scholarly journals One-Stage Repair of Aortic Arch Hypoplasia Associated With Ventricular Septal Defect

2020 ◽  
pp. 52-56
Author(s):  
Y. Truba ◽  
R. Sekelyk ◽  
I. Dzyurii ◽  
L. Prokopovych ◽  
O. Golovenko ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Postoperative Period ◽  
Balloon Dilation ◽  
Early Postoperative Period ◽  
Long Term Results ◽  
One Stage ◽  
The Mean ◽  
Aortic Arch Hypoplasia

  Background. Aortic arch hypoplasia is a congenital anomaly of the development of the aortic arch characterized by ground. Aortic arch hypoplasia is a congenital anomaly of the development of the aortic arch characterized by hemodynamically significant narrowing of one or more segments of the aortic arch. Aortic arch hypoplasia combined ynamically significant narrowing of one or more segments of the aortic arch. Aortic arch hypop with ventricular septal defect (VSD) characterizes a special category of children who are in serious condition and need ptal defect (VSD) characterizes a special category immediate surgery. Despite the improvement in the results of surgical treatment of this abnormality in recent years, the gery. Despite the imp issue of choosing treatment tactics remains debatable. g The aim. To analyze immediate and long-term results of one-stage aortic arch hypoplasia repair and VSD repair in infants. Materials and methods. From 2011 to 2019, 55 infants underwent simultaneous aortic arch hypoplasia repair in ypoplasia rep conjunction with VSD repair at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and junction with VSD repair at the National Amosov Institute of Cardiovascular Surgery Ukrainian Children’s Cardiac Center. There were 30 (55%) male patients and 25 (45%) female patients. The mean age of (55%) male patients and 25 (45%) female patients. The mean ag the patients was 1.3 ± 1.2 months (from 0.1 to 9.1 months), the average body weight was 3.9 ± 1.3 kg (from 2.4 to 8.7 patients was 1.3 ± 1.2 months (from 0.1 to 9.1 months), the average body weight was 3.9 ± 1.3 kg ( kg). The mean body surface area was 0.27 ± 0.1 m2. Antegrade selective cerebral perfusion was performed in 23 (42%) g). The mean body patients during the aortic arch reconstruction. g Results.The hospital mortality rate was 1.8% (n = 1). The average duration of artificial circulation was 108.5 ± 38.6 minpital mortality rate was 1.8% (n = 1). The averag utes (from 55 to 204 minutes), aortic clamping time was 56.9 ± 36.4 minutes (from 21 to 126 minutes), the time of selec(from 55 to 204 minutes), aortic clamping time was 56.9 ± 36.4 minutes (from 21 to 126 minutes) tive cerebral perfusion was 26.4 ± 11.5 minutes (14 to 49 minutes). In eight patients (14.5%) the sternum was spread perfusion was 26.4 ± 11.5 minutes (14 to 49 minutes). In eight patients (14.5%) the sternum was sp apart in the early postoperative period. Echocardiography before discharge revealed the average pressure gradient at the part in the early postoperative period. Echocardiograp site of plasticity of the aortic arch of 20.5 ± 14.9 mm Hg. plasticity of the aortic arch of 20.5 ± 14.9 mm Hg. The mean long-term follow-up was 2.6 ± 2.1 years (from two months to 8.1 years). There were no fatal cases in the reg-term follow-up was 2.6 ± 2.1 years (from two months to 8.1 years) mote period. In 5 (9.1%) patients aortic arch restenosis occurred in the postoperative period; it was successfully treated period. In 5 (9.1%) patients aortic arch restenosis occurred in the postoperative period; it was successfully endovascularly by balloon dilation in 3 patients, the other 2 of them underwent repeated aortic arch repair. Long-term y by balloon dilation in 3 patients, the other 2 of them underwent repeated aortic arch repair. Long follow-up of other patients showed good results with respect to the pressure gradient at the aortic arch. There were p of other patients showed good results with respect to the pressure g no hemodynamically significant gradient after VSD closure. There were no neurological complications in the long-term follow-up. p Conclusions. One-stage complete repair is an effective and safe treatment for infants which provides good immedige complete repair is an effective and safe treatment for infants which provides g ate and long-term results. This surgical strategy may be an acceptable alternative to two-stage surgical treatment of this g complex pathology.

