Successful Surgical Correction Research Articles

RAPID PROTOTYPING

Surgeons frequently must perform delicate surgery without the benefit of a firsthand look at what they will be operating on. Fracture orientation can be difficult to conceptualize, especially in the acetabulum or spine. Anatomic reduction and stable fixation remain a challenge and have required long incisions with wide exposure, sometimes with increased postoperative morbidity1-9. The inadvertent penetration of screws into the hip joint, during the treatment of both complex acetabular fractures and posterior wall pelvic fractures, has been well documented10,11. Successful surgical correction of deformities of the hip joint before the onset of osteoarthritis requires accurate characterization of the anatomic deviations from normal as the first step in the planning of a corrective osteotomy. Pedicle screws inserted with a standard surgical technique have sometimes penetrated the wall or even missed the pedicle12-20. Diagnostic techniques such as radiography, computed tomography, and magnetic resonance imaging provide only two-dimensional images of fractures and may not depict subtle fractures. Advances in radiology combined with advances in computer technology have made the three-dimensional representation of anatomic structures in living subjects easily obtainable. With use of modern rapid prototyping techniques, computers can now accurately reproduce three-dimensional models of actual osseous anatomy, which can be invaluable for understanding the characteristics of the fracture, for preoperative contouring of plates, and for selection of screw trajectories. The surgical precision that is possible with use of computer image guidance for placement of screws or pins about the hip joint for the treatment of complex acetabular fractures and for insertion of pedicle screws is impressive1,2,21-27. However, this technology is not yet commonly used by surgeons because of its apparent complexity. Easy fabrication of accurate three-dimensional models of the osseous anatomy, easy …

Long-Term Followup Of 158 Young Adults Surgically Treated For Vesicoureteral Reflux In Childhood: The Ongoing Risk Of Urinary Tract Infections

We recorded urinary tract infections in the long term after surgical reflux correction. A total of 158 of 189 patients (160 females and 29 males) who were followed in 1985, an average of 10.8 years after reflux surgery were contacted again in 1995. At that time median patient age was 26 years (range 15.7 to 38.8) and the average period of observation was 20.3 years (range 13.4 to 26). In 82% of the patients febrile and in 18% afebrile symptomatic urinary tract infections had developed preoperatively. In the first 10-year period after operation 46% of patients continued to have symptomatic urinary tract infections compared with 52% in the second 10-year interval. In the 2 periods the incidence of febrile urinary tract infection was about 17%. In the whole postoperative observation period symptomatic urinary tract infections developed in 66% of all patients, including 74% of female patients. Symptomatic urinary tract infections were observed during 8 of 46 pregnancies (17%). After successful surgical reflux correction susceptibility to urinary tract infection continues for a number of years in many girls and women. However, postoperatively urinary tract infections are primarily afebrile.

Long-term follow-up of surgically corrected patients with common arterial trunk

The first successful surgical correction of truncus arteriosus (common arterial trunk) was performed in 1967 and long-term follow-up is now available on 137 operative survivors. Actuarial survival was 46.4% at 24 years. Late survival was statistically significantly improved in patients having correction during the first 2 years of life when compared to those corrected after the age of 2. Late mortality was secondary to reoperation, most commonly for truncal valve replacement, progressive pulmonary vascular obstructive disease and right ventricular failure, or progressive left ventricular deterioration and failure. Reoperation for isolated conduit replacement was associated with low mortality (one death in 54 reoperations) and morbidity. Reoperation for truncal valve replacement was frequently necessary in patients showing significant truncal incompetence immediately after operative correction, but had not been observed in any patients showing no or minimal incompetence at the time of initial hospital discharge. Of the 86 presently surviving patients, many of whom are now adults, 78 (91%) were NYHA Class I or II, capable of full-time school or employment, at the time of most recent follow-up. Operative correction of truncus arteriosus is now possible at low mortality during the first few months of life, and this is the approach now utilized in all centers to relieve the large left ventricular volume load and its detrimental effects on left ventricular function as soon as possible, as well as to minimize the risk of irreversible pulmonary vascular obstructive disease. With this present approach, late mortality and morbidity could be expected to be significantly less in infants operated today than the late results seen in our unique group of patients corrected, for the most part, at older ages, many even as adolescents or young adults. An infant born with truncus arteriosus today has an excellent chance of survival with good quality of life well into adulthood years.

