Partial atrio-ventricular canal is usually symptomatic and treated surgically in a childhood. In the literature, only eight cases have been operated on over fifty years of age. We experienced two cases of partial atrio-ventricular canal; one was 63-year-old female and the other was 67-year-old male. The female patient showed rapid increase of the pulmonary pressure during the last three years. The male patient had moderate mitral regurgitation with mild pulmonary hypertention. Although the repair of the mitral valve was successful in the female patient, it was difficult in the male patient because of massive calcification along the edges of the mitral cleft. Blood biochemistry data revealed the liver cirrhosis due to congestion in the male patient. Because of poor tolerance of the viscera in aged patients, it is quite important not to raise the central venous pressure more than 15cmH₂O at the cessation of the cardio-pulmonary bypass. Over-hydration may cause congestive heart failure easily, and take into vicious cycle. Of course early operation is better, these two cases, however, had uneventful course and resumed active life early in their postoperative days. Results of them encouraged us to treat aged patient of partial atrio-ventricular canal surgically.

When coronary artery bypass grafting (CABG) is to be done, we use the internal thoracic artery (ITA) as a graft conduit in order to obtain longer patency. When the ITA acts as a good collateral to the lower extremities, blood flow to the extremities may decrease after CABG with ITA. Simultaneous open heart surgery and laparotomy may cause pulmonary complication. We made an algorithm of treatment for patients with coronary artery disease (CAD) and aortoiliac occlusive disease including these problems. From July 1991 to March 1992, 6 patients were operated and reviewed. Four patients were operated on for CAD and AIOD simultaneously. Two patients were operated on for CAD or AIOD at first and for the other secondarily. All 6 cases were discharged without any complications and are now free from angina and intermittent claudication. When the therapeutic plan for the patients with CAD and AIOD is made, it is very important that coronary revascularization is planned at first with careful evaluation of the blood flow to the lower extremities in cases with AIOD.

A rare case of atlantoaxial rotatory subluxation occurred after pediatric cervical spine surgery performed to remove a dumbbell-shaped meningioma at the level of the C1/C2 vertebrae. This case is classified as a post-surgical atlantoaxial rotatory subluxation, but has a very rare morphology that has not previously been reported. Although there are several reports about post-surgical atlantoaxial rotatory subluxation, an important point of this case is that it might be directly related to the spinal cord surgery in C1/C2 level. On day 6 after surgery, the patient presented with the Cock Robin position, and a computed tomography scan revealed a normal type of atlantoaxial rotatory subluxation. Manual reduction was performed followed by external fixation with a neck collar. About 7 months after the first surgery, the subluxation became severe, irreducible, and assumed an atypical form where the anterior tubercle of C1 migrated to a cranial position, and the posterior tubercle of C1 and the occipital bone leaned in a caudal direction. The pathogenic process suggested deformity of the occipital condyle and bilateral C2 superior facets with atlantooccipital subluxation. A second operation for reduction and fixation was performed, and the subluxation was stabilized by posterior fixation. We encountered an unusual case of a refractory subluxation that was associated with an atypical deformity of the upper spine. The case was successfully managed by posterior fixation.
Congenital Abnormalities ; Humans ; Meningioma ; Neck ; Occipital Bone ; Songbirds ; Spinal Cord ; Spine

A total of 183 patients who underwent surgical repair of secundum type atrial septal defect (ASD), were divided into 5 age groups. Hemodynamic parameters, arrhythmia, and abnormality of the atrio-ventricular valve function were compared among the 5 groups. Although the pulmonary to systemic blood flow ratio was not different, the pulmonary to systemic pressure ratio was higher in the sixth decade than in the third (p<0.05) and fourth (p<0.01). Pulmonary to systemic vascular resistance ratio increased with age, although the difference was not statistically significant. The cardiothoracic ratio, atrial fibrillation and tricuspid regurgitation (TR) also increased with age. These data suggest that ASD progresses with age. There were 41 patients who showed more than grade II TR, 10 patients underwent tricuspid annuloplasty (TAP), 1 underwent tricuspid valve replacement, and the other 30 patients had no treatment of the tricuspid valve. TAP with DeVega's (6 cases) or Carpentier-ring (1) method was effective. In 30 untreated TR patients, 9 patients remained with grade II TR after closure of the defect. Because TAP is an easy and very effective procedure, TAP should have been applied to all patient with TR more severe than grade II. There were 10 patients with mitral regurgitation (MR) of more than grade II. Two patients in whom mitral valve prolapse had been detected on ultrasound cardiography (UCG) before operation underwent mitral valve plasty successfully. Although MR decreased in 6 patients after only ASD closure, two patients remained with grade II MR. We now recommend that the mitral valve should be assessed under direct vision, and intraoperative trans-esophageal echo cardiography, and also that the mitral regurgitation test as well as preoperative UCG should be performed. Because ASD is progressive with age, surgical repair should be performed before age 40.

STUDY DESIGN: The strength effects of a pedicle screw-rod system supplemented with a novel cross-link configuration were biomechanically evaluated in porcine spines. PURPOSE: To assess the biomechanical differences between a conventional cross-link pedicle screw-rod system versus a novel cross-link instrumentation, and to determine the effect of the cross-links. OVERVIEW OF LITERATURE: Transverse cross-link systems affect torsional rigidity, but are thought to have little impact on the sagittal motion of spinal constructs. We tested the strength effects in pullout and flexion-compression tests of novel cross-link pedicle screw constructs using porcine thoracic and lumbar vertebrae. METHODS: Five matched thoracic and lumbar vertebral segments from 15 porcine spines were instrumented with 5.0-mm pedicle screws, which were then connected with 6.0-mm rods after partial corpectomy in the middle vertebral body. The forces required for construct failure in pullout and flexion-compression tests were examined in a randomized manner for three different cross-link configurations: un-cross-link control, conventional cross-link, and cross-link passing through the base of the spinous process. Statistical comparisons of strength data were analyzed using Student's t-tests. RESULTS: The spinous process group required a significantly greater pullout force for construct failure than the control group (p=0.036). No difference was found between the control and cross-link groups, or the cross-link and spinous process groups in pullout testing. In flexion-compression testing, the spinous processes group required significantly greater forces for construct failure than the control and cross-link groups (p<0.001 and p=0.003, respectively). However, there was no difference between the control and cross-link groups. CONCLUSIONS: A novel cross-link configuration that features cross-link devices passing through the base of the spinous processes increased the mechanical resistance in pullout and flexion-compression testing compared to un-cross-link constructs. This configuration provided more resistance to middle-column damage under flexion-compression testing than conventional cross-link configuration.
Lumbar Vertebrae ; Pedicle Screws ; Spinal Fusion ; Spine