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Successful “correction” of transposed great arteries by Mustard's operation
94
INTERNATIONAL
and 29 per cent were resistant to chloramphenicol. Prompt surgical management of
ABSTRACTS
OF PEDIATRIC
SURGERY
found to be a 2.5 cm. diverticulum of the pericardium. The lesion was excised uneventfully.-CoIin C. Ferguson
were asymptomatic and twenty-nine were symptomatic, with vomiting occurring in twenty-eight, bleeding in thirteen, esophageal obstruction in eleven and pain in two. Roentgen studies demonstrated anatomic as well as functional abnormalities at the esophagogastric junction; however, there was no correlation between hernia size and severity of symptoms. The authors emphasize that persistent neonatal vomiting is an indication for appropriate roentgen studies to rule out hiatal hernia. In such infants, where a hiatal hernia can be demonstrated as the cause of vomiting, postural treatment often makes the infant asymptomatic. Hematemesis, melena, or anemia indicate esophagitis due to reflux and are indications for surgical consultation. Transthoracic repair of the hernia in uncomplicated cases gives good results. With esophagitis and esophageal stricture, dilation
DIWRTICULIJ~~ OF THE LEFT VENTRICLE. E. El-Akkari, M. K. B. El-Din and A. S.
may be of some value, but esophagectomy and bowel interposition have given best results.
complications man
is required.-Edward
.I. Be+
DIVERTICULUM OF THE PERICARDIUM.M. N.
Srouji and Surg.
W.
8:296,
T.
Mustard.
Canad.
J,
1965.
A chest roentgenogram of a 12 year old boy suffering from asthma revealed an abnormal density on the left side of the cardiac shadow near the apex. An aneurysm of the left ventricle was suspected. Complete investigation, including angiocardiography, however, was negative. An exploratory thoracotomy was performed and the mass was
Kassem. A case verticulum
Arch.
Dis.
Child.
40:545,
1965.
is described of a congenital diof the left ventricle which pro-
truded through a defect in the diaphragm behind the xiphoid process into a large epigastric hernia. The hernia was covered with thin, pigmented skin. At operation the diverticulum was excised and the diaphragmatic defect and the hernia were repaired. The child died from ventricular fibrillation shortly after operation. Autopsy revealed a large ventricular septal defect. The condition is due to an abnormality of the septum transversum, which normally gives rise to the basilar part of the pericardium, the ventral part of the diaphragm and the ventral cephalic portion of the abdominal wall. If the epimyocardium of the cardiac loop fuses to the septum transversum, a cardiac diverticulum develops when the septum descends.-.I.
H. Johnston
ESOPHAGEAL HIATUS HEHNIA IN INFANCY AND CHILDHOOD. George H. Humphreys, P. D. Wiedel, D. H. Baker and W. E. B&n.
Pediatrics
36:351-358,
1965.
The diagnosis of esophageal hiatus hernia was established in thirty-four infants and children I2 years of age and less during the twenty year period from 1943 to 1963 at Babies Hospital in New York City. Five
Sixteen of the thirty-four patients were treated without operation. Twelve of these had a good or a fair result, and two died. Eighteen patients were operated upon; twenty-three operations were performed. The result in fifteen patients was good; seven of these were treated by simple transthoracic herniorrhaphy and eight by esophagectomy and bowel interposition. Five operations failed, and reoperation was done. There were two deaths.-W. Sieber
HEART
AND
GREAT
VESSELS
SUCCESSFUL “CORRECTION” OF TRANSPOSED GREAT ARTERIES BY MUSTARD’S OPERATION. Eoin Aberdeen, David J. Waterston, Ian Carr, Gerald Graham, R. E. BonhamCartm and S. Subramanian. Lancet 2: 1233-1235,
1965.
The successful operative correction of transposed great arteries in seven children is reported in this article. A functionally normal circulation was achieved by rerouting the blood within the atria. The method used to redirect the blood flow within the atria was Mustards technic with certain modifications introduced by the authors. All children in the series had an atria1 septal defect created by the technic of Blalock and Hanlon. All the children had care-
INTERNATIONAL
ful preoperative
ABSTBACTS
catheter
OF PEDIATRIC
studies.
