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Pulmonary artery sling: Primary repair by tracheal resection in infancy
402
life-threatening sequelae if not quickly identified and treated. A canine model of progressive pneumothorax on ECMO was developed to study the pathophysiology and verify observed changes that occur in hemodynamic parameters. Bilateral chest tubes were placed in nine dogs and air was introduced to create a tension pneumothorax. Physiological parameters were monitored. Another six dogs were placed on ECMO and the same protocol for tension pneumothorax completed. Physiological changes occurred in both groups of dogs including decreased venous return, decreased pulse pressure, and decreased mean arterial pressure. In the dogs on ECMO, a triad of changes seen in children on ECMO was reproduced and included an increase in Pa 0,, a decrease in peripheral perfusion, and a decrease in ECMO flow. The clinical diagnosis of a tension pneumothorax may be difficult in a child on ECMO. The triad of changes found in children and confirmed in the laboratory animal can lead to early diagnosis and treatment.-Marlet Reynolds
INTERNATlONAL
ABSTRACTS
The only postoperative complication was an inguinal hernia resulting from poor repair of the inguinal ligament. The child died 5 months later as a result of the cardiac lesion.-iV.P. Madden THORAX True Thymic Hyperplasia: A Clinicopathological Study. C. Ricci, E. Pescamona, E.A. Rendina, et al. Ann Thorac Surg 47:741-
745, (May), 1989 Four children were described with “true thymic hyperplasia.” Two were asymptomatic and two had symptoms of dyspnea. All four had a large anterior mediastinal mass. Histological examination of the masses showed normal thymus with some peculiar features. Review of the literature identified seven other cases reported in children. The authors recommend complete excision to differentiate this lesion from other benign and malignant pathological conditions.-M&era Reynolds
Extracorporeal Membrane Oxygenation for Perioperative Support in Pediatric Heart Transplantation. M.E. Galuntowicz and C.J.H. Sfofur. 3 Thorac Cardiovasc Surg 102~148-152,(July), 1991.
Acquired Tracheal Stenosis in Infants and Children. T.R. Weber, R.H. Connors, and T.F. Tracy, Jr. J Thorac Cardiovasc Surg
The authors have reviewed the cases in which extracorporeal membrane oxygenation (ECMO) was used as an adjunct to pediatric cardiac transplantation through data obtained from the Extracorporeal Life Support Organization, as well as other registries and case reports. Twenty children were supported with ECMO perioperatively. In 4 cases, ECMO was used as a bridge to transplantation; in 10 cases it facilitated resuscitation of the cardiac allograft in the immediate postoperative period, and in 6 cases it complimented therapy for severe rejection in the late postoperative period. Twelve patients survived ECMO, with 7 alive more than 8 months, 1 in the bridge-to-transplant group, 4 in the immediate postoperative group, and 2 in the rejection group. The data suggest that ECMO can be used to support profound cardiac failure and is a useful adjunct to pediatric cardiac transplantation--Thomas F.
In a lo-year period, 62 patients (aged 4 weeks to 14 years) were treated for acquired tracheal stenosis. The causes of stenosis were endotracheal intubation (44) caustic aspiration (6), recurrent infection (5), bronchoscopic perforation (4), and gastric aspiration (3). The subglottic or upper trachea was involved in 47 patients, midportion in 8, and distal or carinal area in 7. Fifty children underwent tracheostomy as part of the therapy. Therapy was individualized, frequently sequentially utilizing rigid or balloon dilatation (20), bronchoscopic electrocoagulation resection (44) steroid injection (48) T tube stent (8) resection with anastomosis (12) cricoid split (3). and rib cartilage graft (12). Most patients required several techniques and repeated procedures. Seven patients (11%) died of unrelated causes. Forty-four of 55 surviving patients (80%) are without tracheostomy, although 14 have required continued endotracheal treatment after tracheostomy removal (dilatation, endotracheal resection). This series demonstrates that acquired tracheal stenosis in childhood is a common, difficult problem, but is manageable with the use of a variety of techniques. Resection and grafting procedures should be reserved for cases in which less complex modalities fail--l”homas F. Tracy,
Tracy, Jr Microvascular Surgery in Children. KS. Devaraj, S.P. Kay, A.J. Batchelor, et al. Br J Plast Surg 44:276-280, 1991.
