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Superior vena cava to right pulmonary artery anastomosis: Results in 46 infants and children
ABS’IRACTS The anomaly is rare. The authors, in this first report of its correction, stress that it can be repaired and adequate mitral valvular function achieved.-]. C. Rosenkrantz
a significant postoperative
TETRALOGYOF FALLOT. R. B. Karp and I. W. Kirklin. Ann. Thorac. Surg. 10:370-388
chylothorax. Surviving
(October),
1970.
A review of the anatomy, and management festations, (55 refs.) .-I. G. Rosenkrantz
clinical maniis presented.
LONG-TERM FOLLOWUP AFTER SUPERIOR VENA CAVA-RIGHT PXJLMON.~RY ARTERY ANASTOMOSIS.S. P. Martin, I. N. Anabtawi, C. A. Selmonosky, G. M. Folger, L. T. Ellison, and R. G. Ellison, Ann. Thorac. Surg. 9:339-346 (April), 1970. The authors report 22 patients who had SVC-RPA shunts for tetralogy of Fallot (15 patients), tricuspid atresia (5 patients 1, or pulmonary atresia (2 patients ) . Five of these patients were less than 1 year of age. There were 3 operative deaths and 2 late deaths in a followup ranging from 9 months to 8 years in the 14 patients not lost to followup. Generally, complications such as persistent superior vena caval hypertension and chylothorax occurred rarely, but the degree of palliation seemed to decrease with time. The authors feels that many of these patients will require other palliative or definitive procedures for adequate well-being-J. G.
complication
in 6
patients. All required surgical procedures for its correction. In three instances multiple procedures were necessary and in one of the six patients death was due to persistent patients
have
all had
mild to
moderate persistent cyanosis. Two of seven infants with an initially excellent result deteriorated due to tricuspid insufficiency in one instance and due to the development of venous collaterals in another. The others have maintained the good result. These pa-
tients as followed appear to be more limited at the time of puberty than those with Blalock Taussig shunts. The venous anastomoses tend to maintain a fixed level of pulmonary blood ilow and, therefore, little reserve is present for effort. The size of the pulmonary artery may be a technical limiting factor in the performance of the shunt. It should be ideally at least one-half the diameter of the superior vena cava. Delayed ligature of the axygos vein has been helpful. The authors believe that a systemic artery to pulmonary artery anastomosis offers the best chance for survival in the first 2 months of life, the Waterston shunt being the one of choice. The cava-pulmonary anastomosis in their opinion is preferable in the prepubertal years-that Sieher
is, after infancy.-W.
K.
Rosenkrantz
SUCCESSFUL TOTAL CORRECTION OF CONGENITAL INTERRUPTION OF THE AORTIC ARCH AND VENTRICULAR SEPTAL DEFECT. M. P. SVPEZRIOR VENA CAVA TO RIGHTPULMONARY Singh, H. H. Bentall, and C. M. Oakley. ARTERYANMTOMOSIS: RESULTSIN 46 INThorax 25615-623 (September), 1970. FANTS AND CHILDREN. Dauid Hunt, W. Sterling Edwards, Philip B. Deuerall, and L. M. Bargeron, Jr. Thorax 25:558-555 ( September ) , 1970. Superior vena cava to right pulmonary artery anastomosis (Glenn procedure) has been accomplished in 46 infants and children 1 day to 12 years in age between 1960 and 1969, for cyanotic congenital heart disease with low pulmonary blood flow and pulmonary vascular resistance, due to currently surgically uncorrectable anomalies. Twenty-nine of these &&hen are alive up to 8 years following surgery; 15 died in the hospital; and 2 died later. Chylothorax was
A 5-year-old boy with interruption of the aortic arch was successfully surgically treated in two surgical procedures. In the first, the ductus was divided, the pulmonary artery side closed, and a teflon graft interposed between the proximal hypoplastic aorta and the distal (aortic) end of the ductus. Five years later, the huge intraventricular septal defect was closed with a teflon patch. Both procedures were done under cardiopulmonary bypass. The patient is well and asymptomatic 2 years following the last procedure.-W. K. Sieber
a significant postoperative
TETRALOGYOF FALLOT. R. B. Karp and I. W. Kirklin. Ann. Thorac. Surg. 10:370-388
chylothorax. Surviving
(October),
1970.