Right
and
left ventricmar pressures were obtained in all, and pulmonary artery pressures in two. The pulmonary-systemic flow ratio and pulmonary vascular resistance as fraction of systemic were estimated. The cases reported are a selected series and include only those with a near-normal pulmonary vascular resistance. No major communications were present between the pulmonary and systemic circulations. The operative technic is fully described. In the first case, the atria1 septum was completely excised as described by Mustard. A pericardia1 graft was sutured into the atrium so as to redirect the caval return to the left ventricle and pulmonary venous return to the right ventricle. In the subsequent cases, a modification was introduced which consisted of preserving the atria1 septum as a pedicle flap. This method ensured that sutures were not placed in a region close to the atrioventricular node and bundle of His. Secondly. norma tissue with vascular supply which will not contract was preserved. This normal tissue could even stretch, should the pericardial graft contract after operation. In this series, seven out of nine children treated by this operation have survived. The survivors showed two prominent features. First there was a significant incidence of supraventricular arrhythmias. Secondly. there was immense clinical improvement in the survivors.-D. J. Waterston
STAGED REPAIR OF PULMONIC HYP~PLASTIC
RIGHT
STENOSIS AND
VENTRICLE.
G.
D.
Berman, L. M. Linde and D. G. Mulder. Arch. Surg., 91:597, 1965. T\+o infants were reported, wherein severe pulmonary valvular stenosis is associated with hypoplasia of the right ventricle. A closed transventriculotomy was performed as an emergency procedure. This was subsequentIy folIowed with definitive repair. Both children are now asymptomatic and appear to be normal.-Edtr;ard .I. Berman
A
MEMBRANE PRIMING
OXYGENATOR
VOLUME
WITH
Low
FOR EXTRACORPOREAL
CIRCULATION. R. Wilson, and E. Llewellyn-Thomas. 6309, 1965.
D. 1. Sheplcy, Canad. J. Surg.
95
SURGERY
The
authors
describe
a membrane
oxy-
genator utilizing small-bore tubes made of silicone rubber, through which the blood is circulated. The blood first flows into a small lower reservoir, then through the small-bore tubes into an upper reservoir. The apparatus is enclosed in a supporting acrylic plastic jacket, through which oxygen passes. Flow rates up to 50 ml./min. have been obtained. The priming volume is small. Experimentally. the oxygenator has been used to maintain adequate oxygenation of mammalian fetuses of up to 150 Cm. by connecting it into the umbilical circulation as an artificial placenta.-C&n C. Ferguson THE EFFECT OF METHANUROSTENOLONE NITROGEN
EXCRETION
HEART
SURGEIIY.
93:816,
1965.
FOLLOWING
Canud.
Med.
ON
OPEN-
Ass.
J.
Forty-nine patients (adults and children) undergoing open-heart surgery were given methandrostenolone (Danabol) starting on the day before operation. In the children, dose administered was 0.04 mg./lb./day. Alternate patients not given the drug, but undergoing the same type of surgery, served as controls. The purpose of the study was twofold: ( 1) to determine whether a nitrogensparing effect could be demonstrated, and (2 to determine whether the postoperative course was altered in any way by the administration of methandrostenolone. No significant differences were found in the two groups of patients, either as to nitrogen excretion or their clinical recovery.C&n C. Ferguson POST-PERFUSION
Hahas,
LUNG
D. G. Melrose,
B. Robinson. Lancet articles), 1965.
R. A. M. K. Sykes and
SYNDROME.