高齢者不完全型心内膜床欠損症に対する開心根治術

高齢者不完全型心内膜床欠損症に対する開心根治術

Vesicoureteral reflux and evidence-based management

Vesicoureteral reflux and evidence-based management

The fate of the unligated vertical vein after surgical correction of total anomalous pulmonary venous connection in early infancy

The Journal of Thoracic and Cardiovascular Surgery • Volume 122, Number 3 615 T he vertical vein, when present, is usually ligated or divided during surgical correction of total anomalous pulmonary venous connection (TAPVC).1 However, some recent work has suggested that ligation of the vertical vein is not a mandatory component of successful surgical correction of this anomaly. In selected cases, nonligation of the vertical vein may be an advantage and the unligated vein could be expected to close off.2 We investigated the fate of the vertical vein in 4 consecutive patients in whom it was left unligated for various reasons.

Successful surgical treatment of spontaneous coronary artery dissection

To present a case of spontaneous coronary artery dissection (SCAD). Spontaneous coronary artery dissection is rare and often difficult to surgically repair. Additionally, diagnosis by coronary angiography is uncommon. We present a case of SCAD in a postpartum woman who underwent successful surgical correction of the left anterior descending artery. Such surgical intervention in cases similar to ours is critical for survival.

Multiple Ectopic Parathyroid Glands

Parathyroid surgery to correct primary hyperparathyroidism is successful in 80 to 97 per cent of initial explorations. Failures are often linked to inability to locate ectopic parathyroid glands. Although ectopic parathyroid glands are relatively common (15%) multiple ectopic glands are rarely reported. We describe a case of multiple ectopic parathyroid glands and the intraoperative approach to their localization and review the anatomy and embryology of ectopic parathyroid glands. A 39-year-old woman presented with fatigue, lethargy, and depression. On biochemical evaluation she was noted to be hypercalcemic and hyperparathyroid. Preoperative parathyroid localization failed to identify abnormal parathyroid glands. At exploration three of four parathyroid glands, including an adenoma, were located in ectopic positions by a meticulous and systematic dissection. A careful exploration coupled with a thorough knowledge of parathyroid anatomy and embryology will produce successful surgical correction of primary hyperparathyroidism in greater than 95 per cent of patients even in the few patients with multiple ectopic parathyroid glands.

Surgical management of intrathoracic tracheal avulsion in cats: long-term results in 9 consecutive cases.

To evaluate the outcomes and complications in a consecutive series of cats undergoing surgical repair of intrathoracic tracheal avulsion injuries. Retrospective clinical study. Nine client-owned cats. The medical records of all cats undergoing surgical repair of intrathoracic tracheal avulsion injuries from 1994 to 1997 were reviewed. The results of physical examination, laboratory evaluations, radiography, tracheoscopy, surgery, and patient follow-up were reviewed. Complications that arose and long-term outcome were noted. Long-term resolution of clinical signs was achieved in all cats after resection of the damaged trachea and its repair by end-to-end anastomosis. Follow-up periods ranged from 12 months to 2.9 years. One cat developed unilateral left-sided laryngeal paralysis 2 to 3 months after surgery; however, this was transient and resolved without intervention within 6 months of surgery. Surgical management of intrathoracic tracheal avulsion injuries in cats can be accomplished via a right lateral thoracotomy. Careful anesthetic technique is an integral part of the surgical procedure if a successful outcome is to be achieved. The incidence of both short-term and long-term complications was low. Care should be exercised to visualize and protect the left recurrent laryngeal nerve if postoperative iatrogenic unilateral left-sided laryngeal paralysis is to be prevented. This retrospective study documents the successful surgical correction of a series of clinical cases of intrathoracic tracheal avulsion in cats.

Myocardial protection in hypoxic immature hearts.

