Supravalvular aortic stenosis surgical repair using modified Sousa's technique

Relato de uma paciente de sete anos apresentando progressiva intolerância ao esforço. A criança apresentava taquicardia e sopro pansistólico de maior intensidade no foco aórtico. O ecocardiograma evidenciava hipertrofia ventricular esquerda e estenose aórtica supravalvar com gradiente sistólico de 190 mmHg. A angioressonância e o cateterismo cardíaco confirmaram o diagnóstico, sugerindo estenose do óstio da artéria coronária esquerda. A correção foi realizada modificando a técnica descrita por Sousa. A evolução pósoperatória transcorreu sem intercorrências, com gradiente pós-operatório de 23 mmHg e boa mobilidade da valva aórtica.Report of a patient with seven years old and effort intolerance progressing. The child had tachycardia, pansystolic murmur in the aortic focus. Echocardiography showed left ventricle hypertrophy and aortic narrowing at the level of sinotubular junction with sistolic gradient of 190 mmHg. Cardiac catheterization confirmed the diagnostic suggesting left coronary ostium stenosis. The surgery was performed modification the technique, described by Sousa. Immediate post-operative has presented no complications, with gradient of 23 mmHg, and good leaflets mobility

Technical modification for composite grafts in myocardial revascularization surgery

OBJECTIVE: In the last decade, the coronary artery bypass grafts (CABG) with arterial grafting had been remarkable, mainly the combined ones in Y or T form, which start from the left internal thoracic artery (LITA). Elaborating this kind of grafting, we identified a certain worry related to the anastomoses of the radial artery in LITA, principally when realized in T, since any small traction, angulations or spasms of the radial artery might impaired the flow of the distal anastomoses of LITA to the anterior interventricular artery. METHOD: We modified the combined graft technique, by making anastomoses of the radial artery to the anterior interventricular artery, and, consequently the LITA is sewed above the anastomoses of the radial artery to the anterior interventricular artery, favoring therefore, the revascularization of the anterior interventricular artery with the LITA, transforming the radial artery into almost an extension of the LITA to the remaining branches of the left coronary artery. CONCLUSIONS: This technical modification for these composite grafts is simple, safer and effective, and it will enable a larger number of surgeons to routinelyuse composite grafts in coronary artery bypass grafting