Download Cardiac Reconstructions by P. K. Ghosh (auth.), Probal K. Ghosh MD, MS, MCh, FRCSE, PDF

By P. K. Ghosh (auth.), Probal K. Ghosh MD, MS, MCh, FRCSE, Felix Unger (eds.)

Attempts to reconstruct a variety of components of the center began even sooner than the start of open cardiac surgical procedure. by way of the overdue Nineteen Fifties and early 1960 s a number of closed and open tactics had already been defined. In that period, a number of surgeons in Europe and the Americas have been quite brought on to advance numerous ideas of valve re­ building due to the loss of applicable valve prostheses and conduits that have turn into to be had hence. at the moment, numerous congenital lesions nonetheless defied definitive correction, and scientific makes an attempt at left ventricular wall alternative had now not but bought below means. A renaissance in several cardiac reconstructive methods all started initially of the Nineteen Eighties. because the difficulties in terms of valve prostheses grew to become extra in general favored and the significance of chamber volumes and geometry (atrial or ventricular) used to be accorded due significance within the long term follow-up, there has been a resurgence of surgical makes an attempt at reconstruction in congenital and purchased cardiac lesions on the way to approximate the ordinary country. even as numerous features of this reconstructive "discipline" turned obvious. First, cardiac reconstructive surgical procedure has remained a surgical "art" with a progressively expanding variety of cardiac surgeons.

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There was only one hospital death (4%), and two late deaths. Residual mitral regurgitation and/or new mitral stenosis, however, were not uncommon in the survivors, accounting for suboptimal results in this subset of patients. A variety of surgical techniques has been reported in the literature. Early experiences with division of the bridging tissue between the two orifices, as first described by Reeds et al. [10], resulted in massive mitral regurgitation and were disastrous [7-9]. At present, therefore, preservation of the bridging tissue is considered an essential point of the operation.

The degree of mitral regurgitation was estimated as none to mild in three patients, moderate in four, and severe in one. Operative Techniques The technique of repair by using two separate patches for closure of the ASD and of the interventricular communication is based on principles described by McGoon et al. in 1959 [1]. Cardiopulmonary bypass with moderate perfusion hypothermia (24°28°C) and myocardial protection by crystalloid cold cardioplegia was used in all patients. By an ample right atriotomy the configuration of the A V valves and chordae tendineae was carefully assessed.

Pediatr CardioI6:215-217 5. Wakai CS, Edwards JE (1958) Pathologic study of persistent common atrioventricular canal. Am Heart J 56:779-794 6. Studer M, Blackstone EH, Kirklin JW, Pacifico AD, Soto B, Chung GKT, Kirklin JK, Bargeron LM (1982) Determinants of early and late results of repair of atrioventricular septal (canal) defects. J Thorac Cardiovasc Surg 84:523-542 7. Ilbawi MN, Idriss FS, De Leon SY, Riggs TW, Muster AJ, Berry TE, Paul MH (1983) Unusual mitral valve abnormalities complicating surgical repair of endocardial cushion defects.

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