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Neonatal aortic thrombosis. A case description and an explanation for pathogenesis
ABSTRACTS
Metabolic problems involved with cross-clamping in children operated upon for coarctation of the aorta are quite different to those found in adults. Twelve children were studied in this series before, during and after intraoperative cross-clamping of the aorta. Peripheral arterial blood pressure, ATP, p h o s p h o - c r e a t i n e , glucose, glucose6-phosphate, and lactate were calculated for the muscle-cell metabolism. Muscle tissue was obtained by needle biopsy from the quadriceps representing distal muscle circulation and from the deltoid as a control of the upper body half. The cross-clamping lasted an average of 48 rain. It was shown that after clamping there was a decrease of the systolic blood-pressure of about 35 mm Hg down to a mean arterial pressure of 43 mm Hg registered in the dorsal artery of the foot. This showed the development of good collateral circulation in this age group in contrast to adults. The metabolic data monitored indicated only slight changes without obvious hypoxia during the time of clamping up to periods of 75 rain. At the end of the clamping, no increase of tissue-lactate and pyruvate occurred in the beginning, but only later on. Venous pyruvate and lactate levels were elevated immediately after clamping. Muscle phosphocreatine was lowered significantly postoperatively and ATP and glucose-6-phosphate were unchanged. There was a good degree of safety for the distal muscle metabolism during cross-clamping and damage to the spinal cord should not be expected. Karl-Ludwig Waag Etiology of Right Bundle Branch Block Pattern Following Surgical Repair of Atrioventricular Cushion Defects, R, Antar
and E. Krongrad. Chest 73:642-646 (May), 1978. A prospective review of 12 patients with A-V canal defects and 24 with ostium primum revealed 10 of 12 and 7 of 24 developing RBBB. All of the A-V canal patients had septal sutures placed and the seven patients with ostium primum defects who developed RBBB had septal sutures placed. tntraoperative delineation of the conduction system aided in prevention of this complication in one of the A-V canal patients. The technique should decrease the incidence of this complication. Randall W. Powell
101
Echocardiographic findings in a 10-hr-old neonate with clinical evidence of hypoplastic left heart syndrome revealed a mass in the left ventricle. The infant expired very soon after the echocardiographic study and postmortem examination revealed a 3 • 5 cm rhabdomyoma. The technique illustrates that early diagnosis of this rare condition may lead to early surgical intervention.--Randall W. Powell Ligation of Patent Ductus Arteriosus in the Very Low Birthweight Newborn Infant. R. W. ]. Cooke, B. Gribbin, A. J.
Gunning, and D. Pickering. Arch Dis Child 53:27l 275 (April), 1978. Eight cases of surgical closure of a PDA in low birthweight infants are presented. Four of the patients died, two due to respiratory failure. The latter 2 had undergone 5 to 6 wk of medical therapy prior to ductus ligation. Until better pharmacologic methods of ductal closure are found, surgical closure remains a safe alternative. Early operation is suggested to prevent lung damage.--Randall W. Powell Neonatal Aortic Thrombosis. A Case Description and an Explanation for Pathogenesis. I. J. Cohen, I. Yanai-lnbar, and P.