scholarly journals Two-Stage Repair of Aortic Arch Hypoplasia Associated with Other Congenital Heart Defects in Newborns and Infants

2021 ◽  
pp. 56-61
Author(s):  
Y. Truba ◽  
I. Dziuryi ◽  
R. Sekelyk ◽  
O. Golovenko ◽  
V. Lazoryshynets
Keyword(s):  
Aortic Arch ◽  
Congenital Heart Defects ◽  
Postoperative Period ◽  
Congenital Heart ◽  
Heart Defects ◽  
Early Postoperative Period ◽  
Long Term Results ◽  
Two Stage ◽  
Aortic Arch Hypoplasia

Background. The optimal tactics of surgical treatment of aortic arch hypoplasia combined with other congenital heart defects remain controversial. In recent years, the leading clinics of the world prefer one-stage repair of such a combination, however, two-stage treatment is still used by cardiac surgeons and remains one of the variants of surgical tactics. The aim. To analyze immediate and long-term results of a two-stage repair of aortic arch hypoplasia with other con-genital heart defects in newborns and infants. Materials and methods. The study included 138 infants who were selected for a two-stage repair of aortic arch hy-poplasia with other congenital heart defects. There were 79 (57.2%) male and 59 (42.8%) female patients. The mean age of the patients was 1.4 ± 0.7 months, mean body weight was 4.1 ± 2.0 kg. The main method of the defect diagnosis and evaluation of immediate and long-term results was echocardiographic examination. The aortic arch segment was consid-ered hypoplastic if the Z-score deviation was less than –2.0. Results. The hospital mortality rate was 5.8% (n = 8). Two patients (1.4%) had delayed sternal closure in the early postoperative period. As a result of severe myocardial failure, two patients underwent extracorporeal membrane oxy-genation (ECMO). According to echocardiography before discharge, the mean pressure gradient at the site of aortic arch repair was 16 ± 6 mmHg. There was one death in the follow-up period. In 16 (11.5%) patients, aortic arch restenosis developed in the postoperative period. In total, 20 re-interventions were performed: 11 endovascular balloon dilatations and 9 surgical re-interventions. In the early postoperative period, aortopexia was performed in two patients (1.4%) due to compression of the left main bronchus. Conclusions. Two-stage repair of aortic arch hypoplasia with other congenital heart defects in newborns and infants is effective and safe treatment with good immediate and long-term results. This study shows that this surgical strategy can be effectively used in this complex pathology.

scholarly journals Reconstruction of the Aortic Arc through Left Thoracotomy in Patients with Isolated Coarctation and Aortic Arch Hypoplasia

2021 ◽  
pp. 70-74
Author(s):  
Y. Truba ◽  
I. Dziuryi ◽  
O. Motrechko ◽  
O. Golovenko
Keyword(s):  
Surgical Treatment ◽  
Aortic Arch ◽  
Median Sternotomy ◽  
Long Term Results ◽  
Aortic Cross Clamp Time ◽  
Left Thoracotomy ◽  
The Mean ◽  
Aortic Arch Hypoplasia

