Surgical closure of atrial septal defect in patients older than 30 years: risk factors for late death from arrhythmia or heart failure.

BACKGROUND: Little is known about prognostic markers for late cardiac-related death after surgical atrial septal defect (ASD) closure in adults. METHODS: Long-term follow-up data of 281 patients who underwent surgical secundum ASD closure when they were older than 30 years, were retrospectively examined. RESULTS: Mean age at surgery was 43.8 +/- 10.0 years (30 to 76 years). There were 2 early deaths. Mean follow-up was 14.1 +/- 8.4 years (0.4 to 28.9 years). Death from arrhythmia or heart failure occurred in 9 patients (3.6 %) at a mean time of 8.5 +/- 6.6 years after the operation. Patients > 43 years exhibited significantly higher pulmonary artery pressures. Preoperative systolic pulmonary artery pressure > 36 mmHg, and mean pulmonary artery pressure > 21 mmHg were predictive of late death from arrhythmia or heart failure. However, age at operation was not. CONCLUSIONS: Older age at the time of ASD closure is not a risk factor for late death from arrhythmia or heart failure in adults. However, older patients presented more often with pulmonary hypertension. Since elevated pulmonary artery pressure is predictive of late death from arrhythmia or heart failure, timely ASD closure is warranted.

Timing of repair in ventricular septal defect with aortic insufficiency.

OBJECTIVE: Trusler's valvuloplasty technique and its modifications are the standard approach for the repair of aortic insufficiency in combination with ventricular septal defect. However, recurrent aortic insufficiency may occur after repair. The timing of surgical intervention in patients with ventricular septal defect and aortic insufficiency is still controversial. METHODS: Between 1985 and 2000, 33 patients were analyzed retrospectively focusing on echocardiographic findings. For statistical analysis, the patients were divided into two groups according to the grade of preoperative aortic insufficiency: there were 5 patients with preoperative severe aortic insufficiency and 28 patients with mild to moderate aortic insufficiency. RESULTS: The mean age at operation was 6.05 +/- 3.61 years. The aortic valve was repaired by means of Trusler's valvuloplasty in the majority of the patients. All but three had patch closure of the ventricular septal defect, with a transaortic approach in 54 %. Mean follow-up was 5.1 years with a maximum of 16.9 years (168.9 patient years). Rates for freedom from reoperation at 1, 3, and 8 years were 90 %, 85 %, and 75 %, respectively. In 3 patients, a mechanical prosthesis was implanted at the time of reoperation. One sudden death occurred after 3.6 years. Patients with preoperative severe aortic insufficiency were reoperated significantly more often (P < 0.03). In patients with preoperative severe aortic insufficiency, the underlying pathology (insufficiency) was detected earlier on in life (8.4 +/- 10 months) than in patients (45.0 +/- 30 months) with mild to moderate aortic insufficiency at the time of intervention (P < 0.05). CONCLUSION: Severe aortic insufficiency at the time of operation has less favorable long-term results. Therefore, early surgical intervention, even in young patients, seems warranted to avoid potential reoperation or valve replacement.

Surgical removal of a rhabdomyoma in a neonate as rescue therapy.

Primary cardiac and mediastinal tumors are rare at all ages. We report on a rescue therapy in a neonate due to a severely obstructed left ventricular outflow tract.

Temporary pulmonary vein stenosis during intraoperative transesophageal echocardiography in total cavopulmonary connection.

Two patients operated on by one of the authors (MK) developed hemodynamic instability after otherwise uneventful completion of total cavopulmonary anastomosis with an extracardiac tube. In both, a stenosis of the right pulmonary veins was demonstrated during routine intraoperative transesophageal echocardiography. The transesophageal probe was found to be the underlying problem. Apparently, the pulmonary veins became compressed between the probe and the extracardiac conduit.

Improved patient survival following surgery for coarctation of the aorta.

