Mauro Arruda

Ventricular septal defect following nonpenetrating trauma. Case report and review of the surgical literature

From the Institute of Diseases of the Chest of Recife. Real Hospital Português de Beneficência em Pernambuco. Av. Portugal, 163, Recife Brazil. Rupture of the interventricular septum may result from blunt trauma of the chest or from a penetrating wound of the heart. Patients with traumatic ventricular septal defect from a penetrating wound usually have symptoms and signs of cardiac tamponade or hemothorax and do not develop the typical clinical picture of an acute ventricular septal defect, due to blunt trauma, which is quite similar to those of interventricular septal ruptures following myocardial infarction. Traumatic ventricular septal defect was first described by Hewett’ in 1847. EaSt2 made the first diagnosis in life and Guilfoil and Doyle3 reported the first case proven by cardiac catheterization. The first successful repair of traumatic ventricular septal defect was performed by Lillehei in 1955. This case was reported upon by Campbell .4 Since then, at least twenty-one4-23 patients have received surgical treatment for ventricular septal defect due to indirect trauma. In the present paper a case of traumatic ventricular septal defect repaired surgically is described and the surgical literature reviewed.

Congenital Aneurysm of the Left Atrium

Aneurysm of the left atrium is considered to be congenital in origin, in the absence of predisposing conditions such as mitral valve disease, congenital heart disease, or acquired inflammatory changes in the myocardium. It is a rare condition that may involve either the atrial appendage (aneurysmal dilatation of the left atrial appendage) or the atrial wall (aneurysm of the body of the left atrium). Aneurysmal dilatation of the left atrial appendage may occur with an intact pericardium or may be associated with a pericardial defect. In 1974

Mitral Valve Surgery in Children

During the period from January 1960 to April 1977, 585 patients underwent mitral valve surgery at the Federal University of Pernambuco Medical School Hospital and at the Institute of Diseases of the Chest, Recife, Brazil. Among these patients, 50 (8.5%) were under 15 years of age. There were 28 girls and 22 boys ranging in age from 6 to 15 years (average 11 years). Forty-six (92%) had a history of rheumatic disease or were in active carditis at the time of hospital admission. Mitral valve lesion was diagnosed on the basis of clinical, electrocardiographic, and radiologic findings, but in 33 patients the severity of the lesion was estimated by cardiac catheterization and cineangiocardiography. Every effort was made to operate in the inactive phase of the rheumatic fever, and medical treatment was instituted whenever there was clinical

Correction of transposition of the great arteries using homologous dura mater: a preliminary report.

were present. His blood pressure was 100/70 mm Hg, and the pulse regular at 100/minute. The heart showed a hyperdynamic right ventricular impulse. A Grade II/VI systolic murmur was heard in the second and third intercostal spaces at the left sternal edge. The second heart sound was loud at the pulmonic area. The ECG showed right ventricular hypertrophy. On the chest x-rays, the heart appeared slightly enlarged and an increase in pulmonary vascular markings could be noted. Cardiac catheterization data is given in Table I. The cineangiograms (Fig. 1) established the diagnosis of simple transposition of the great arteries.

Mitral annuloplasty either in isolation or associated with posterior quadrantectomy in young patients

OBJETIVO: Descrever procedimento cirurgico de anuloplastia concentrica do anel mitral sem protese, isolada ou associada a resseccao quadrangular com plicatura postero-medial do anel mitral, e analisar os resultados imediatos e tardios obtidos. METODO: Entre fevereiro de 1986 e fevereiro de 2001, realizamos 790 procedimentos abordando a valva mitral, 41 foram realizados em criancas e adolescentes menores de 20 anos (media de 9,7 anos). Vinte (48,7%) pacientes eram do sexo feminino e 21 (51,3%) do masculino. A doenca reumatica foi responsavel pelas lesoes em 92,6% dos casos e a degeneracao mixomatosa em apenas 7,4%. No periodo pre-operatorio, 22 (53,6%) pacientes estavam em classe funcional III e 19 (46,4%) em classe funcional IV, advindos de repetidos surtos de febre reumatica, agravados pela desnutricao. A tecnica cirurgica utilizada foi a anuloplastia concentrica, aplicada isoladamente ou em associacao a resseccao quadrangular com plicatura postero-medial. O curso do seguimento pos-operatorio foi de 7 meses a 15 anos (3/2/1986 a 12/2/2001). RESULTADOS: A mortalidade hospitalar foi de 2,4%. Os pacientes receberam alta sem sopro sistolico de regurgitacao mitral. Dois pacientes apresentaram, ao longo dos anos (4 e 11 anos), estenose mitral e necessitaram reoperacao, um deles operado com dois anos de idade. Dois doentes foram reoperados para corrigir disfuncao aortica previamente abordada por plastia (12 e 18 meses apos a primeira operacao), morrendo e contribuindo para mortalidade tardia de 5%. CONCLUSAO: Consideramos a tecnica empregada um procedimento alternativo, valido, de aplicacao preferencial em criancas e adolescentes, de facil reproducao e de baixissimo custo.

Surgical Experience with Rheumatic Mitral Valve Disease in Children

In developing countries, rheumatic heart disease continues to be a challenging problem. The disease often affects young people from the lower strata of the population in an accelerated and severe form that produces early valve damage, which can be relieved in some patients only by surgery [1–3]. In this paper, we review our experience with surgical management of rheumatic mitral valve disease in patients below the age of 15 years.