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G Cordovilla Zurdo

Publications and source records attributed to G Cordovilla Zurdo.

At least 19 recordsLinked to original sources
PubMed1999

[Congenital heart defects with tracheal and bronchial stenoses: surgical treatment with extracorporeal circulation].

We present our experience with the surgical management of congenital cardiac defects when tracheal or bronchial stenosis is present. Concerning pulmonary artery sling, we think that it is necessary to correct the cardiac malformation and trachea-bronchial stenosis at the same time. After surgical correction, if the patient cannot be weaned from mechanical ventilation (10-15 days), it is mandatory to rule out the presence of tracheo-bronchial tree lesions in order to perform surgery without delay. The operation should be performed under cardiopulmonary by-pass at the same time as the surgical correction of the cardiac malformation. We believe that the best technique for localized obstruction is resection of the stenotic area, followed by termino-terminal anastomosis (one case in our patient group). However, when the length of the obstruction is longer, our election is to enlarge the stenotic area with pre-molded cartilage (four cases).

Bronchial Diseases↗
PubMed1997

[Surgical treatment of Fallot's tetralogy with hyperplasia or agenesis of the conal septum].

INTRODUCTION: The clinical evolution, anatomosurgical aspects, and postoperative evolution of a specific group of Fallot's tetralogy with hipoplasic or agenesic of the conal septum (representing a 7% of our Fallot's tetralogy cases) is presented. METHODS: A total of 41 patients surgically corrected in our Service between February 1973 and December 1995 has been retrospectively studied. Ages ranged between 13 months and 13 year. Clinically all cases developed moderate or severe hypoxemia. In 43.9% of cases it was necessary to perform a palliative surgery at an age between 15 days and 4 years. RESULTS: There was no hypoxemics spells. In the ECG we have found a QS in the aVR in 40% of cases. There was 7 deaths (17% of mortality rate). Four cases required reoperation. The clinical evolution, ECG, EKO, and hemodynamics findings are commented. CONCLUSIONS: In this type of Fallot's tetralogy, specifically in those cases with a pulmonary artery ring of normal size, it is necessary to have a good preoperative diagnoses in order to perform a longitudinal ventriculotomy with right ventricular outflow tract enlargement. Also, it is important to be meticulous with the stitches in the closure of the ventricular septal defect with a patch in order to avoid the potential lesion of the aortic valve.

Abnormalities, Multiple↗
PubMed1996

[Tetralogy of Fallot: total repair in the first year of life].

OBJECTIVE: Since the first correction of tetralogy of Fallot in 1955, the optimal age for total correction has been in continuous debate and remains a controversy. PATIENTS AND METHODS: Here we present our experience with 44 patients with tetralogy of Fallot which was surgically corrected in the first year of life. In 37 cases total correction was achieved with the first operation. In the remaining 7 cases previous palliative surgery was performed. Details of surgical decision making, hemodynamic data and surgical procedure are described in detail. RESULTS: There were 8 deaths (18.1% mortality rate). There were no deaths in the last 24 consecutive cases. Complications, need for reoperation and long-term follow-up of the 36 survivors are discussed. CONCLUSIONS: After a detailed analysis of both results and follow-up, our surgical criteria is described, with the intention of performing palliative surgery in only a restricted number of cases of tetralogy of Fallot where the anatomy is unfavorable for total correction with a single intervention.

Age Factors↗
PubMed1995

[Technical innovations in total extracardiac cavo-pulmonary connection in Fontan-type operation. An experimental study and first 2 operated clinical cases with excellent immediate results].

INTRODUCTION: Three technical modalities are presented with total extracardiac cava-pulmonary connection, with bidirectional Glenn, as coverage of this type of extracardiac connection for all types of cardiopathies suitable for Fontan type correction. METHODS: Development of an experimental protocol for the perfecting of the three technical variants tested: "Tunnel from inferior cava to right pulmonary artery by means of right atrial wall and vascularized pericardium", "Tunnel from inferior cava to the trunk of the pulmonary artery with or without pulmonary valve with P.T.F.E. hemiconduit" and "Tunnel from inferior cava to the pulmonary graft as a artery with P.T.F.E. graft as a hemiconduit". RESULTS: The first two clinical cases operated on using the third technical variant are presented. Both cases evolved during immediate postoperative period with a very favourable hemodynamic response, with pressures at conduit and P.A. level of 10-12 mmHg, normal cardiac output and sinus rhythm. The later clinical evolution in both cases is very satisfactory. The five cases published by Laschinger with this same technique showed a very favourable evolution during the immediate postoperative period and later. CONCLUSION: The technical facility of its performance, the slight traumatism of this surgery, the important technical advantages with respect to the total cava-pulmonary intraauricular connection and the good initial hemodynamic results make us consider the total extracardiac cava-pulmonary connection as an important contribution in this type of surgery. It is clear that time and greater clinical experience with this type of connection is required for the correct evaluation of all and each one of the numerous theoretical advantages shown and in order to detect possible disadvantages.