The authors report the results of microvascular procedures in 38 children during a 3-year period. The patients ranged from an 8-day-old, 28-week-gestation neonate to a 15 year old, with an average age of 5.4 years. Congenital hand deformity was the largest single indication (12 patients); other indications included tumor and trauma including replantation of limbs. Sixty-three percent of operations were performed electively (13 free flaps and 14 toe transfers). There were no failures. Three of the 16 emergency procedures failed, including 2 of the 4 replantations. The smallest vessel anastomosed had an external diameter of 0.4 mm. The authors comment that vessel size per se was not a limiting factor. Stress is laid on the anesthetic and postoperative management, particularly elective ventilation overnight and appropriate analgesia to minimize vasospasm. Although the mean postoperative stay was 9.8 days, the authors comment that this is decreasing as experience increases.--llrP. Madden Combined Microsurgical and Thrombolytic Salvage of an lschaemic Lower Limb in a 1079 Gram Pre-term Neonate. S. Kay nnd D.J. Gilpin. Br .I Plast Surg 44:310-311, 1991.
The authors report the salvage of the leg of a 1,079-g neonate. The femoral artery had been avulsed following a balloon valvotomy to correct aortic stenosis. The ipsilateral femoral vein was used to perform a femoral arterial bypass. The graft occluded on two occasions but was finally salvaged by using a streptokinase infusion.
10229-35, (July), 1991.
Jr Slide Tracheoplasty for Congenital Funnel-Shaped Tracheal Stenosis. V. Tsang, A. Murday, C. Gillbe, et al. Ann Thorac Surg
48:632-635, (November), 1988. An intriguing technique of “slide tracheoplasty” is described. Two infants with funnel-shaped tracheal stenosis underwent this procedure. The trachea is divided and the distal segment is spatulated to serve as a patch graft to the proximal segment. One patient’s postoperative course was complicated and he died. Bronchoscopic examination prior to death showed an intact tracheal anastomosis. The other child is doing well 12 months following repair. The procedure avoids prosthetic or nontracheal tissue grafts, cardiopulmonary bypass, and tracheoplasty. Long-term follow-up is needed to evaluate the restenosis rate. The technique appears promising but will need more lengthy follow-up before it can be compared with other techniques.-Murlern Reynolds Pulmonary Artery Sling: Primary Repair by Tracheal Resection in Infancy. R.A. Jonas, P.J. Sperak, T. McGill, et al. .I Thorac
Cardiovasc Surg 97:548-550, (April), 1989. A pulmonary artery sling is often associated with moderate or severe tracheal stenosis. Conventional treatment of this anomaly
INTERNATIONAL
403
ABSTRACTS
includes division of the left pulmonary artery with reimplantation into the main pulmonary artery and tracheal resection with reanastomosis of the trachea. The authors describe two patients in whom they performed an alternative procedure. Their approach involves resection of the tracheal stenosis and reanastomosis using a continuous suture with absorbable polydioxanone. The pulmonary artery is brought anterior to the trachea after the trachea is divided. This method obviates the need for vascular anastomosis and its complications The patients have been followed for 9 and 6 months with excellent results. This technique appears to be an improvement over the conventional method.-Marlera Reynokis Right Pneumonectomy Syndrome in Infancy Treated With an Expandable Prothesis. D.K. Rasch, F.L. Grover, B.M. SchnopJ et al. Ann Thorac Surg 50:127-129, (July), 1990.
Marked mediastinal shift following pneumonectomy in infants and small children can be life threatening. This complication can be prevented by the insertion of a prosthesis into the involved chest, a technique which has been previously described. Applying advances in technology, the authors recommend the use of an expandable prothesis. Elective expansion of the prosthesis as the child grows would simplify management and eliminate the need to repeatedly replace the prosthesis.-Mar/eta Reynolds Percutaneous Needle Aspiration of Neonatal Lung Abscesses. SK. Lee, R.F. Morris, and B. Cramer. Pediatr Radio1 21:254-257,
nal aortogram, and a standard MRI study. The scimitar vein was best visualized with tine-MRI technology. The patient underwent an uneventful repair of his ASD and reimplant of the anomalous pulmonary vein. The authors recommend the tine-MRI as the technique of choice to demonstrate the anomalousvein without the use of contrast in a noninvasive manner.-M&era Revnolds ALIMENTARY
TRACT
Erosions of the Angelchik Prosthesis in Pediatric-Sized Developmentally Disabled Patients. D. Jakaite, G.R. Got&y, and J. R. Pellett. J Pediatr Gastroenterol Nutr 13:186-191, (August). 1991.
