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Pacemaker installation in the pediatric patient: An improved technique
x3
ABSTRACTS
leaflets are useless). The “depulsating” effect of the atrialized ventricle or right ventricular filling is eliminated. When this method of repair was first described five years ago, it was greeted with some skepticism. This paper shows the soundness of the principles underlying the operation.--lens G. Rosenkrantz. METABOLIC COMPARISON OF A NEW PIJLSATILE PUMP AND A ROLLER PUMP FC)R CARDIOPULMONARYBYPASS. J. K. Trinkle, N. E. Helton, R. E. Wood and L. R. Bryant. J. Thorac. Cardiovasc. Surg. 58:
562-569,
(October)
1969.
Experiences are reported with two hours of cardiopulmonary bypass in 10 dogs and open-heart surgery in 18 patients, with random use of a roller pump or the HeltonPemco pulsatile pump. Bypass time averaged 83.6 minutes for the eight patients treated with the pulsatile pump and 76.2 minutes for the 10 patients operated upon with a roller pump. All eight patients with the pulsatile pump survived; nine of the 10 patients with the roller pump survived. A variety of measurements were made during and after bypass in the animals and humans. There was a decreased peripheral resistance in both species with the pulsatile pump with a higher flow rate and less intraoperative transfusion. Also noted were lower serum lactate concentration during and after bypass, and lower serum hemoglobin levels after bypass with the pulsatile pump. The authors conclude that these differences reflect a better microcirculation during bypass with the pulsatile pump. Although their methods of measurement of various physiologic and biochemical parameters are not described and their conclusions are not based on any direct evidence, their conclusions seem logical and are consistent with other, more carefully studied experiments. showing the advantages of pulsatile flow in organ perfusion. The pump described seems to possess features not present in other pulMile pumps: less in vitro hemolysis, higher output capabilities and a simpler mechanical design which reduces the hazard of air or hydraulic fluid embolization.-./ens G. Rosen-
Doyne
Williams and Gilbert S. Campbeli.
Surgery
66:412-414,
(August)
1969.
Complete heart block following intracardiac surgery requires the implantation of a pacemaker. In little children and small, thin adults, the size of the pacemaker module has created a problem of finding a location for implantation which will be comfortable and cosmetically suitable. The epigastric subrectus site has proved satisfacA midline epigastric incision is made and the linea alba incised. Each rectus muscle is dissected free laterally from its posterior sheath. The peritoneum is left intact. The posterior rectus sheaths are then sutured in the midline and the pacemaker module placed on them. The rectus muscle bellies and anterior sheaths are sutured anteriorly. Electrode wires may be brought up through a subpectoral tunnel into the neck for transvenous insertion, or through the diaphragm for epicardial application. The technique has been employed in two small, thin adults and two small five-year-old patients. There are excellent illustrations of the method.Daniel
T. Cloud.
HEART BLOCK IN CHILDREN. TREATMENI WITH A RADIOFREQUENCY PACEMAKER. W. W. L. Glenn, N. de Leachtenherg, D. W. ,‘an Heeckeren. G. Saro, W. G. Holcomb and K. Palsson. I. Thorac.
Cardiovasc.
Surg. 58:361-372,
(Septem-
her) 1969.
Nine children, six months to 10 years of age, had a radiofrequency pacemaker implanted because of complete heart block. The cathode is sutured into the left ventricular myocardium, the anode in the mediastinum, and the receiver is placed subcutaneously in the chest wall. Following wound closure the antenna of the radio is taped to the skin over the receiver and pacing is begun. One patient died of ventricular fibrillation three months postoperative: one showed reversal of the arrhythmia and required no further pacing about five months one patient died after two postoperative, years of pacing with SBE, and the remainder krantz. are alive two to four years later. Five patients required reoperation, four because of PACEMAKERINSTALLATION IN THE PEDIATRIC failure of the receiver and one for splicing of a fractured cathode wire. These results PATIENT: AN IMPROVED TECHNIQUE. G.
