Possibilities for fertility restoration: a new surgical technique

Previously published work concluded that uterine artery microvascular anastomosis in the porcine model was feasible with subsequent normal vascular function in pregnancy. of the anastomosed vessels. The objective of this study was to assess the feasibility of uterine autotransplantation in a porcine model using microvascular anastomoses. Eight large white/landrace sows of proven fertility were used. A supracervical hysterectomy with or without bilateral salpingo-oophorectomy (BSO) was performed. After 1 hour of cold storage in a transplant solution, the specimen was reintroduced and followed by stepwise vascular reanastomosis. Objective perfusion index measurements suggested adequate uterine perfusion after transplantation. Postoperatively, sow 1 survived to 3 months with no signs of oestrus, and sows 2, 6, and 8 were killed on days 6, 33, and 54, respectively, for pelvic infection. Histopathology of the uterine grafts revealed gradual vessel thromboses. Microvascular reanastomosis is feasible, however, unsuccessful in uterine autotransplantation because of gradual vessel thromboses. The porcine model is highly susceptible to postoperative infection.     

Reshaping the remodelled left ventricle: a new concept.

OBJECTIVE: Based on the law of Laplace, transventricular tension members were designed to diminish wall stress by changing the left ventricle (LV) globular shape to a bilobular one, thus reducing the ventricular wall radius of curvature. This concept was tested in a model of congestive heart failure. METHODS: Seven calves were used for the study (74.3+/-4.2 kg). Treatment efficacy was assessed with sonomicrometric wall motion analysis coupled with intraventricular pressure measurement. Preload increase was applied stepwise with tension members in released and tightened position. RESULTS: Tightening of the tension members improved systolic function for CVP>10 mmHg (dP/dt: 828+/-122 vs. 895+/-112 mmHg/s, P=0.019, for baseline and 20% stress level reduction respectively; wall thickening: 11.6+/-1.5 vs. 13.3+/-1.7%, P<0.001) and diastolic function (LV end-diastolic pressure: 15.9+/-4.8 vs. 13.6+/-2.7 mmHg, P<0.001, for CVP>10 mmHg; peak rate of wall thinning: -12.2+/-2.2 vs. -14+/-2.3 cm(2)/s, P<0.001 and logistic time constant of isovolumic relaxation: 48.4 +/-10.9 vs. 39.8+/-9.6ms, P<0.001, for CVP>5 mmHg). CONCLUSIONS: This less aggressive LV reduction method significantly improves contractility and relaxation parameters in this model of congestive heart failure.     

Diverticulum of the left ventricle: etiology and surgical treatment

Congenital left ventricular (LV) diverticula are rare findings, particularly when first diagnosed in adulthood. We describe successful surgical repair of an isolated congenital apical LV diverticulum associated with an abnormal submitral apparatus in a young adult who received his diagnosis following a peripheral embolism. We intraoperatively identified an abnormally originating belly of the posteromedial papillary muscle, which arose from the interventricular septum, causing partition of the LV cavity and forming an apical aneurysmal communicating chamber. This anatomy of abnormal papillary muscle bifurcation was possibly the mechanism for the development of the apical diverticulum and to the best of our knowledge has not previously been described. Reattachment of the abnormal belly to its normal position preserved mitral valve competence, and an endoventricular patch repair restored LV volume and geometry.     

A case report of successful surgical removal of a lipoma in the left ventricle

A 63-year-old man with anterior chest oppression was diagnosed as an acute myocardial infarction. The two-dimensional echocardiogram revealed a mass which bulged into the left ventricular cavity. Subsequently, the computed tomographic findings of the mass lesion demonstrated the attenuation values of -49 Hounsfield units, which corresponded to that of fatty tissues. From these findings the left ventricular lipoma was highly suspected. The tumor existed at the base of the anterior papillary muscle. It was successfully resected and mitral valve replacement was performed concomitantly. The tumor was yellowish and sized by 25 X 20 mm. On histological examination of the specimen, the tumor was composed of mature fatty cells. CT scanning was very useful for the preoperative evaluation of lipoma.     