Adolescent↗
PubMed1994

[Vascular rings of aortic origin: the surgical experience in 43 cases].

INTRODUCTION AND OBJECTIVES: Aortic vascular rings can produce compression and obstruction in the airway and/or esophagus early surgical treatment in the first days or months of life. The reported incidence range between 0.3-0.6% with an 0.5% in our series. The following is a retrospective analysis with clinical, radiological and angiocardiographic study of the patients operated on in our service with the diagnosis of aortic vascular ring focused on the surgical results. METHODS: A total of 43 children with ages ranging between 21 days and 10 years (mean age 17 months) underwent surgical treatment for aortic vascular ring, during the period between january 68 and january 94. Clinically, 74% had stridor, 27.4% gastroesophageal reflux, 34% pulmonary infection, 14% respiratory insufficiency with mechanical ventilation, 12% heart failure, 9% dysphagia, 2% crisis of bronchospasm and 2% tracheomalacia that require tracheotomy prior to surgical correction. Diagnosis was made by esophagogram 86% of the cases. Aortography as the late diagnosis method or for election to surgical approach was made in 85% of the cases. In 42% were double aortic arch, 32% anomalous right subclavian artery and 25% right aortic arch with left ductal ligamentum. RESULTS: Reoperation was performed in 4 cases. Two early (1 case for hemorrhage, 1 case for phrenic paralysis requiring diaphragmatic plication), and two late reoperations (1 aortopexy, 1 tracheal termino-terminal anastomosis) at 2 and 13 months respectively. Hospital mortality was 1 case (2%) with 1 additional late death (2%). Follow-up was performed in the remaining 39 cases with a mean of 11 years (ranging between 1 and 25 years. Thirty seven of 41 patients alive asymptomatic (90%). CONCLUSIONS: Due to a low mortality rate (2.3%) not related with the age of the patient at the moment of the surgical procedure based in our experience, we conclude that it is very important to perform both, early diagnosis and surgical treatment in order to avoid the potential residual lesion on the airway caused by tracheo-broncho malacia, in order to avoid the deleterious effect on the results both at early and later follow-up.

Airway Obstruction↗
PubMed1993

Direct atrioventricular versus atriopulmonary connection: a comparative experimental study.

A study of 31 dogs, divided into two groups, was conducted to compare direct atrioventricular with atriopulmonary connection using a valved conduit to treat tricuspid atresia. The first group (n = 9) acted as controls. In the second group (n = 22), an experimental model was established for direct atrioventricular connection that could be converted to atriopulmonary connection. In subgroup A (n = 11), the blood from the right atrium (RA) was conducted to a haemodynamically effective residual right ventricle (RV), whereas in subgroup B (n = 11) the blood was conducted from the RA to an ineffective residual RV. There were haemodynamic advantages of atrioventricular connection in subgroup A. No such differences were found between the two surgical techniques in subgroup B. In both subgroups, light external compression of the pulmonary artery produced a profound deterioration in the haemodynamic state. The technique of direct atrioventricular connection does not appear to offer any advantages as a method of atriopulmonary bypass.

Animals↗
PubMed1993

[Perioperative management of systemic pulmonary shunts in the neonatal period].

We have analyzed 36 newborns (19 males and 17 females), with cyanotic cardiopathies in whom a systemic-pulmonary shunt had been performed. These patients were admitted to the Neonatal Intensive Care Unite between January 1985 and June 1990. We studied the perioperative events with the aim of describing the general features of this palliative surgery in the neonatal period and to determine the factors which indicate a bad prognosis. The age at admission was 10.5 +/- 16.5 days and at surgery was 19.5 +/- 20 days. Cardiopathy types included: 13 pulmonary atresias, 9 pulmonary stenoses, 6 D-transposition of the great arteries and 8 tetralogies of Fallot. Of these patients, 83% required prostaglandin administration before surgery. Cardiac catheterization was performed in 54% (in 1/3 balloon atrioseptostomy was performed). The mean diameter of the pulmonary branches was 3.5 +/- 0.7 mm. In 89%, a modified Blalock-Taussig shunt and in 11% a central aorto-pulmonary shunt were performed. The size of the prosthetic graft used was 4 mm in diameter in 77% of the cases, 5 mm in 20% and 3 mm in 3% of the patients. The mortality rate was 27% (intraoperative = 0%, early postoperative = 16%, late postoperative = 11%) with two critical periods: the initial 48 postoperative hours and the reoperation. Bad prognosis factors related to mortality are; preoperative (shorter gestational age and low newborn weight), operative (performance of a central aortopulmonary shunt, surgical ligation of the ductus during operation) and postoperative (arrhythmias, metabolic acidosis in the immediate postoperative period, lower oxygen saturation at 24 hours after the operation, hemorrhage). Our data are compared with other reports of systemic-pulmonary shunt in the neonatal period.