Background. The choice of surgical approach for the reconstruction of aortic arch hypoplasia is a rather controversial issue. Traditionally, left lateral thoracotomy is used to correct aortic coarctation with hypoplasia of one or more arc seg-ments. However, in recent years, more and more clinics have begun widespread use of median sternotomy for the surgical treatment of aortic arch hypoplasia. The purpose of the research was to analyze the immediate and long-term results of surgical treatment of isolated hypoplasia of the aortic arch in infants through left thoracotomy. Materials and methods. From 2010 to 2019, 159 infants with coarctation and hypoplasia of one or more segments of the aortic arch underwent reconstruction of the aortic arch at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and Ukrainian Children’s Cardiac Center. The study included only patients with biventricular physiology and subsequent biventricular correction. There were 108 male patients (68%) and 51 female patients (32%). The mean age of the patients was 2.4 ± 0.9 months, the mean body weight was 4.7 ± 2.0 kg. The main method of diagnosis, i.e. determining the defect and assessing the immediate and long-term results, was echocardiographic examination. The study group consisted of 155 patients (97.5%) in whom the reconstruction of the aortic arch was performed through left thoracotomy, in the remaining 4 patients (2.5%) the intervention was performed through median sternotomy.   Results. In-hospital mortality was 0.6% (n = 1). The average time of the operation was 126 ± 40 minutes, the aortic cross-clamp time was 24.7 ± 5.1 minutes. The mean duration of mechanical ventilation after the surgery was 41 ± 15.9 hours. The mean follow-up period ranged from 1 month to 13 years. There were no deaths in the long-term period. Ten (6.4%) patients developed aortic arch restenosis in the postoperative period. In 8 patients, the narrowing was treated by endovascular dilatation. Two patients underwent repeated aortic arch repair using median sternotomy. There were no cases of compression of the trachea, main bronchi, neurological complications in the follow-up period.   Conclusions. Reconstruction of the aortic arch hypoplasia through left thoracotomy is an effective and safe treatment option in infants associated with good immediate and long-term results. The study indicates that this surgical strategy can be used in most patients with hypoplasia of the isthmus and distal aortic arch.

scholarly journals Reconstruction of the Aortic Arch in Newborns and Infants Using an Extended End-to-End Anastomosis

2021 ◽  
pp. 63-68
Author(s):  
Iaroslav P. Truba ◽  
Ivan V. Dziuryi ◽  
Roman I. Sekelyk ◽  
Oleksandr S. Golovenko
Keyword(s):  
Hospital Mortality ◽  
Aortic Arch ◽  
Median Sternotomy ◽  
Term Survival ◽  
Long Term Survival ◽  
The Mean ◽  
End To End ◽  
Aortic Arch Hypoplasia

The problem of the effectiveness of obstruction at the level of the aortic arch is still a matter of discus-sion in the modern literature. Traditionally, by excision of the coarctation part, in the presence of hypoplasia, the incision is extended to a narrowed area and a modification of the classical end-to-end anastomosis is applied in the form of an elongated or expanded variant. Recently, when proximal part is involved in the pathological process, cardiac surgeons have been more likely to use median sternotomy using other types of plastic surgery, including dilation of the narrowed area with a pericardial patch, or pulmonary artery tissue. Accordingly, the analysis of the results of the use of end-to-end anastomosis in young children with aortic arch hypoplasia, especially in view of long-term survival and the level of reoperation, is an important issue of neonatal cardiac surgery. The aim. To evaluate the effectiveness of the use of an extended end-to-end anastomosis after reconstruction of the aortic arch in children under 1 year of age. Materials and methods. The study material included 348 infants who underwent surgical correction of aortic arch hypoplasia through the method of extended end-to-end anastomosis from 2010 to 2020. The operations were performed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and the Ukrainian Children’s Cardiac Center. The study group included only patients with two-ventricular physiology. There were 233 male patients (67%) and 115 female patients (33%). The mean age was 1.07 (0.20; 2.30) months, the mean weight was 3.89 (3.30; 4.90) kg, the mean body surface area was 0.23 (0.20; 0.28) m2. Diagnosis of aortic arch hypoplasia was based on two-dimensional echocardiography. Results. According to echocardiography, after surgery there was a significant decrease in the pressure gradient in the aortic arch from 48.3 ± 20.3 to 16 ± 6.9 (p<0.05), left ventricular PV increased significantly from 61.6 ± 12% to 66.3 ± 6.4% (p> 0.05). The hospital mortality was 1.7% (n = 6). The causes of mortality were not related to the end-to-end aortic arch technique. The duration of follow-up period ranged from 1 month to 9.3 years. Two deaths occurred in the follow-up period. Thirty-two (9.1%) patients developed aortic arch restenosis in the postoperative period. Balloon dilatation of restenosis was performed in 21 patients. Eleven patients underwent repeated aortic arch repair surgery through the median sternotomy. There were no central nervous system complications in the follow-up period. Conclusions. The use of an extended end-to-end anastomosis in the surgical treatment of aortic arch hypoplasia demon strates low hospital mortality and high long-term survival. Indications for the effective use of this type of reconstruction are hypoplasia of the isthmus and distal aortic arch.

