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Intracardiac repair of tetralogy of fallot. Five-year review of 403 patients
ABSTRACTS
279
exceptions are the patients with unfavorable anatomy with Tetralogy of Fallot and patients with transposition of the great arteries who are less than 4 mo of age.-Keirh W. Ashcrufr The
Blalock-Taussig
Months
of life.
Willman.
J
(October),
Shunt
in
the
H. Laks, 1. D. Marco,
Thorac
Cardiovasc
Surg
First and
Six V.
L.
70X&7-691
1975.
Eighteen patients less than 6 mo of age having Blalock-Taussig shunts are presented. The mortality rate was 33%. In the four patients less than 2 wk of age, two died and a 3rd had an inadequate shunt while IO of I4 patients 2 wk to 6 mo survived and had an adequate shunt. It was recommended that patients greater than 2 wk of age requiring a systemic pulmonary shunt have a Blalock-Taussig procedure since it is reasonably safe, effective and had distinct advantages over Waterston-Cooley or Potts shunts. Anastomosis was carried out with interrupted horizontal mattress sutures in the posterior row and interrupted simple sutures in the anterior row using 7-O synthetic suture materialThomas M. Holder Complex of Secundum Congestive
J. E.
lips, A.
Heart
Okies,
Starr.
Septal Defect and
in Infants.
D. Henken,
J Thorac
(October),
Atrial
Failure
C. 0.
Cardiovasc
S. J. Phi/-
Sunder/and, Surg
and
70:696-700
1975.
Five patients less than 2 yr of age with congestive heart failure, recurrent pneumonia, and failure to thrive secondary to secundum atrial septal defect who did not respond to medical therapy are presented. All were corrected without mortality and had a good clinical result. Only a rare patient with a secundum atrial septal defect has marked symptoms in infancy. When this occurs and the patient does not respond to digitalis and diuretics, correction is the desired approach.-Thomas M. Holder Intracardiac year Meyer, Cooley.
Repair of Tetmlogy
Review D.
of 403
Wukasch,
J
Thorac
(September),
1975.
Patients. G.
L.
Cardiovasc
of Fallot.
Five-
1. Chiariello,
Hallman, Surg
and
D.
J. A.
70:529-535
Four hundred and three patients had repair of tetralogy of Fallot during the 5 yr from 1968 to 1973. The mortality was 9.5%. For the I2 patients less than 2 yr of age the mortality was 16% and for the 42 patients greater than 20 yr of age--14.5%. The lowest mortality (3.5%) was
for the I I5 patients age 6-10 yr. This, therefore, was judged the optimal age for elective repair. The increased risk in the older patient resulted from pulmonary vascular diseases secondary to systemic pulmonary shunt. In 57% a patch graft was used in the right ventricular outflow tract. A conduit from the right ventricle to the pulmonary artery was employed in 1 I patients. Residual ventricular septal defect occurred in 3% of patients and a right ventricular aneurysm developed in seven patients having pericardial patches to the outflow tract. The follow-up data was available on 26.5?, of the patients with a mean follow-up time of I9 mo.-Thomas M. Holder
ALIMENTARY Mortality
in Esophageal
A. W.
Wilkinson.
(July),
1975.
J R Coil
TRACT Atresia. Surg
Edinb
F. Cozzi
and
20:236-243
The results of treatment in 60 patients with esophageal atresia treated in one unit in the Hospital for Sick Children, London, between 1967 and 1973 are reported. These results are compared with those on 93 patients treated in the same unit between 1959 and 1967 and reported previously. Details of birth weight, gestation, age on admission, and incidence of other congenital abnormalities and of pneumonia are given. Sixteen of the 60 babies died during their first admission to hospital and four of these before surgical treatment could be undertaken. There were four deaths during later admissions. Using the previously described classification into groups there were 20 patients in group A (33% of the whole series) of whom 5% died, I8 patients in group B (30% of series) with a mortality of 1 I%, and 22 patients in group C (37”, of series) with a mortality of 53%. Surgery in group C patients was only staged if the gap between the two ends of esophagus was too wide for a primary anastomosis to be made. Of I4 such patients six died. A primary anastomosis was carried out in eight group C patients. Four of these died and at autopsy the anastomosis was intact in all. Stretching of the upper pouch with a bougie was not found to be successful. In five of the nine patients treated in this way who survived, the delayed primary anastomosis broke down and a colon replacement was necessary. The authors suggest that in the poorest risk patients more effort should be made to define
279
exceptions are the patients with unfavorable anatomy with Tetralogy of Fallot and patients with transposition of the great arteries who are less than 4 mo of age.-Keirh W. Ashcrufr The
Blalock-Taussig
Months
of life.
