- Email: [email protected]
Notice from the American Board of Thoracic Surgery
211 How to Do It: Robertson and Laks: Pediatric Permanent Pacemaker Implantation
Use of the peritoneal space was suggested previously by Donahoo and co-workers [7];however, others who have used this technique have had problems with generator migration [2].Our technique, which uses a generator cradled in a Silastic blanket suspended from the abdominal fascia, should eliminate this problem. In addition, a simple continuous midline incision may be used, which provides easy access to the heart for permanent atrial and ventricular epicardial lead placement either at the time of repair or later in the postoperative period [6]. Over the last 18 months, we have used this technique to place 5 permanent dual-chamber DDD generators and 1 single-chamber (VVI) generator and their respective leads. Our patients ranged in age from 15 months to 10 years and have been observed closely for 4 to 18 months without any problems (Table). All of these children had markedly less postoperative discomfort with this preperitoneal positioning than did previous children in whom subcutaneous or preposterior rectus fascia1 placement was used. In addition, as no child had any evidence of the classic generator "bulge," this technique produced superior cosmetic results. Programming of the pacer generator (including in the DDD mode) has been performed in all patients without any difficulty. Although only time will tell if any difficulty will be encountered during the required battery changes, we anticipate
none. In summary, we recognize that our patient population is small and our long-term follow-up is limited, but to date we feel that this new technique is easy to perform and produces very good overall results.
References 1. Fleming WH, Sarafian LB, Kugler JD, et a 1 Changing indications for pacemakers in children. Ann Thorac Surg 31:329, 1981 2. Amato JJ, Payne DD, Rheinlander HF, Cleveland RJ: Intermuscular abdominal implantation of permanent pacemakers in infants and children. Ann Thorac Surg 25:243, 1978 3. Furman S, Young D: Cardiac pacing in children and adolescents. Am J Cardiol 39:550, 1977 4. Lindesmith GG, Stiles QR, Meyer BW, et al: Experience with an implantable synchronous pacemaker in children. Ann Thorac Surg 6358,1968 5. Marco JD, Codd JE, Barner HB, et a1 Implantable pacemaker in children. Arch Surg 110:880, 1975 6. DeLeon SY, Ilbawi MN, Idriss FS: Pacemaker implantation in infants and children: a simplified approach. Ann Thorac Surg 30:599, 1980 7. Donahoo JS, Haller JA, Zonnebelt S, et al: Permanent cardiac pacemakers in children: technical considerations. Ann Thorac Surg 22:584, 1976 8. Williams GD, Campbell GS: Pacemaker installation in the pediatric patient: an improved technique. Surgery 66:412, 1969
Notice from the American Board of Thoracic Surgery The American Board of Thoracic Surgery began its recertification process in 1984. Diplomates interested in participating in this examination should maintain a documented list of the cardiothoracic operations they performed during the year prior to application for recertification. They should also keep a record of their attendance at thoracic surgical meetings, and other continuing medical education activities pertaining to thoracic surgery and thoracic disease, for the two years prior to application. A minimum of 100 hours of approved CME activity is required. In place of a cognitive examination, candidates for recertification will be required to complete both the general thoracic and cardiac portions of the SESATS I11 syllabus (Self-Education/Self-Assessmentin Thoracic Surgery). It is not necessary for candidates to purchase
SESATS I11 booklets prior to applying for recertification. SESATS I11 booklets will be forwarded to candidates after their applications have been accepted. Diplomates whose 10-year certificates will expire in 1990 may begin the recertification process in 1988. This new certificate will be dated 10 years from the time of expiration of the original certificate. Recertification is also open to any Diplomate with an unlimited certificate and will in no way affect the validity of the original certificate. The deadline for submission of applications is July 1, 1988. A recertification brochure outlining the rules and requirements for recertification in thoracic surgery is available upon request from the American Board of Thoracic Surgery, One American Plaza, Suite 803, Evanston, IL 60201.
Use of the peritoneal space was suggested previously by Donahoo and co-workers [7];however, others who have used this technique have had problems with generator migration [2].Our technique, which uses a generator cradled in a Silastic blanket suspended from the abdominal fascia, should eliminate this problem. In addition, a simple continuous midline incision may be used, which provides easy access to the heart for permanent atrial and ventricular epicardial lead placement either at the time of repair or later in the postoperative period [6]. Over the last 18 months, we have used this technique to place 5 permanent dual-chamber DDD generators and 1 single-chamber (VVI) generator and their respective leads. Our patients ranged in age from 15 months to 10 years and have been observed closely for 4 to 18 months without any problems (Table). All of these children had markedly less postoperative discomfort with this preperitoneal positioning than did previous children in whom subcutaneous or preposterior rectus fascia1 placement was used. In addition, as no child had any evidence of the classic generator "bulge," this technique produced superior cosmetic results. Programming of the pacer generator (including in the DDD mode) has been performed in all patients without any difficulty. Although only time will tell if any difficulty will be encountered during the required battery changes, we anticipate
none. In summary, we recognize that our patient population is small and our long-term follow-up is limited, but to date we feel that this new technique is easy to perform and produces very good overall results.
References 1. Fleming WH, Sarafian LB, Kugler JD, et a 1 Changing indications for pacemakers in children. Ann Thorac Surg 31:329, 1981 2. Amato JJ, Payne DD, Rheinlander HF, Cleveland RJ: Intermuscular abdominal implantation of permanent pacemakers in infants and children. Ann Thorac Surg 25:243, 1978 3. Furman S, Young D: Cardiac pacing in children and adolescents. Am J Cardiol 39:550, 1977 4. Lindesmith GG, Stiles QR, Meyer BW, et al: Experience with an implantable synchronous pacemaker in children. Ann Thorac Surg 6358,1968 5. Marco JD, Codd JE, Barner HB, et a1 Implantable pacemaker in children. Arch Surg 110:880, 1975 6. DeLeon SY, Ilbawi MN, Idriss FS: Pacemaker implantation in infants and children: a simplified approach. Ann Thorac Surg 30:599, 1980 7. Donahoo JS, Haller JA, Zonnebelt S, et al: Permanent cardiac pacemakers in children: technical considerations. Ann Thorac Surg 22:584, 1976 8. Williams GD, Campbell GS: Pacemaker installation in the pediatric patient: an improved technique. Surgery 66:412, 1969
Notice from the American Board of Thoracic Surgery The American Board of Thoracic Surgery began its recertification process in 1984. Diplomates interested in participating in this examination should maintain a documented list of the cardiothoracic operations they performed during the year prior to application for recertification. They should also keep a record of their attendance at thoracic surgical meetings, and other continuing medical education activities pertaining to thoracic surgery and thoracic disease, for the two years prior to application. A minimum of 100 hours of approved CME activity is required. In place of a cognitive examination, candidates for recertification will be required to complete both the general thoracic and cardiac portions of the SESATS I11 syllabus (Self-Education/Self-Assessmentin Thoracic Surgery). It is not necessary for candidates to purchase
SESATS I11 booklets prior to applying for recertification. SESATS I11 booklets will be forwarded to candidates after their applications have been accepted. Diplomates whose 10-year certificates will expire in 1990 may begin the recertification process in 1988. This new certificate will be dated 10 years from the time of expiration of the original certificate. Recertification is also open to any Diplomate with an unlimited certificate and will in no way affect the validity of the original certificate. The deadline for submission of applications is July 1, 1988. A recertification brochure outlining the rules and requirements for recertification in thoracic surgery is available upon request from the American Board of Thoracic Surgery, One American Plaza, Suite 803, Evanston, IL 60201.