Results at 10–24 years after single-stage revision arthroplasty of infected total hip arthroplasty in patients under 45 years of age

2019 ◽  
pp. 112070001988887 ◽  
Author(s):  
Matthias Wolff ◽  
Christian Lausmann ◽  
Thorsten Gehrke ◽  
Akos Zahar ◽  
Malte Ohlmeier ◽  
...  
Keyword(s):  
Infection Control ◽  
Revision Surgery ◽  
Single Stage ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Study Cohort ◽  
One Stage ◽  
The Mean

Introduction: The management of periprosthetic joint infection (PJI) of the hip is a challenging procedure. One-stage exchange is carried out in specialist centres with comparable infection free survival rates. However, there is a paucity of long-term results of this approach in young patients. Methods: All patients undergoing one-stage exchange due to PJI with a known causative organism ⩽45 years of age with a minimum of 10-year follow-up (mean 15 years; range 10–24 years) were enrolled in this retrospective study. Patients older than 45 years of age or patients with a two-stage procedure were excluded from the study. The primary outcome measure was failure rate with special focus on reinfection at latest follow-up. Failure was defined as revision surgery for infection. Furthermore, functional outcome using the Harris Hip Score was determined initially and at latest follow-up. 26 patients fulfilled the inclusion criteria and were available for final follow-up. Results: The study cohort consists of 16 male and 10 female patients with a mean age of 36.8 years (range 20–45 years) and a mean BMI of 29.8 kg/m2 (range 20.7–40.6 kg/m2). Prior to the single-stage procedure, the patients underwent an average of 3.1 previous surgical interventions (range 1–9). The mean hospital stay after septic revision was 19.7 days (11–33 days). Most infections were caused by Staphylococcus epidermidis ( n = 8, 30.8%), followed by Staph. aureus ( n = 7, 26.9%) and Propionibacterium acnes ( n = 6, 23.1%). At latest follow-up, the overall survival rate was 76.9 %, while infection control could be achieved in 96.2%. At final examination, the mean Harris Hip Score improved from 46.2 to 78.9 (range 18.0–99; SD, 22.6). Conclusions: Single-stage revision surgery for the management of PJI in patients ⩽45 years is a successful treatment option with high infection control, even after long-term follow-up.

scholarly journals A 6-year experience of the Ross procedure in children with congenital aortic valve disease

2020 ◽  
Vol 48 (4) ◽  
pp. 240-245
Author(s):  
D. S. Akatov ◽  
V. A. Belov ◽  
D. E. Khomich ◽  
O. N. Bukhareva ◽  
A. A. Makarov ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pulmonary Artery ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Ross Procedure ◽  
Optimal Method ◽  
Advantages And Disadvantages ◽  
The Mean

Background: The choice of an optimal method for correction of aortic valve stenosis or insufficiency remains the matter of debate. Some clinicians prefer transluminal balloon angioplasty, some would perform an open type commissurotomy, or aortic valve replacement, or to valve leaflets repair with various materials, while others opt for the Ross procedure. Each of these techniques has its advantages and disadvantages both in the early postoperative period and in the long-term.Aim: To assess the results of the Ross procedure, its complications, survival, and probability of reoperations in the long-term.Materials and methods: We retrospectively analyzed the results of 32 Ross procedures performed from the end of 2012 to the beginning of 2019 in children aged from 3 days to 18 years. Eight children were below 1 year of age, including one newborn. A pulmonary autograft was placed into the aortic position in all children. In 31 children, a homograft was placed into the pulmonary artery. In one patient, an aortic autograft was implanted instead of the pulmonary artery valve. The mean patient age was 6.8 years, mean bodyweight 27.7 kg (range, 3.9–74.6 kg).Results: Two patients died in the early postoperative period (mortality 6.25%). We examined 26 patients at the follow-up, with its mean duration of 2.5 years. There were no indications for replacement of the homograft during the follow-up. One patient, in whom we had implanted an aortic autograft into the pulmonary position, required its replacement after 4.5 years. We have no data on death rates in the long-term.Conclusion: The Ross procedure provides satisfactory results in the early and intermediate postoperative period. Continuous follow-up is needed to determine the time points and the proportion of repeated interventions with a pulmonary homograft and aortic valve.

