Surgical management of pectus deformities.

We analyzed the long-term results in 87 patients who had pectus deformities repaired at Fitzsimons Army Medical Center during the period 1953 to 1975. Seventy-one patients had operations for correction of pectus excavotum; 16 had pectus carinatum deformities repaired. A variety of surgical techniques was used in these patients. Our findings show that in excavatum deformities the best results were obtained by removing all deformed cartilage, mobilizing the sternum, using an anterior osteotomy, and stabilizing the chest with a metal strut (which was removed after one year). For carinatum defects, the Ravitch procedure has produced good results. We are encouraged to be more aggressive in advocating repair of the deformities, not only for cosmetic results but because the patients seem to feel healthier both physically and mentally after repair. For these reasons we advocate operation for pectus deformity as any age.

Congenital aneurysm of the sinus of Valsalva protruding into the left ventricle. Review of diagnosis and treatment of the unruptured aneurysm.

During a routine physical examination, a 34-year-old man, in apparent good health, had an electrocardiogram which revealed left axis deviation. Cardiac evaluation disclosed mild aortic regurgitation and left anterior fascicular block. Nine months later, the patient was admitted to the critical care unit after he had experienced cardiac arrest while jogging. Angiograms demonstrated a large unruptured aneurysm in the right coronary sinus of Valsalva protuding into the left ventricle. Echocardiographic manifestations also suggested also suggested a sinus of Valsalva aneurysm. The defect was repaired through an aortic approach. The aneurysmal sac was emptied and the neck sutured securely. Twenty-two months postoperatively, the patient continues to be asymptomatic. We anticipate that this will decrease the threat of recurrent arrhythmias..

Revascularization of the heart through the coronary veins.

Fifty-six dogs were used in a study to evaluate perfusion of the left anterior descending vein by the internal mammary artery in hearts with normal coronary arteries and those with ligated desending coronary arteries. Perfusion of the myocardium with arterial blood through the cardiac veins offers minimal immediate protection from infarction, as evidenced by light and electron microscopy studies. This protection is of short duration due to intimal fibrosis and luminal stenosis or obstruction of the perfused veins. Nineteen animals in which the coronary vein was perfused and the corresponding coronary artery was not ligated died within sixty hours from the time of operation. Pathological examination revealed patent grafts in all the animals. There was marked congestion of the myocardium with petechial hemorrhages over the surface of the heart. No evidence of myocardial infarction was found.

Pulmonary sequestration. A broad spectrum of bronchopulmonary foregut abnormalities.

We believe the broad clinical, embryological, and radiological spectrum of pulmonary sequestration has not been adequately emphasized. In order to gain clearer understanding of these foregut abnormalities, all cases from the files of three Army Medical Centers were reviewed. Thirty-two patients, the largest single series in the literature, met the criteria for a diagnosis of bronchopulmonary sequestration. Clinical manifestations varied from no symptoms to recurrent pulmonary infection, hemoptysis, and intrapleural hemorrhage. The presence of symptoms strongly correlated (23/32) with air-containing cystic sequestrations. The embryological and radiological spectra as well as appropriate operative therapy are reviewed.

Use of intercostal muscle in primary repair of esophageal atresia with tracheoesophageal fistula.

Forty-one patients with esophageal atresia and distal tracheoesophageal fistula underwent primary repair. Results are compared among patients in whom an intercostal muscle graft was interposed between the trachea and esophagus and those without the graft. Patients with muscle interposition had lower morbidity and mortality and better long-term results.

Bilateral atrial myxomas. Preoperative diagnosis and successful removal.

A case of bilateral atrial myxomas is presented. The diagnosis was made preoperatively with the aid of echocardiography and cineangiography. The use of the echocardiogram in the diagnosis of this lesion is emphasized.