Successful closure of ventricular septal defect through a left-sided ventriculotomy in corrected transposition of the great vessels.

Corrected transposition of the great vessels is often associated with other cardiac anomalies. Ventricular septal defect (VSD) is the most common among them. Closure of a VSD is usually performed through a right-sided ventriculotomy. We had previously closed the VSD through the right-sided ventricle in 2 patients with corrected transposition of the great vessels and in 2 others with double-outlet right ventricle with ventricular inversion, which resulted in complete heart block. Recently we have closed the VSD through the left-sided ventricle in 3 patients with corrected transposition, and no block resulted.     

Effect of Gender Differences on Transplant Kidney Function

Background

Transplant kidney function is thought to be affected by sex differences, such as physical conditions including muscle volume, sex hormones, immune responses, and so forth. We examined the effect of sex differences on transplant kidney function.

Loco-check presents a useful tool to determine health-related quality of life in elderly people with lumbar spinal stenosis

BackgroundLocomotive syndrome (LS) is a condition of decreased mobility caused by disorders of the locomotive organs. Lumbar spinal stenosis (LSS) is an LS disorder. The loco-check is a simple questionnaire comprising seven questions that can detect LS. The differences between the health-related quality of life (HRQoL) of elderly persons without LSS and those with LSS remain unclear. The primary aim of this study was to clarify these differences using the European quality of life (EuroQoL) scale. The secondary aim was to clarify the differences between the groups based on loco-check questionnaire responses.MethodsWe recruited patients aged ≥65 years. Our age- and sex-matched case/control cohorts included 28 elderly patients with LSS and 28 without LSS. The study participants were evaluated by the number of “yes” answers on the loco-check, the HRQoL using EuroQoL-5 dimension (EQ-5D) utility values, and the EuroQoL-visual analog scale (EQ-VAS). We compared differences between patients with and without LSS regarding HRQoL using EQ-5D utility values, EQ-VAS scores, the number of “yes” answers on the loco-check, and details of the loco-check.ResultsPatients with LSS had significantly lower EQ-5D utility values (p < 0.01) and more “yes” answers on the loco-check (p < 0.01) than those without LSS. There were no significant differences in EQ-VAS scores between groups (p = 0.09). There were statistically significant differences between groups in all questions except two: You often trip up or slip around the house and You can't make it across the road before the light turns red.ConclusionsElderly patients with LSS had lower EQ-5D utility values and more “yes” answers on the loco-check than elderly persons without LSS. Our results may clarify differentiating features of elderly patients with and without LSS.     

Repair of corrected transposition associated with ventricular septal defect and pulmonary stenosis

Five patients with the diagnosis of classically corrected transposition of the great arteries, ventricular septal defect (VSD), and pulmonary outflow tract obstruction underwent surgical repair. A variant of a previously described technique was used to avoid injury to conduction tissue. Through an incision into the anatomical left ventricle, the VSD patch was sutured inferiorly to the right and away from the edges of the defect and superiorly to the epicardial border of the ventriculotomy. The pulmonary artery was opened, and its proximal end was closed with a suture. A pouch containing the conduction tissue was therefore obtained. Pulmonary ventriculoarterial continuity was reestablished using a valved or nonvalved Dacron or pericardial conduit. The postoperative course of the patients was uneventful. No changes were demonstrated on comparison with preoperative cardiac rhythm. Good hemodynamic performance was noted in 2 patients in whom postoperative catheterization was performed.     

Magnetic resonance imaging analysis of the extensor carpi ulnaris tendon and distal radioulnar joint in triangular fibrocartilage complex tears

Background

We compared the incidence of extensor carpi ulnaris (ECU) tendon and distal radioulnar joint (DRUJ) abnormalities using magnetic resonance imaging (MRI) between patients with triangular fibrocartilage complex (TFCC) tears and subjects without ulnar wrist pain. Additionally, we aimed to identify potential predictors of these MRI lesions.

