Post-trauma “abrasive” right ventricular rupture without mediastinitis early post-CABG. Is the Robicsek closure technique necessary for all elderly patients?

INTRODUCTION

Right ventricular (RV) rupture with mediastinitis, is a very rare but extremely dangerous (even fatal) complication, following CABG surgery.

PRESENTATION OF CASE

In this paper, we present the case of a post-trauma (after fall) RV rupture (without mediastinitis) in a patient who had undergone cardiac surgery several days ago. The cause of the rupture proved to be a broken bone piece from the lower sternal edge.

DISCUSSION

RV rupture post-operatively caused by broken bone pieces or bone dislocation may occur through two mechanisms: either penetration of the RV, or through the “sandpaper effect”. In order to prevent the rupture, we should be able to recognize patients with aggravating factors (age, weight) and choose intra-operatively a suitable closure technique.

CONCLUSION

We propose that the technique that could prevent such ruptures is the Robicsek technique.     

A completely atraumatic pickup forceps designed to hold vein grafts

A completely atraumatic pickup forceps to hold vein grafts during bypass procedures is described.     

A New Method to Treat Fusiform Aneurysms of the Ascending Aorta Associated with Aortic Valve Disease: An Alternative to Radical Resection

A new method designed to deal with special forms of fusiform aneurysms of the ascending aorta associated with aortic valve disease is presented. The procedure consists of replacing the aortic valve, decreasing the aortic diameter by excision of an oval segment, placing a well-tailored Dacron vascular graft around the ascending aorta, and anchoring it with previously placed sutures driven through the sewing ring of the valve prosthesis through the aortic wall. The technique has been applied in 6 patients with postoperative observation ranging from six weeks to two and a half years. Technically the operation was carried out without difficulty, and all the patients are doing well.     

Patency rate of bifurcated aortic grafts: comparative analysis of woven versus knitted prostheses in the same patient

To investigate the difference in patency rate between woven and knitted aortofemoral or aortoiliac prosthetic grafts, a special vascular prosthesis was manufactured with one limb of the graft knitted and the other, woven. The prosthesis was implanted in 143 consecutive patients with occlusive aortoiliac arteriosclerotic disease or aneurysms. Detailed statistical analysis failed to reveal any difference in the patency rate between the woven and knitted limbs of the grafts during an observation period ranging from one month to two years.     

升主动脉成形人工血管外包裹治疗儿童马方综合征

目的:探讨升主动脉外人工血管包裹术(Robicsek手术)对儿童马方综合征主动脉根部扩张症的诊治及疗效。方法:1996年9月至2001年7月共收治儿童马方综合征9例,其中6例存在主动脉根部扩张症,治疗采用升主动脉外人工血管包裹术。3例在全麻非体外循环下进行升主动脉外包裹手术;3例在体外循环下行升主动脉外包裹手术,其中2例伴有主动脉瓣关闭不全,1例行同种瓣移植,1例行机械瓣置换。结果:1例术后2 d死于急性左心衰竭,5例存活,随访2~5年效果满意。结论:升主动脉外包裹术是治疗儿童马方综合征主动脉根部扩张症的一种较好选择。     

Technical considerations in the surgical management of pectus excavatum and carinatum

During the past 25 years, 650 operations have been performed on 608 patients for anatomically significant pectus excavatum or carinatum deformities of the anterior chest wall. There were no deaths in this series, and serious complications were very rare.We conclude that repair of pectus excavatum and carinatum deformities should include the following operative steps: (1) adequate mobilization of the sternum and correction of its abnormal angulation by transverse osteotomy; (2) adequate bilateral removal of the involved costal cartilage; and (3) securing the corrected position of the sternum with the patient's own living tissue, retaining its blood supply and using it as an internal support.Using these principles, new surgical procedures were developed for the correction of: symmetrical pectus excavatum, asymmetrical pectus excavatum, pectus carinatum with xiphoid angulation, pectus carinatum without xiphoid angulation, asymmetrical pectus carinatum, chondromanubrial prominence with chondrogladiolar depression, and recurrent pectus excavatum.We recommend surgical correction for patients in whom the deformity is significant and no contraindication exists. The ill effects of this condition should not be underestimated.     

An Epitaph for Cavopulmonary Anastomosis

Cavopulmonary anastomosis was developed by several surgical groups working independently and probably unaware of each other. In a most unusual way, the primary discoveries were left unnoticed, the initial trials were not followed up, and the first clinical successes were generally disregarded. After that, however, there was intensive experimental and clinical activity during which the physiology of this new operation was studied intensively and it was applied in a large number of clinical cases. After the development of more radical procedures, the operation gradually fell into disuse. This essay discusses the place of the cavopulmonary shunt in surgical history.     

Ascending-distal abdominal aorta bypass for treatment of hypoplastic aortic arch and atypical coarctation in the adult

Repair of aortic coarctation is usually an easy operation. However, it can be very difficult under certain circumstances. These include operating on an adult or operating when specific anatomical variations, such as hypoplasia of the transverse aortic arch or calcification of the coarctation area, are present. We recommend that in such cases the situation be handled using ascending aorta-lower abdominal aorta bypass grafts rather than conventional resection and anastomosis of the coarctation itself. The cases of 2 patients are presented in whom a hypoplastic aortic arch associated with atypical coarctation was repaired using such a procedure.