Surgical management of anomalous left pulmonary artery causing tracheobronchial obstruction

56 ‘I

ABSTRACTS

A I-mo-old

Brazilian

infant

with

cleft

ster-

num operated upon aboard the S.S. Hope is presented. While the condition is called lifethreatening. no report of nonoperative death is presented. In the four previous operative reports there was one death. A technique for repair is presented in which alternate costal cartilages are divided near and far from the sternum. The ribs with long cartilages are then shifted inferiorly to approximate the long sternal cartilages. This maneuver allows the cleft sternum to be approximated successfully. There are 17 references.-?%omas M. Holder Thoracocervical

Cysts as a

8. T. le Roux., 8. I. Henderson, M. A.

Rogers.

Thorax

Cause

of

Stridor.

E. U. Kiirklii,

29:564-566

out really producing

evidence, that open biopsy is better than percutaneous needle biopsy or aspiration of the lung. They emphasize that the early diagnosis allows proper treatment stating that probably 9 to IO days of treatment are necessary for survival to be expected.-Keith W. Ashcraft The Spectrum of Pulmonary Surg. l&644-658

(December), 1974.

sequestration involving a 20-yr-old man is presented, and the entire subject of pulmonary sequestration is reviewed in this collective review.-Keith W. Ashcraft

and

HEART Treatment

AND GREAT

of Congenital

Bentlqv Respiratory Obstruction ated with

in the Newborn

lncre.ased Volume

of the Hemithorax. and J. P. Geiger.

Associ-

and Opacification

G. L. Zumbro,

R. L. Treasure,

Ann. Thorac. Surg. 18:622-625

VESSELS

Superior

Stenosis in a Child. 6. Ii&%.

In five patients out of 82 with a mediastinal cyst or tumor, seen in a 7-yr period in Durban, South Africa, the presenting symptom was severe strider. Three patients were children and two were young adults, one of whom had a large mediastinal cystic hygroma. All the others had foregut duplications, and the adult experienced hypoxic cardiac arrest. All the patients recovered well after excisional surgery.-J.F.R.

R. M.

A case of pulmonary

(September),

1974.

Sequestration.

Sode, M. Clause, ond F. H. Ellis, Jr. Ann. Thoroc.

Vena

Cava

Rozhl. Chir. 53:708-

713,1974. A stenosis of the superior vena cava was demonstrated by cavography and detailed cardiologic examination in a 4-yr-old boy. At operation a hypoplasia of the superior vena cava in its intrapericardial segment was discovered, and there was a stenosis measuring 4 mm in diameter before the cava entered the left atrium. The entire segment was reconstructed using a pericardial flap patch. The postoperative course was uneventful. Cavography I yr after operation showed a good lumen of the vein. The author did not find a similar successfully treated case in the literature.V. Kafka

(December), 1974.

This article reports two patients with newborn respiratory distress and unilateral opacification of the chest. The first had a subcarinal bronchogenic cyst compressing the left main bronchus, and the other had a vascular sling. The clue to the diagnostic effort seems to be the unilaterality of the lesion.--Keith IV. Ashcraft The Role of Early Open lung Biopsy in the Diagnosis and Pneumonia.

Treatment

of

Pneumocystis

D. H. Tyros, W. Campbell,

carinii

C. Corley,

and C. R. Hatcher, Jr. Ann. Thorac. Surg. 18:571577 (December), 1974.

This article reports 12 patients with pneumocystic pneumonia complicating chemotherapy or immunosuppression for transplant or malignant tumor. Although all the patients are adults, the authors detail some of the clinical features which would indicate the value of early diagnosis of this infection. They conclude, with-

Surgical

Management

monory

Artery

of Anomalous

Causing

struction. R. Koopot,

left

Tracheobronchial

PulOb-

H. Nikoidoh, and F. S. Id&s.

J. Thoroc. Cordiovasc. Surg. 69:239-246

(February),

1975.

Five patients with pulmonary artery shng from the Children’s Memorial Hospital in Chicago and a survey of the world literature are presented. Of the five patients, three survived and two were diagnosed at autopsy. (One of these had a thoracotomy for respiratory distress, and the condition was unrecognized.) Recommended therapy is division of the left pulmonary artery and reanastomosis in front of the trachea by way of a left thoracotomy. Out of the 66 patients in the literature with pulmonary artery sling the symptoms in order of decreasing frequency were: intercostal retraction, 50; circumoral cyanosis, 41; stridor. 28; apneic episodes, 22; inspiratory and expiratory wheeze, IS; expiratory wheeze, 14;

562

ABSTRACTS

difficulty in feeding, 13; unequal motion of the chest, 7; inspiratory wheeze, 4. Diagnosis was not easy. Only 18 patients were reported to have the characteristic anterior indentation on the esophagus at the level of the carina. Tracheal and right main-bronchus narrowing on the tracheogram was a helpful diagnostic aid as was pulmonary arteriography. Seven patients were not operated upon because of mild symptoms. In 13 the diagnosis was made at autopsy. Of the 46 patients operated upon. 19 survived. There are 43 references.-Thomas M. Holder Pulmonary

Sling-Case

Review. F. I. Grover, and

1. K.

295-300

Trinkle.