This a retrospective review of 40 pediatric-sized developmentally disabled patients who participated in a study comparing Nissen fundoplication with Angelchik prosthesis for treatment of severe gastroesophageal reflux. Five patients experienced erosions of the prosthesis between 2 years and 2 years 8 months following surgical insertion of this device. The erosions were associated with vomiting, increased discomfort, melena, anemia, coffee ground gastric residuals, and repeated small bowel obstructions. None of the patients developed peritonitis. The period of the study was from 1981 to 1985 and demonstrates results that parallel those of adult series. The authors note that a 12.5% erosion rate in this patient population eliminates this prosthesis as a possible treatment for severe gastroesophageal reflux.-Thomas F. Trucy. Jr
(May). 1991. Following treatment of three premature infants with lung abscesses, the authors conclude that ultrasound or fluoroscopically guided needle aspiration is a simple and effective diagnostic and therapeutic method of managing this condition. The advantages of needle aspiration include choice of the most appropriate antibiotics, faster recovery, fewer complications, and, in some cases, surgery may no longer be necessary. Resolution of the abscesses did not appear to be dependent on the use of a drainage catheter. Any complications arising from this procedure were deemed by the authors to have been benign.-Prem Puti HEART AND GREAT VESSELS Repair of Aortic Coarctation in Infants. M.H.J. Brouwer, C.E.E. Kuntze, T Rebels. et al. J Thorac Cardiovasc Surg 101:1093-1098,
Replacement of the Esophagus by a Segment of Colon Provided With an Antireflux Valve. S. Larson, G. Lycke, and G. Radbetg. Ann Thorac Surg 48:677-682, (November), 1989
The construction of an antireflux valve in colon interposition of the esophagus is described in 5 adult patients. Bile or acid reflux with chronic aspiration has been reported in children with colon interpositions and can be difficult to manage. The conduits were subsequently studied clinically and with endoscopy, scintigraphy. and manometry and were found to be continent. lntussusscepted valves to prevent reflux have been described in other conduits and have been found to be useful. The authors’ technique appears safe and could easily be applied to colon interpositions performed in children.-Murletu Reynolds
(June), 1991. Repair of the aortic coarctation in infants younger than 2 years of age continues to have a risk of recoarctation in up to 60% of cases. In this study 53 consecutive infants younger than age 2 underwent repair. Recoarctation occurred in 21%. Through a multivariate stepwise logistic regression analysis, patient weight was found to be a risk factor for recoarctation, as was the residual gradient after the operation. Weight was also found to be a more significant risk factor than age. The authors conclude that deferring operation is indicated only when the infant gains weight.Thomas F. Tracy. Jr Scimitar Syndrome: Cine Magnetic Resonance Imaging Demonstration of Anomalous Pulmonary Venous Drainage. R. Baxter, P.M. McFadden, M. Gradman, et al. Ann Thorac Surg
50:121-123, (July), 1990. An asymptomatic patient with Scimitar syndrome is described. The diagnosis was suggested on chest roentgenogram. Echocardiogram demonstrated an additional atria1 septal defect (ASD). Other studies included a technetium-pertechnetate nuclear study, cardiac catheterization with pulmonary angiography and thoracoabdomi-
Patient and Procedure Variables Associated With Complications Following Variceal Sclerotherapy in Children. R. Proujansky, S.R. Orenstien, and S.A. Kocoshis. J Pediatr Gastroenterol Nutr
12:33-38, (January), 1991. Variceal sclerotherapy in the pediatric population is increasing in application and success. This report reviews an experience of 37 pediatric patients (aged 1 to 18) who underwent 150 sclerotherapy sessions. There were 12 early complications in 11 patients that included bleeding (5). respiratory problems (3). false channel formation (2), and gross hematuria (2). Four patients developed strictures. Four patients had rebleeding within 10 days of the procedure. The majority of patients had biliary atresia (12) o-antitrypsin deficiency (6) or portal vein thrombosis (6). Statistical analysis of specific procedural and patient parameters leading to complications showed that the significant variables were platelet count < 100,000/mm3 for rebleeding, weight < 12 kg for respiratory complications and false channel formation, dosage of sclerosant per milliliter per kilogram per session > 1.75 mL/kg for gross hematuria, and > 6 sclerotherapy sessions for stricture formation. The adjustments in these variables should limit complications from successful sclerotherapy in the future.-Thomas F. Tracy Jr
