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Internal Banding for Truncus Arteriosus
CORRESPONDENCE
Another Method for Tunneling Defibrillator Leads To the Editor: The recent correspondence by Almassi and Olinger [ l ] details the use of a Penrose drain to tunnel defibrillator leads during implantation of an automatic implantable cardioverter defibrillator. We describe another method using equipment that normally would be used during a left anterior thoracotomy approach. A 32F chest tube is tunneled from the pocket to the chest incision. All four lead ends can be placed safely into the beveled end of the chest tube, which is then easily withdrawn down into the pocket. The same chest tube is then used for chest drainage.
MA1 V . C . Smith, USAF, M C COL Christopher L. Leach, USAF, M C Department of Cardiothoracic Surgery Wilford Hall USAF Medical Center Luckland AFB, TX 78236-5300
Reference 1. Almassi GH, Olinger GN. Tunneling of defibrillator leads.
Ann Thorac Surg 1989;47486.
undistorted. The catheter could not be passed through the patch perforation. Pulmonary venous wedge measurements of pulmonary artery pressure ranged from 16 to 20 mm Hg, which is slightly higher than we would have preferred. The child is now 2.5 years of age and remains asymptomatic with good growth and development and is awaiting a modified Fontan procedure. We continue to believe that truncus arteriosus should be treated with biventricular repair, regardless of age, if the level of pulmonary vascular resistance will permit it. In this case, because of the coexistence of tricuspid atresia, interval palliation was necessary. This may be the ideal indication for the innovative technique described by Young and associates.
Vincent A. Parnell, l r , M D Division of Cardiovascular Surge ry Department of Surgery North Shore University Hospital 300 Community Drive Manhasset, N m York 11030
Reference 1. Young IN, Piancastelli MC, Harrell JE Jr, Hardy C, Ahearn EN, Ecker RR. Internal banding for palliation of truncus arteriosus in the neonate. Ann Thorac Surg 1989;47620-2.
Reply To the Editor: Using a chest tube is another means for transporting the defibrillator leads into the generator pocket. We happen to like the Penrose drain better because it does not create a large tunnel, which can potentially serve as a route for excess pericardial fluid to get into the generator pocket. G . Hossein Almassi, M D Gordon N . Olinger, M D
Department of Cardiothoracic Surgery Medical College of Wisconsin 8700 West Wisconsin Ave Milwaukee, W l 53226
Reply To the Editor: My colleagues and I were pleased to see that others have had experience with the internal banding technique described in our article. We were also particularly pleased to see that their patient, as ours, had been afforded excellent palliation with good growth and development of the native pulmonary arteries. We would also agree that truncus arteriosus should be treated with biventricular repair when first seen; however, the internal banding technique described in our case report may afford a level of therapeutic flexibility in complex cases, when it is felt that total repair is unlikely to succeed.
1. Nilas Young, M D Internal Banding for Truncus Arteriosus To the Editor: 1 read with interest the account of the experience of Young and associates [ l ] with internal banding of the pulmonary artery to palliate truncus arteriosus. I have also had some experience with this technique. A newborn male infant, weighing 2.9 kg, was seen by our pediatric cardiology group with heart failure. Echocardiogram revealed truncus arteriosus and tricuspid atresia. Our goal was to prepare the patient for an eventual modified Fontan procedure and protect the patient’s pulmonary vascular bed from resistance changes without distorting the pulmonary artery anatomy. We therefore palliated the patient using a technique similar to the one described. Using moderate hypothermia and a period of cross-clamp with cold blood cardioplegia we placed a polytetrafluoroethylene patch over the ostia of both pulmonary arteries inside the truncal vessel using 7-0 Prolene sutures. We then punched a 3-mm hole in the center of the Gore-Tex patch using an aortic punch. Postoperative recovery was uneventful, with extubation on the first postoperative day. The patient was restudied at 15 months of age. At that time he was growing well and asymptomatic. The aortic saturation was 81%. The pulmonary arteries appeared to be good size and were
0 1989 by The Society of Thoracic Surgeons
Cardiac and Thoracic Surge ry Medical Group 365 Hawthorne Ave, Suite 301 Oakland, C A 94609-3102
Percutaneous Venous Cannula To the Editor: In a recent case report published in The Annals [ l ] my colleagues and I described a new percutaneous venous cannula. Dr John Laschinger should be credited with the suggestion of utilizing a Malecot tip at the distal end of the venous catheter. I regret the omission and am grateful for his suggestion.
Glenn W .h u b , M D Deborah Heart and Lung Center Browns Mills, NJ 08015
Reference 1. Laub GW, Banaszak D, Kupferschmid J, Magovern GJ, Young JC. Percutaneous cardiopulmonary bypass for the treatment of hypothermic circulatory collapse. Ann Thorac Surg 1989; 4760S11.