Tikva. Clin Pediatr 17:490-493 (June), 1978. An 8-day-old full-term infant who developed aortic thrombosis is presented. The pathogenesis was uncertain but the combination of sepsis, hypothermia, polycythemia, dehydration, and intracranial hemorrhage may have led to an altered coagulation state. Daniel Thomas Aortic Thrombosis in the Newborn Period. G. T, Knowlson and
H. B. Marsden. Arch Dis Child 53:164 166, (February), 1978. Three neonates who died from complications of aortic thrombosis associated with ductus arteriosus are described. Although thromboembolism is far more commonly associated with the use of indwelling catheters, it remains important to consider the ductus as a source.--P. A. M. Raine ALIMENTARY TRACT Vocal Cord Paralysis and Mediastinal Mass: An Unusual
Silent Unilateral Pulmonary Venous Obstruction. J. E. Lock,
R. V. Lucas, Jr., K. Amplatz, and F. B. Bessinger, Jr. Chest 73:224-227 (February), 1978. An l l-yr-otd female with asymptomatic left pulmonary venous obstruction following a Mustard procedure for transposition of the great arteries at age of 30 mo is presented. The absence of the usual symptoms of unilateral pulmonary venous obstruction, the catheterization findings of retrograde flow from the left to right lung without right pulmonary hypertension, and the demonstration of the pulmonary venous anatomy by pulmonary arterial wedge studies is presented. The authors conclude that this complication of the Mustard procedure should be evaluated with the first postoperative cardiac catheterization when corrective surgery might be more feasible.--Randall W. Powell Echocardiographic Evidence of Left Ventricular Tumor in a Neonate. A. H. Rees, F. E. Elbl, K. V. Minhas, and R. E.
Solinger. Chest 73:433-435 (March), 1978.
Esophageal Foreign Body Presentation. M. Poncz and M. W, Schwartz. Clin Pediatr 17:196-198 (February), 1978.
A I 0-roD-old female presented with a history of hoarseness and expiratory wheezing. A chest x-ray revealed tracheal deviation to the right with compression of the left main stem bronchus. The left vocal cord was paralyzed. The esophagus was deviated to the right at the level of the aortic knob by an extrinsic mass. Exploratory thoracotomy revealed a hard nutshell surrounded by an inflammatory process. Three days later, massive hemoptysis and hematemesis required another exploration that revealed tracheoesophageal and aorticoesophageal fistulas which were repaired. Four days later massive bleeding recurred and the patient died.--Randall W. Powell Successful Management of Esophageal Atresia Type Ilia by Esophageal Stretching. A Case Report. D. Nuss. S Afr Med J
52:457-460 (September), 1977. This paper describes a case of esophageal atresia type llla and anorectal agenesis in which stretching of the esophagus
Metabolic problems involved with cross-clamping in children operated upon for coarctation of the aorta are quite different to those found in adults. Twelve children were studied in this series before, during and after intraoperative cross-clamping of the aorta. Peripheral arterial blood pressure, ATP, p h o s p h o - c r e a t i n e , glucose, glucose6-phosphate, and lactate were calculated for the muscle-cell metabolism. Muscle tissue was obtained by needle biopsy from the quadriceps representing distal muscle circulation and from the deltoid as a control of the upper body half. The cross-clamping lasted an average of 48 rain. It was shown that after clamping there was a decrease of the systolic blood-pressure of about 35 mm Hg down to a mean arterial pressure of 43 mm Hg registered in the dorsal artery of the foot. This showed the development of good collateral circulation in this age group in contrast to adults. The metabolic data monitored indicated only slight changes without obvious hypoxia during the time of clamping up to periods of 75 rain. At the end of the clamping, no increase of tissue-lactate and pyruvate occurred in the beginning, but only later on. Venous pyruvate and lactate levels were elevated immediately after clamping. Muscle phosphocreatine was lowered significantly postoperatively and ATP and glucose-6-phosphate were unchanged. There was a good degree of safety for the distal muscle metabolism during cross-clamping and damage to the spinal cord should not be expected. Karl-Ludwig Waag Etiology of Right Bundle Branch Block Pattern Following Surgical Repair of Atrioventricular Cushion Defects, R, Antar
and E. Krongrad. Chest 73:642-646 (May), 1978. A prospective review of 12 patients with A-V canal defects and 24 with ostium primum revealed 10 of 12 and 7 of 24 developing RBBB. All of the A-V canal patients had septal sutures placed and the seven patients with ostium primum defects who developed RBBB had septal sutures placed. tntraoperative delineation of the conduction system aided in prevention of this complication in one of the A-V canal patients. The technique should decrease the incidence of this complication. Randall W. Powell
101
Echocardiographic findings in a 10-hr-old neonate with clinical evidence of hypoplastic left heart syndrome revealed a mass in the left ventricle. The infant expired very soon after the echocardiographic study and postmortem examination revealed a 3 • 5 cm rhabdomyoma. The technique illustrates that early diagnosis of this rare condition may lead to early surgical intervention.--Randall W. Powell Ligation of Patent Ductus Arteriosus in the Very Low Birthweight Newborn Infant. R. W. ]. Cooke, B. Gribbin, A. J.
