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Mediastinal masses following corrective surgery for congenital heart disease
396
ABsTRAcrs
LOBE WITH EMPHYSEMA. A. Hislop
L. Reid. Thorax 25682690 1970.
and
(November)
A detailed quantitative study of the airways, lung avleoli, and associated pulmonary arteries in three lung specimens removed for clinical lobar emphysema in a 17 day old, a 2 month old, and an 8 month old child disclosed qualitatively and quantitatively normal structures except for a fivefold increase in the number of alveoli. The alveoli were of normal size and shape. A new pathological entity, designated by the authors as “polyalveolar lobe with or without emphysema”, is thus documented. Polyalveolar lobe may cause clinical feature of lobar emphysema in childhood.-W. K. Sieber. GROWTH OF THE ALVEOLI AND PULMONARY ARTERIES IN CHIJ.DH~~D. G. Davies and
L. Reid. Thorax 25:669-681 1970.
(November)
A comprehensive study of the bronchial and vascular anatomy of eight lungs obtained from five children ranging from stillborn to 11 years of age is the basis of this excellent review of the normal growth and development of the pulmonary alveoli and pulmonary arteries of the human lungs. The bronchial tree is developed by the 16th week of intrauterine life. Alveoli, few in number at birth, are saccules which increase in number until 8 years of age and alter contour, surface area, and size, until growth of the chest wall is completed. The greatest increase in the number of alveoli occurs up to 3 years of age. This increase probably occurs by alveolization of the terminal bronchioli. The thick muscular walls of the pulmonary arteries noted at birth rapidly become thinner during the first 2 weeks of life (probably due to dilatation of the pulmonary arteries), and by 4 months of age they are similar to that of an adult. Pulmonary arteries in the neonate are small and few in number with no arterial musculature in the periacinar vessels. In the first few months the pulmonary vessels increase in size without adding muscular tissue. As the multiplication and growth of alveoli occur, thin-walled pulmonary arteries without muscle multiply
slowly. Later muscle gradually extends into become larger in size but multiply more slowly. Later muscle gradually extends into the walls of the arteries in the acinus and the adult anatomical pattern is present at 19 years of age.-W. K. Sieber. EFFECT OF TOLAZOLINE HYDROCHLORIDE ON SPUTUM VISCOSITY IN CYSTIC FIBROSIS.
E. A. Feather and G. Russell. Thorax 25:732 (November) 1970. Tolaxoline hydrochloride administered to five patients with cystic fibrosis did not differ significantly from a placebo in its effect on sputum viscosity. The authors conclude that they were unable to detect an autonomic effect of the drug on the physical properties of bronchial mucus.-W. K. Sieber. VOLUME PRFS~IJRE RELATIONSOF THE LUNGS OF CHILDREN MEANRED DURING THORACOTOMY. G. C. Fisk and C. W. Deal.
Aust. Paediat. 1970.
J. 6:203-212
(December)
Pulmonary compliance was estimated by direct measurement of the airway pressure in children under 7 years of age during intrathoracic surgery, mainly for congenital cardiac disease. In the 36 patients over 12 months of age the compliance measured at the beginning of operation increased with age, weight, height, and surface area. In the 42 patients under 12 months of age pulmonary compliance was markedly lower in those with very large pulmonary to systemic flow ratios but on excluding this group the compliance of the remainder increased with age, weight, height, and surface area as in the older group of children. In 5 of 14 patients who underwent banding of the pulmonary artery there was a marked increase in compliance measured just after the operation.-]. R. Solomon. MEDIASTINAL MASSES FOLLOWING CORRECTIVE SURGERY FOR CONGENITAL HEART DISEASE. E. Krongrad, G. H. Gunn-
kzugsson, R. H. Feldt, and D. C. McGooh. Mayo Clin. Proc. 45 (November-December) 1970. TWO cases, both I3 years of age, ported in whom mediastinal masses oped subsequent to corrective surgery. In one patient a simple
are redevelcardiac thymic
397
ABSTRACTS
cyst was found 2 years following cardiac surgery, and in the other, Hodgkins disease of the mediastinum. The authors advise selective angiocardiography, followed by exploratory thoracotomy for all patients who have mediastinal masses-M. Gilbert.
