Anaesthetic management of the surgical separation of a pair of thoracopagus-cardiopagus twins.

We describe the anaesthetic management of the surgical separation of a pair of thoracopagus-cardiopagus twins with a common right atrium and a myocardial tissue bridge containing vascular channels between their ventricles. One of them died during the procedure, the surviving twin is now two years old. The survival of one twin for two years without significant sequelae, after the surgical separation of twins with shared right atrium and fused ventricles, has not previously been reported. Careful preoperative assessment is essential to anticipate potential serious problems during the procedure.

[Anesthesia for the surgery of delayed postoperative stenosis in the pulmonary suture in children with corrected transposition of the great vessels with Jatene's technique]. / Anestesia para la cirugía de la estenosis postoperatoria tardía en la sutura pulmonar, de niños corregidos de la D-transposición de grandes arterias mediante la técnica de Jatene.

Any patient with congenital heart disease is at high risk for anesthesia no matter what surgical procedure is performed. Children undergoing D-transposition of the great arteries using Jatene's technique present stenosis of the pulmonary artery in 10-20% of cases and may require surgery to correct that or some other surgically caused anomally. In either case the children must be managed as patients with heart disease, with special attention to cardiovascular depression and rhythm abnormalities. We report the cases of two children who underwent D-transposition of the great arteries in the neonatal period using Jatene's anatomical technique. They were later anesthetized at ages 5 and 6 years to correct pulmonary suture stenosis. Recovery was good.

Anaesthesia and the Beckwith-Wiedemann syndrome.

Infants with Beckwith-Wiedemann syndrome usually present different abnormalities which may require surgical correction. Anaesthetic management may be complicated by abnormal airway anatomy, congenital heart disease and severe hypoglycaemia. Careful preoperative evaluation, perioperative monitoring and suitable choice of anaesthetic technique are required for a successful outcome. We report the perioperative management of a patient with Beckwith-Wiedemann syndrome presenting for omphalocoele surgery on his first day of life and for bilateral inguinal hernia repair four months later.

[Anesthesia and perioperative complications of correcting transposition of the great arteries using the Jatene technique]. / Anestesia y complicaciones peroperatorias de la transposición de las grandes arterias corregida mediante la técnica de Jatene.

We present a retrospective morbi-mortality study in 12 patients undergoing Jatene's arterial repair for transposition of the great vessels between 1988 and 1992. Half of the patients were boys ranging in age from 4 days to 35 months. In 34% heart failure was grade III, while in 65.6% it was grade IV (NYHA). Anesthetic induction was with ketamine in 11 patients and with halothane in 1. Maintenance was with pancuronium and fentanyl supplemented with N2O in 2 and with isoflurane in 1. The overall intra- and perioperative death rate was 16.6%. Nine cases have undergone surgical repair since 1988 with no mortality. We conclude that Jatene's technique is the best alternative for repair of transposition of the great vessels when there is no hypoplasia of the right cavity.

[Anomalous origin of left coronary artery in pulmonary artery]. / Origen anómalo de la arteria coronaria izquierda en la arteria pulmonar.

We report 2 infants aged 6 months and one year with an anomalous left coronary artery origin treated surgically at our centre with direct aortic reimplantation of the anomalous coronary. Evolution has been satisfactory, with a great improvement of ventricular function. The mitral incompetence and congestive heart failure have disappeared and myocardic perfusion electrocardiographic patterns were corrected. Because of the unfavorable natural course of the disease and the improvement in techniques of coronary revascularization in infants we recommend an early surgical treatment as soon as it be diagnosed. We consider that the most adequate surgical treatment is the direct aortic reimplantation of the anomalous coronary artery.

[Percutaneous transluminal pulmonary valvuloplasty. Results in 34 cases]. / Valvuloplastia transluminal percutánea pulmonar. Resultados en 34 pacientes.

Percutaneous transluminal valvuloplasty with catheter-balloon were performed in thirty-four patients with pulmonary valve stenosis, aged 2 to 11 years (mean = 4.8 +/- 2.4 years). It was a slight stenosis in 24 cases (70.5%) and severe in 10 cases (29.5%). In three of them it was a dysplastic valve. We achieved good results, since right ventricle systolic pressure, decreased from mean = 67 +/- 18 mmHg to mean = 23 +/- 12 mmHg (p less than 0.0001). In the three cases with dysplastic valve, results were rather poor. Procedure was well stood-up and there were no serious complication. We conclude that at the present time valvuloplasty its the elective treatment in pulmonary stenosis in childhood except in cases with dysplastic valve.