Gunning, and D. Pickering. Arch Dis Child 53:27l 275 (April), 1978. Eight cases of surgical closure of a PDA in low birthweight infants are presented. Four of the patients died, two due to respiratory failure. The latter 2 had undergone 5 to 6 wk of medical therapy prior to ductus ligation. Until better pharmacologic methods of ductal closure are found, surgical closure remains a safe alternative. Early operation is suggested to prevent lung damage.--Randall W. Powell Neonatal Aortic Thrombosis. A Case Description and an Explanation for Pathogenesis. I. J. Cohen, I. Yanai-lnbar, and P.
Tikva. Clin Pediatr 17:490-493 (June), 1978. An 8-day-old full-term infant who developed aortic thrombosis is presented. The pathogenesis was uncertain but the combination of sepsis, hypothermia, polycythemia, dehydration, and intracranial hemorrhage may have led to an altered coagulation state. Daniel Thomas Aortic Thrombosis in the Newborn Period. G. T, Knowlson and
H. B. Marsden. Arch Dis Child 53:164 166, (February), 1978. Three neonates who died from complications of aortic thrombosis associated with ductus arteriosus are described. Although thromboembolism is far more commonly associated with the use of indwelling catheters, it remains important to consider the ductus as a source.--P. A. M. Raine ALIMENTARY TRACT Vocal Cord Paralysis and Mediastinal Mass: An Unusual
Silent Unilateral Pulmonary Venous Obstruction. J. E. Lock,
R. V. Lucas, Jr., K. Amplatz, and F. B. Bessinger, Jr. Chest 73:224-227 (February), 1978. An l l-yr-otd female with asymptomatic left pulmonary venous obstruction following a Mustard procedure for transposition of the great arteries at age of 30 mo is presented. The absence of the usual symptoms of unilateral pulmonary venous obstruction, the catheterization findings of retrograde flow from the left to right lung without right pulmonary hypertension, and the demonstration of the pulmonary venous anatomy by pulmonary arterial wedge studies is presented. The authors conclude that this complication of the Mustard procedure should be evaluated with the first postoperative cardiac catheterization when corrective surgery might be more feasible.--Randall W. Powell Echocardiographic Evidence of Left Ventricular Tumor in a Neonate. A. H. Rees, F. E. Elbl, K. V. Minhas, and R. E.
Solinger. Chest 73:433-435 (March), 1978.
Esophageal Foreign Body Presentation. M. Poncz and M. W, Schwartz. Clin Pediatr 17:196-198 (February), 1978.
A I 0-roD-old female presented with a history of hoarseness and expiratory wheezing. A chest x-ray revealed tracheal deviation to the right with compression of the left main stem bronchus. The left vocal cord was paralyzed. The esophagus was deviated to the right at the level of the aortic knob by an extrinsic mass. Exploratory thoracotomy revealed a hard nutshell surrounded by an inflammatory process. Three days later, massive hemoptysis and hematemesis required another exploration that revealed tracheoesophageal and aorticoesophageal fistulas which were repaired. Four days later massive bleeding recurred and the patient died.--Randall W. Powell Successful Management of Esophageal Atresia Type Ilia by Esophageal Stretching. A Case Report. D. Nuss. S Afr Med J
52:457-460 (September), 1977. This paper describes a case of esophageal atresia type llla and anorectal agenesis in which stretching of the esophagus