ABSTRACTS
leaflets are useless). The “depulsating” effect of the atrialized ventricle or right ventricular filling is eliminated. When this method of repair was first described five years ago, it was greeted with some skepticism. This paper shows the soundness of the principles underlying the operation.--lens G. Rosenkrantz. METABOLIC COMPARISON OF A NEW PIJLSATILE PUMP AND A ROLLER PUMP FC)R CARDIOPULMONARYBYPASS. J. K. Trinkle, N. E. Helton, R. E. Wood and L. R. Bryant. J. Thorac. Cardiovasc. Surg. 58:
562-569,
(October)
1969.
Experiences are reported with two hours of cardiopulmonary bypass in 10 dogs and open-heart surgery in 18 patients, with random use of a roller pump or the HeltonPemco pulsatile pump. Bypass time averaged 83.6 minutes for the eight patients treated with the pulsatile pump and 76.2 minutes for the 10 patients operated upon with a roller pump. All eight patients with the pulsatile pump survived; nine of the 10 patients with the roller pump survived. A variety of measurements were made during and after bypass in the animals and humans. There was a decreased peripheral resistance in both species with the pulsatile pump with a higher flow rate and less intraoperative transfusion. Also noted were lower serum lactate concentration during and after bypass, and lower serum hemoglobin levels after bypass with the pulsatile pump. The authors conclude that these differences reflect a better microcirculation during bypass with the pulsatile pump. Although their methods of measurement of various physiologic and biochemical parameters are not described and their conclusions are not based on any direct evidence, their conclusions seem logical and are consistent with other, more carefully studied experiments. showing the advantages of pulsatile flow in organ perfusion. The pump described seems to possess features not present in other pulMile pumps: less in vitro hemolysis, higher output capabilities and a simpler mechanical design which reduces the hazard of air or hydraulic fluid embolization.-./ens G. Rosen-
Doyne
Williams and Gilbert S. Campbeli.
Surgery
66:412-414,
(August)
1969.
Complete heart block following intracardiac surgery requires the implantation of a pacemaker. In little children and small, thin adults, the size of the pacemaker module has created a problem of finding a location for implantation which will be comfortable and cosmetically suitable. The epigastric subrectus site has proved satisfacA midline epigastric incision is made and the linea alba incised. Each rectus muscle is dissected free laterally from its posterior sheath. The peritoneum is left intact. The posterior rectus sheaths are then sutured in the midline and the pacemaker module placed on them. The rectus muscle bellies and anterior sheaths are sutured anteriorly. Electrode wires may be brought up through a subpectoral tunnel into the neck for transvenous insertion, or through the diaphragm for epicardial application. The technique has been employed in two small, thin adults and two small five-year-old patients. There are excellent illustrations of the method.Daniel
T. Cloud.
HEART BLOCK IN CHILDREN. TREATMENI WITH A RADIOFREQUENCY PACEMAKER. W. W. L. Glenn, N. de Leachtenherg, D. W. ,‘an Heeckeren. G. Saro, W. G. Holcomb and K. Palsson. I. Thorac.
Cardiovasc.
Surg. 58:361-372,
(Septem-
her) 1969.
Nine children, six months to 10 years of age, had a radiofrequency pacemaker implanted because of complete heart block. The cathode is sutured into the left ventricular myocardium, the anode in the mediastinum, and the receiver is placed subcutaneously in the chest wall. Following wound closure the antenna of the radio is taped to the skin over the receiver and pacing is begun. One patient died of ventricular fibrillation three months postoperative: one showed reversal of the arrhythmia and required no further pacing about five months one patient died after two postoperative, years of pacing with SBE, and the remainder krantz. are alive two to four years later. Five patients required reoperation, four because of PACEMAKERINSTALLATION IN THE PEDIATRIC failure of the receiver and one for splicing of a fractured cathode wire. These results PATIENT: AN IMPROVED TECHNIQUE. G.