Biomedical subjects

F J Vargas

Publications and source records attributed to F J Vargas.

11 recordsLinked to original sources

PubMed1998

Tricuspid annuloplasty and ventricular plication for Ebstein's malformation.

BACKGROUND: Seven patients with the diagnosis of Ebstein's malformation of the tricuspid valve were operated on. Mean age was 12 years (range, 7 to 16 years). All were cyanotic, with severe tricuspid regurgitation. Thromboembolism was not present. No associated cardiac malformations were present. METHODS: Surgical repair included tricuspid annuloplasty associated with longitudinal plication of the atrialized portion of the right ventricle. This was attained by approximating the anterior-posterior commissure with either the posterior-septal commissure or the septal leaflet remnant. The thin atrialized ventricular wall thus excluded remained as a cul du sac and was plicated by suturing along the longitudinal axis of the heart. When present, the dysplastic posterior leaflet was included in the plication. In essence, a monocuspid right atrioventricular valve was fashioned out of the anterior leaflet. The remaining septal leaflet played a minimal functional role. No additional procedures for treatment of arrhythmia were associated with the technique described. RESULTS: The postoperative course was uneventful in all patients. Mean follow-up is 4.3 years (range, 1 to 10 years). Doppler echocardiographic studies reveal satisfactory monocusp valve function in all patients, with adequate coaptation of the anterior leaflet and the septal structures. CONCLUSIONS: This technique seems applicable to most forms of Ebstein's malformation and is reproducible. The technique relies on the adequate mobilization of the anterior leaflet. Occasionally it is necessary to free fibrous adhesions of the leaflet to the underlying ventricular surface.

Adolescent↗

PubMed1998

Aortico-right ventricular tunnel.

A successful operation on an infant with a tunnel through which the aorta communicated with the right ventricle is reported. The diagnosis was suspected preoperatively on the basis of two-dimensional Doppler color echocardiography and confirmed by cardiac catheterization. The aortico-right ventricular tunnel originated independently from the left coronary ostium and above the sinus of Valsalva. Patch closure from inside the tunnel under deep hypothermia was successfully performed. Follow-up is satisfactory 5 years later.

Aorta↗

PubMed1995

Bidirectional cavopulmonary shunt in patients with multiple risk factors.

BACKGROUND: Twenty-five patients in whom a modified Fontan operation was deferred because of multiple risk factors underwent a bidirectional cavopulmonary shunt. Two or more of the following risk factors were present in all: age less than 1 year, severe pulmonary artery distortion, impaired left ventricular function, subaortic obstruction, anomalous systemic-pulmonary venous connection, atrioventricular valve incompetence, and increased mean pulmonary artery pressure. METHODS: Additional procedures included take-down of systemic-pulmonary artery shunt, atrial septectomy, pulmonary artery reconstruction, bulboventricular foramen enlargement, and atrioventricular valve repair. RESULTS: There were three hospital deaths (12%). Mean follow-up is 21 months. There was no late mortality. Mean oxygen saturation increased from 71% to 83%. Results obtained from pulmonary artery reconstruction, enlargement of bulboventricular foramen, and atrioventricular valve repair were satisfactory for the patients in whom these risk factors were present preoperatively. Ventricular function also improved in the survivors in whom it was previously deteriorated, this being related to the suppression of the sources of ventricular volume overload. CONCLUSIONS: In this risk group of patients for a modified Fontan operation, a bidirectional cavopulmonary shunt provided adequate palliation at reasonable low risk. Early bidirectional cavopulmonary shunt would minimize complications originating from systemic-pulmonary shunts such as pulmonary artery distortion and the potential harm of chronic ventricular volume overload.

Child↗

PubMed1987

Atrioventricular valve repair or replacement in atriopulmonary anastomosis: surgical considerations.

Three patients who underwent a modified Fontan-Kreutzer (F-K) operation required additional procedures to correct left atrioventricular valve regurgitation. Valve replacement was performed in two additional procedures, and initial annuloplasty with a Carpentier ring was carried out in the third. All 3 survived the combined procedures and are doing well after a follow-up period ranging from five months to three years. More frequent presentation of these types of patients can be expected with broadening indications for F-K procedure to more complex lesions.

Adolescent↗

PubMed1987

Anomalous systemic and pulmonary venous connections in conjunction with atriopulmonary anastomosis (Fontan-Kreutzer). Technical considerations.

