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Surgical management of the hypoplastic right heart syndrome
784
ABSTRACTS
Thorac. Cardiovasc. (February) 1970. The effects pluronic F-68,
Surg.
59: 178-184
of the nonionic detergent, on free-plasma hemoglobin,
fat in the urine, fat and debris in the pump filter, and (in dead patients) fat embolization were studied in 50 patients randomly selected who underwent open heart surgery and compared with 53 similar patients who did not receive pluronic. “Significant” differences were found between the two groups in free-plasma hemoglobin levels up to 90 min of bypass. No such evidence of decreased fat in the urine, fat in the pump filter, or fat embolization in the six patients autopsied within 24 hr of surgery was found. Unfortunately, the authors do not tell us their methods of statistical analysis, and some of their statements indicate a certain degree of naivity about statistics. Nevertheless, this paper points out one of the beneficial effects of the use of this detergent, which has been shown by other groups.J. G. Rosenkrantz A
NEW METHOD OF RIGHT VENTRICULAR ChrrFLOWRECONSTRUCTION IN CORRECTIVE SURGERY FOR TETIULOGY OF FALLOT. K. Asano and S. Eguchi. J. Thorac. Cardiovast. Surg. 59:512-517 (April) 1970.
This is a report of two cases wherein a homograft or heterograft (pig) of pulmonary artery and valve was used to reconstruct the right ventricular oudlow tract in tetralogy of Fallot. Both patients survived operation. Follow-up period is short; therefore no long-term assessments are as yet possible. -J. G. Rosenkrantz CoRREunoN OF MEAN PULMONARY ARTEFUAL PRESSURE WITH RESULTS OF SURGERY FORNONRESTFU~TNEVENTRIC~LARSEPTAL JDEFEIXS. R. B. Wagner, 1. L. Ankeney, and J. Ltebman. J. Thorac. Cardiovasc. Surg. 60: 510-515 (October) 1970. The authors reviewed 30 consecutive cases with ventricular septal defect and pulmonary arterial pressures at essentially systemic levels, who underwent operation in the University Hospitals, Cleveland. The patients’ ages ranged for the most part between 4 and 8 yr, with three patients less than 4 yr old and seven patients over
8 yr (two patients in their 20s). Correlating surgical results with preoperative catheterization, the authors found that these patients fell into two groups, with excellent correlation between the results of surgery and the preoperative mean pulmonary arterial pressure. In the group whose mean pulmonary arterial pressure was Iess than 65 mm Hg, all patients survived surgery and all but three (two persistent left-to-right shunts and one with block) seemed to do well. On the other hand, 15 patients had preoperative mean pulmonary arterial pressure of 65 mm Hg or greater: eight died within 36 hr of surgery, two more died late (40 days and 6 yr), three developed progressive pulmonary vascular disease postoperatively and one had a persistent left-to-right shunt. Only one had a good result. It is felt that, in this group of patients with ventricular septal defect and pulmonary hypertension near systemic levels, the mean pulmonary pressure of 65 mm Hg or above is the single best prognostic sign, since similar correlations of results with pulmonary: systemic flow or resistance ratios were not high. This clearly presented study gives a good baseline of the results to be expected in this high-risk group of patients and underscores the devastating effects of pulmonary hypertension of this degree on survival, even with a preoperative left-to-right shunt (all but three patients in this group of 30 had pulmonary/systemic flow ratios over 1%: 1) . -.l. G. Rosenkrantz
SURGICAL MANAGEMENT OF THE HYPOPLAST~CRIGHTHEARTSYNDROME.C.S. Weldon, A. F. Hartmann, Jr., R. E. Clark, T. B. Ferguson. Ann. Thorac. Surg. 10:489-501 (December) 1970. The authors have grouped together severa1 different anomalies in which right ventricular hypoplasia is prominent, and discussed them as a group. They collected 20 patients: eight were treated by pulmonary valvulotomy and five without operation, and all patients in both groups died; six patients had- systemic-pulmonary arterial shunts and only one died. One patient, with tight pulmanic stenosis and hypoplastic right ventricle survived correction, the outflow tract being repaired with a unicusp aortic homograft. -I. G. Rosenkrantz
ABSTRACTS
Thorac. Cardiovasc. (February) 1970. The effects pluronic F-68,
Surg.