Aorta, Thoracic↗
PubMed1993

[Long-term results of surgical management of congenital aortic stenosis].

This retrospective study and review of the literature was undertaken to assess the long term results of valvotomy in congenital aortic stenosis (AS). One hundred and seven patients, aged between 14 days and 15 years (mean: 6.2 years), were operated on between 1966 and 1989. Thirty-three cases had valvular AS, 48 discrete subvalvular AS, 10 supravalvular AS and 16 combined AS. Thirty-three patients had associated cardiac anomalies. The surgical mortality was 6.5% (3.5% in children over 2 years of age). Three patients were lost. Ninety-seven patients had a follow-up period between 6 months and 16 years (mean: 5.4 years) with an actuarial survival of 95% at the age of 15 years. There were adverse events in 39 patients: AS, aortic regurgitation, bacterial endocarditis, third-degree heart block. Thirteen patients required re-operation and 4 balloon valvuloplasty; the late mortality was 5%. We conclude that this surgery has a low surgical mortality, but must be considered as palliative in most cases.

Adolescent↗
PubMed1992

[The perioperative management of aortic coarctation in the neonatal period].

Clinical records of 30 neonates with aortic coarctation admitted to neonate ICU from January 1985 to June 1990 are reviewed. We analyzed perioperative data to search for adverse prognostic signs. Patients weights were 2,970 +/- 500 grams and gestational age 38.5 +/- 1.7 weeks. Mean age at admission was 10.5 +/- 10 and mean age of surgery 13 +/- 11 days. 70% had associated congenital heart defects. Surgical technique was patch angioplasty in 86% and subclavian flap in 14%. Early or late mortality among patients with isolated aortic coarctation was nonexistent, and it was 28.5% in patients with other congenital heart defects. 13% has postoperative hypertension and 3.3% recoarctation. Adverse prognosis signs were preoperative (associated congenital heart defects, especially ventricular septal defect and interrupted aortic arch, greater dose of catecholamines and mechanical ventilation), intraoperative (pulmonary artery banding), and postoperative (hypotension, cardiac failure, arrhythmia, oligoanuria, metabolic acidosis, greater need of mechanical ventilation, bleeding and thrombopenia). Date are compared with other neonatal series.

Aortic Coarctation↗
PubMed1991

[Left subclavian-pulmonary trunk fistula with a vascular prosthesis as palliative treatment in Fallot conditions].

In this paper, our experience with a new systemic-to-pulmonary artery shunt: subclavian-pulmonary artery trunk shunt with PTFE (central shunt) is presented. Between November 1985 and March 1990 this central shunt was employed in 8 children with ages ranged between 4 days and 3 years, and weights between 2 and 12 kg. Diagnosis were Fallot's tetralogy in three; pulmonary atresia with intact septum in three; complete AV canal and Fallot's tetralogy in one, and univentricular heart and pulmonary atresia in 1 patient. There were no surgical deaths. Hospital mortality was present in 1 case (AV canal and Fallotś tetralogy) at the moment of reoperation 1 month later. Follow-up ranged between 2 and 46 months. One case, pulmonary atresia with intact septum, has undergone total correction. The remainder 6 cases are in good situation with O2 saturation above 70%. This central shunt has the advantages to provide a bidirectional blood flow to both pulmonary branches avoiding the risk of direct damage in the pulmonary arteries found with the conventional aorto-pulmonary shunts.

Arterio-Arterial Fistula↗
PubMed1991

[Medical pericarditis: study of 19 cases].