BACKGROUND: We conducted a retrospective review of children undergoing surgery for coarctation of the aorta in our institution over the last ten years with the aim of evaluating overall patient survival as well as detecting factors affecting it. We tried to identify the risk factors for mortality. METHODS AND DATA: Between January 1992 and December 2001, 201 patients with aortic coarctation were operated on at the Department of Cardiac Surgery of the Children's University Hospital, Bratislava. The three classes of aortic coarctation were represented: isolated coarctation, coarctation with ventricular septal defect (VSD) and coarctation with complex cardiac anomalies. Patients' preoperative, operative and immediate postoperative medical records were carefully studied with special attention paid to the type of lesion, patients' preoperative state, type of surgical technique employed, as well as the period of operation. For comparison, two equal time periods of follow-up were reviewed--1992 to 1996 and 1997 to 2001. The overall postoperative conditions of patients were also regularly monitored. Patient data were statistically analyzed using the JMP program version 4.04. RESULTS: An overall survival of 90% was recorded over the period of follow-up, ranging between one and ten years. A further break down showed a statistically significant difference between the various types of aortic coarctation, p=0.0001. Patients with simple or isolated coarctation had a survival rate of 100%, those with ventricular septal defect (VSD) in addition to coarctation had a survival rate of 80% while patients with associated complex cardiac anomalies had a survival rate of 65%. An improvement on overall patient survival was recorded in the period between 1997 and 2001--96% as against 86% for the period between 1992 and 1996. On univariate statistical analysis, the following variables were identified as significant risk factors for death: 1) Complex cardiac anomalies (p<0.0001), 2) Age at operation less than one month (p<0.0001) and 3) Treatment prior to the year 1997 (p=0.02). CONCLUSION: A considerable improvement on patient survival following surgery for coarctation of the aorta was recorded over the last five years. This could be attributed to new measures in preoperative, operative and postoperative care for patients with aortic coarctation. (Tab. 4, Fig. 5, Ref. 8.).

Extended resection of a chest wall desmoid tumour with concomitant coronary artery bypass grafting.

We report on the resection of a large desmoid tumour of the anterior chest wall in a 65-year-old male patient. The patient had a coronary artery bypass operation 2 years prior to the first detection of a tumour. Because the left internal mammary artery bypass to the left anterior descending coronary artery (LAD) was embedded in the tumour mass, it had to be resected together with the tumour. A saphenous vein aorto-coronary bypass to the LAD with an off-pump technique was then performed, and the chest was reconstructed with polypropylene mesh and a latissimus dorsi musculocutaneous flap.

Surgical treatment of transposition of the great arteries.

BACKGROUND: With regard to risk of the failure of systemic right ventricle after physiological correction of transposition of great arteries, anatomic repair is a current method of choice. OBJECTIVE OF STUDY: Analysis of results of surgical correction of transposition of great arteries performed between 1992 and October 1998. METHOD: A total of 111 patients were operated on for transposition of the great arteries. In the 1st group of patients (n = 21, mean age was 135 +/- 55 days), physiological correction according to Senning was performed. Patients of the 2nd group (n = 90, mean age was 15.4 +/- 21.6 days) underwent anatomic repair. RESULTS: Early mortality was 6% (7 patients). Mean follow-up is 2.95 years (1.9 SD) ranging from 0.2 years to 6.1 years. Actuarial 1-month survival in the whole cohort (n = 111) is 94%, and it remains unchanged at 1, 2, 3, 4, 5, and 6 years of follow-up. Patients, who underwent surgery after 1997, show significantly better survival compared to those operated before 1997 (p = 0.0997). Thus, a date of operation (before 1997) is the only significant risk factor for death. Survival in patients operated after 1997 (n = 40) is 98%. All patients belonging to the 2nd group are in functional group NYHA 1. CONCLUSION: Anatomic repair of transposition of the great arteries is a method of choice for treatment of this congenital heart defect. Left ventricle becomes systemic ventricle, which is essential in view of long-term performance. Psychomotor development of children, who underwent ASO, is comparable with that of healthy population. (Tab. 3, Fig. 3, Ref. 18.)

