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Anomalous pulmonary venous return into inferior vena cava and associated bronchovascular anomalies (the scimitar syndrome)
760 Forty-five and severe
INTERNATIONAL
children with congenital pulmonary hypertension
heart disease were treated
by surgical banding of the pulmonary artery. Nine children were over 18 months of age and were selected for banding because of associated malformations unsuitable for total correction, such as truncus arteriosus and single ventricle. When the procedure was done for an uncomplicated interventricular septal defect the mortality was 5.5 per cent. When other anomalies were associated, the mortality was 63 per cent. On follow-up examinations those patients surviving have been noted to have diminution in cardiac size and a lessening of pulmonary vascular congestion. Two patients have had subsequent successful repair of their ventricular septal defects-w. K. Sieber. ANOMALOUS PULMONARY VENOUS RETURN INTO INFERIOR VENA CAVA AND ASSOCIATED BRONCHOVASCULARANOMALIES (THE SCIMITAR SYNDROME). J. Mathey, J. J. Galey, Santoro, A. Vanetti, A. Maurel, flein. Thorax
23:398-407
Y. Logeais, E. and R. Wuer-
(July) 1968.
Case reports of scimitar syndrome in a 7-yearold girl, a Q-year-old girl, and a 15-year-old boy are supplemented by a complete review of the literature. Specific findings of the syndrome include: (1) anomalous venous return of the right pulmonary veins into the vena cava, the vein entering the vena cava above the renal veins and usually below the diaphragm, (2) anomalies of the right lung, (3) anomalies of vasculature of the right lung (systemic origin of pulmonary arteries); and (4) dextraposition of the heart. Cardiovascular anomalies such as atria1 septal defects may be associated. In 22 (40 per cent of 53 patients, the anomaly was asymptomatic. The remainder had cardiovascular symptoms which included pneumonitis, cough and hemoptysis. Diagnosis is established by angiography. Roentgenograms of the chest, however, may be characteristic when the “scimitar sign” (due to direct visualization of the anomalous vessel) is apparent. The anomalous trunk can be catheterized by way of the saphenous vein. Treatment is surgical. Only 25 of the 75 patients referred to in the literature have been treated surgically since the anomaly is well tolerated for long periods of time. Progressive pulmonary hypertension appears to be a major indication for treatment.
ABSTRACI’S
OF PEDIATRIC
SURGERY
Pneumonectomy or correction of the venous return are the surgical procedures advocated. Correction of the venous return has been accomplished by reimplantation of the anomalous vein into the left atrium. The vein has been implanted into the right atrium in the proximity of an atria1 septal defect. In one of the cases here reported, a dacron graft was passed through the right atrium and sutured to an atria1 septal defect.-W. K. &her.
ALIMENTARY
TRACT
TREATMENT OF ESOPHAGEAL ATRESIA. A. Cuendet. Helv. Chir. Acta 35:338-367, The author
gives a good review
1968. of present
con-
cepts in the treatment of esophageal atresia and reports illustrative cases from his personal experience. An infant with total atresia of the thoracic esophagus was submitted immediately after birth to eso’phageal reconstruction with the colon in one stage; the operation was successful.-M. Bettex. END-TO-END ANASTOMOSIS IN ESOPHAGEAL ATHESIA WITHOUT TRACHEAL FISTULA: A CASE REPORT. 23.W. Cram.
Canad.
J. Surg.
11:381-384
(July) 1968. An 8 lb., 13 oz. girl born of a mother with marked hydramnios, had excessive frothy salivation and was diagnosed as having esophageal atresia without associated fistula. Roentgenograms revealed a blind upper pouch and a gasless abdomen. On the third day of life a feeding gastrostomy was created under local anesthesia and the upper pouch was kept empty by repeated aspiration. It was estimated by barium gastrogram that 7 cm. separated the upper and lower esophageal segments. For 6 weeks the infant had twice daily stretching of the upper pouch by mercury weighted bougies. By these manipulations the esophageal gap was reduced to 1.5 cm., and at the age of 8 weeks through a transpleural right thoracotomy approach it was possible to mobilize both esophageal segments for primary anastomosis. The infant made an uneventful recovery and was discharged from hospital 4 weeks postoperative weighing 15 lbs.-C. C. Ferguson. THE FUNCTION OF THE OESOPHACUS AFTER SURGICAL TREATMENT OF OESOPHACEAL ATRESLL K. D. Ebe and E. Helming. Z. K. Chir. 6:‘26-34, 1968. Cineradiologic investigations were carried out on the 26 children who had been treated for esophageaI atresia. Normal function of the distal
INTERNATIONAL
children with congenital pulmonary hypertension
heart disease were treated
by surgical banding of the pulmonary artery. Nine children were over 18 months of age and were selected for banding because of associated malformations unsuitable for total correction, such as truncus arteriosus and single ventricle. When the procedure was done for an uncomplicated interventricular septal defect the mortality was 5.5 per cent. When other anomalies were associated, the mortality was 63 per cent. On follow-up examinations those patients surviving have been noted to have diminution in cardiac size and a lessening of pulmonary vascular congestion. Two patients have had subsequent successful repair of their ventricular septal defects-w. K. Sieber. ANOMALOUS PULMONARY VENOUS RETURN INTO INFERIOR VENA CAVA AND ASSOCIATED BRONCHOVASCULARANOMALIES (THE SCIMITAR SYNDROME). J. Mathey, J. J. Galey, Santoro, A. Vanetti, A. Maurel, flein. Thorax
23:398-407
Y. Logeais, E. and R. Wuer-
(July) 1968.