19 cases of medical pericarditis admitted to the PICU from 1978 to 1989 were reviewed, to asses the diagnostic and therapeutical approach. The overall incidence is low, 0.32% of the patients admitted to the PICU in that time period. We have found neither tuberculous nor purulent pericarditis, with a 42% of idiopatic forms. Echocardiography was the best method for syndromic diagnosis. The ethiological diagnosis of pericarditis was made, in most cases, by means of non invasive methods or in association with the underlying disease. The cualitative analysis of the pericardial fluid was not useful for the ethiological diagnosis, therefore, we suggest pericardiocentesis should be performed mainly as a therapeutical tool. There were no correlation between the amount of fluid obtained on the first pericardiocentesis and the later incidence of the pericardial effusion. Biopsy brought no ethiological specificity in the cases it was performed.

Adolescent↗
PubMed1990

[Experimental evaluation of the role of the coronary sinus pressure in the regulation of coronary return volume via the coronary sinus. Surgical considerations in atrio-pulmonary diversion procedures].

In order to find out the validity of the vascular waterfall mechanism in coronary venous circulation, the role of coronary sinus pressure in the regulation of coronary return volume via the coronary sinus is studied in healthy animals. An experimental model of pressure regulation in the coronary sinus was prepared, and aortic pressure, EKG and the cardiac output (measured by thermodilution) were recorded. The return volume via the coronary sinus was measured at coronary sinus pressure of 10 or less, 15, 20, and 25 mmHg or more, for a total of 36 determinations. Increased coronary sinus pressure did not produce significant changes in aortic pressure, heart rate, cardiac index or coronary return volume via coronary sinus. When coronary sinus pressure was 25 mmHg or more, there was a significant decline in the average of coronary return volume via coronary sinus. Nevertheless, stepwise variant regression showed that the coronary sinus pressure per se does not condition the volume of coronary return via the coronary sinus. Our results suggest that in the healthy animals, the vascular waterfall mechanism in coronary venous circulation is not valid. Our results suggest that in the correction of congenital cardiac malformations using atriopulmonary anastomosis procedures, employing techniques that ensure coronary sinus drainage into the left atrium, in order to avoid the hemodynamic repercussions attributable to the vascular waterfall mechanism, is not justified.

Anastomosis, Surgical↗
PubMed1989

A new physiologic correction technique for re-establishment of pulmonary circulation. Experimental surgical development.

A new physiologic technique is presented for surgical correction of truncus arteriosus, pseudotruncus, transposition of the great arteries, double right ventricular outflow tract with subpulmonary ventricular septal defect and certain cases of Fallot's tetralogy. The basis of the technique are creation of a neo-right atrium, neo-pulmonary trunk, neo-right atrioventricular valve and a neo-pulmonary valve by right angular atriotomy and insertion of a homologous pericardial patch with a monocuspid valve. The pulmonary circulation is re-established by anastomosis of the neo-pulmonary trunk to the pulmonary tree. The technique was used on 26 mongrel dogs. In 14 the experiments were preliminary, to evaluate the technique's validity, and in the other 12 it was performed with extracorporeal circulation and the hemodynamic status was studied at 30 and 180 min postoperatively. The technique and its results and potential advantages are described. Clinical application is considered to be feasible.

Anastomosis, Surgical↗
PubMed1989

[Anatomy and surgical implications of incomplete forms of atrioventricular septal defects].

We present an anatomic intraoperative study of 93 consecutive operated cases with an ostium primum defect. The type of the ostium primum, size of interauricular defect, position of the coronary sinus, tricuspid valve, mitral valve and subvalvular apparatus, are analyzed. Inside the mitral valve apparatus, the size, form, type and number of clefts are described as well as septal valve anomalies. We point out the importance of performing a detailed and fast anatomic study within a surgical protocol to obtain the optimal anatomic correction of the cardiopathy.

Child↗
PubMed1987

Extraatrial interatrial duct and reestablishment of aortopulmonary communication by enlarging the aortic arch. Experimental development of two surgical techniques for hypoplastic left heart syndrome palliation without extracorporeal circulation.

A new surgical procedure is presented for palliation of hypoplastic left heart syndrome. The first palliative technique consists of creation of an extraatrial interatrial duct and the second, reestablishment of the aortopulmonary communication by enlarging the aortic arch with a "conduit patch". Both procedures avoid having to clamp small systemic vessels and pulmonary veins and extracorporeal circulation is not needed. Extraatrial interatrial ducts were created in 10 dogs and the effectiveness of the procedure was evaluated. Reestablishment of the aorto-pulmonary communication and enlargement of the aortic arch was done in 7 specimens from patients with hypoplastic left heart syndrome who had died in the first hours of life and in 8 dogs. The surgical procedures, their advantages and the results obtained are described.

Animals↗