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Repair of aortic coarctation in infants: Experience with an intraluminal shunt
INTERNATIONAL ABSTRACTS
tory and the remainder in the operating room. The authors describe the technique in great detail and report success in 26 of 52 (50%). Success or failure was determined by (1) Radiographic change in the vessel diameter by more than 1 mm; (2) Decrease in the pressure gradient across the stenosis; (3) Decrease in the pressure proximal to the obstruction; (4) Decreased RV or MPAP/Sys pressure; (5) Radionucleotide measured increase in ipsilateral lung perfusion. Failure resulted because of inadequate technique (11) or from "non-dilatable vessels." These non-dilatable lesions were more common in older children and more difficult when near a previous shunt. The procedure was complicated by exsanguinating hemorrhage and death in one child secondary to balloon rupture of the pulmonary artery. Other complications included postoperative hemoptysis, iliac vein thrombosis, and arrhythmia. Hemodynamic follow-up from 2 to 11 months is available in only 7 patients and has shown that the vessel diameter is maintained after dilation. It is a technique worth considering in the younger child with stenotic pulmonary arteries.-Marleta Reynolds False Aneurysm of the Ascending Aorta from an Expanded Polytetraethylene (Gortex) Aorto-Pulmonary Shunt. V.L. Evans, G.L.
Hallman, T.A. Vargo, et al. Ann Thorac Surg 39:573-575, (June), 1985. This case report describes the formation of a false aneurysm of the ascending aorta at the site of a Gortex aorto-pulmonary shunt. The shunt was placed at 3 months of age, and total repair of the tetralogy of Fallot included closure of the graft with metal clips at 19 months. Six months later, the aneurysm was discovered and repaired without complication. The authors recommend the use of nonabsorbable multifilament polyester suture for the anastomosis and excision of the graft with patch repair of the systemic artery at the time of intracardiac repair.--Marleta Reynolds Reoperation for Aortic Coarctation: Techniques, Results and Indications for Various Approaches. M.S. Sweeney, W.E. Walker, J.M.
Duncan, et al. Ann Thorac Surg 40:46-50, (July), 1985. Over a 23-year period, 53 patients underwent reoperation for coarctation of the aorta. Ninety-four percent were hypertensive. Three patients were in congestive heart failure at the time of reoperation. Methods of correction included Dacron patch angioplasty (26), bypass grafting around the recoarctation (I 6), resection and interposition grafting (8), and resection with end-to-end anastomosis (3). Four patients required ascending-descending aortic bypass grafts because of postoperative scarring from two previous repairs. There were no deaths in this group and only 3 complications (postoperative bleeding, recurrent laryngeal nerve paralysis, and chylothorax) that responded to conservative management. Choice of procedure is individualized and depends on the type of initial repair, amount of postoperative scarring, and the length of aortic narrowing. Patch angioplasty has been the procedure of choice for long stenoses. When scarring is excessive, a bypass around the narrowed segment is preferred.--Marleta Reynolds
459
ative paraplegia, the use of an intraluminal shunt to prevent paraplegia cannot be adequately evaluated in this study. The authors state that the combination of preoperative management (especially the use of prostaglandin), subclavian flap angioplasty, and the use of the intraluminal shunt have improved their results.--Marleta Reynolds Developmental Sequelae in Premature Infants Undergoing Ligation of Patent Ductus Arteriosus. S..,4. Wilkerson, J. Fleischaker, C.
Mavrondis, et al. Ann Thorac Surg 39:541-546, (June), 1985. Over a four-year period ending in January 1984, 116 of 194 infants survived following ligation of a patent ductus arteriosus and were evaluated for mental and motor development. The infants were followed a mean of 20.7 months. Fifty-eight percent of the infants followed 6 to 54 months demonstrated some postnatal growth retardation. No infants developed left arm dysfunction. Only 10 of 100 infants tested had some hearing loss, and 26 infants had some degree of retinopathy. Twenty infants (17.2%) had mild sensorneural handicaps. Of these 20 infants, 9 had documented evidence of intraventricular hemorrhage and 6 required ventriculoperitoneal shunts for hydrocephalus. Moderate to severe handicaps were found in 18 infants, and of these, 18 had had an intraventricular hemorrhage. An intraventricular hemorrhage was present more often in this group of patients when compared with infants of similar gestational age. The reason for this increased incidence is still unclear, and the long-term developmental sequelae are yet to be determined.--Marleta Reynolds Hormonal Role of Adenosine in Maintaining Patency of the Ductus Arteriosus in Fetal Lambs. R.M. Mentzer, S.W. Ely, R.D. Lasley, el
al. Ann Surg 202:223-230, (August), 1985. It has previously been demonstrated that tissue hypoxia is a potent stimulus for the formation and release of the vasodilator adenosine
from intracellular adenine nucleotides. To test this hypothesis, the authors used a fetal lamb model to determine whether low PO2 in utero is responsible for a constant release of adenosine, which results in high circulating plasma adenosine concentrations, which in turn maintains the relaxation of ductal vascular smooth muscle. Conversely, at birth with ventilation, the improvement in tissue oxygenation would reduce adenosine release, lowering plasma concentrations, thus permitting the expression of vascular smooth muscle tone and closure of the ductus. This study was designed to (1) determine the effect, if any, of exogenous adenosine on blood flow through the ductus arteriosus, and (2) to evaluate the relationship among the partial pressure of oxygen in arterial blood, circulating endogenous plasma adenosine concentration, and the rate of blood flow through the ductus. The study suggested that (1) adenosine is a potent vasodilator of the lamb ductus arteriosus during oxygen-induced vasoconstriction; (2) fetal endogenous plasma adenosine levels fall significantly when PO2 is increased; and (3) the fall in adenosine concentrations parallels a decrease in ductal blood flow. Thus, endogenous adenosine may be an important vasodilator maintaining ductal patency in utero.--Richard J. Andrassy
Repair of Aortic Coarctation in Infants: Experience with an Intraluminal Shunt. D.G. Pennington, H.M. Dennis, M.T. Swartz, et al.
