A. Juffe

Cardiac Echinococcosis: Report of 3 Cases and Review of the Literature

Three patients who underwent successful surgical treatment of cardiac hydatid disease are discussed. The nonspecificity of diagnostic measures and the importance of keeping this diagnosis in mind when faced with a patient coming from an area where hydatidosis is endemic are stressed. We propose the use of cardiopulmonary bypass in the surgical treatment of this problem.

CARDIAC VALVE REPLACEMENT WITH THE BJORK-SHILEY PROSTHESIS IN YOUNG PATIENTS

Between 1971 and 1974, 26 valve replacements with the Björk-Shiley tilting disc valve prosthesis were performed in 23 children between 4 and 16 years of age. Mitral valve replacement was carried out in 11 patients, aortic valve replacement in 9 and double replacement in the other 3 patients. Several of the patients presented associated lesions which were also corrected at the same intervention, One patient died during the postoperative period; the remaining 22 all showed significant clinical remission. No incidents of thromboembolism or complications of any other nature were observed during follow-up periods of 6 to 26 months. It is our belief that the Björk-Shiley valve represents an improvement over other prostheses currently used for the surgical correction of valve disease in children.

Long-Term Results of Cardiac Valve Replacement with the Delrin-Disc Model of the Björk-Shiley Valve Prosthesis

One hundred two Björk-Shiley valve prostheses with the Delrin-disc occluder were implanted in 83 patients between January, 1971, and July, 1972. Fifty-eight were in the mitral position, 42 in the aortic, and 2 in the tricuspid. Complete follow-up until 1981 was obtained in 93% of the patients (mean follow-up, 66.8 months). Hospital mortality was 18% and late mortality, 19%. Survival according to actuarial methods was 84.8% at 5 years and 78.1% at 9 years after operation. Thromboembolism was detected in 8.8% of patients but caused no deaths. The incidence was 1.2% and 1.5% per year in those patients treated with Coumadin and antiplatelet agents, respectively. Reoperation was necessary in 13% of the patients. Most survivors (72%) are in New York Heart Association Functional Class I, despite a preoperative status of Class III or IV in 57% of the patients. Hospital mortality may be due to poorer understanding of patient management and less refined techniques of myocardial protection. Long-term survival with this prosthesis is similar to that in more recent studies, and rates of thromboembolism and malfunction compare favorably with other prosthetic valves.

Coarctation of the aorta and severe aortic insufficiency: What to repair first?

A new surgical approach is proposed for patients with coarctation of the aorta associated with severe aortic valvular insufficiency. The valvular lesion should be repaired first and the coarctation corrected during a second operation; both interventions should be done during the same hospital stay. We base our approach on the belief that improved coronary perfusion can be achieved when the aortic insufficiency is corrected first. The disadvantages of the opposite surgical approach, such as anticoagulation problems, renal underperfusion, and hypertensive complications are easily avoided.

Combined Mitral and Aortic Valve Replacement with the Björk-Shiley Prosthesis

Combined mitral and aortic valve replacement with the BJORK-Shiley tilting-disc valve prosthesis was performed in 42 patients. Hospital and late mortality rates were both at the 9.5% level. No correlation was seen between mortality and combination of concomitant valve lesions. Morbidity was elevated. No episodes of embolism were observed after surgery, although one patient died of severe haemorrhage. Only one patient showed valvular dysfunction (grade 2/4 leakage), but did not require reoperation. Postoperatively, 75.7% of the patients were asymptomatic for a mean follow-up period of 21.1 months. The Björk-Shiley prosthesis offers a small gradient associated with a low profile, which constitute important advantages in multiple valve replacement.

Pulmonary Arteriovenous Fistula: A Review

A successfully treated case of an arteriovenous fistula of the lung is reported. An exhaustive review is made of the pertinent literature and the pathophysiology, embryology, clinical aspects, diagnosis and treatment are discussed.

Dysfunction of the Björk–Shiley Prosthesis. Report of 32 Cases

We present 32 cases of dysfunction of the Björk-Shiley valvular prosthesis, representing 3.01% of the 1,063 BS prostheses implanted at this clinic. The complications observed were thrombosis of the prosthesis, suture dehiscence with or without endocarditis and disc-suture interference. In selected, favourable cases, we prefer thrombectomy with generous washing of the prosthesis and rotation of the disc, without removal of the disc from the prosthesis. Furthermore, when the dehiscence does not exceed 1/3 of the circumference of the ring, we have achieved very good results with single sutures supported on Teflon patches. Subsequent failures of this procedure were not of a technique nature, but rather due to the poor condition of the patients. In situations of clinical emergency, the diagnosis of valvular dysfunction may suffice as indication of surgery, further diagnostic measures being postponed in view of the data of the physical exploration.

Surgical Management of Aortic Root . Aneurysm Associated With Aortic Insufficiency

an important surgical procedure, whose main difficulty is the reimplantation of both coronary arteries. This, together with the peculiar pathophysiology of this condition results in concrete and peculiar problems that demand a special therapeutic solution. The purpose of the present work is to describe our experience in the surgical correction of this nosologic entity, with emphasis on the pathophysiologic aspects, etiology, and current surgical treatment.