HEART AND GREAT VESSELS INDICATIONSAND RESULTS OF TOTAL REPAIR OF THE MOST IMPORTANTTYPES OF CONGENITALHEART DISEASE.K. Schriber, J. Ammann, V. Gasser, W. Glinz, C. Minale, M. Rothlin, and A. Senning.
Schweiz.
Med. Wschr.
100:33, 1970.
In uncomplicated patent ductus arteriosus the diagnosis is the indication for surgical repair; 96 patients, including 8 infants, have been operated upon. There has been no operative death and no case of recanalization. One hundred and one cases of pure coarctation have been corrected. In about 90% of the patients a reduction of blood pressure was obtained. There has been no operative mortality. Thirty-six cases of congenital aortic stenosis ( all three types) have been corrected. Indication for repair is present in any case where a pressure gradient of 50 mm Hg or more with normal cardiac output rate has been measured, or where serious symptoms are present, or where EKG shows a severe hypertrophy of the left ventricle. The resection of subvalvular stenosis was successful in all cases. In valvular stenosis a good palliative effect could be obtained. A late mortality occurred in both groups. Forty-seven cases of uncomplicated pulmonary stenosis have been repaired. The indication for correction is present when there exists a pressure gradient of 50 mm Hg or more. Two patients have died of right heart failure in the postoperative phase; two patients have shown a recurrence of the stenosis. Two hundred patients have been operated upon because of secundum type atria1 septal defect. The defect must be corrected if there is a left-to-right shunt of 50% of the pulmonary flow rate or more. No operative morality was registered. Follow-up examination showed good results in 95% of the cases. Thirty-eight cases of endocardial cushion defect have been corrected. Operative mor-
tality was 5%; one case of late death has been registered. Eighty per cent of the patients have shown a good result. Forty-five cases of ventricular defect have been submitted to surgery. The indication for surgical repair is present when there is a left-to-right shunt of 50% of the pulmonary flow rate or more. The operative mortality was 11%; one case of late death has been registered Ninety-two per cent of the patients have shown a good result. Three patients have had a recurrence of the defect. Eighty-three cases of tetralogy of Fallot have been operated upon. All 83 patients have had total repair, 41 after palliative operations. The operative mortality was 6%; four cases had to be reoperated. All of the 68 cases which have been thoroughly studied later on have shown a significant improvement of the hemodynamic situation.-A. Zimmermann
and hf. Bettex.
SURGERYOF VENTRICULARSEPTAL DEFECT AND PULMONARYVASCULAR RESISTANCE. H. A. Samaan.
ber)
Thorax 25:665,
(Novem-
1970.
In this series of 65 patients operated upon for ventricular septal defects (LSD) at the Royal Infirmary, Edinburgh, no mortality was attributed to preoperative raised pulmonary vascular resistance. Eight patients with a severe degree of pulmonary vascular resistance made a full recovery after surgical closure of the ventricular septal defect. Mortality in the series was due to inadequate perfusion during operation, hemorrhage, cardiac tamponade, mediastinal infection, complete heart block, or the development of postoperative aortic incompetence. The authors conclude that raised pulmonary vascular resistance and clinical evidence of a dominant left-to-right shunt in the absence of serious intracardiac anatomical complications does not contraindicate surgery for the repair of VSD.-W. K. Sieber. TOTAL ANOMALOUS PULMONARY VENOUS RETURN WITH INTACT ATRIAL SEPTUM AND ASSOCIATED MITRAL STENOSIS.W. G. Wolfe and P. A. Ebert. Thorax 25:769,
(November) 1970. This paper represents the first reported case of total anomalous pulmonary venous return with an intact atrial septum and
