Obstruction of superior vena cava after the mustard procedure for transposition of the great arteries: Conservative management of chylothorax

135

ABSTRACTS

technique of either Malm should be used in the infant

or Barratt-Boyes group.-Keith W.

Ashcraft of Systemic-Pulmonary Shunts on Re-

ERectr

gionol Myocordiol Blood Flow in Experimental Pulmonary Shnosis. N. Cooper, 1. Brazier, ond G.

B&berg.

J Thoroc Cardiovosc

Surg 70:166176

(July), 1975.

This experimental study entailed measurement of blood flow to the right ventricular myocardium while varying pulmonary and systemic resistances. When the pulmonary artery was constricted the right ventricular perfusion increased with right ventricular pressure to a point. When the perfusion failed to keep pace with increased right ventricular pressure the right ventricle failed. Opening of a systemic to pulmonary artery shunt distal to the pulmonary artery band caused a decrease in right ventricular perfusion and promoted right ventricular failure. Constriction of the aorta increased right ventricular myocardial perfusion and decreased right ventricular failure.-Thomas M. Holder

Exercise Tolerance After Repair of Telrology of Pallet. D. J. Stricder, K. Aziz, A. G. Zover, and K. E. Fellows. Ann Thoroc Surg 19:397-405 (April),

ascending aorta, the aortic valve, and remnants of the anterior leaflet of the mitral valve. The cadaver homografts are collected within 48 hr of death and stored in an antibiotic-nutrient medium. The patients included 48 with Fallot’s tetralogy or pulmonary atresia, 5 with truncus arteriosus, 2 with transposition of the great arteries with ventricular septal defect, and 6 with tricuspid atresia or common ventricle. Ease of insertion and satisfactory function have encouraged the use of this conduit. The results and relevant literature are reviewed.J.F. R. Bentley Toke-Down of Cove-Pulmonary mosis (Glenn)

During

Artery Anasto-

Repair of

Congenital

Cardiac Molformotions. A. D. Pocifko ond 1. W. Kirk/in.

J Thoroc

Cordiovosc

Surg

70:272-277

(August), 1975.

Five patients with a superior vena cava to right pulmonary artery shunt had the shunt disassembled at the time of total correction of their heart defect. The continuity of the superior vena cava and the right pulmonary artery was reestablished. While all survived the procedure the authors believe that the superior vena cava to right pulmonary artery shunt should not be used for palliation of correctable cardiac malformations.-Thomas M. Holder

1975.

This study involved I2 patients ranging in age from 8 to 27 yr who had undergone repair of their tetralogy l-9 yr prior to this study. Several of the repairs were imperfect with residual ventricular septal defects and moderate left-toright shunts. Pulmonary function studies indicated some pulmonary disease in 5 of I2 patients. When exercised against a predicted workload on the bicycle ergometer all 12 patients were found to be able to exercise to 50% of predicted capacity, and 7 performed to more than 80%. Generally it seemed that the patients with some impairment in pulmonary function had more restriction in exercise tolerance. The exercise tolerance ability did not seem to be correlated with the residual cardiac lesion.Keith W. Ashcraft Reconstruclion of With

a

Valved

Right

Ventricular

Homogmft

Wheat/y,

S. Prusty,

and

D.

617-623

(November), 1974.

N.

Outflow

Conduit. Ross.

D.

J.

Thorax 29:

In this series of 123 operations performed at the National Heart Hospital, London, since 1966, the homograft conduit consisted of the

Obstruction of Sqaerior Veno Covo After the

Mustard Great

Procedure

for

Tronsposi,ion of

Arteries: Conservative Management

Chylothomx. G. R. Gumming

ond

C.

C.

J Thoroc Cordiovosc Surg 70:242-247

the of

Ferguson.

(August),

1975.

A patient had a Mustard procedure for transposition of the great vessels at age 24 mo. He developed a chylothorax in the immediate postoperative period. Cardiac catheterization at I6 days postoperatively showed narrowing of the superior vena cava at the sight of the intraatrial baffle. The narrowing progressed to complete caval obstruction with venous drainage via the azygos system. The chylothorax was troublesome for the next 8 mo. The chylothorax gradually subsided with keeping the patient upright. A second operation was thus averted. A second patient is mentioned who developed chylothorax following superior vena cava to right pulmonary artery shunt in which the azygos vein was not ligated. When the azygos was ligated the chylothorax disappeared. Elevated pressure in the azygos system as well as in the superior vena cava contributed to lymphatic

ABSTRACTS

136

obstruction

and

chylothorax.~Thomas

M.