Ann Thorac Surg 40:35-40, (July), 1985. A review of 63 infants who underwent repair of coarctation of the aorta from 1962 to 1984 identifies three different groups. In the earlier years, repair was accomplished by resection and end-to-end anastomosis. Since 1978, the majority were repaired with a subclavian aortoplasty. The statistics relating to mortality (36% to 4.9%), and late stenosis (40% to 5.9%) favor the subclavian aortoplasty. Since 1980, all infants (15) were repaired with the use of an intraluminal shunt. Because of the low incidence (1/63) of pestoper-
ALIMENTARY TRACT Pharyngonasal Reflux: Spectrum and Significance in Early Childhood. A.E. Oestreich and J.S. Dunbar. Am J Roentgenol 141:923-
925, (May), 1984. Fifty-seven infants and children were found to have reflux of barium from the ore or hypopharynx into the nasopharynx or nose during swallowing. The M:F ratio was 37:20, 49 were premature, and 43 were 3 months of age or less at the time of the initial study. Clinical symptoms included choking or cyanotic spells with feeding (16), apnea (16), pneumonia (12), dysmorphic features (5), cleft
tory and the remainder in the operating room. The authors describe the technique in great detail and report success in 26 of 52 (50%). Success or failure was determined by (1) Radiographic change in the vessel diameter by more than 1 mm; (2) Decrease in the pressure gradient across the stenosis; (3) Decrease in the pressure proximal to the obstruction; (4) Decreased RV or MPAP/Sys pressure; (5) Radionucleotide measured increase in ipsilateral lung perfusion. Failure resulted because of inadequate technique (11) or from "non-dilatable vessels." These non-dilatable lesions were more common in older children and more difficult when near a previous shunt. The procedure was complicated by exsanguinating hemorrhage and death in one child secondary to balloon rupture of the pulmonary artery. Other complications included postoperative hemoptysis, iliac vein thrombosis, and arrhythmia. Hemodynamic follow-up from 2 to 11 months is available in only 7 patients and has shown that the vessel diameter is maintained after dilation. It is a technique worth considering in the younger child with stenotic pulmonary arteries.-Marleta Reynolds False Aneurysm of the Ascending Aorta from an Expanded Polytetraethylene (Gortex) Aorto-Pulmonary Shunt. V.L. Evans, G.L.
Hallman, T.A. Vargo, et al. Ann Thorac Surg 39:573-575, (June), 1985. This case report describes the formation of a false aneurysm of the ascending aorta at the site of a Gortex aorto-pulmonary shunt. The shunt was placed at 3 months of age, and total repair of the tetralogy of Fallot included closure of the graft with metal clips at 19 months. Six months later, the aneurysm was discovered and repaired without complication. The authors recommend the use of nonabsorbable multifilament polyester suture for the anastomosis and excision of the graft with patch repair of the systemic artery at the time of intracardiac repair.--Marleta Reynolds Reoperation for Aortic Coarctation: Techniques, Results and Indications for Various Approaches. M.S. Sweeney, W.E. Walker, J.M.