ABsTRAcrs
LOBE WITH EMPHYSEMA. A. Hislop
L. Reid. Thorax 25682690 1970.
and
(November)
A detailed quantitative study of the airways, lung avleoli, and associated pulmonary arteries in three lung specimens removed for clinical lobar emphysema in a 17 day old, a 2 month old, and an 8 month old child disclosed qualitatively and quantitatively normal structures except for a fivefold increase in the number of alveoli. The alveoli were of normal size and shape. A new pathological entity, designated by the authors as “polyalveolar lobe with or without emphysema”, is thus documented. Polyalveolar lobe may cause clinical feature of lobar emphysema in childhood.-W. K. Sieber. GROWTH OF THE ALVEOLI AND PULMONARY ARTERIES IN CHIJ.DH~~D. G. Davies and
L. Reid. Thorax 25:669-681 1970.
(November)
A comprehensive study of the bronchial and vascular anatomy of eight lungs obtained from five children ranging from stillborn to 11 years of age is the basis of this excellent review of the normal growth and development of the pulmonary alveoli and pulmonary arteries of the human lungs. The bronchial tree is developed by the 16th week of intrauterine life. Alveoli, few in number at birth, are saccules which increase in number until 8 years of age and alter contour, surface area, and size, until growth of the chest wall is completed. The greatest increase in the number of alveoli occurs up to 3 years of age. This increase probably occurs by alveolization of the terminal bronchioli. The thick muscular walls of the pulmonary arteries noted at birth rapidly become thinner during the first 2 weeks of life (probably due to dilatation of the pulmonary arteries), and by 4 months of age they are similar to that of an adult. Pulmonary arteries in the neonate are small and few in number with no arterial musculature in the periacinar vessels. In the first few months the pulmonary vessels increase in size without adding muscular tissue. As the multiplication and growth of alveoli occur, thin-walled pulmonary arteries without muscle multiply
slowly. Later muscle gradually extends into become larger in size but multiply more slowly. Later muscle gradually extends into the walls of the arteries in the acinus and the adult anatomical pattern is present at 19 years of age.-W. K. Sieber. EFFECT OF TOLAZOLINE HYDROCHLORIDE ON SPUTUM VISCOSITY IN CYSTIC FIBROSIS.
E. A. Feather and G. Russell. Thorax 25:732 (November) 1970. Tolaxoline hydrochloride administered to five patients with cystic fibrosis did not differ significantly from a placebo in its effect on sputum viscosity. The authors conclude that they were unable to detect an autonomic effect of the drug on the physical properties of bronchial mucus.-W. K. Sieber. VOLUME PRFS~IJRE RELATIONSOF THE LUNGS OF CHILDREN MEANRED DURING THORACOTOMY. G. C. Fisk and C. W. Deal.
Aust. Paediat. 1970.
J. 6:203-212
(December)
Pulmonary compliance was estimated by direct measurement of the airway pressure in children under 7 years of age during intrathoracic surgery, mainly for congenital cardiac disease. In the 36 patients over 12 months of age the compliance measured at the beginning of operation increased with age, weight, height, and surface area. In the 42 patients under 12 months of age pulmonary compliance was markedly lower in those with very large pulmonary to systemic flow ratios but on excluding this group the compliance of the remainder increased with age, weight, height, and surface area as in the older group of children. In 5 of 14 patients who underwent banding of the pulmonary artery there was a marked increase in compliance measured just after the operation.-]. R. Solomon. MEDIASTINAL MASSES FOLLOWING CORRECTIVE SURGERY FOR CONGENITAL HEART DISEASE. E. Krongrad, G. H. Gunn-
kzugsson, R. H. Feldt, and D. C. McGooh. Mayo Clin. Proc. 45 (November-December) 1970. TWO cases, both I3 years of age, ported in whom mediastinal masses oped subsequent to corrective surgery. In one patient a simple
are redevelcardiac thymic
397
ABSTRACTS
cyst was found 2 years following cardiac surgery, and in the other, Hodgkins disease of the mediastinum. The authors advise selective angiocardiography, followed by exploratory thoracotomy for all patients who have mediastinal masses-M. Gilbert.