life-threatening sequelae if not quickly identified and treated. A canine model of progressive pneumothorax on ECMO was developed to study the pathophysiology and verify observed changes that occur in hemodynamic parameters. Bilateral chest tubes were placed in nine dogs and air was introduced to create a tension pneumothorax. Physiological parameters were monitored. Another six dogs were placed on ECMO and the same protocol for tension pneumothorax completed. Physiological changes occurred in both groups of dogs including decreased venous return, decreased pulse pressure, and decreased mean arterial pressure. In the dogs on ECMO, a triad of changes seen in children on ECMO was reproduced and included an increase in Pa 0,, a decrease in peripheral perfusion, and a decrease in ECMO flow. The clinical diagnosis of a tension pneumothorax may be difficult in a child on ECMO. The triad of changes found in children and confirmed in the laboratory animal can lead to early diagnosis and treatment.-Marlet Reynolds
INTERNATlONAL
ABSTRACTS
The only postoperative complication was an inguinal hernia resulting from poor repair of the inguinal ligament. The child died 5 months later as a result of the cardiac lesion.-iV.P. Madden THORAX True Thymic Hyperplasia: A Clinicopathological Study. C. Ricci, E. Pescamona, E.A. Rendina, et al. Ann Thorac Surg 47:741-
745, (May), 1989 Four children were described with “true thymic hyperplasia.” Two were asymptomatic and two had symptoms of dyspnea. All four had a large anterior mediastinal mass. Histological examination of the masses showed normal thymus with some peculiar features. Review of the literature identified seven other cases reported in children. The authors recommend complete excision to differentiate this lesion from other benign and malignant pathological conditions.-M&era Reynolds
Extracorporeal Membrane Oxygenation for Perioperative Support in Pediatric Heart Transplantation. M.E. Galuntowicz and C.J.H. Sfofur. 3 Thorac Cardiovasc Surg 102~148-152,(July), 1991.
Acquired Tracheal Stenosis in Infants and Children. T.R. Weber, R.H. Connors, and T.F. Tracy, Jr. J Thorac Cardiovasc Surg
The authors have reviewed the cases in which extracorporeal membrane oxygenation (ECMO) was used as an adjunct to pediatric cardiac transplantation through data obtained from the Extracorporeal Life Support Organization, as well as other registries and case reports. Twenty children were supported with ECMO perioperatively. In 4 cases, ECMO was used as a bridge to transplantation; in 10 cases it facilitated resuscitation of the cardiac allograft in the immediate postoperative period, and in 6 cases it complimented therapy for severe rejection in the late postoperative period. Twelve patients survived ECMO, with 7 alive more than 8 months, 1 in the bridge-to-transplant group, 4 in the immediate postoperative group, and 2 in the rejection group. The data suggest that ECMO can be used to support profound cardiac failure and is a useful adjunct to pediatric cardiac transplantation--Thomas F.
In a lo-year period, 62 patients (aged 4 weeks to 14 years) were treated for acquired tracheal stenosis. The causes of stenosis were endotracheal intubation (44) caustic aspiration (6), recurrent infection (5), bronchoscopic perforation (4), and gastric aspiration (3). The subglottic or upper trachea was involved in 47 patients, midportion in 8, and distal or carinal area in 7. Fifty children underwent tracheostomy as part of the therapy. Therapy was individualized, frequently sequentially utilizing rigid or balloon dilatation (20), bronchoscopic electrocoagulation resection (44) steroid injection (48) T tube stent (8) resection with anastomosis (12) cricoid split (3). and rib cartilage graft (12). Most patients required several techniques and repeated procedures. Seven patients (11%) died of unrelated causes. Forty-four of 55 surviving patients (80%) are without tracheostomy, although 14 have required continued endotracheal treatment after tracheostomy removal (dilatation, endotracheal resection). This series demonstrates that acquired tracheal stenosis in childhood is a common, difficult problem, but is manageable with the use of a variety of techniques. Resection and grafting procedures should be reserved for cases in which less complex modalities fail--l”homas F. Tracy,
Tracy, Jr Microvascular Surgery in Children. KS. Devaraj, S.P. Kay, A.J. Batchelor, et al. Br J Plast Surg 44:276-280, 1991.