Report

1. 6. Norton,

and Jr.,

Collective

G. E.

Webb,

J. Thorac. Cardiovasc. Surg. 67:

(February), 1975.

A case of pulmonary artery sling and review of the literature is presented. There are 41 references.-Thomas M. Holder Reoperation

for Residual

of Tetralogy

of Fallot.

Defects

Aldo

After

R. Costonedo,

M. Sode, John Lomb&i, ond Demeire M. Surgery 76:1010-1017 (December), 1974.

Repair Robert Nicoloff.

ALIMENTARY at Forming

Aberrant

female infant with vomiting and diarrhea had a palpable pyloric mass. At laparotomy for hypertrophic pyloric stenosis, an unusual irregular yellow firm mass involved the pylorus. A pyloromyotomy was attempted but abandoned in favor of a posterior gastrojejunostomy. Two months later symptoms recurred. Six months postoperatively a gastric resection and gastroduodenostomy was done. The resected specimen contained aberrant pancreatic tissue but no Isles of Langerhans. The authors suggest that unusual pyloric masses, when encountered at pyloromyotomy should be biopsied. If aberrant pancreatic tissue is identified, a gastric resection and duodenogastrostomy

Vitamin

be

William

done.-

K.

B,,

Absorption

After Resection of Ileum

H. B. Volmon and P. D. Roberts.

Arch. Dis. Child. 49:932-935,

(December), 1974.

The author has carried out studies in absorption of Vitamin B,, in 12 patients who had ileal resection of more than 45 cm. Eight of these were in the neonatal period. The standard hematologic parameters were measured as were the serum Bt, and serum folate. After administration of vitamin B,, with intrinsic factor the absorption of vttamm Biz was measured by a whole-body counter technique. Absorption varied from 0 to 77%. Although there is a broad correlation with the absorption being more satisfactory if adequate terminal ileum remains. one neonate left with I5 cm of terminal ileum had 72% retention of the vitamin B,, whereas another with only 10 cm of terminal ileum had 18%. The serum B,, levels tended to be low. Clinical manifestations of B,, deficiency were not found.--D.G. Young

TRACT an

Effective

Gartro-

Appendiceal T.

Surgery

77:225-230

(Feb-

G.

Antolovir.

Peritonitis

in

Children.

E.

Teritianska, M. Schnierer, 1. Hrk, Rozhl. Chir.

53:673-676

Peand

(October),

1974.

ruary), 1975. Excision

should

in Childhood.

wicz,

esophageal

(November), 1974.

A 5-day-old

korovf,

J. Sforzewski.

Pyloric Obstruction.

yoshio Kowoi, and Ken Kimuro.

Surgery 76:827-829

esophageal Mucosal Valve. S. Tobik, S. Lukosieand

Pancreas Causing

yoichi Mah~mofo,

Sieber

Forty patients with tetralogy of Fallot totally corrected surgically, required reoperation. The indications were persistent ventricular septal defect with a 2:l shunt and/or a 60-mm gradient in the pulmonary outflow tract. Ventricular septal defects, inadequate right ventricular outflow tract, and aneurysms of the ventriculatory outflow tract were singly, or in combination, the anatomic defects encountered. VSD was found alone in seven (176%). In five patients there was a right ventricular aneurysm. Thirty-eight (95%) of the patients survived this second operative procedure which was done I day to 92 mo after the first procedure. Thirtysix of the surviving patients are well, The authors conclude that reoperation for residual lesions after surgical correction of tetralogy of Fallot can be accomplished with mortality and morbidity essentially the same as with the original procedure.William K. Sieber

An Attempt

folding the mucosa into the lumen, produces a mucosal gastroesophageal valve and is the technique devised experimentally, and used successfully, to control esophageal reflux after a Heller procedure.William K. Sieber

of a 2- to 3-cm cuff musculature

and

of the distal

reapproximation,

This paper reports on a series dren with appendicitis operated

of 1523 chilupon at the