scholarly journals long-term results after the one-stage posterior-only surgical correction of thoraco-lumbar kyphoscoliosis in congenital spine deformity caused by two ipsilateral hemi-vertebrae

2020 ◽  
Author(s):  
Xuhong Xue ◽  
Sheng Zhao ◽  
Feng Miao ◽  
Kai Li ◽  
Bin Zhao
Keyword(s):  
Sagittal Plane ◽  
Surgical Correction ◽  
Neurological Injury ◽  
Long Term Results ◽  
Spine Deformity ◽  
One Stage ◽  
The Mean ◽  
The One

Abstract Background Two ipsilateral hemivertebrae is less common and presents severe growth imbalance produced by the vertebral anomalies. However, there is a paucity of reports regarding this double ipsilateral thoracolumber hemivertebrae. The purpose was to evaluate the long-term outcomes of the one-stage posterior-only surgical correction of thoraco-lumbar kyphoscoliosis caused by two ipsilateral hemi-vertebrae. Methods From 2006 to 2014, a total of 14 consecutive pediatric patients with congenital thoraco-lumbar kyphoscoliosis due to two ipsilateral hemivertebrae were treated by posterior excision of hemivertebrae with short segment fusion. The following parameters were measured: coronal segmental curve, cranial and caudal compensatory curve, segmental kyphosis, lumbar lodorsis, trunk shift, apical vertebra translation and sagittal vertical axis. These results were compared and evaluated in preoperative, immediately postoperative and at the final follow-up. All patients had a minimum of 5 years of follow-up period. Results The mean age at surgery was 11.1 ± 4.8 years (2yos to 17yos). The mean follow-up period was 80.2 ± 19.4 months (60mons to 117mons). There was a mean improvement of 74.2% in the segmental curve from a mean angle of 64.1° before surgery to 15.8° at the latest follow-up. The cranial and caudal curve improved of 69.8% and 69.0% from 25.6° to 7.7°, 26.9 to 8.2, respectively. The mean thoracolumbar kyphosis was 59.9° before and 13.6° after surgery, 20.8° at the final follow-up. Alignment in the coronal and sagittal plane was either maintained or improved within normal values in all patients. Conclusions Good correction and spinal balance can be achieved by posterior-only hemivertebrectomy in patients with thoracolumbar kyphocsoliosis caused by two ipsilateral hemivertebra. The complication of neurological injury is low but a technically demanding procedure. More attention should be paid in residual curve progression after surgery.

scholarly journals Aortic Arch Reconstruction in Infants Using Autologus Pericardium

2020 ◽  
pp. 51-55
Author(s):  
Y. Truba ◽  
A. Dovhaliuk ◽  
I. Dziuryi ◽  
O. Golovenko ◽  
V. Lazoryshynets
Keyword(s):  
Aortic Arch ◽  
Long Term Results ◽  
Autologous Pericardium ◽  
Autologous Pericardial Patch ◽  
Aortic Arch Reconstruction ◽  
The Mean ◽  
Arch Reconstruction ◽  
Average Body