Willman.
J
(October),
Shunt
in
the
H. Laks, 1. D. Marco,
Thorac
Cardiovasc
Surg
First and
Six V.
L.
70X&7-691
1975.
Eighteen patients less than 6 mo of age having Blalock-Taussig shunts are presented. The mortality rate was 33%. In the four patients less than 2 wk of age, two died and a 3rd had an inadequate shunt while IO of I4 patients 2 wk to 6 mo survived and had an adequate shunt. It was recommended that patients greater than 2 wk of age requiring a systemic pulmonary shunt have a Blalock-Taussig procedure since it is reasonably safe, effective and had distinct advantages over Waterston-Cooley or Potts shunts. Anastomosis was carried out with interrupted horizontal mattress sutures in the posterior row and interrupted simple sutures in the anterior row using 7-O synthetic suture materialThomas M. Holder Complex of Secundum Congestive
J. E.
lips, A.
Heart
Okies,
Starr.
Septal Defect and
in Infants.
D. Henken,
J Thorac
(October),
Atrial
Failure
C. 0.
Cardiovasc
S. J. Phi/-
Sunder/and, Surg
and
70:696-700
1975.
Five patients less than 2 yr of age with congestive heart failure, recurrent pneumonia, and failure to thrive secondary to secundum atrial septal defect who did not respond to medical therapy are presented. All were corrected without mortality and had a good clinical result. Only a rare patient with a secundum atrial septal defect has marked symptoms in infancy. When this occurs and the patient does not respond to digitalis and diuretics, correction is the desired approach.-Thomas M. Holder Intracardiac year Meyer, Cooley.
Repair of Tetmlogy
Review D.
of 403
Wukasch,
J
Thorac
(September),
1975.
Patients. G.
L.
Cardiovasc
of Fallot.
Five-
1. Chiariello,
Hallman, Surg
and
D.
J. A.
70:529-535
Four hundred and three patients had repair of tetralogy of Fallot during the 5 yr from 1968 to 1973. The mortality was 9.5%. For the I2 patients less than 2 yr of age the mortality was 16% and for the 42 patients greater than 20 yr of age--14.5%. The lowest mortality (3.5%) was
for the I I5 patients age 6-10 yr. This, therefore, was judged the optimal age for elective repair. The increased risk in the older patient resulted from pulmonary vascular diseases secondary to systemic pulmonary shunt. In 57% a patch graft was used in the right ventricular outflow tract. A conduit from the right ventricle to the pulmonary artery was employed in 1 I patients. Residual ventricular septal defect occurred in 3% of patients and a right ventricular aneurysm developed in seven patients having pericardial patches to the outflow tract. The follow-up data was available on 26.5?, of the patients with a mean follow-up time of I9 mo.-Thomas M. Holder
ALIMENTARY Mortality
in Esophageal
A. W.
Wilkinson.
(July),
1975.
J R Coil
TRACT Atresia. Surg
Edinb
F. Cozzi
and
20:236-243
The results of treatment in 60 patients with esophageal atresia treated in one unit in the Hospital for Sick Children, London, between 1967 and 1973 are reported. These results are compared with those on 93 patients treated in the same unit between 1959 and 1967 and reported previously. Details of birth weight, gestation, age on admission, and incidence of other congenital abnormalities and of pneumonia are given. Sixteen of the 60 babies died during their first admission to hospital and four of these before surgical treatment could be undertaken. There were four deaths during later admissions. Using the previously described classification into groups there were 20 patients in group A (33% of the whole series) of whom 5% died, I8 patients in group B (30% of series) with a mortality of 1 I%, and 22 patients in group C (37”, of series) with a mortality of 53%. Surgery in group C patients was only staged if the gap between the two ends of esophagus was too wide for a primary anastomosis to be made. Of I4 such patients six died. A primary anastomosis was carried out in eight group C patients. Four of these died and at autopsy the anastomosis was intact in all. Stretching of the upper pouch with a bougie was not found to be successful. In five of the nine patients treated in this way who survived, the delayed primary anastomosis broke down and a colon replacement was necessary. The authors suggest that in the poorest risk patients more effort should be made to define