surgery and cavernostomy with transposition of muscle flap compromised the postoperative course. Surgery is very effective in controlling and preventing hemoptysis in patients who have pulmonary cavity associated with fungus ball. Elective surgery and formal pulmonary resection may be the proper option for low risk patients. Cavernostomy with transposition of muscle flap may be suitable for patients who have poor pulmonary reserve.