2:251
and
254
(2
Open-heart surgery under total cardiopulmonary bypass is frequently complicated by postoperative hypoxia as a consequence of venous admixture caused by ventilation perfusion inequalities and right-to-left intrapulmonary shunts. The shunt is much greater following open than closed heart surgery, It causes cyanosis and dyspnea, beginning at about the third day after operation, and may be fatal. At necropsy, the lungs show patchy ^ __ areas ot collapse and haemorrhage. The
INTERNATIONAL
and 29 per cent were resistant to chloramphenicol. Prompt surgical management of
ABSTRACTS
OF PEDIATRIC
SURGERY
found to be a 2.5 cm. diverticulum of the pericardium. The lesion was excised uneventfully.-CoIin C. Ferguson
were asymptomatic and twenty-nine were symptomatic, with vomiting occurring in twenty-eight, bleeding in thirteen, esophageal obstruction in eleven and pain in two. Roentgen studies demonstrated anatomic as well as functional abnormalities at the esophagogastric junction; however, there was no correlation between hernia size and severity of symptoms. The authors emphasize that persistent neonatal vomiting is an indication for appropriate roentgen studies to rule out hiatal hernia. In such infants, where a hiatal hernia can be demonstrated as the cause of vomiting, postural treatment often makes the infant asymptomatic. Hematemesis, melena, or anemia indicate esophagitis due to reflux and are indications for surgical consultation. Transthoracic repair of the hernia in uncomplicated cases gives good results. With esophagitis and esophageal stricture, dilation
DIWRTICULIJ~~ OF THE LEFT VENTRICLE. E. El-Akkari, M. K. B. El-Din and A. S.
may be of some value, but esophagectomy and bowel interposition have given best results.
complications man
is required.-Edward
.I. Be+
DIVERTICULUM OF THE PERICARDIUM.M. N.
Srouji and Surg.
W.
8:296,
T.
Mustard.
Canad.
J,
1965.
A chest roentgenogram of a 12 year old boy suffering from asthma revealed an abnormal density on the left side of the cardiac shadow near the apex. An aneurysm of the left ventricle was suspected. Complete investigation, including angiocardiography, however, was negative. An exploratory thoracotomy was performed and the mass was
Kassem. A case verticulum
Arch.
Dis.
Child.
40:545,
1965.
is described of a congenital diof the left ventricle which pro-
truded through a defect in the diaphragm behind the xiphoid process into a large epigastric hernia. The hernia was covered with thin, pigmented skin. At operation the diverticulum was excised and the diaphragmatic defect and the hernia were repaired. The child died from ventricular fibrillation shortly after operation. Autopsy revealed a large ventricular septal defect. The condition is due to an abnormality of the septum transversum, which normally gives rise to the basilar part of the pericardium, the ventral part of the diaphragm and the ventral cephalic portion of the abdominal wall. If the epimyocardium of the cardiac loop fuses to the septum transversum, a cardiac diverticulum develops when the septum descends.-.I.
H. Johnston
ESOPHAGEAL HIATUS HEHNIA IN INFANCY AND CHILDHOOD. George H. Humphreys, P. D. Wiedel, D. H. Baker and W. E. B&n.
Pediatrics
36:351-358,
1965.
The diagnosis of esophageal hiatus hernia was established in thirty-four infants and children I2 years of age and less during the twenty year period from 1943 to 1963 at Babies Hospital in New York City. Five
Sixteen of the thirty-four patients were treated without operation. Twelve of these had a good or a fair result, and two died. Eighteen patients were operated upon; twenty-three operations were performed. The result in fifteen patients was good; seven of these were treated by simple transthoracic herniorrhaphy and eight by esophagectomy and bowel interposition. Five operations failed, and reoperation was done. There were two deaths.-W. Sieber
HEART
AND
GREAT
VESSELS
SUCCESSFUL “CORRECTION” OF TRANSPOSED GREAT ARTERIES BY MUSTARD’S OPERATION. Eoin Aberdeen, David J. Waterston, Ian Carr, Gerald Graham, R. E. BonhamCartm and S. Subramanian. Lancet 2: 1233-1235,
1965.
The successful operative correction of transposed great arteries in seven children is reported in this article. A functionally normal circulation was achieved by rerouting the blood within the atria. The method used to redirect the blood flow within the atria was Mustards technic with certain modifications introduced by the authors. All children in the series had an atria1 septal defect created by the technic of Blalock and Hanlon. All the children had care-
INTERNATIONAL
ful preoperative
ABSTBACTS
catheter
OF PEDIATRIC
studies.