Current myocardial protection techniques in cyanotic immature hearts are not optimal. Despite successful surgical correction of congenital cardiac defects causing hypoxemia, myocardial dysfunction remains the leading cause of postoperative mortality. New studies indicate that the intraoperative reintroduction of molecular oxygen on cardiopulmonary bypass causes a reoxygenation injury leading to postoperative cardiac dysfunction. Biochemical and functional changes of reoxygenation injury can be avoided by several methods aimed at reducing oxygen free radical production and nitric oxide release. The present investigation provides an overview of our current understanding of pathogenesis, implication, and treatment of myocardial reoxygenation injury. New surgical concepts of myocardial protection including normoxic CPB and controlled reoxygenation are introduced.

A practical classification of septonasal deviation and an effective guide to septal surgery.

The conventional designation of septal pathology is a deviated septum, and the common treatment of choice is submucous resection of the septum. These limited generic terms leave the surgery open to frequent failure and render the education of this topic suboptimal. During 1224 septal surgeries, we have observed six different categories of septal deviation requiring different surgical treatments. A study was conducted to investigate the frequency of different classes of septal deviation and to develop guidelines for a more successful surgical correction of each category. Ninety-three consecutive patients who underwent septoplasty were carefully evaluated for the type of septal deformity, age, gender, history of trauma, and previous septal surgery. The surgical technique was reviewed for each category of the septal deformity. Of the 93 patients, 71 were women and 22 were men. Ages ranged from 13 to 76, with an average age of 31.5. Most patients exhibited a "septal tilt" deformity (40 percent; 37 of 93) or a C-shape anteroposterior deviation (32 percent; 30 of 93). The other deformities were C-shape cephalocaudal (4 percent; 4 of 93), S-shape anteroposterior (9 percent; 8 of 93), S-shape cephalocaudal (1 percent; 1 of 93), or localized deviations or large spurs (14 percent; 13 of 93). Each of the six categories of septal deviation requires specific management. If a single procedure is selected for all of the septal deformities, disappointing results may ensue.

Anatomic Reconstruction of the Nasal Tip Cartilages in Secondary and Reconstructive Rhinoplasty

The conventional designation of septal pathology is a deviated septum, and the common treatment of choice is submucous resection ofthe septum. These limited generic terms leave the surgery open to frequent failure and render the education of this topic suboptimal. During 1224 septal surgeries, we have observed six different categories of septal deviation requiring different surgical treatments. A study was conducted to investigate the frequency of different classes of septal deviation and to develop guidelines for a more successful surgical correction of each category. Ninety-three consecutive patients who underwent septoplasty were carefully evaluated for the type of septal deformity, age, gender, history of trauma, and previous septal surgery. The surgical technique was reviewed for each category of the septal deformity. Of the 93 patients, 71 were women and 22 were men. Ages ranged from 13 to 76, with an average age of 31.5. Most patients exhibited a septal tilt deformity (40 percent ; 37 of 93) or a C-shape anteroposterior deviation (32 percent; 30 of 93). The other deformities were C-shape cephalocaudal (4 percent; 4 of 93), S-shape anteroposterior (9 percent; 8 of 93), S-shape cephalocaudal (1 percent ; 1 of 93), or localized deviations or large spurs (14 percent; 13 of 93). Each of the six categories of septal deviation requires specific management. If a single procedure is selected for all of the septal deformities, disappointing results may ensue.

Aortopulmonary window with anomalous origin of the right coronary artery

We report a case of an aortopulmonary window with a right coronary artery arising from the pulmonary trunk. This exceedingly rare anomaly with anomalous coronary artery presented without myocardial ischemia owing to the aortopulmonary window. The correct diagnosis was made by angiography and a successful surgical correction was performed.

Cardiac Arrest During Exercise: Anomalous Left Coronary Artery from the Pulmonary Trunk

Anomalous origin of the left coronary artery from the pulmonary trunk is associated with high mortality in infancy but in rare cases the condition is diagnosed in adults. The present report describes three adult cases of this anomaly. Two of the patients (age 18 and 34 years) were resuscitated from cardiac arrest, which had occurred in relation to physical exercise. The third patient (20 years) had presented with angina pectoris and signs of ischaemia on exercise ECG. In all patients, coronary arteriography revealed a large right coronary artery with collateral filling of the left coronary artery, which originated from the pulmonary trunk. A successful surgical correction of the anomalous coronary artery was performed in two of the patients.