The authors report the results of microvascular procedures in 38 children during a 3-year period. The patients ranged from an 8-day-old, 28-week-gestation neonate to a 15 year old, with an average age of 5.4 years. Congenital hand deformity was the largest single indication (12 patients); other indications included tumor and trauma including replantation of limbs. Sixty-three percent of operations were performed electively (13 free flaps and 14 toe transfers). There were no failures. Three of the 16 emergency procedures failed, including 2 of the 4 replantations. The smallest vessel anastomosed had an external diameter of 0.4 mm. The authors comment that vessel size per se was not a limiting factor. Stress is laid on the anesthetic and postoperative management, particularly elective ventilation overnight and appropriate analgesia to minimize vasospasm. Although the mean postoperative stay was 9.8 days, the authors comment that this is decreasing as experience increases.--llrP. Madden Combined Microsurgical and Thrombolytic Salvage of an lschaemic Lower Limb in a 1079 Gram Pre-term Neonate. S. Kay nnd D.J. Gilpin. Br .I Plast Surg 44:310-311, 1991.
The authors report the salvage of the leg of a 1,079-g neonate. The femoral artery had been avulsed following a balloon valvotomy to correct aortic stenosis. The ipsilateral femoral vein was used to perform a femoral arterial bypass. The graft occluded on two occasions but was finally salvaged by using a streptokinase infusion.
10229-35, (July), 1991.
Jr Slide Tracheoplasty for Congenital Funnel-Shaped Tracheal Stenosis. V. Tsang, A. Murday, C. Gillbe, et al. Ann Thorac Surg
48:632-635, (November), 1988. An intriguing technique of “slide tracheoplasty” is described. Two infants with funnel-shaped tracheal stenosis underwent this procedure. The trachea is divided and the distal segment is spatulated to serve as a patch graft to the proximal segment. One patient’s postoperative course was complicated and he died. Bronchoscopic examination prior to death showed an intact tracheal anastomosis. The other child is doing well 12 months following repair. The procedure avoids prosthetic or nontracheal tissue grafts, cardiopulmonary bypass, and tracheoplasty. Long-term follow-up is needed to evaluate the restenosis rate. The technique appears promising but will need more lengthy follow-up before it can be compared with other techniques.-Murlern Reynolds Pulmonary Artery Sling: Primary Repair by Tracheal Resection in Infancy. R.A. Jonas, P.J. Sperak, T. McGill, et al. .I Thorac
Cardiovasc Surg 97:548-550, (April), 1989. A pulmonary artery sling is often associated with moderate or severe tracheal stenosis. Conventional treatment of this anomaly
INTERNATIONAL
403
ABSTRACTS
includes division of the left pulmonary artery with reimplantation into the main pulmonary artery and tracheal resection with reanastomosis of the trachea. The authors describe two patients in whom they performed an alternative procedure. Their approach involves resection of the tracheal stenosis and reanastomosis using a continuous suture with absorbable polydioxanone. The pulmonary artery is brought anterior to the trachea after the trachea is divided. This method obviates the need for vascular anastomosis and its complications The patients have been followed for 9 and 6 months with excellent results. This technique appears to be an improvement over the conventional method.-Marlera Reynokis Right Pneumonectomy Syndrome in Infancy Treated With an Expandable Prothesis. D.K. Rasch, F.L. Grover, B.M. SchnopJ et al. Ann Thorac Surg 50:127-129, (July), 1990.
Marked mediastinal shift following pneumonectomy in infants and small children can be life threatening. This complication can be prevented by the insertion of a prosthesis into the involved chest, a technique which has been previously described. Applying advances in technology, the authors recommend the use of an expandable prothesis. Elective expansion of the prosthesis as the child grows would simplify management and eliminate the need to repeatedly replace the prosthesis.-Mar/eta Reynolds Percutaneous Needle Aspiration of Neonatal Lung Abscesses. SK. Lee, R.F. Morris, and B. Cramer. Pediatr Radio1 21:254-257,
nal aortogram, and a standard MRI study. The scimitar vein was best visualized with tine-MRI technology. The patient underwent an uneventful repair of his ASD and reimplant of the anomalous pulmonary vein. The authors recommend the tine-MRI as the technique of choice to demonstrate the anomalousvein without the use of contrast in a noninvasive manner.-M&era Revnolds ALIMENTARY
TRACT
Erosions of the Angelchik Prosthesis in Pediatric-Sized Developmentally Disabled Patients. D. Jakaite, G.R. Got&y, and J. R. Pellett. J Pediatr Gastroenterol Nutr 13:186-191, (August). 1991.