  Background. Aortic arch hypoplasia is a congenital anomaly of the development of the aortic arch characterized by hemodynamically significant narrowing of one or more segments of the aortic arch. This defect occurs either as an isolated condition or combined with other congenital heart defects. The materials used to enlarge aorta for successful repair and prevention of postoperative complications range from the patient’s own aortic tissue (in most cases) to other materials (autopericardium, xenopericardium, pulmonary artery tissues, synthetic patches). An autologous pericardial patch is the most common, available and cheap option. The purpose of this work is toanalyze immediate and long-term results of our experience using autologous pericardium to reconstruct the aortic arch. Materials and methods. From 2011 to 2019 at the National M.M. Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and Ukrainian Children’s Cardiac Center 16 infants underwent aortic arch repair using autologous pericardial patch. The group included 6 (37.5%) male and 10 (62.5%) female patients. The mean age of the patients was 1.3 ± 0.9 months (from 0.06 to 4.5 months), the average body weight was 3.8 ± 1.6 kg (from 2.2 to 8.7 kg). The average body surface area was 0.24 ± 0.05 m?. Antegrade selective cerebral perfusion was performed in all the patients during the aortic arch reconstruction. Results. Hospital mortality was 6.2% (n = 1). The cause of death was not related to the reconstruction technique. The average duration of cardiopulmonary bypass was 142.5 ± 38.5 minutes, the aortic cross-clamp time was 76.9 ± 33.7 minutes, and the time of selective cerebral perfusion was 50.4 ± 25.4 minutes. Six patients (37.5%) in the early postoperative period had delayed sternal closure. According to echocardiographic data at discharge, the average pressure gradient at the site of aortic arch reconstruction was 15 ± 5.5 mm Hg, the left ventricular ejection fraction was 65.9 ± 5.9%. The mean follow-up period ranged from one month to 6.1 years (mean 2.8 ± 2.3 years). There were no deaths in the long-term period. Four (25%) patients developed aortic arch restenosis in the postoperative period. One patient presented with an aortic arch aneurysm 1 month after the initial operation. There were no cases of compression of the trachea, main bronchi, neurological complications in the follow-up period. Conclusions. The use of autologous pericardium in aortic arch reconstruction is an effective and safe procedure for infants with good immediate and long-term results. The study showed that autologous pericardium may be an acceptable alternative to reconstruct the aortic arch. A large percentage of reinterventions encourages more thorough removal of ductal tissues and determining the size of the autopericardial patch.

Long-term Results After the One-stage Posterior-only Surgical Correction of Thoraco-lumbar Kyphoscoliosis in Congenital Spine Deformity Caused by Two Ipsilateral Hemi-vertebrae

2020 ◽  
Author(s):  
Xuhong Xue ◽  
Sheng Zhao ◽  
Feng Miao ◽  
Kai Li ◽  
Bin Zhao
Keyword(s):  
Sagittal Plane ◽  
Surgical Correction ◽  
Neurological Injury ◽  
Long Term Results ◽  
Spine Deformity ◽  
One Stage ◽  
The Mean ◽  
The One

Abstract Background: Two ipsilateral hemivertebrae is less common and presents severe growth imbalance produced by the vertebral anomalies. However, there is a paucity of reports regarding this double ipsilateral thoracolumber hemivertebrae. The purpose was to evaluate the long-term outcomes of the one-stage posterior-only surgical correction of thoraco-lumbar kyphoscoliosis caused by two ipsilateral hemi-vertebrae. Methods: From 2006 to 2014, a total of 14 consecutive pediatric patients with congenital thoraco-lumbar kyphoscoliosis due to two ipsilateral hemivertebrae were treated by posterior excision of hemivertebrae with short segment fusion. The following parameters were measured: coronal segmental curve, cranial and caudal compensatory curve, segmental kyphosis, lumbar lodorsis, trunk shift, apical vertebra translation and sagittal vertical axis. These results were compared and evaluated in preoperative, immediately postoperative and at the final follow-up. All patients had a minimum of 5 years of follow-up period.Results: The mean age at surgery was 11.1±4.8 years (2yos to 17yos). The mean follow-up period was 80.2±19.4 months (60mons to 117mons). There was a mean improvement of 74.2% in the segmental curve from a mean angle of 64.1° before surgery to 15.8° at the latest follow-up. The cranial and caudal curve improved of 69.8% and 69.0% from 25.6° to 7.7°, 26.9 to 8.2, respectively. The mean thoracolumbar kyphosis was 59.9° before and 13.6° after surgery, 20.8° at the final follow-up. Alignment in the coronal and sagittal plane was either maintained or improved within normal values in all patients.Conclusions: Good correction and spinal balance can be achieved by posterior-only hemivertebrectomy in patients with thoracolumbar kyphocsoliosis caused by two ipsilateral hemivertebra. The complication of neurological injury is low but a technically demanding procedure. More attention should be paid in residual curve progression after surgery.