Criss-cross heart with supero-inferior ventricles: successful surgical correction of associated defects

SummaryWe present an unusual case of criss-cross heart with supero-inferior ventricles, double outlet of the right ventricle, restrictive ventricular septal defect, severe infundibular stenosis and “absent” pulmonary valve who underwent successful surgical repair. Complete preoperative diagnosis was established with cross-sectional echocardiography combined with colour Doppler and angiocardiography, which facilitated successful surgical correction.

Biventricular systolic function and mass studied with MR imaging in children with pulmonary regurgitation after repair for tetralogy of Fallot.

To study biventricular systolic function and mass of the heart in young patients with residual pulmonary regurgitation who had undergone surgical correction of tetralogy of Fallot. Transverse gradient-echo magnetic resonance (MR) images covering both ventricles were obtained in 19 patients who had undergone corrective surgery for tetralogy of Fallot at the age of 1.5 years +/- 1 and in 12 age-matched control subjects. In addition, MR velocity maps of the pulmonary artery were obtained. Biventricular volumes, ejection fraction and myocardial mass, and pulmonary flow volumes were measured. Exercise tests were performed in 17 patients. The right ventricular ejection fraction was lower (P < .001) and the right ventricular mass was higher (P < .0005) in patients than in control subjects; the left ventricular ejection fraction was lower (P < .0005) in patients and correlated statistically significantly with pulmonary regurgitation (r = -.68; P < .005). Exercise performance inversely correlated with pulmonary regurgitation (tau = -0.5; P = .01). In children who undergo early surgical repair of tetralogy of Fallot, residual pulmonary regurgitation correlates with biventricular systolic dysfunction and diminished exercise capacity. Despite successful surgical correction, right ventricular hypertrophy may persist.

Successful conduit repair using aortic homograft in a jehovah's witness child

A 10-year-old female child of the Jehovah's Witness faith presented with congenitally corrected transposition of the great arteries (S,L,L), pulmonary atresia, and a ventricular septal defect. A successful surgical correction was performed using an aortic homograft as a valved extracardiac conduit without the use of homologous blood or blood products. We used permanent splinting of the sternum with a methyl methacrylate resin plate to prevent compression of the conduit.

Polydactyly in the pre-adolescent foot: An unusual case presentation with impending pathologic fracture

Polydactyly of the foot is a common congenital deformity. The authors report a case of postaxial polydactyly with impending pathological fracture. Successful surgical correction was performed with an uneventful 10-month follow-up. Pertinent literature was reviewed and presented regarding classification systems, etiology, and treatment recommendations.

Right superior caval vein draining into the left atrium—diagnosis by color flow mapping

AbstractWe report two female patients, one aged four years and the other a newborn, referred for evaluation of cyanosis with otherwise normal cardiovascular findings, who proved to have the right superior caval vein draining into the morphologically left atrium. In both patients, the diagnosis was made by color flow mapping. The older child underwent catheterization and subsequent successful surgical correction. A right superior caval vein draining into the left atrium, although very rare, should always be considered a diagnostic possibility in the presence of cyanosis and normal clinical findings. Color flow mapping is an excellent method with which to make the diagnosis.

First Case of Human Infection Caused by Pasteurella gallinarum Causing Infective Endocarditis in an Adolescent 10 Years After Surgical Correction for Truncus Arteriosus

To report the first case of human infection (infective endocarditis [IE]) caused by Pasteurella gallinarum and to review the literature regarding IE caused by the genus Pasteurella. University hospital based. An adolescent boy who underwent successful correction for truncus arteriosus 10 years before the present illness. Persistent fever, pallor, and a palpable spleen suggested IE clinically. Echocardiography documented vegetation in the conduit that was used for surgical correction. Blood cultures grew P. gallinarum and confirmed its role as the causative organism for IE in the patient. This case illustrates that IE may develop in a child with congenital heart disease several years after surgical intervention using material that is foreign to the body (conduit), and that such a complication may involve unusual pathogens. These observations emphasize the need for careful long-term follow-up of children with congenital heart disease even after successful surgical correction.