59: 178-184
of the nonionic detergent, on free-plasma hemoglobin,
fat in the urine, fat and debris in the pump filter, and (in dead patients) fat embolization were studied in 50 patients randomly selected who underwent open heart surgery and compared with 53 similar patients who did not receive pluronic. “Significant” differences were found between the two groups in free-plasma hemoglobin levels up to 90 min of bypass. No such evidence of decreased fat in the urine, fat in the pump filter, or fat embolization in the six patients autopsied within 24 hr of surgery was found. Unfortunately, the authors do not tell us their methods of statistical analysis, and some of their statements indicate a certain degree of naivity about statistics. Nevertheless, this paper points out one of the beneficial effects of the use of this detergent, which has been shown by other groups.J. G. Rosenkrantz A
NEW METHOD OF RIGHT VENTRICULAR ChrrFLOWRECONSTRUCTION IN CORRECTIVE SURGERY FOR TETIULOGY OF FALLOT. K. Asano and S. Eguchi. J. Thorac. Cardiovast. Surg. 59:512-517 (April) 1970.
This is a report of two cases wherein a homograft or heterograft (pig) of pulmonary artery and valve was used to reconstruct the right ventricular oudlow tract in tetralogy of Fallot. Both patients survived operation. Follow-up period is short; therefore no long-term assessments are as yet possible. -J. G. Rosenkrantz CoRREunoN OF MEAN PULMONARY ARTEFUAL PRESSURE WITH RESULTS OF SURGERY FORNONRESTFU~TNEVENTRIC~LARSEPTAL JDEFEIXS. R. B. Wagner, 1. L. Ankeney, and J. Ltebman. J. Thorac. Cardiovasc. Surg. 60: 510-515 (October) 1970. The authors reviewed 30 consecutive cases with ventricular septal defect and pulmonary arterial pressures at essentially systemic levels, who underwent operation in the University Hospitals, Cleveland. The patients’ ages ranged for the most part between 4 and 8 yr, with three patients less than 4 yr old and seven patients over
8 yr (two patients in their 20s). Correlating surgical results with preoperative catheterization, the authors found that these patients fell into two groups, with excellent correlation between the results of surgery and the preoperative mean pulmonary arterial pressure. In the group whose mean pulmonary arterial pressure was Iess than 65 mm Hg, all patients survived surgery and all but three (two persistent left-to-right shunts and one with block) seemed to do well. On the other hand, 15 patients had preoperative mean pulmonary arterial pressure of 65 mm Hg or greater: eight died within 36 hr of surgery, two more died late (40 days and 6 yr), three developed progressive pulmonary vascular disease postoperatively and one had a persistent left-to-right shunt. Only one had a good result. It is felt that, in this group of patients with ventricular septal defect and pulmonary hypertension near systemic levels, the mean pulmonary pressure of 65 mm Hg or above is the single best prognostic sign, since similar correlations of results with pulmonary: systemic flow or resistance ratios were not high. This clearly presented study gives a good baseline of the results to be expected in this high-risk group of patients and underscores the devastating effects of pulmonary hypertension of this degree on survival, even with a preoperative left-to-right shunt (all but three patients in this group of 30 had pulmonary/systemic flow ratios over 1%: 1) . -.l. G. Rosenkrantz
SURGICAL MANAGEMENT OF THE HYPOPLAST~CRIGHTHEARTSYNDROME.C.S. Weldon, A. F. Hartmann, Jr., R. E. Clark, T. B. Ferguson. Ann. Thorac. Surg. 10:489-501 (December) 1970. The authors have grouped together severa1 different anomalies in which right ventricular hypoplasia is prominent, and discussed them as a group. They collected 20 patients: eight were treated by pulmonary valvulotomy and five without operation, and all patients in both groups died; six patients had- systemic-pulmonary arterial shunts and only one died. One patient, with tight pulmanic stenosis and hypoplastic right ventricle survived correction, the outflow tract being repaired with a unicusp aortic homograft. -I. G. Rosenkrantz