A review of the anatomy, and management festations, (55 refs.) .-I. G. Rosenkrantz
clinical maniis presented.
LONG-TERM FOLLOWUP AFTER SUPERIOR VENA CAVA-RIGHT PXJLMON.~RY ARTERY ANASTOMOSIS.S. P. Martin, I. N. Anabtawi, C. A. Selmonosky, G. M. Folger, L. T. Ellison, and R. G. Ellison, Ann. Thorac. Surg. 9:339-346 (April), 1970. The authors report 22 patients who had SVC-RPA shunts for tetralogy of Fallot (15 patients), tricuspid atresia (5 patients 1, or pulmonary atresia (2 patients ) . Five of these patients were less than 1 year of age. There were 3 operative deaths and 2 late deaths in a followup ranging from 9 months to 8 years in the 14 patients not lost to followup. Generally, complications such as persistent superior vena caval hypertension and chylothorax occurred rarely, but the degree of palliation seemed to decrease with time. The authors feels that many of these patients will require other palliative or definitive procedures for adequate well-being-J. G.
complication
in 6
patients. All required surgical procedures for its correction. In three instances multiple procedures were necessary and in one of the six patients death was due to persistent patients
have
all had
mild to
moderate persistent cyanosis. Two of seven infants with an initially excellent result deteriorated due to tricuspid insufficiency in one instance and due to the development of venous collaterals in another. The others have maintained the good result. These pa-
tients as followed appear to be more limited at the time of puberty than those with Blalock Taussig shunts. The venous anastomoses tend to maintain a fixed level of pulmonary blood ilow and, therefore, little reserve is present for effort. The size of the pulmonary artery may be a technical limiting factor in the performance of the shunt. It should be ideally at least one-half the diameter of the superior vena cava. Delayed ligature of the axygos vein has been helpful. The authors believe that a systemic artery to pulmonary artery anastomosis offers the best chance for survival in the first 2 months of life, the Waterston shunt being the one of choice. The cava-pulmonary anastomosis in their opinion is preferable in the prepubertal years-that Sieher
is, after infancy.-W.
K.
Rosenkrantz
SUCCESSFUL TOTAL CORRECTION OF CONGENITAL INTERRUPTION OF THE AORTIC ARCH AND VENTRICULAR SEPTAL DEFECT. M. P. SVPEZRIOR VENA CAVA TO RIGHTPULMONARY Singh, H. H. Bentall, and C. M. Oakley. ARTERYANMTOMOSIS: RESULTSIN 46 INThorax 25615-623 (September), 1970. FANTS AND CHILDREN. Dauid Hunt, W. Sterling Edwards, Philip B. Deuerall, and L. M. Bargeron, Jr. Thorax 25:558-555 ( September ) , 1970. Superior vena cava to right pulmonary artery anastomosis (Glenn procedure) has been accomplished in 46 infants and children 1 day to 12 years in age between 1960 and 1969, for cyanotic congenital heart disease with low pulmonary blood flow and pulmonary vascular resistance, due to currently surgically uncorrectable anomalies. Twenty-nine of these &&hen are alive up to 8 years following surgery; 15 died in the hospital; and 2 died later. Chylothorax was
A 5-year-old boy with interruption of the aortic arch was successfully surgically treated in two surgical procedures. In the first, the ductus was divided, the pulmonary artery side closed, and a teflon graft interposed between the proximal hypoplastic aorta and the distal (aortic) end of the ductus. Five years later, the huge intraventricular septal defect was closed with a teflon patch. Both procedures were done under cardiopulmonary bypass. The patient is well and asymptomatic 2 years following the last procedure.-W. K. Sieber