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Esophageal atresia associated with duodenal atresia
1045
ABSTRACTS
Aortic Arch Interruption W i t h Truncus Arteriosus or Aorticopulmonary Septal Defect. C. A. F. Moes and R. M.
Freedom. Am J Roentgenol 135:1011-1016, (November), 1980. Angiographic features of five patients with aortic arch interruption with associated truncus arteriosus (3) or aorticopulmonary septal defect (2) and a review of the literature form the basis for this report. Three patients presented as neonates with congestive failure and cyanosis. The other two presented at ages 1.5 and 8.5 mo. None of the patients exhibited differential cyanosis. Angiographic findings in arch interruption with truncus arteriosis include the ascending aortic originating anteriorly and appearing as an appendage of the much larger pulmonary trunk. In a review of 60 cases, 22 mention the site of interruption with 20 being type B (distal to the left carotid artery) and 2 type A (distal to the left subclavian). In patients with arch interruption with an aorticopulmonary septal defect angiograms demonstrate two separate great artery roots and two semilunar valves. Of 25 cases in the literature, 14 had type A arch interruption and four had type B. Ventricular septal defects are unusual in this setting but almost always present with the trunchus arteriosus and aortic arch interruption.--Randall W. Powell Aortic Arch Interruption in Infancy: Radio- and Angiographic Features. S. Neye-Bock and K. E. Fellows. Am J
Roentgenol 135:1005-1010, (November), 1980. A retrospective review of 19 infants (ages 2 days to 7 wk) revealed 3 with type A aortic arch interruption (distal to the left subclavian), 15 with type B (between left carotid and left subclavian), and 1 with type C (between the innominate and left carotid). Clinical findings included congestive failure in all 19, with 5 exhibiting mild cyanosis. Differential cyanosis was not seen in any infant while weak or absent femoral pulses were noted in 12. Chest radiographs revealed nonspecific findings related to congestive failure including cardiomegaly, increased pulmonary flow, pulmonary congestion, and pulmonary edema. No identifiable aortic arch could be found. Preoperative angiography was diagnostic in all 19 infants and revealed many associated cardiovascular anomalies. These included VSD (19), PDA (18), ASD (4), single ventricle/L-transposition (2), D-transposition (1), double outlet left ventricle (I), truncus arteriosus (2), and aberrant right subclavian artery (5). The findings of a VSD in 19 patients associated with aortic valve atresia (1), aortic valve deformity (7), and subvalvar narrowing (8) lends support to the theory of diminished aortic flow causing involution of the arch or isthmus in this anomaly. Sixteen infants (84%) underwent surgery. Three underwent palliative surgery only (conduit from main pulmonary artery to descending aorta, PDA ligation and PA banding), while one underwent total repair after palliative surgery. Twelve underwent total repair (PDA ligation, aortic arch reconstruction, and VSD closure) with six done in two stages and six done in one operative procedure. Seven patients survive now at ages 12 wk to 11 yr. Angiography via a left ventricular injection represents the most important diagnostic study in this anomaly with the optimum views being the right oblique and cranially angled left oblique. The authors recom-
mend early angiography in these critically ill patients for rapid diagnosis so that corrective surgery can be performed.--Randall IV. Powell Anatomic Correction of Interrupted Aortic Arch Complex in N e o n a t e s . L. L. Bailey, J. G. Jacobson, R. W. Doroshow,
W. H. Merritt, and E. L. Petry. Surgery 89:553, 1981. Complete correction of the interrupted aortic arch complex was performed in five neonates, ages 2-19 days. Hypothermic circulatory arrest was employed. The descending aorta was widely mobilized via transverse bilateral thoracotomy. After dividing and excising the ductus, the descending aorta was anastomosed end-to-site to the ascending aorta. The VSD was patched with Dacron and atrial defects closed with running suture. Three babies survived and are doing well. The authors recommend newborn total correction as the procedure of choice in these infants.--E. S. Wiener Indirect Anterial Pulse Tracings in Children W i t h Coarctation of the Aorta Before and A f t e r Operation. M . Oyanarte,
D. F. Dickinson, D. Medici, and D. I. Hamilton. Thorax 35:128-132, (February), 1980. In this study of I 1 children from Liverpool synchronous indirect tracings were made of the carotid and femoral arterial pulse before and after operation. The time interval between the peak of the femoral pulse and the dicrotic notch of the carotid pulse was shorter before operation than after. This observation may be valuable in detecting residual or recurrent coarctation.--John F. R. Bentley ALIMENTARY TRACT Esophageal Atresia Associated W i t h Duodenal Atresia. M .