Anomalous systemic or pulmonary venous connections can coexist with certain forms of complex cyanotic heart diseases that are reparable only by atriopulmonary anastomotic procedures, thus complicating the intraatrial separation of systemic and pulmonary venous pathways. Anomalous systemic or pulmonary venous connections were encountered isolated or in combination in 17 patients (10%) among a series of 170 modified Fontan-Kreutzer procedures. Fourteen of these 17 patients (82.3%) survived their operations, which utilized different techniques to deal with the various forms of anomalous systemic and pulmonary venous connections. There was one late death (5.8%). Extracardiac exclusion of a left superior vena cava with an end-to-side left cavopulmonary shunt proved to be a more successful alternative than the use of complicated intratrial baffles. Because of the complexity of the anatomic variables, repair of anomalous systemic or pulmonary venous connections in conjunction with a modified Fontan-Kreutzer procedure requires a detailed preoperative anatomical and physiologic diagnosis, and an individualized plan for each patient must be formulated to provide unobstructed venous pathways.

Adolescent↗

PubMed1986

Complete atrioventricular canal and tetralogy of Fallot: surgical considerations.

A review of 13 autopsy specimens and of 13 patients who were operated on for complete atrioventricular (AV) canal and tetralogy of Fallot between 1975 and 1985 revealed a number of anatomical details that are important in the successful repair of this combined lesion. A bridging anterior leaflet was present in 25 hearts. A septum primum was present and attached to leaflet tissue in 13. In all 26, a ventricular septal communication was present beneath the bridging anterior leaflet and extended anteriorly, but in 14 there was no ventricular septal defect underneath the posterior leaflet. Additional pathological features included the following: leaflet tissue deficiency (4 hearts), single left papillary muscle (3), accessory valve orifice (4), and left ventricular (4) or right ventricular (RV) (1) dominance. All 26 had infundibular stenosis, and 10 had hypoplastic pulmonary annuli. One had pulmonary atresia, and 6 had branch pulmonary artery stenosis. Surgical technique was modified to include incision of the septum primum in 7. Because of rightward displacement of the anterior ventricular septum and also to minimize the risk of causing subaortic stenosis, the bridging anterior leaflet was divided more toward the tricuspid orifice so as to parallel the crest of the ventricular septum. Transannular RV outflow patches were used in 10 patients, and a right ventricle-pulmonary artery conduit was placed in 1 patient. Three required repair of branch pulmonary artery stenosis. There were no hospital deaths. Three patients died late of residual AV valve regurgitation and branch pulmonary artery stenosis (2) and sepsis (1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1986

Tetralogy of Fallot with subarterial ventricular septal defect. Diagnostic and surgical considerations.

Since 1964, 77 patients underwent repair for tetralogy of Fallot with subarterial ventricular septal defect. Median age at operation was 5 years. Cyanosis was commonly mild, and hypoxic episodes were infrequent. Accordingly, only 12 patients (15.58%) needed either palliative or corrective operations before the age of 2 years. Characteristic angiographic and echocardiographic features were observed, which allowed this entity to be differentiated from either classic tetralogy or other types of double-outlet right ventricle. The earliest series of operations (in which no right ventricular outflow patch was used) was followed by a prohibitive mortality (50%). Residual subpulmonary obstruction was the cause of all of these deaths. In a second series of patients, a transannular patch was frequently used (79.59%), with the rationale that closure of the ventricular septal defect would make restrictive the deficient infundibulum of these patients. In a later series, we observed that most of the patients had a nonrestrictive pulmonary anulus (80%); the patch therefore was limited to the ventriculotomy. In the absence of pulmonary annular hypoplasia, the need for patching of the right ventricular outflow tract in this entity has to be confined to preventing the subpulmonary obstruction induced by closure of the ventricular septal defect. A considerable improvement in the results followed our first series (4.3% mortality). Follow-up of the survivors (mean 7 years) has been satisfactory.

Child, Preschool↗

PubMed1986

Extending the limits for modified Fontan procedures.

During the early development of atriopulmonary anastomotic operations (Fontan-Kreutzer), a number of physiologic and anatomical limits were proposed by the Fontan group as selection criteria. Among 167 consecutive patients undergoing modified Fontan procedures from 1973 through 1985, 109 (65%) patients exceeded one or more of the original selection criteria in areas of age, anomalies of systemic or pulmonary venous connection, pulmonary artery distortion, and pulmonary artery pressure. Twenty-six patients had a mean pulmonary artery pressure greater than 15 mm Hg, with 16 operative survivors (62%). Nineteen patients had anomalies of systemic and/or pulmonary venous connection, and 16 survived (84%). There were 44 patients under the age of 4 years, and 26 survived (59%). Twenty-five patients were older than 15 years, and 23 (92%) survived the Fontan procedure. Pulmonary artery distortion, relating to prior palliative operations, was found in 34 patients. Seventeen of these 34 survived a modified Fontan procedure (50%). Twenty-six patients had a pulmonary arteriolar resistance more than 2 Wood units times square meter, and 14 survived (54%), whereas 81 of 93 with a pulmonary arteriolar resistance of less than 2 U X m2 survived (87%). Multivariate analysis showed that pulmonary arteriolar resistance and pulmonary artery distortion had a significant, negative impact on survival, but age and anomalies of systemic and/or pulmonary venous connection did not. Pulmonary artery pressure was not an independent predictor of outcome. The results show that the original criteria may be exceeded in the areas of age and anomalies of pulmonary or systemic venous connection. Pulmonary artery pressure alone should not contraindicate a Fontan procedure if pulmonary arteriolar resistance is low. Pulmonary artery distortion from a prior palliative operation and elevated pulmonary arteriolar resistance increase the risk of a Fontan procedure.

