Background: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results.Objective: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease.Methods: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant.Results: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. Conclusion:The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes.

Aim Case report regarding the repair of a complex incisional hernia, with loss of domain (LoD), where adjuvant techniques were used. Materials and methods Data from the patient's electronic chart and literature review. Results A 77-year-old female patient is referred for evaluation. She had a multi-recurrent incisional hernia, symptomatic with pain and recurrent episodes of intestinal occlusion. Clinical and imaging evaluation confirmed a complex incisional hernia with LoD, located in the left iliac and flank regions. Abdominal wall muscle blockade was done with botulinum toxin. A progressive pneumoperitoneum catheter was placed laparoscopically, and 11 liters of air were instilled over 13 days. Imaging showed lengthening of the AW muscles. Posterior component separation and transversus abdominis release was performed on the left side, and a retrorectus dissection the right side. A macroporous polypropylene mesh was attached on the left to the twelfth rib, psoas muscle, transverse process of lumbar vertebrae, iliac crest, Cooper's ligament and pubis, and on the right with transfascial sutures. A seroma developed on the post operative period. No other complications occurred. Discussion If a patient never had an AW reconstruction surgery, with a mesh on the retromuscular plane, this option should be offered, by a specialized hernia surgeon, regardless of the number of recurrences. Progressive pneumoperitoneum has existed for many years, but is seldom used. Likewise, botulinum toxin is emerging as a powerful tool to prepare AW reconstruction, but much is still unknow. Heterogeneity in the data is a hinderance to the wide adoption of these techniques.

Se estudian 38 pacientes intervenidos de anuloplastia mitral con anillo de Carpentier. Se hace una correlación entre el grado de soplo mitral pre- y postoperatorio, y se comparan estos hallazgos con la cardiomegalia y el tamaño de la aurícula izquierda en la radiología, así como el estudio angiocardiográfico pre- postoperatorio. De los 38 pacientes que fueron inteirvenidos, solamente 3 (7'8%) presentaron una elevación significativa de la presión sistólica de la arteria pulmonar, así como regurgitación importante desde el punto de vista angiocardiográfico. Estos tres enfermos precisaron una reintervención quirúrgica. El 60'52% no presentaron soplos postoperatorios o éstos eran de grado I y, en cambio, el 76'32% no presentaron regurgitación mitral. De 14 pacientes con soplo sistólico grado II en el postoperatorio, solamente ocho tenían regurgitación grado II.  Por tanto se observa que no existe una correlación entre la magnitud del soplo y el grado de regurgitación mitral angiocardiográfica.  Se concluye que el anillo de Carpentier restaura la función valvular mitral a su normalidad en la mayoría de los casos y que los resultados angiocardiográficos son favorables.