This a retrospective review of 40 pediatric-sized developmentally disabled patients who participated in a study comparing Nissen fundoplication with Angelchik prosthesis for treatment of severe gastroesophageal reflux. Five patients experienced erosions of the prosthesis between 2 years and 2 years 8 months following surgical insertion of this device. The erosions were associated with vomiting, increased discomfort, melena, anemia, coffee ground gastric residuals, and repeated small bowel obstructions. None of the patients developed peritonitis. The period of the study was from 1981 to 1985 and demonstrates results that parallel those of adult series. The authors note that a 12.5% erosion rate in this patient population eliminates this prosthesis as a possible treatment for severe gastroesophageal reflux.-Thomas F. Trucy. Jr
(May). 1991. Following treatment of three premature infants with lung abscesses, the authors conclude that ultrasound or fluoroscopically guided needle aspiration is a simple and effective diagnostic and therapeutic method of managing this condition. The advantages of needle aspiration include choice of the most appropriate antibiotics, faster recovery, fewer complications, and, in some cases, surgery may no longer be necessary. Resolution of the abscesses did not appear to be dependent on the use of a drainage catheter. Any complications arising from this procedure were deemed by the authors to have been benign.-Prem Puti HEART AND GREAT VESSELS Repair of Aortic Coarctation in Infants. M.H.J. Brouwer, C.E.E. Kuntze, T Rebels. et al. J Thorac Cardiovasc Surg 101:1093-1098,
Replacement of the Esophagus by a Segment of Colon Provided With an Antireflux Valve. S. Larson, G. Lycke, and G. Radbetg. Ann Thorac Surg 48:677-682, (November), 1989
The construction of an antireflux valve in colon interposition of the esophagus is described in 5 adult patients. Bile or acid reflux with chronic aspiration has been reported in children with colon interpositions and can be difficult to manage. The conduits were subsequently studied clinically and with endoscopy, scintigraphy. and manometry and were found to be continent. lntussusscepted valves to prevent reflux have been described in other conduits and have been found to be useful. The authors’ technique appears safe and could easily be applied to colon interpositions performed in children.-Murletu Reynolds
(June), 1991. Repair of the aortic coarctation in infants younger than 2 years of age continues to have a risk of recoarctation in up to 60% of cases. In this study 53 consecutive infants younger than age 2 underwent repair. Recoarctation occurred in 21%. Through a multivariate stepwise logistic regression analysis, patient weight was found to be a risk factor for recoarctation, as was the residual gradient after the operation. Weight was also found to be a more significant risk factor than age. The authors conclude that deferring operation is indicated only when the infant gains weight.Thomas F. Tracy. Jr Scimitar Syndrome: Cine Magnetic Resonance Imaging Demonstration of Anomalous Pulmonary Venous Drainage. R. Baxter, P.M. McFadden, M. Gradman, et al. Ann Thorac Surg
50:121-123, (July), 1990. An asymptomatic patient with Scimitar syndrome is described. The diagnosis was suggested on chest roentgenogram. Echocardiogram demonstrated an additional atria1 septal defect (ASD). Other studies included a technetium-pertechnetate nuclear study, cardiac catheterization with pulmonary angiography and thoracoabdomi-
Patient and Procedure Variables Associated With Complications Following Variceal Sclerotherapy in Children. R. Proujansky, S.R. Orenstien, and S.A. Kocoshis. J Pediatr Gastroenterol Nutr
12:33-38, (January), 1991. Variceal sclerotherapy in the pediatric population is increasing in application and success. This report reviews an experience of 37 pediatric patients (aged 1 to 18) who underwent 150 sclerotherapy sessions. There were 12 early complications in 11 patients that included bleeding (5). respiratory problems (3). false channel formation (2), and gross hematuria (2). Four patients developed strictures. Four patients had rebleeding within 10 days of the procedure. The majority of patients had biliary atresia (12) o-antitrypsin deficiency (6) or portal vein thrombosis (6). Statistical analysis of specific procedural and patient parameters leading to complications showed that the significant variables were platelet count < 100,000/mm3 for rebleeding, weight < 12 kg for respiratory complications and false channel formation, dosage of sclerosant per milliliter per kilogram per session > 1.75 mL/kg for gross hematuria, and > 6 sclerotherapy sessions for stricture formation. The adjustments in these variables should limit complications from successful sclerotherapy in the future.-Thomas F. Tracy Jr