Scandinavian journal of thoracic and cardiovascular surgery最新文献

A 12-year-old child with tricuspid atresia and acquired hypoplasia of the left pulmonary artery was successfully treated with unilateral Fontan operation. Angiography at age 2 months had shown a normal left pulmonary artery, and a modified Potts shunt was performed. An emergency central shunt was required a year later. Reinvestigation 5 years after the initial operation revealed severe hypoplasia of the left pulmonary artery.

Of 141 hospital survivors after intracardiac repair of tetralogy of Fallot, eight died suddenly 6-23 years later. Compared with the other 133 patients, these eight were older at operation, with higher post-repair systolic right ventricular pressure and more often complete atrioventricular block; ventricular arrhythmia was diagnosed before death in three cases. In follow-up totalling 2255 patient years, the linearized rate of sudden death was 0.35%/year. The instantaneous risk of sudden death showed continuous increase with the length of follow-up. Of 80 survivors electrocardiographically evaluated 13-26 (median 20) years postoperatively, none had complete block, but 79 had complete right bundle branch block, including seven with left anterior hemiblock. Ventricular extrasystoles were recorded in 1% at rest, in 34% during exercise and in 83% during 24-hour ambulatory monitoring, with Lown Grade > or = II in 27%. Old age and possibly presence of fibrosis and/or fibroelastosis in right ventricular outflow Lown Grade. A patient with Lown grade III died suddenly 2 years after our follow-up. Old age at repair thus was associated with increased risk of late sudden death and with frequent ventricular arrhythmia in long-term survivors.

A consecutive series of 1400 patients who had undergone open-heart surgery was retrospectively reviewed concerning postoperative cerebral dysfunction. The 30-day mortality was 1.6%. Forty-one patients (2.9%) showed signs of cerebral dysfunction, which proved fatal in seven cases. Neurologic symptoms were observed immediately after surgery in 14 patients, suggesting intraoperative damage. In 20 others there was an interval between surgery and the onset of cerebral symptoms, which in 12 cases were preceded by supraventricular tachycardia. Computed tomographic scans were performed on 27 patients and showed recent brain infarction in 22. No bleeding was found. At follow-up 34 of the 41 patients were alive, 21 of them with neurologic sequelae and 13 reporting complete recovery. Nineteen of the 34 survivors experienced no diminution of quality of life. Since half of the cerebral complications occurred postoperatively, more aggressive prevention and management of supraventricular tachyarrhythmia and anticoagulation therapy should be considered.

In a case of thymoma associated with myasthenia gravis, symptoms of relapse appeared 14 years after thymectomy. Tumour tissue from repeat resection showed the same histologic pattern and aneuploidy as in the original specimen. The case illustrates the necessity of wide surgical exposure to permit maximal thymectomy, though recurrence remains possible.

Cardiac echinococcosis is rare and usually occurs in adults. In a 12-year-old boy a left ventricular hydatid cyst was diagnosed by two-dimensional echocardiography and computed tomography and the cyst was surgically removed.

The right gastroepiploic artery, increasingly used as an in situ coronary artery bypass graft, has good long-term patency. This study aimed to assess the accuracy and limitations of magnetic resonance imaging (MRI) and colour Doppler ultrasound (US) in postoperative follow-up of such cases. In eight consecutive patients (6 men, 2 women, mean age 57 years), conventional angiography, MRI and US were performed to evaluate graft patency. Colour Doppler US, performed within a week of the operation, correctly detected flow in three patent grafts. MRI (1.5 tesla) was performed c. 17 months after surgery, using a spine coil and a coronal two-dimensional Flash-type imaging sequence. At angiography six of the eight gastroepiploic artery grafts were patent, and two were occluded. The sensitivity and specificity of MRI were 100%. This accuracy makes MRI a promising method for noninvasive post-operative evaluation of right gastroepiploic artery graft patency.

The success rate of thoracoscopic resection of parenchymal blebs in spontaneous pneumothorax was evaluated after 54 thoracoscopies (cases) in 52 patients. Switch to open thoracotomy was necessitated by interpleural adhesions or large bullae in five cases, while 49 were treated thoracoscopically. The median duration of the operation was 75 (25-240) min, and the postoperative hospital stay was 7 (3-25) days. Early postoperative complications were haemothorax and recurrence of pneumothorax, each in one case, treated with thoracoscopy and chest drain, respectively. Forty-six patients were followed up for a median of 11 (1-32) months. there were two recurrences (at 4 and 6 months). One was successfully treated with thoracoscopy and the other with thoracotomy. Only five patients complained of slight sensitivity in the scar area, caused by weather changes. Thoracoscopic bleb resection is an effective alternative to thoracotomy, with low rates of complications and recurrent pneumothorax.

To determine factors influencing early and late mortality associated with cardiovascular surgery in end-stage renal disease, 48 consecutive patients (mean age 56.3 years) were reviewed: 30 underwent coronary and 18 valvular surgery. There were eight early deaths, three in the former and five in the latter group. Factors significantly related to early mortality in univariate testing included infective valvular disease, emergency vs elective surgery (both p = 0.02) poor left ventricular function and prolonged clamping and bypass times (all p = 0.001). When these factors were included in a stepwise logistic regression analysis, infective valvular disease (p = 0.02), poor left ventricular function (p = 0.01) and long cross-clamping (p = 0.01) were independently associated with early mortality. There were six late deaths. Survival for the whole cohort at 1, 5 and 7 years was 95%, 60.4% and 42.6%, respectively. Related to late mortality at univariate testing were age (p = 0.03), smoking (p = 0.04), diabetes (p = 0.03) and poor left ventricular function (p = 0.02), and stepwise logistic regression analysis showed independent association with age, diabetes and impaired left ventricular function. Mortality associated with cardiac surgery in patients with end-stage nephropathy can be reduced by better patient selection, early operation in patients with infective endocarditis, and minimized cross-clamping and bypass times.

A non-sleeve resection technique was used in 15 patients requiring reconstruction of the main or secondary carina because of malignant invasion. The technique, which can be employed only in cases of partial carina invasion, utilizes healthy bronchial tissue to cover the defect after resection. The operations comprised right pneumonectomy with reconstruction of the main carina (11 cases), left lower lobectomy with reconstruction of the secondary carina (2) and right upper lobectomy (1) and right lower bilobectomy (1), both with reconstruction of the upper lobe carina. There were no intraoperative deaths or major complications, except for one bronchopleural fistula. Six patients died after 20-month to 4-year observation, six are alive (2 with and 4 without malignant disease) after 6 months to 3 years, and three have survived for more than 5 years. These initial results that our "modified sleeve resection technique" is a reliable option when the carina is partially invaded.