Adolescent↗

PubMed1985

Repair of corrected transposition associated with ventricular septal defect and pulmonary stenosis.

Five patients with the diagnosis of classically corrected transposition of the great arteries, ventricular septal defect (VSD), and pulmonary outflow tract obstruction underwent surgical repair. A variant of a previously described technique was used to avoid injury to conduction tissue. Through an incision into the anatomical left ventricle, the VSD patch was sutured inferiorly to the right and away from the edges of the defect and superiorly to the epicardial border of the ventriculotomy. The pulmonary artery was opened, and its proximal end was closed with a suture. A pouch containing the conduction tissue was therefore obtained. Pulmonary ventriculoarterial continuity was reestablished using a valved or nonvalved Dacron or pericardial conduit. The postoperative course of the patients was uneventful. No changes were demonstrated on comparison with preoperative cardiac rhythm. Good hemodynamic performance was noted in 2 patients in whom postoperative catheterization was performed.

Abnormalities, Multiple↗

PubMed1985

A surgical technique for correction of total anomalous pulmonary venous drainage.

A technique was employed successfully for correction of total anomalous pulmonary venous drainage into the upper right superior vena cava. A J-shaped right atriotomy was performed; the posterior flap was sutured to the anterior border of a previously enlarged atrial septal defect. The right superior vena cava was divided above the site of drainage of the pulmonary veins, and its proximal opening closed with a suture. The pulmonary venous return was directed to the left atrium in this way. The right atrial-right superior vena caval continuity was then reestablished by an anastomosis between the previously opened right atrial appendage and the distal end of the right superior vena cava. Finally the remaining atriotomy was closed. The azygos vein must be ligated to avoid systemic unsaturation. For correction of anomalous pulmonary venous drainage into the azygos vein with this technique, ligature of the azygos vein must be placed distally to the site of anomalous drainage. Three patients, aged 2 months, 7 years, and 16 years, respectively, with different anatomic types of the anomaly, were successfully operated on with this procedure. Findings displayed from the postoperative hemodynamic, echocardiographic, and clinical evaluation are encouraging, after a follow-up period that ranges from 4 months to 4 years. The advantages of the repair are discussed.

Adolescent↗

PubMed1982

Atriopulmonary anastomosis.

Atriopulmonary anastomosis (APA) has been performed in 29 patients, 3 to 22 years of age, since 1971. The diagnoses were tricuspid atresia in 21, single ventricle with low pulmonary vascular resistance in seven, and one case of dextro-transposition of the great arteries with ventricular septal defect and pulmonary stenosis. Four different techniques were used: Technique I (anterior end-to-end APA with a homograft or Dacron tube); Technique II (anterior end-to-end APA with the patient's own pulmonary artery); Technique III (nonvalved anterior anastomosis between the right atrium and the right ventricle); and Technique IV (largest, posterior, nonvalved direct APA between the right atrium and the main pulmonary artery and its right branch). Since the right atrium does not function as a pump, caval valves were never used. The total hospital mortality was 17.2%. Proper patient selection and the development of Technique IV reduced the mortality to 9%. Low end-diastolic ventricular pressure and a nonrestrictive APA are mandatory to obtain a good clinical result without pleural effusion. Twenty-one survivors are in Functional Class I, 17 of them without medication. Twelve of the 24 survivors were recatheterized. The best clinical and hemodynamic results were achieved in patients with low right atrial pressure and low end-diastolic ventricular pressure. The follow-up demonstrated a consistent superiority of the posterior nonvalved APA (Technique IV) in comparison with other techniques described. Therefore, this technique is proposed as the procedure of choice for the performance of an APA, irrespective of the precise diagnosis (tricuspid atresia or single ventricle) and irrespective of the type of great arterial relationship.

Adolescent↗