Duncan, et al. Ann Thorac Surg 40:46-50, (July), 1985. Over a 23-year period, 53 patients underwent reoperation for coarctation of the aorta. Ninety-four percent were hypertensive. Three patients were in congestive heart failure at the time of reoperation. Methods of correction included Dacron patch angioplasty (26), bypass grafting around the recoarctation (I 6), resection and interposition grafting (8), and resection with end-to-end anastomosis (3). Four patients required ascending-descending aortic bypass grafts because of postoperative scarring from two previous repairs. There were no deaths in this group and only 3 complications (postoperative bleeding, recurrent laryngeal nerve paralysis, and chylothorax) that responded to conservative management. Choice of procedure is individualized and depends on the type of initial repair, amount of postoperative scarring, and the length of aortic narrowing. Patch angioplasty has been the procedure of choice for long stenoses. When scarring is excessive, a bypass around the narrowed segment is preferred.--Marleta Reynolds
459
ative paraplegia, the use of an intraluminal shunt to prevent paraplegia cannot be adequately evaluated in this study. The authors state that the combination of preoperative management (especially the use of prostaglandin), subclavian flap angioplasty, and the use of the intraluminal shunt have improved their results.--Marleta Reynolds Developmental Sequelae in Premature Infants Undergoing Ligation of Patent Ductus Arteriosus. S..,4. Wilkerson, J. Fleischaker, C.
Mavrondis, et al. Ann Thorac Surg 39:541-546, (June), 1985. Over a four-year period ending in January 1984, 116 of 194 infants survived following ligation of a patent ductus arteriosus and were evaluated for mental and motor development. The infants were followed a mean of 20.7 months. Fifty-eight percent of the infants followed 6 to 54 months demonstrated some postnatal growth retardation. No infants developed left arm dysfunction. Only 10 of 100 infants tested had some hearing loss, and 26 infants had some degree of retinopathy. Twenty infants (17.2%) had mild sensorneural handicaps. Of these 20 infants, 9 had documented evidence of intraventricular hemorrhage and 6 required ventriculoperitoneal shunts for hydrocephalus. Moderate to severe handicaps were found in 18 infants, and of these, 18 had had an intraventricular hemorrhage. An intraventricular hemorrhage was present more often in this group of patients when compared with infants of similar gestational age. The reason for this increased incidence is still unclear, and the long-term developmental sequelae are yet to be determined.--Marleta Reynolds Hormonal Role of Adenosine in Maintaining Patency of the Ductus Arteriosus in Fetal Lambs. R.M. Mentzer, S.W. Ely, R.D. Lasley, el
al. Ann Surg 202:223-230, (August), 1985. It has previously been demonstrated that tissue hypoxia is a potent stimulus for the formation and release of the vasodilator adenosine
from intracellular adenine nucleotides. To test this hypothesis, the authors used a fetal lamb model to determine whether low PO2 in utero is responsible for a constant release of adenosine, which results in high circulating plasma adenosine concentrations, which in turn maintains the relaxation of ductal vascular smooth muscle. Conversely, at birth with ventilation, the improvement in tissue oxygenation would reduce adenosine release, lowering plasma concentrations, thus permitting the expression of vascular smooth muscle tone and closure of the ductus. This study was designed to (1) determine the effect, if any, of exogenous adenosine on blood flow through the ductus arteriosus, and (2) to evaluate the relationship among the partial pressure of oxygen in arterial blood, circulating endogenous plasma adenosine concentration, and the rate of blood flow through the ductus. The study suggested that (1) adenosine is a potent vasodilator of the lamb ductus arteriosus during oxygen-induced vasoconstriction; (2) fetal endogenous plasma adenosine levels fall significantly when PO2 is increased; and (3) the fall in adenosine concentrations parallels a decrease in ductal blood flow. Thus, endogenous adenosine may be an important vasodilator maintaining ductal patency in utero.--Richard J. Andrassy
Repair of Aortic Coarctation in Infants: Experience with an Intraluminal Shunt. D.G. Pennington, H.M. Dennis, M.T. Swartz, et al.
Ann Thorac Surg 40:35-40, (July), 1985. A review of 63 infants who underwent repair of coarctation of the aorta from 1962 to 1984 identifies three different groups. In the earlier years, repair was accomplished by resection and end-to-end anastomosis. Since 1978, the majority were repaired with a subclavian aortoplasty. The statistics relating to mortality (36% to 4.9%), and late stenosis (40% to 5.9%) favor the subclavian aortoplasty. Since 1980, all infants (15) were repaired with the use of an intraluminal shunt. Because of the low incidence (1/63) of pestoper-
ALIMENTARY TRACT Pharyngonasal Reflux: Spectrum and Significance in Early Childhood. A.E. Oestreich and J.S. Dunbar. Am J Roentgenol 141:923-
925, (May), 1984. Fifty-seven infants and children were found to have reflux of barium from the ore or hypopharynx into the nasopharynx or nose during swallowing. The M:F ratio was 37:20, 49 were premature, and 43 were 3 months of age or less at the time of the initial study. Clinical symptoms included choking or cyanotic spells with feeding (16), apnea (16), pneumonia (12), dysmorphic features (5), cleft