Biomedical subjects
Publications and source records attributed to E Otero Coto.
A fifty-eight year old patient presented subacute right heart failure. Transthoracic and transesophageal echocardiography revealed thrombi in both atria, and initial anticoagulation and subsequent surgical treatment were successful. Echocardiography is defined as being decisive to diagnosis, and the role of surgery in the treatment of these patients is commented.
We report successful treatment of pulmonary valve agenesia with pulmonary stenosis and ventricular septal defect by infundibular resection, patch-closure of the VSD and implantation of a cryopreserved pulmonary homograft. Cases with mild to moderate hypoplasia of the pulmonary annulus are particularly well suited for direct pulmonary homograft implantation, while cases with severe hypoplasia and high right ventricular pressure after correction may be better treated with aortic homografts. Some technical aspects of homograft implantation (doing first the proximal suture, preserving the normal configuration of the valvular sinuses and using the subvalvular homograft tissue to enlarge the right ventricular outflow tract) may prevent significant valvular incompetence.
We report two hearts with rare anomalies of the atrioventricular connection. Both cases showed muscular partitions within the right ventricle, giving it a double-chambered morphology. In case 1 the floor of the right atrium was muscular, creating the impression of the absent connexion variant of tricuspid atresia. A hypoplastic valve, however, was seen in the right ventricular inlet chamber. Case 2 apparently showed an imperforate Ebstein's anomaly of the tricuspid valve but a supernumerary valve, draining into the left ventricle, was found in a chamber that might correspond to part of the coronary sinus.
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Explore the source record for details and available documents.
Seven specimens with a 'cleft' mitral valve associated with anomalous chordal fixation and abnormal ventriculo-arterial connection are presented. Four were associated with a discordant ventriculo-arterial connection, two with double-outlet right ventricle, and one with double-outlet left ventricle. In six the chordae from the cleft were attached to the anterior border of a small ventricular septal defect. In the seventh the chordae were attached to an accessory papillary muscle in the left ventricular outflow tract. These clefts differ from those of atrioventricular defects. The cleft is more anterior, there are no septal defects of the atrioventricular canal type, and no deficiency of the basal ventricular septum. Mitral regurgitation or left ventricular outlet obstruction are possible consequences of the anomaly.
Anatomically corrected malposition is a rare anomaly usually associated with other complex malformations. However, less complicated cases do occur and we report one such case treated surgically with success. Our experience underlines the importance of careful digital examination of the right ventricle from the atrium to determine the position of the septum, as the position of the left anterior descending coronary artery can be misleading.