Miyamoto, K. Nambu, T. Wada, and T. Kajimoto. J Jpn Soc Pediatr Surg 17:301-306, (April), 1981. A premature with esophageal atresia and duodenal atresia was reported. The patient died of septicemia 23 days after the operation (gastrostomy and jejunostomy). The authors collected eight cases of esophageal atresia associated with duodenal atresia from the Japanese literature. Four of these eight cases were prematures and only one of them was salvaged by staged operation.--H. Suzuki Esophageal Atresia Type Vogt II|b W i t h Fistula of the Distal Segment to the Cervical Trachea, Combined W i t h Right Descending Aorta and Further Malformations. H. Kraeft
and W. Ch. Hecker. Z Kinderchir 32:371-375, 1981. The authors report a variation of esophageal atresia that was not described in the literature as yet. The upper segment was blind ended and the lower segment was joined by a fistula to the cervical trachea, both segments being surrounded by a muscle sheath. Additionally, a right descending aorta and malformations of the heart and the spine were found. Because of the unusual high position of the fistula it was necessary to approach the defect through a cervical incision. After dissection of the fistula both segments were anastomosed. To determine the site of the fistula the authors recommend a preoperative tracheoscopy and a hard ray exposure chest X-ray showing the course of the aorta in any case of esophageal atresia.--Thomas A. Angerpointner
ABSTRACTS
Aortic Arch Interruption W i t h Truncus Arteriosus or Aorticopulmonary Septal Defect. C. A. F. Moes and R. M.
Freedom. Am J Roentgenol 135:1011-1016, (November), 1980. Angiographic features of five patients with aortic arch interruption with associated truncus arteriosus (3) or aorticopulmonary septal defect (2) and a review of the literature form the basis for this report. Three patients presented as neonates with congestive failure and cyanosis. The other two presented at ages 1.5 and 8.5 mo. None of the patients exhibited differential cyanosis. Angiographic findings in arch interruption with truncus arteriosis include the ascending aortic originating anteriorly and appearing as an appendage of the much larger pulmonary trunk. In a review of 60 cases, 22 mention the site of interruption with 20 being type B (distal to the left carotid artery) and 2 type A (distal to the left subclavian). In patients with arch interruption with an aorticopulmonary septal defect angiograms demonstrate two separate great artery roots and two semilunar valves. Of 25 cases in the literature, 14 had type A arch interruption and four had type B. Ventricular septal defects are unusual in this setting but almost always present with the trunchus arteriosus and aortic arch interruption.--Randall W. Powell Aortic Arch Interruption in Infancy: Radio- and Angiographic Features. S. Neye-Bock and K. E. Fellows. Am J
Roentgenol 135:1005-1010, (November), 1980. A retrospective review of 19 infants (ages 2 days to 7 wk) revealed 3 with type A aortic arch interruption (distal to the left subclavian), 15 with type B (between left carotid and left subclavian), and 1 with type C (between the innominate and left carotid). Clinical findings included congestive failure in all 19, with 5 exhibiting mild cyanosis. Differential cyanosis was not seen in any infant while weak or absent femoral pulses were noted in 12. Chest radiographs revealed nonspecific findings related to congestive failure including cardiomegaly, increased pulmonary flow, pulmonary congestion, and pulmonary edema. No identifiable aortic arch could be found. Preoperative angiography was diagnostic in all 19 infants and revealed many associated cardiovascular anomalies. These included VSD (19), PDA (18), ASD (4), single ventricle/L-transposition (2), D-transposition (1), double outlet left ventricle (I), truncus arteriosus (2), and aberrant right subclavian artery (5). The