Now a day there are many surgical procedures that require intervention on the normal right ventricular outflow tract (RVOT) and its reconstruction. We present the surgical anatomy of the pulmonary root in the normal RVOT and its reconstruction in the Ross operation in 13 patients operated on from February 1992 through February 1994. The surgical excision of the pulmonary valve was done and in order to keep right ventricle-pulmonary artery continuity (RV-PA), autologous pericardium tubes with bovine pericardium valve [done at the Instituto Nacional de Cardiología (INC)], were elaborated during the surgical procedure in all patients. The postoperative period and its clinical status was satisfactory in all cases, without transpulmonary gradient or regurgitation. We conclude that is important to know the surgical anatomy of the pulmonary root in order to avoid irreversible damage. In the other hand, it is worthy to know the different choices to reconstruct RVOT and its postoperative clinical course.

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PubMedDate not supplied

[Mitral valve replacement by mechanical disk valve. A surgical alternative].

From July to December 1993, 10 patients underwent mitral valve replacement with mechanical disc valve and running suture, preserving the posterior mitral valve apparatus. There were 6 men and 4 women, with a mean age of 44.2 years (25 to 63 years old). Three patients were in functional class II of the NYHA, 5 in functional class III and 2 in functional class IV. Eight patients were operated on for simple mitral valve replacement, of which, 2 underwent the first replacement 4 the second replacement and 2 the third replacement. One patient underwent double valve replacement (mitral and aortic valves) plus "bicuspidization" of the tricuspid valve and one patient underwent myocardial revascularization with two grafts of reverse saphenous vein besides mitral valve replacement. We used cardiopulmonary bypass in all patients with moderate hypothermia at 28 degrees and cardiac protection with cold cardioplegia at 4 degrees with potassium. One to 2 dosis of cardioplegia were required. Aortic cross clamping time was 37 minutes and 64 minutes of cardiopulmonary bypass in the patients operated on of simple mitral valve replacement. Supported by these preliminary results, we conclude that this surgical alternative is effective and safe with less ischemic and cardiopulmonary bypass time, preserve the posterior mitral apparatus and avoid disc jamming by the residual leaflet or tendinous chordae.

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