Results of the Damus-Stansel-Kaye procedure for transposition of the great arteries and for double-outlet right ventricle with subpulmonary ventricular septal defect

From 1975 through 1982, the Damus-Stansel-Kaye procedure was performed on 20 patients with complete transposition of the great arteries (TGA) and on 4 with double-outlet right ventricle (DORV) and subpulmonary ventricular septal defect (VSD). The patients ranged from 6 days to 20 years old (median age, 13 months). Associated anomalies included atrial septal defect (24 patients), VSD (14), and others (25). Thirteen patients had had palliative operations previously. Of the 14 hospital deaths (58%), 13 occurred among the 17 patients with one or more risk factors: age less than 18 months, weight less than 10 kg, and left ventricular peak systolic pressure less than 75% of systemic pressure. Follow-up ranged from 12 to 87 months (mean, 51 months). One patient died of cardiac failure two years postoperatively, and 2 required conduit replacement at 40 and 50 months because of stenosis. All 9 survivors are free from major symptoms. The Damus-Stansel-Kaye repair is most suitable for patients with TGA or DORV with subpulmonary VSD who are older than 18 months, weight more than 10 kg, and have a "prepared left ventricle," and whose coronary artery anatomy precludes transplantation.     

Toward a rational operation for transposition of the great arteries

Current methods for physiological correction of transposition of the great arteries are well established. Continuing morbidity is associated with them, however. The development of hypothermic open-heart surgery and the perfection of microsurgical techniques coupled with our observations of favorable coronary anatomy in many patients with transposition lead us to suggest that the time is ripe for attempts at complete anatomical correction. Our experimental background and several alternatives are suggested.     

A proposed new technique for correction of transposition of the great arteries

A proposed new technique for correction of transposition of the great arteries is presented that restores normal anatomical and physiological continuity of blood flow through the cardiac chambers, valves, and great vessels. Thus, blood from the right ventricle can be shunted through a tube made of Dacron, the pulmonary artery, or the rectus sheath sutured proximally at a level between the aortic root annulus and the coronary ostia and distally into the pulmonary artery bifurcation. A common aortopulmonary trunk serves as the new aorta with blood flowing through it from the anatomical left ventricle and its valves around the interposed graft, thus supplying both the coronary arteries proximally and the aorta distally. Preliminary experiments are discussed.     

Does anatomic resection improve the postoperative outcomes of solitary hepatocellular carcinomas located on the liver surface?

Background

It is unclear whether anatomic resection achieves better outcomes than nonanatomic resection in patients with hepatocellular carcinoma. This study aimed to compare the outcomes of anatomic resection and nonanatomic resection for hepatocellular carcinoma located on the liver surface via one-to-one propensity score-matching analysis.

Management of large aortopulmonary collateral arteries in patients with ventricular septal defect and pulmonary atresia: simultaneous ligation through median sternotomy during intracardiac repair

Nine consecutive patients with ventricular septal defect (VSD) and pulmonary atresia associated with large aortopulmonary collateral arteries underwent primary repair with simultaneous ligation of these collateral arteries. The patients ranged from 1 year to 20 years old (average, 8.0 years). The average number of large aortopulmonary collateral arteries was 1.9 per patient. Arborization abnormality was found in 5 patients. The aortopulmonary collateral arteries were reached solely through a median sternotomy, with dissection of the posterior pericardium or anterior mediastinal pleura before or after the initiation of cardiopulmonary bypass. The immediate postoperative peak pressure ratio between the right and left ventricles was higher in patients with an arborization abnormality, but all ratios ranged from 0.60 to 0.87. There was 1 operative death. Postoperative transcatheter embolization for a residual large aortopulmonary collateral artery was required in 1 patient and pulmonary infarction of mild degree developed with spontaneous recovery in another. These results indicate the usefulness and safety of simultaneous ligation of large aortopulmonary collateral arteries through median sternotomy, even with an associated arborization abnormality.     

Aneurysm of the main pulmonary artery: long-term survival after aneurysmorrhaphy and closure of a ventricular septal defect.