Delayed rupture of the left ventricle inferior wall: a diagnostic and surgical challenge

Abstract   An acute rupture after an acute myocardial infarction with an unusually delayed presentation is described. The etiology, factors contributing to the delayed presentation, diagnosis, and management are discussed.     

Preoperative modeling of an optimal left ventricle volume for surgical treatment of ventricular aneurysms.

OBJECTIVE: We evaluated the results of surgical treatment postinfarction ventricular aneurysms, with preoperative modeling of an optimal left ventricle volume. METHODS: From January 1998 to December 2000, 41 patients underwent left ventricular (LV) aneurysm repair. There were 39 men and two women, with a mean age 45.6+/-6.2 years. With echocardiography study, an optimal end-diastolic volume of LV was modeled on the basis of the proper stroke index and the contractile ejection fraction (EF). A permissible area of aneurysm resection was calculated by using a difference between the initial and the projected surface area of LV. The patch position and sizes were measured preoperatively. Ventricular reconstruction was performed by using linear plasty in eight patients, septal plasty of the Stoney et al. technique in 14 patients, and endoventriculoplasty of the Dor et al. technique in 19 patients. RESULTS: The mean NYHA functional class decreased from 2.9+/-0.6 to 1.6+/-0.7 postoperatively. The improvement of LV contracting function made itself evident in a decreased end-diastolic volume from 216+/-98 to 158+/-35 ml, and end-systolic volume from 133+/-85 to 80+/-34 ml postoperatively. The mean EF increased from 38+/-11 to 49+/-9% after operation. We noted that preoperative contractile EF corresponded with postoperative EF (49.8+/-11% and 49.3+/-9%, respectively). The projected optimal end-diastolic volume of LV estimated before operation agreed with postoperative data (152+/-33 ml and 158+/-35 ml, respectively). The hospital mortality rate was 7.3%. CONCLUSIONS: Preoperative modeling of an optimal LV volume allows for the estimation of a permissible area of aneurysm resection, the position and sizes of the patch, as well as for the prevention of an excessive reduction of the LV cavity after aneurysm repair.     

Endocardectomy for the surgical treatment of endocardial fibrosis of the left ventricle.

Two patients with endomyocardial fibrosis of the left ventricle were treated by endocardectomy plus mitral valve replacement. In both cases the results of surgery were satisfactory. No consequences related to eosinophilia, which was present before operation in one of them, were noted. The poor prognosis of this progressive disease and the inefficiency of medical treatment compared with the good surgical results already reported from various centres encourage early operation for all patients with endomyocardial fibrosis who have symptoms. Because of the pathophysiology of the disease, endocardectomy should be attempted in all cases and anti-coagulant treatment continued for life.     

Complete surgical repair of aortic atresia with a normal left ventricle

Aortic atresia with a normal left ventricle and normal mitral valve is an uncommon congenital lesion. We present two such cases and describe two different approaches of achieving biventricular surgical repair.     

Portoenterostomy: an old treatment for a new disease

HYPOTHESIS: Portoenterostomy may be an effective treatment for patients sustaining a thermal injury to the hepatic duct confluence during laparoscopic cholecystectomy. DESIGN: Case series. SETTING: A tertiary care referral hospital. PATIENTS: A consecutive series of 5 female patients referred and treated between November 13, 1991, and December 17, 1998. Ages ranged from 29 to 65 years. In addition to the ductal injuries at or above the hepatic duct confluence, 3 patients also had a major hepatic vascular injury. The patients were available for follow-up for 7 to 91 months postoperatively. INTERVENTIONS: All patients underwent a portoenterostomy (Kasai procedure) with suturing of a Roux limb to the hepatic tissue surrounding the transected hepatic ducts. Transhepatic stents were inserted either preoperatively or postoperatively for rising liver enzyme levels in 4 patients. MAIN OUTCOME MEASURES: Symptoms and results of liver function tests. RESULTS: Stents remained in place for 9 to 25 months in 4 patients. All 5 patients were symptom free and functioning normally; 3 had normal liver functions; 2 had mildly elevated alkaline phosphatase levels only. CONCLUSION: Portoenterostomy, usually in combination with postoperative stenting, may be an option to consider in life-threatening injuries involving the hepatic duct bifurcation in which standard biliary reconstruction techniques are not feasible.