Right
and
left ventricmar pressures were obtained in all, and pulmonary artery pressures in two. The pulmonary-systemic flow ratio and pulmonary vascular resistance as fraction of systemic were estimated. The cases reported are a selected series and include only those with a near-normal pulmonary vascular resistance. No major communications were present between the pulmonary and systemic circulations. The operative technic is fully described. In the first case, the atria1 septum was completely excised as described by Mustard. A pericardia1 graft was sutured into the atrium so as to redirect the caval return to the left ventricle and pulmonary venous return to the right ventricle. In the subsequent cases, a modification was introduced which consisted of preserving the atria1 septum as a pedicle flap. This method ensured that sutures were not placed in a region close to the atrioventricular node and bundle of His. Secondly. norma tissue with vascular supply which will not contract was preserved. This normal tissue could even stretch, should the pericardial graft contract after operation. In this series, seven out of nine children treated by this operation have survived. The survivors showed two prominent features. First there was a significant incidence of supraventricular arrhythmias. Secondly. there was immense clinical improvement in the survivors.-D. J. Waterston
STAGED REPAIR OF PULMONIC HYP~PLASTIC
RIGHT
STENOSIS AND
VENTRICLE.
G.
D.
Berman, L. M. Linde and D. G. Mulder. Arch. Surg., 91:597, 1965. T\+o infants were reported, wherein severe pulmonary valvular stenosis is associated with hypoplasia of the right ventricle. A closed transventriculotomy was performed as an emergency procedure. This was subsequentIy folIowed with definitive repair. Both children are now asymptomatic and appear to be normal.-Edtr;ard .I. Berman
A
MEMBRANE PRIMING
OXYGENATOR
VOLUME
WITH
Low
FOR EXTRACORPOREAL
CIRCULATION. R. Wilson, and E. Llewellyn-Thomas. 6309, 1965.
D. 1. Sheplcy, Canad. J. Surg.
95
SURGERY
The
authors
describe
a membrane
oxy-
genator utilizing small-bore tubes made of silicone rubber, through which the blood is circulated. The blood first flows into a small lower reservoir, then through the small-bore tubes into an upper reservoir. The apparatus is enclosed in a supporting acrylic plastic jacket, through which oxygen passes. Flow rates up to 50 ml./min. have been obtained. The priming volume is small. Experimentally. the oxygenator has been used to maintain adequate oxygenation of mammalian fetuses of up to 150 Cm. by connecting it into the umbilical circulation as an artificial placenta.-C&n C. Ferguson THE EFFECT OF METHANUROSTENOLONE NITROGEN
EXCRETION
HEART
SURGEIIY.
93:816,
1965.
FOLLOWING
Canud.
Med.
ON
OPEN-
Ass.
J.
Forty-nine patients (adults and children) undergoing open-heart surgery were given methandrostenolone (Danabol) starting on the day before operation. In the children, dose administered was 0.04 mg./lb./day. Alternate patients not given the drug, but undergoing the same type of surgery, served as controls. The purpose of the study was twofold: ( 1) to determine whether a nitrogensparing effect could be demonstrated, and (2 to determine whether the postoperative course was altered in any way by the administration of methandrostenolone. No significant differences were found in the two groups of patients, either as to nitrogen excretion or their clinical recovery.C&n C. Ferguson POST-PERFUSION
Hahas,
LUNG
D. G. Melrose,
B. Robinson. Lancet articles), 1965.
R. A. M. K. Sykes and
SYNDROME.
2:251
and
254
(2
Open-heart surgery under total cardiopulmonary bypass is frequently complicated by postoperative hypoxia as a consequence of venous admixture caused by ventilation perfusion inequalities and right-to-left intrapulmonary shunts. The shunt is much greater following open than closed heart surgery, It causes cyanosis and dyspnea, beginning at about the third day after operation, and may be fatal. At necropsy, the lungs show patchy ^ __ areas ot collapse and haemorrhage. The