Research Article         Month : 04 (2019)

Comparison of the Mortality Rates of Surgical Techniques for Correcting Atrioventricular Disjunction

  Marcelo Luiz Peixoto Sobral

Objective: A left ventricular rupture is a rare but lethal complication of surgical mitral valve replacement. We compared the mortality rates of two different surgical techniques for the correction of atrioventricular disjunction. Methods: From January 2005 to January 2012, 720 patients underwent mitral valve replacement at our institution. Two different surgical techniques were used for the correction of atrioventricular disjunction. The techniques were: in group I, the mitral annulus was fixed with bovine pericardial strips; in group II, a ‘patch’ of bovine pericardium was sutured; the patch extended from the base of the lateral and medial papillary muscle, covered the posterior wall of the left ventricle, went through the posterior mitral annulus, and ended in the posterior wall of the left atrium adjacent to the mitral ring. Results: Atrioventricular disjunction occurred in 10 (1.39%) of 720 patients, out of which the group I technique was used in 6 (60%) patients, and the group II technique in 4 (40%) patients. The mortality rate for the group I technique was 100% (6 patients) with 5 deaths in the operating room and 1 death from postoperative cardiogenic shock. For the group II technique, the mortality rate was 25% (1 patient) and the death was associated with late pulmonary sepsis. Conclusion: The group II technique showed a lower mortality, and was more efficient than the group I technique. Descriptors: Mitral valve. Heart rupture, Mitral valve insufficiency, Mitral valve stenosis

   Research Article         Month : 04 (2019)

Treatment and Prognostic Factors of Subaracnoid Aneurysmatic Hemorrhage

  José Manuel Ortega Zufiría

Aneurysmal Subarachnoid Haemorrhage (SAH) is a very serious neurosurgical problem, associated with high rates of morbidity and mortality. After the initial haemorrhage, up to 50% of the patients die, and 30-40% of the patients suffer a new bleeding during the first month. The percentage of deaths due to a new bleeding is between 60% and 75%. Both endovascular embolization and surgery treatments reduce the mortality rate and improve the quality of life of the survivors. In recent years, endovascular embolization has become the method of choice to prevent new bleeding, especially in Europe, widely replacing surgery. The aim of this study was to describe a series of patients with spontaneous subarachnoid haemorrhage, secondary to aneurysmal rupture, treated at the University Hospital of Getafe between 2010 and 2019, to study the different diagnostic and treatment options, and to define the most important prognostic factors. In addition, compare the results of both treatments (surgical and endovascular). Material and Methods: We studied 110 patients, 58 men and 52 women, with an average age of 40.8 years. A retrospective study has been carried out, reviewing clinical histories and collecting epidemiology. Results: Of the total, 25 patients have been treated surgically and 85 by endovascular embolization. It has been established that the best management in this type of patients is the performance of Computed Tomography (CT) of the skull and cerebral arteriography, as well as admission for surveillance in the ICU. Discussion: In this study, the neurological clinical situation at admission, the volume and distribution of blood in the CT and the age of the patient, seem to be the most influential variables in the final result.

   Research Article         Month : 04 (2019)

Outcomes of Dermal Sling Based Breast Reconstruction

  Tarannum Fasih

Background: Dermal sling is a de-epithelialized skin flap created for breast reconstruction. It acts as a cover for the breast implant placed in the sub muscular pocket. The advantage of this technique is the use of redundant breast skin to act as support for the implant whilst also reducing size of the breast. The aim of this study is to review outcomes following this type of reconstruction. Methods: All patients undergoing this form of breast reconstruction from 2011- April 2015 were included. The indication of surgery (cancer and prophylactic group), implant sizes, neo-adjuvant and adjuvant treatment given, follow up and significant local complications were recorded. Results: 23 patients underwent 28 procedures. 15 ladies had breast cancer and13 had prophylactic surgery. Average size of implant used was 532g (295-765g). 5 received radiation to the reconstructed breast 1 had previous wide local excision & radiation. 9 patients had adjuvant and 1 had neo-adjuvant chemotherapy. No loss of implant was seen after radiation treatment. Follow up was 49.3 months (7-56).There was necrosis of T junction in 1 patient who had previous radiotherapy treatment after WLE. 3(10.7%) cases of infection were seen, 1 of the patient lost the implant due to severe infection. There were 2 local recurrences and 1 reconstruction was taken down. 2 extrusions of implant took place 1 of which was replaced and 1 was lost. Total implant loses were seen in 3 cases (10.7%). Conclusion: Dermal sling reconstruction is a safe option despite local and systemic adjuvant treatment and has a dual benefit of creating a smaller breast and avoids using a biological or synthetic mesh: the long-term results of which are not known