Ann Thorac Surg 1989;48:610
0003-4975/89/$3.50
Another Method for Tunneling Defibrillator Leads To the Editor: The recent correspondence by Almassi and Olinger [ l ] details the use of a Penrose drain to tunnel defibrillator leads during implantation of an automatic implantable cardioverter defibrillator. We describe another method using equipment that normally would be used during a left anterior thoracotomy approach. A 32F chest tube is tunneled from the pocket to the chest incision. All four lead ends can be placed safely into the beveled end of the chest tube, which is then easily withdrawn down into the pocket. The same chest tube is then used for chest drainage.
MA1 V . C . Smith, USAF, M C COL Christopher L. Leach, USAF, M C Department of Cardiothoracic Surgery Wilford Hall USAF Medical Center Luckland AFB, TX 78236-5300
Reference 1. Almassi GH, Olinger GN. Tunneling of defibrillator leads.
Ann Thorac Surg 1989;47486.
undistorted. The catheter could not be passed through the patch perforation. Pulmonary venous wedge measurements of pulmonary artery pressure ranged from 16 to 20 mm Hg, which is slightly higher than we would have preferred. The child is now 2.5 years of age and remains asymptomatic with good growth and development and is awaiting a modified Fontan procedure. We continue to believe that truncus arteriosus should be treated with biventricular repair, regardless of age, if the level of pulmonary vascular resistance will permit it. In this case, because of the coexistence of tricuspid atresia, interval palliation was necessary. This may be the ideal indication for the innovative technique described by Young and associates.
Vincent A. Parnell, l r , M D Division of Cardiovascular Surge ry Department of Surgery North Shore University Hospital 300 Community Drive Manhasset, N m York 11030
Reference 1. Young IN, Piancastelli MC, Harrell JE Jr, Hardy C, Ahearn EN, Ecker RR. Internal banding for palliation of truncus arteriosus in the neonate. Ann Thorac Surg 1989;47620-2.
Reply To the Editor: Using a chest tube is another means for transporting the defibrillator leads into the generator pocket. We happen to like the Penrose drain better because it does not create a large tunnel, which can potentially serve as a route for excess pericardial fluid to get into the generator pocket. G . Hossein Almassi, M D Gordon N . Olinger, M D
Department of Cardiothoracic Surgery Medical College of Wisconsin 8700 West Wisconsin Ave Milwaukee, W l 53226
Reply To the Editor: My colleagues and I were pleased to see that others have had experience with the internal banding technique described in our article. We were also particularly pleased to see that their patient, as ours, had been afforded excellent palliation with good growth and development of the native pulmonary arteries. We would also agree that truncus arteriosus should be treated with biventricular repair when first seen; however, the internal banding technique described in our case report may afford a level of therapeutic flexibility in complex cases, when it is felt that total repair is unlikely to succeed.
1. Nilas Young, M D Internal Banding for Truncus Arteriosus To the Editor: 1 read with interest the account of the experience of Young and associates [ l ] with internal banding of the pulmonary artery to palliate truncus arteriosus. I have also had some experience with this technique. A newborn male infant, weighing 2.9 kg, was seen by our pediatric cardiology group with heart failure. Echocardiogram revealed truncus arteriosus and tricuspid atresia. Our goal was to prepare the patient for an eventual modified Fontan procedure and protect the patient’s pulmonary vascular bed from resistance changes without distorting the pulmonary artery anatomy. We therefore palliated the patient using a technique similar to the one described. Using moderate hypothermia and a period of cross-clamp with cold blood cardioplegia we placed a polytetrafluoroethylene patch over the ostia of both pulmonary arteries inside the truncal vessel using 7-0 Prolene sutures. We then punched a 3-mm hole in the center of the Gore-Tex patch using an aortic punch. Postoperative recovery was uneventful, with extubation on the first postoperative day. The patient was restudied at 15 months of age. At that time he was growing well and asymptomatic. The aortic saturation was 81%. The pulmonary arteries appeared to be good size and were
0 1989 by The Society of Thoracic Surgeons
Cardiac and Thoracic Surge ry Medical Group 365 Hawthorne Ave, Suite 301 Oakland, C A 94609-3102
Percutaneous Venous Cannula To the Editor: In a recent case report published in The Annals [ l ] my colleagues and I described a new percutaneous venous cannula. Dr John Laschinger should be credited with the suggestion of utilizing a Malecot tip at the distal end of the venous catheter. I regret the omission and am grateful for his suggestion.
Glenn W .h u b , M D Deborah Heart and Lung Center Browns Mills, NJ 08015
Reference 1. Laub GW, Banaszak D, Kupferschmid J, Magovern GJ, Young JC. Percutaneous cardiopulmonary bypass for the treatment of hypothermic circulatory collapse. Ann Thorac Surg 1989; 4760S11.
Ann Thorac Surg 1989;48:610
0003-4975/89/$3.50