Holder Calcified Postoperative Epicardial Granuloma. 8. 6. Roe. Ann Thorac

Surg

19:472-473

(April),

1975. A case is reported of an 8-yr-old boy who had a calcific granuloma on the external surface of the right ventricle 4 yr following the repair of a ventricular septal defect. The lesion was removed, and a systolic ejection murmur present prior to its removal disappeared. The granuloma is postulated as a response to surgical silk. The murmur is suspected to be based on pressure on the right ventricular outflow tract by this I&cm-diameter mass.--Keith W. Ashcraf Congenital Rhabdomyoma of the Heart. K. D. Bhoolo. S Afr Med J 49:936-938

(May), 1975.

More than 100 cases of cardiac rhabdomyomata have been reported in the English literature. In most cases the tumor is found during postmortem examination of stillborn, newborn, or neonatal patients. This is a single case report of a female infant delivered by cesarean section, the product of a pregnancy complicated by preeclamptic toxemia and maternal diabetes mellitus. The baby developed severe cardiac failure within hours after delivery, culminating in cardiopulmonary death on the seventh day of life. On postmortem examination the heart was markedly increased in size and weight and contained a nonencapsulated tumor 4.3 cm in diameter situated in the interventricular septum. I%stology confirmed the presence of a tumor containing “spider cells,” a characteristic of cardiac rhabdomyomata.M.R.Q. Davies

ALIMENTARY

Volsred Pedersen Congenital

Oesophageal

Stenosis

Tracheobronchial Remnants. A. K.

Thorax 29:720-725

due

to

Deeraniyo.

(November), 1974.

Two patients are reported with a later complication of distal esophageal obstruction apparent following operative treatment for esophageal atresia and tracheoesophageal fistula. One child who died also had rectal atresia and a sigmoid colostomy. In this child there was a crescent of cartilage and tracheobronchial seromucinous glands present at the site of the esophageal stenosis. Dilatation of the stenosis proved difficult and excision is advocated. No similar cases appear to have been reported.J. F. R. Benlley Simultaneous Occurrence of a Congenital Pyloric

TRACT

Web and Hiatal Insufficiency in an Infant. M.

Congenital Atresia of the Oesophagus. Sigmund

Vooge, Kje/f Levorstad, and Leif Efskind. Thorac Cordiovosc Surg 9:68-74, 1975.

X-ray examination and cinefluorography revealed a severe stenosis at the anastomotic site (diameter of the anastomosis less than one-half the diameter of the esophagus below the anastomosis) in 5 patients. a moderate stenosis in I I patients, and no stenosis at all in 17 patients. Some correlation between the ability to swallow and the degree of stenosis is claimed, whereas no correlation was found between swallowing and esophageal motility as seen by intraluminal pressure recordings and cinefluorography. These investigations revealed a normal motor function in the upper segment, absent peristalsis in the intermediate portion just below the anastomosis, and secondary peristaltic waves in the lower segment. One patient with a 6-cm gap between the upper and lower ends who was treated by intrathoracic esophagogastrostomy when 3 days old and 15 mo later by pyloroplasty was doing well and eating normally at 12 yr of age.--Peter

Stand

J

A study was conducted of 33 patients with esophageal atresia (2 without tracheoesophageal fistula) and 3 patients with tracheoesophageal fistula examined I IL24 yr postoperatively. Most of the patients suffered from repeated respiratory infections throughout early childhood. This tendency decreased at 5-10 yr of age. Six patients had a severe dysphagia, 7 a moderate dysphagia, especially when eating more rapidly than normally, and 23 patients were asymptomatic.

K&m&i 595-598

and P. Kuitunen.

Helv Poediotr

Aeta 29:

(December), 1974.

The authors report the case history of an infant who was under observation for many months before the etiology of his intractable vomiting was diagnosed. The first contrast examination of the stomach at the age of Id mo showed hiatal insufficiency but emptying of the stomach was found to be normal. Nevertheless, conservative therapy with positioning of the infant and feeding of solid food did not normalize the situation. Malabsorption tests proved negative. Pneumoencephalography excluded a cerebral cause of the vomiting and splenoportog-