Case reports of scimitar syndrome in a 7-yearold girl, a Q-year-old girl, and a 15-year-old boy are supplemented by a complete review of the literature. Specific findings of the syndrome include: (1) anomalous venous return of the right pulmonary veins into the vena cava, the vein entering the vena cava above the renal veins and usually below the diaphragm, (2) anomalies of the right lung, (3) anomalies of vasculature of the right lung (systemic origin of pulmonary arteries); and (4) dextraposition of the heart. Cardiovascular anomalies such as atria1 septal defects may be associated. In 22 (40 per cent of 53 patients, the anomaly was asymptomatic. The remainder had cardiovascular symptoms which included pneumonitis, cough and hemoptysis. Diagnosis is established by angiography. Roentgenograms of the chest, however, may be characteristic when the “scimitar sign” (due to direct visualization of the anomalous vessel) is apparent. The anomalous trunk can be catheterized by way of the saphenous vein. Treatment is surgical. Only 25 of the 75 patients referred to in the literature have been treated surgically since the anomaly is well tolerated for long periods of time. Progressive pulmonary hypertension appears to be a major indication for treatment.
ABSTRACI’S
OF PEDIATRIC
SURGERY
Pneumonectomy or correction of the venous return are the surgical procedures advocated. Correction of the venous return has been accomplished by reimplantation of the anomalous vein into the left atrium. The vein has been implanted into the right atrium in the proximity of an atria1 septal defect. In one of the cases here reported, a dacron graft was passed through the right atrium and sutured to an atria1 septal defect.-W. K. &her.
ALIMENTARY
TRACT
TREATMENT OF ESOPHAGEAL ATRESIA. A. Cuendet. Helv. Chir. Acta 35:338-367, The author
gives a good review
1968. of present
con-
cepts in the treatment of esophageal atresia and reports illustrative cases from his personal experience. An infant with total atresia of the thoracic esophagus was submitted immediately after birth to eso’phageal reconstruction with the colon in one stage; the operation was successful.-M. Bettex. END-TO-END ANASTOMOSIS IN ESOPHAGEAL ATHESIA WITHOUT TRACHEAL FISTULA: A CASE REPORT. 23.W. Cram.
Canad.
J. Surg.
11:381-384
(July) 1968. An 8 lb., 13 oz. girl born of a mother with marked hydramnios, had excessive frothy salivation and was diagnosed as having esophageal atresia without associated fistula. Roentgenograms revealed a blind upper pouch and a gasless abdomen. On the third day of life a feeding gastrostomy was created under local anesthesia and the upper pouch was kept empty by repeated aspiration. It was estimated by barium gastrogram that 7 cm. separated the upper and lower esophageal segments. For 6 weeks the infant had twice daily stretching of the upper pouch by mercury weighted bougies. By these manipulations the esophageal gap was reduced to 1.5 cm., and at the age of 8 weeks through a transpleural right thoracotomy approach it was possible to mobilize both esophageal segments for primary anastomosis. The infant made an uneventful recovery and was discharged from hospital 4 weeks postoperative weighing 15 lbs.-C. C. Ferguson. THE FUNCTION OF THE OESOPHACUS AFTER SURGICAL TREATMENT OF OESOPHACEAL ATRESLL K. D. Ebe and E. Helming. Z. K. Chir. 6:‘26-34, 1968. Cineradiologic investigations were carried out on the 26 children who had been treated for esophageaI atresia. Normal function of the distal