Pulmonary artery aneurysm (PAA) usually carries an ominous prognosis due to the associated pulmonary hypertension. Six years ago a patient with a PAA secondary to cystic medial necrosis and pulmonary hypertension due to a ventricular septal defect (VSD) was treated by aneurysmorrhaphy and closure of the VSD. Although the patient had early postoperative cardiac failure, his cardiopulmonary status stabilized, and he has done well without recurrence of his aneurysm or cardiac failure. This report summarizes the patient's clinical course, operative treatment, and long-term follow-up.     

The atrial baffle operation for transposition of the great arteries. A review of 591 reported cases

A survey of the literature on 591 atrial baffle operations for transposition of the great arteries was undertaken, and it was found that the underlying anatomical type strongly influences the results of operation. The overall mortality when an atrial septal defect was present alone was less than 20%. In the presence of a ventricular septal defect and pulmonary stenosis, the prognosis was less favorable. The most immediate postoperative complication was dysrhythmia, followed by ventilation problems necessitating tracheostomy. Long-term complications occurred in 30% of the patients. These included venous obstruction from the baffle itself, dysrhythmia, and tricuspid insufficiency. The 1-month mortality rate with the atrial baffle operation was 23%; at 5 years it was 38%. The long-term results suggest that a new approach should be considered in the surgical management of transposition. The goal remains direct anatomical repair.     

Surgical correction of pulmonary atresia and ventricular septal defect with large systemic-pulmonary collaterals

A two-stage surgical procedure was performed in a young adult with pulmonary atresia and a ventricular septal defect with upper lobe pulmonary artery flow from confluent central pulmonary arteries and lower lobe pulmonary blood flow originating from two large systemic-pulmonary collaterals. Initially a Dacron Y graft was anastomosed between the ascending aorta and the collaterals and a graft to the left pulmonary artery. At the second operation, continuity was established between the right ventricle and the Y graft by using a valved Dacron conduit and the ventricular septal defect was closed.     

Prefabricated Dacron baffle for use in correction of transposition of the great arteries.

Interatrial venous transposition for correction of transposition of the great arteries (TGA) is facilitated by using a premolded Dacron baffle. Fine-mesh Dacron is easily fashioned to the desired shape in a metallic brass mold at 200 degrees C. The resultant baffle material can be autoclaved without losing its shape or altering the fabric characteristics of flexibility and porosity. This premolded baffle has been used in our last 7 patients with TGA over the past two years without complication, and the use of Dacron in 13 survivors over the past seven years has shown no pulmonary or venous obstructions related to the material.     

Traumatic ventricular septal defect following closed-chest massage: a new approach to closure

A 59-year-old man underwent a quadruple coronary bypass. Nine hours postoperatively, cardiac arrest developed; it was preceded by bradycardia resistant to pacing. Closed-chest massage resulted in a rapid recovery of stable cardiac function followed by the development of cardiogenic shock. A new systolic murmur was appreciated 36 hours following arrest. It was diagnosed at catheterization as a ventricular septal defect that was subsequently found to lie in the posterior ventricular septum, and two operations were necessary to effect closure. The final operation was performed with exposure of the septal defect through the right atrium. Sixteen months after operation, the patient remained well. To our knowledge, this is the first reported instance of a ventricular septal defect occurring secondary to closed-chest massage and also of the closure of a traumatic defect using a right atrial approach.     

Beneficial preparatory aortopulmonary shunt for anatomical repair of transposition of the great arteries with intact ventricular septum

Anatomical repair was successfully performed in an infant with transposition of the great arteries and intact ventricular septum who had previously received a Blalock-Taussig shunt. In this patient, creation of an aortopulmonary anastomosis induced a well-developed left ventricle with concomitant adequately increased pressure and mass. Beneficial aortopulmonary shunt that precedes the anatomical repair in selected patients with simple transposition is discussed.     

Correction of transposition of the great arteries in infants under surface-induced deep hypothermia

Thirty-five infants with transposition of the great arteries underwent primary surgical repair. There were 2 deaths in the 20 infants with uncomplicated transposition of the great arteries and 5 deaths among the 15 infants with complex transposition. Patients with pulmonary vascular disease and an intact ventricular septum present a higher risk, but it is our policy to repair the defect in these patients since normal hemodynamics and full oxygen saturations following correction protect them against cerebrovascular accidents.