findings of a VSD in 19 patients associated with aortic valve atresia (1), aortic valve deformity (7), and subvalvar narrowing (8) lends support to the theory of diminished aortic flow causing involution of the arch or isthmus in this anomaly. Sixteen infants (84%) underwent surgery. Three underwent palliative surgery only (conduit from main pulmonary artery to descending aorta, PDA ligation and PA banding), while one underwent total repair after palliative surgery. Twelve underwent total repair (PDA ligation, aortic arch reconstruction, and VSD closure) with six done in two stages and six done in one operative procedure. Seven patients survive now at ages 12 wk to 11 yr. Angiography via a left ventricular injection represents the most important diagnostic study in this anomaly with the optimum views being the right oblique and cranially angled left oblique. The authors recom-
mend early angiography in these critically ill patients for rapid diagnosis so that corrective surgery can be performed.--Randall IV. Powell Anatomic Correction of Interrupted Aortic Arch Complex in N e o n a t e s . L. L. Bailey, J. G. Jacobson, R. W. Doroshow,
W. H. Merritt, and E. L. Petry. Surgery 89:553, 1981. Complete correction of the interrupted aortic arch complex was performed in five neonates, ages 2-19 days. Hypothermic circulatory arrest was employed. The descending aorta was widely mobilized via transverse bilateral thoracotomy. After dividing and excising the ductus, the descending aorta was anastomosed end-to-site to the ascending aorta. The VSD was patched with Dacron and atrial defects closed with running suture. Three babies survived and are doing well. The authors recommend newborn total correction as the procedure of choice in these infants.--E. S. Wiener Indirect Anterial Pulse Tracings in Children W i t h Coarctation of the Aorta Before and A f t e r Operation. M . Oyanarte,
D. F. Dickinson, D. Medici, and D. I. Hamilton. Thorax 35:128-132, (February), 1980. In this study of I 1 children from Liverpool synchronous indirect tracings were made of the carotid and femoral arterial pulse before and after operation. The time interval between the peak of the femoral pulse and the dicrotic notch of the carotid pulse was shorter before operation than after. This observation may be valuable in detecting residual or recurrent coarctation.--John F. R. Bentley ALIMENTARY TRACT Esophageal Atresia Associated W i t h Duodenal Atresia. M .
Miyamoto, K. Nambu, T. Wada, and T. Kajimoto. J Jpn Soc Pediatr Surg 17:301-306, (April), 1981. A premature with esophageal atresia and duodenal atresia was reported. The patient died of septicemia 23 days after the operation (gastrostomy and jejunostomy). The authors collected eight cases of esophageal atresia associated with duodenal atresia from the Japanese literature. Four of these eight cases were prematures and only one of them was salvaged by staged operation.--H. Suzuki Esophageal Atresia Type Vogt II|b W i t h Fistula of the Distal Segment to the Cervical Trachea, Combined W i t h Right Descending Aorta and Further Malformations. H. Kraeft
and W. Ch. Hecker. Z Kinderchir 32:371-375, 1981. The authors report a variation of esophageal atresia that was not described in the literature as yet. The upper segment was blind ended and the lower segment was joined by a fistula to the cervical trachea, both segments being surrounded by a muscle sheath. Additionally, a right descending aorta and malformations of the heart and the spine were found. Because of the unusual high position of the fistula it was necessary to approach the defect through a cervical incision. After dissection of the fistula both segments were anastomosed. To determine the site of the fistula the authors recommend a preoperative tracheoscopy and a hard ray exposure chest X-ray showing the course of the aorta in any case of esophageal atresia.--Thomas A. Angerpointner