[Surgical treatment of total anomalous pulmonary venous return]. / Chirurgická liecba totálneho anomálneho pl'úcneho venózneho návratu.

BACKGROUND: Total abnormal pulmonary venous return (TAPVR), mainly the obstructive type represents the most riskful critical congenital heart defect requiring urgent surgery immediately after birth. THE AIM OF THE STUDY: Analysis of surgical correction of TAPVR results performed from December 1992 to December 1998. METHODS: Twenty-seven patients underwent surgery for TAPVR. 13 of them (48%) presented with hemodynamically severe obstruction. Mean age in the group with obstruction was 3.6 +/- 3.2 days with mean weight of 3282 +/- 537 grams. RESULTS: From the 27 studied patients 5 (18.5%) died. Mean duration of the study in the whole group is 1.91 +/- 2.01 years. Actuarial survival in the first month is 85%, in the second month 81% and remains identical in the 1., 2., 3., 4., 5., 6. year of the study. Univariate analysis identified operation before the year 1996 (p = 0.0056) as a risk factor of immediate mortality. Introduction of ultrafiltration significantly eliminated mortality (p = 0.0101). Remaining variables (age, weight, sex, obstructive TAPVR, TAPVR, extracorporeal circulation duration, pulmonary hypertension) did not significantly influence the survival (p more than 0.05). Multivariate analysis defined operation before the year 1996 as the sole risk factor of mortality (p = 0.0033). In patients operated on in the year 1996 (n = 15) was the survival in the studied period 100%. CONCLUSION: Since the year 1996 the results of surgical treatment of TAPVR significantly improved. The key role in the improvement have better urgent diagnostic and surgery, improvement of surgical technique and myocardial protection, introduction of modified ultrafiltration and the quality of postoperative care. Psychomotor development of children after correction is comparable with healthy population, all patients are in NYHA I class. (Tab. 2, Fig. 4, Ref. 9.)

[Surgical treatment of hyperparathyroidism]. / Chirurgická liecba hyperparatyreoidizmu.

The authors present their experience with the diagnosis and treatment of hyperparathyroidism in a group of eight patients operated between June 1993 and November 1993 at the Surgical Clinic of Dérer's Hospital in Bratislava-Kramáre. They summarize the findings on the disease from the literature and compare them with their own clinical observations, which confirm the indication of surgical revision as a useful localizing method, and the necessity of perioperative histological diagnosis to determine the extent of surgery.

[Comparison of the hemodynamic properties of a reversed and an in situ bypass in an experiment]. / Porovnanie hemodynamických vlastností obráteného a in situ bypassu v experimente.

The authors compared under standard experimental conditions the flow through a reversed venous segment and a non-reversed segment after destruction of the valves by means of a valvulotome. They did not confirm the theoretical assumptions of more favourable haemodynamic properties of a venous bypass in situ.

[Duplex ultrasonic examination of arteries of the lower extremities--comparison with angiography]. / Duplexné ultrazvukové vysetrovanie artérií dolných koncatín--porovnanie s angiografiou.

The authors compared the results of duplex ultrasonic examination of 86 sections of the ileo-femoro-popliteal portion of the arterial circulation with angiographic findings. The correlation between angiographically and ultrasonically assessed degrees of stenosis was close and highly significant (r = 0.895, p = 0.001, y = 0.782x + 17.382). The sensitivity of duplex sonography when assessing significant stenoses (60% of the arterial lumen or more) was 100%, the specificity 76.5%, the probable positive value 75%, the probable negative value 100%, the probable positive ratio 3, the reliability of the test 86%. With regard to these results the authors recommend to make a non-invasive duplex ultrasonic examination of the arteries of the lower extremities in all echocardiographic laboratories and to include it in the algorithm of angiological examinations before angiography.