HEART AND GREAT VESSELS INDICATIONSAND RESULTS OF TOTAL REPAIR OF THE MOST IMPORTANTTYPES OF CONGENITALHEART DISEASE.K. Schriber, J. Ammann, V. Gasser, W. Glinz, C. Minale, M. Rothlin, and A. Senning.
Schweiz.
Med. Wschr.
100:33, 1970.
In uncomplicated patent ductus arteriosus the diagnosis is the indication for surgical repair; 96 patients, including 8 infants, have been operated upon. There has been no operative death and no case of recanalization. One hundred and one cases of pure coarctation have been corrected. In about 90% of the patients a reduction of blood pressure was obtained. There has been no operative mortality. Thirty-six cases of congenital aortic stenosis ( all three types) have been corrected. Indication for repair is present in any case where a pressure gradient of 50 mm Hg or more with normal cardiac output rate has been measured, or where serious symptoms are present, or where EKG shows a severe hypertrophy of the left ventricle. The resection of subvalvular stenosis was successful in all cases. In valvular stenosis a good palliative effect could be obtained. A late mortality occurred in both groups. Forty-seven cases of uncomplicated pulmonary stenosis have been repaired. The indication for correction is present when there exists a pressure gradient of 50 mm Hg or more. Two patients have died of right heart failure in the postoperative phase; two patients have shown a recurrence of the stenosis. Two hundred patients have been operated upon because of secundum type atria1 septal defect. The defect must be corrected if there is a left-to-right shunt of 50% of the pulmonary flow rate or more. No operative morality was registered. Follow-up examination showed good results in 95% of the cases. Thirty-eight cases of endocardial cushion defect have been corrected. Operative mor-
tality was 5%; one case of late death has been registered. Eighty per cent of the patients have shown a good result. Forty-five cases of ventricular defect have been submitted to surgery. The indication for surgical repair is present when there is a left-to-right shunt of 50% of the pulmonary flow rate or more. The operative mortality was 11%; one case of late death has been registered Ninety-two per cent of the patients have shown a good result. Three patients have had a recurrence of the defect. Eighty-three cases of tetralogy of Fallot have been operated upon. All 83 patients have had total repair, 41 after palliative operations. The operative mortality was 6%; four cases had to be reoperated. All of the 68 cases which have been thoroughly studied later on have shown a significant improvement of the hemodynamic situation.-A. Zimmermann
and hf. Bettex.
SURGERYOF VENTRICULARSEPTAL DEFECT AND PULMONARYVASCULAR RESISTANCE. H. A. Samaan.
ber)
Thorax 25:665,
(Novem-
1970.
In this series of 65 patients operated upon for ventricular septal defects (LSD) at the Royal Infirmary, Edinburgh, no mortality was attributed to preoperative raised pulmonary vascular resistance. Eight patients with a severe degree of pulmonary vascular resistance made a full recovery after surgical closure of the ventricular septal defect. Mortality in the series was due to inadequate perfusion during operation, hemorrhage, cardiac tamponade, mediastinal infection, complete heart block, or the development of postoperative aortic incompetence. The authors conclude that raised pulmonary vascular resistance and clinical evidence of a dominant left-to-right shunt in the absence of serious intracardiac anatomical complications does not contraindicate surgery for the repair of VSD.-W. K. Sieber. TOTAL ANOMALOUS PULMONARY VENOUS RETURN WITH INTACT ATRIAL SEPTUM AND ASSOCIATED MITRAL STENOSIS.W. G. Wolfe and P. A. Ebert. Thorax 25:769,
(November) 1970. This paper represents the first reported case of total anomalous pulmonary venous return with an intact atrial septum and