Surgical treatment of trigonocephaly: technique and long-term results in 48 cases

2011 ◽  
Vol 7 (3) ◽  
pp. 300-310 ◽  
Author(s):  
Fatma Ozlen ◽  
Ali Metin Kafadar ◽  
Bashar Abuzayed ◽  
Mustafa Onur Ulu ◽  
Cihan Isler ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Early Postoperative Period ◽  
Frontal Bone ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Structural Abnormality ◽  
Hospitalization Period ◽  
The Mean

Object The authors present their experience in the surgical treatment of metopic synostosis by orbital bandeau remodeling and frontal bone rotation. The pitfalls and advantages of the surgical technique are discussed, along with the long-term clinical results in 48 consecutive cases. Methods Forty-eight consecutive patients in whom trigonocephaly was diagnosed between 1990 and 2009 were treated with frontal bone rotation and frontoorbital bandeau remodeling. Of these patients, 38 (79%) were boys and 10 (21%) were girls. The age at the time of surgical treatment ranged between 4 and 42 months (mean ± SD 11.4 ± 8.7 months). The average follow-up period was 5.5 ± 4.2 years (range 5 months–19 years). The preoperative and latest postoperative photographs of the patients were evaluated for the following features: 1) shape of the forehead; 2) hypotelorism; and 3) temporal depression. Scores of 0, 1, or 2 were assigned for each item: 0 was normal, 1 meant moderate deformity, and 2 denoted severe deformity. Results In the early postoperative period, no complications were documented. The average hospitalization period was 4 days. Follow-up radiographs or 3D CT scans were obtained at regular intervals. The mean preoperative scores for the evaluated items were 1.38 ± 0.49 for the shape of the forehead, 1.33 ± 0.48 for hypotelorism, and 1.7 ± 0.46 for the temporal depression. The mean postoperative scores were 0.06 ± 0.24 for the shape of the forehead, 0.21 ± 0.4 for hypotelorism, and 0.67 ± 0.48 for the temporal depression. Overall, the total preoperative score dropped from 4.4 to 0.93 postoperatively (p < 0.05). All the patients were contented with the cosmetic results. Conclusions Early detection and treatment of metopic suture synostosis has a significant, favorable influence on the outcomes. Good understanding of the structural abnormality and the pathophysiological mechanisms of the possible complications is very important for performing proper surgical reconstruction.

Clinical Experience with a New Nitinol Self-Expanding Stent in Peripheral Arteries

1996 ◽  
Vol 3 (4) ◽  
pp. 369-379 ◽  
Author(s):  
Michel Henry ◽  
Max Amor ◽  
Rafael Beyar ◽  
Isabelle Henry ◽  
Jean-Marc Porte ◽  
...  
Keyword(s):  
Long Term Results ◽  
Lesion Length ◽  
Secondary Patency ◽  
Peripheral Arteries ◽  
External Compression ◽  
Nitinol Stent ◽  
Nitinol Stents ◽  
The Mean

Purpose: To evaluate a new self-expanding nitinol coil stent in stenotic or occluded peripheral arteries. Methods: Seventy-three symptomatic patients (58 men; mean age 67 years) were treated with nitinol stents for lesions in the iliac artery (9 stenoses); superficial femoral artery (SFA) (39 stenoses, 6 occlusions); popliteal artery and tibioperoneal trunk (9 stenoses, 7 occlusions); and 3 bypass grafts. Mean diameter stenosis was 84.4% ± 9.9% (range 75% to 100%), and mean lesion length was 45 ± 23 mm (range 20 to 120 mm). Results: Eighty-eight 40-mm-long stents with diameters between 5 and 8 mm were implanted percutaneously for suboptimal dilation (n = 45); dissection (n = 21); and restenosis (n = 7). All stents but one were implanted successfully; the malpositioned stent was removed, and another stent was successfully deployed. There were 3 (4.1%) failures due to thrombosis at 24 hours. During the mean 16-month follow-up (range to 44 months), 4 restenoses (3 femoral, 1 popliteal) have occurred; 2 were treated with repeat dilation and 2 underwent bypass. Primary and secondary patency rates at 18 months were 87% and 90%, respectively, for all lesions (iliac: 100% for both; femoral: 85% and 88%; popliteal: 87% and 100%). Conclusions: This new nitinol stent seems to be safe and effective with favorable long-term results, even in distal SFA lesions and popliteal arteries. Its flexibility and resistance to external compression allow its placement in tortuous arteries and near joints.

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