Correction of truncus arteriosus with autologous arterial flap in neonates and small infants.

BACKGROUND: This study describes the results of techniques using the autologous truncal wall and part of the pulmonary artery for correction in anticipation of the growth of the pulmonary tract in patients with truncus arteriosus. METHODS: Seven consecutive patients with truncus arteriosus were reviewed. The posterior wall of the pulmonary tract was obtained by anastomosing the lower edge of the truncal arteriotomy to the upper corner of the ventriculotomy from the truncus in types I and II. Anterior translocation of the pulmonary artery was performed in a type III. A pericardial patch with or without a monocusp was placed to complete the right ventricular outflow tract. RESULTS: There were two hospital deaths, one of which was unrelated to a cardiac problem. Postoperative right-to-left ventricular peak pressure ratio was less than 0.55. There was one left pulmonary stenosis due to monocusp adherence in the late postoperative period. The sizes of the pulmonary tract at anastomosis were between 107% and 166% of the normal value between 7 months and 3.8 years of follow-up. CONCLUSIONS: The use of autologous arterial wall instead of a conduit is recommended for the repair of truncus arteriosus to expect growth of the pulmonary tract.

Anterior pulmonary translocation without conduit for the repair of truncus arteriosus.

A technique with autologous tissue for the correction of type III truncus arteriosus is described. The truncal root was excised as a cylinder that incorporated pulmonary arteries and that was translocated anterior to the ascending aorta. The proximal section of the cylinder was closed and the pulmonary tract was reconstructed with anastomosis of a widely opened distal section to the right ventricle. Autologous pericardium was sutured to the entire surface of the pulmonary tract.

[Two cases of left atrial myxoma originating from mitral annulus].

We experienced two cases of left atrial myxoma originating from mitral annulus. Mitral valve replacement and mitral valvulo-annuloplasty were performed in each case, because of the presence of mitral leaflet defect due to removal of the myxoma. Two dimensional echocardiography was a useful method to confirm the location and decide the surgical approach.

[Mitral valve replacement through a right thoracotomy, with intact coronary artery bypass grafts].

A 68-year-old male who had previously undergone aorto-coronary artery bypass grafting was admitted for mitral valve surgery. Because of the presence of anteriorly placed intact coronary artery bypass grafts, we used right thoracotomy to replace the mitral valve. Cardiopulmonary bypass was established after cannulation of the femoral artery and bicaval cannulation, and continuous retorograde cardioplegia with cold blood was infused. Residual air was evacuated through left ventricular vent catheter and aortic air vent hole. Post operative course was uneventful.

[Early omental transposition for postoperative sterno-mediastinitis].

We report 3 successful cases of postoperative sterno-mediastinitis treated with single-stage procedure. 2 of them were infected with MRSA (Methicillin resistant staphylococcus aureus), and the other was with klebsiella pneumoniae. Neither open drainage nor irrigation were performed previously, but only administrations of sensitive antibiotics. Intensive debridement, irrigation and omental transposition were performed at one time, between 6 and 15 days from the diagnosis. It could achieve decrease of hospitalization. We recommend early single-stage procedure with omental transposition for postoperative sterno-mediastinitis before extension and aggravation of the infection.

[Surgical treatments of nonconfluent pulmonary arteries with congenital cardiac defects].

Pulmonary artery angioplasty or reconstruction was performed in seven patients with nonconfluent pulmonary arteries and congenital cardiac defects. Age of these patients were ranged from 6 months to 41 years old. Five of them had pulmonary truncal atresia and complex cardiac anomalies. Two of these five patients demonstrated nonconfluent pulmonary arteries due to deformities at ductal insertion of pulmonary arteries. Three patients had had previous systemic to pulmonary artery shunt operations which caused pulmonary artery distortions. Other two patients had intrapulmonary arterial obstructions due to pulmonary artery thrombosis. Patch pulmonary artery plasty was carried out in three patients, dilatation of severe stenotic pulmonary artery was done in one patient simultaneously with pulmonary valvotomy. Central shunt operation was added in one patient with the pulmonary artery which was unable to be reconstructed. Last two patients underwent intrapulmonary artery reconstruction with the rolled pericardial graft. Hospital death occurred in one patient with unproperly increased pulmonary blood flow by central shunt. Average follow-up period of these six survivors after operation was 1.4 +/- 0.8 years. As definite repairs, two patients had Fontan operation, two patients had right ventricle to pulmonary artery reconstruction. And remaining two patients are still to be followed until sufficient growth of pulmonary artery suitable for Fontan operation.