[Incomplete ventricular laceration post mitral valve change. Report of a case and review of the literature]. / Laceración ventricular incompleta post cambio valvular mitral. Reporte de un caso y revisión de la literatura.

There are numerous reports concerning left ventricular rupture after mitral valve replacement, and it has been classified according to location, treatment and prognosis. A somewhat less terrific complication has appeared as modifications have been introduced to the surgical technique, decreasing the frequency of rupture, but otherwise increasing the frequency of incomplete laceration, which has seldom appeared in literature. We review the case of a patient with incomplete left ventricular laceration after mitral valve replacement.

The transseptal approach for mitral valve replacement revisited.

We describe our experience with the transseptal approach for mitral valve replacement, a technique that we applied especially in cases of 3rd and 4th operations wherein numerous adhesions made the usual left atrial approach difficult. We report 39 cases of mitral procedures in which we used 3 slightly different transseptal approaches, depending on the cardiac anatomy and the preferences of the surgeon. There were no complications associated with any of these approaches. Indeed they made the mitral valve procedure easier, because they enabled full exposure of the mitral valvular and subvalvular apparatus. We also propose the transseptal approach as a very safe and reproducible technique for use in patients with friable tissues, heavily calcified mitral valves, or small left atria- and in patients who must undergo combined tricuspid and mitral procedures. In this series, there were no conduction abnormalities secondary to the approach, nor were there any procedure-related deaths.

[Submammary skin incision for longitudinal medial sternotomy]. / Incisión submamaria para esternotomía media longitudinal.

The submammary incision has been postulated as an alternative in median sternotomy approach since 1960. We used this incision in 32 females patients from 1 to 24 years. The diagnoses were atrial septal defects (ASD) 23 patients, ventricular septal defect (VSD) 2 patients, double outlet right ventricle 1 patient, supravalvular aortic stenosis 1 patient, ASD with VSD 3 patients and partial anomalous pulmonary venous connection 1 patient. Nine patients had a complication: cheloid scar 1 patient, seroma 2 patients, wound dehiscence 3 patients, and diminution of sensitivity 3 patients. We conclude, that this type of surgical approach is an excellent alternative for women with good aesthetic and psychological results. Their complications are easy to correct.

[Effects of polydioxanone and silk on normal cicatrisation of surgically injured myocardial tissue. An experimental model]. / Effecto de la polidioxanona y la seda en el proceso de cicatrización normal del tejido miocárdico lesionado quirúrgicamente. modelo experimental.

The wound healing is the principal process of tissue repair. In the heart this phenomenon is done under special circumstances, because of the constant movement of this organ. An experimental study was done in 15 dogs. By left anterolateral thoracotomy the free left ventricular wall was incised. This incision was done 1 cm long and 3 mm deep and afterwards it was repaired with silk (Group I) and with polydioxanone (Group II). The wound was allowed to heal during 5 weeks, then the scar area was analyzed by light microscope with Masson and HE technics. The results showed the presence of lymphocytes in the scar tissue of group II (p = 0.04).

[Aorto-septal approach (modified Konno procedure). Surgical alternative in the management of diffuse aortic subvalvular stenosis]. / Abordaje aorta-septal (Konno modificado). Alternativa quirúrgica en el manejo de la estenosis subvalvular aórtica difusa.

The surgical treatment of diffuse subaortic stenosis by insertion of a left ventricular apico-aortic valved conduct and Konno-Rastan procedures often fails to provide satisfactory results. These procedures require the insertion of a prosthetic valve. Some patients with diffuse subaortic stenosis have a normal aortic orifice and the replacement of normal aortic valve is questionable. Since 1984 Vouhé' modification of the Konno' procedure was using this described with adequate relief of the diffuse subaortic stenosis preserving the aortic valve. We present our experience with 5 patients in 10 years was using this surgical alternative.

[Myotomy-myomectomy as treatment of localized hypertrophic cardiomyopathy]. / Miotomía-miectomía como tratamiento de la miocardiopatía hipertrófica localizada.

We report the surgical treatment of 23 patients with local hypertrophic cardiomyopathy (LHM). Fifteen patients, group I (65.3%), with LHM were treated by myotomy-myectomy alone. Eight patients, group II (34.7%), with LHM and other cardiac disease, was treated by myotomy-myectomy and complementary procedure (mitral or aortic replacement, correction of congenital malformation). This group II had the major morbidity and mortality. Five years follow up had a 76.14% survival.