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The surgical management of valvular aortic stenosis during infancy
ABSTRACTS
82 Winship, 1. R. Quantrill and M. S. Gotsman. S. Afr. Med. J. 43:1085-1087,
(August)
1969.
Only 18 well-documented cases of anomalous pulmonary venous drainage from the left upper lobe have been reported in the English literature. The case reported had anomalous drainage into a left superior vena cava and then into the innominate vein. Pulmonary valvular stenosis and a patent foramen ovale were also present. The child was studied at 31 months of age at which time she was clinically well. The diagnostic workup and differential diagnosis is described. The pertinent embryology is commented upon and the necessary surgical correction outlined. Surgery has thus far been deferred due to the good condition of the child and the presence of only a moderate gradient across the pulmonary valve.-Hugh V. Firor. AORTIC VALVE REPLACEMENT WITH AUTOGENOUS TISSUE. W. S. Edwards. Ann.
Thor. Surg. 8:126131,
(August)
1969.
A method is described of tailoring a threeleaflet valve from autologous pericardium or fascia lata, which has been used in five patients. One patient died postoperatively without evidence of aortic stenosis or insufficiency; four are free of signs or symptoms of aortic valular dysfunction four to nine months postoperative. No emboli have occurred; no anticoagulants have been used postoperatively. If this method works over the long term it might well be used for the management of congenital aortic stenosis, where valvulotomy leaves a stenotic valve and for pulmanic valve replacement in tetralogy of Fallot where adequate relief of obstruction leaves an incompetent pulmonic valve.-lens G. Rosenkrantz. THE SURGICAL MANAGEMENT OF VALVULAR AORTIC STENOSISDURING INFANCY. A. G. Coran and W. F. Bernhard. J. Thorac.
Cardiovasc. ber) 1969.
Surg. 58:401-408,
(Septem-
The authors review 24 children one week to 24 months of age who were operated upon for aortic stenosis, seven on the pump (five died), two with hypothermia (both died) and 15 with inflow occlusion at a
normothermic temperature at two atmospheres (two died). Two of the 15 survivors died later and two required reoperation, one for severe aortic insufficiency and one for residual stenosis. Unfortunately, no postoperative physiologic data are presented.Jens G. Rosenkrantz. AORTICOPULMONARYSEPTAL DEFECT. CH~LLENGE OF CORRECTION IN THE NEWBORN INFANT. M. F. Lynch, H. Katkov, N. K. Jensen and C. A. Peterson. Amer. J. Surg.
117:748-753,
(May)
1969.
A two-and-a-half-year-old female infant was admitted for dyspnea and failure to thrive, and after study, including angiocardiograms and retrograde cineaortograms, the infant was proved to have an aorticopulmonary septal defect. This was closed through a median sternotomy incision by dividing the defect between clamps and oversewing. It is pointed out that eight of 21 nonoperative deaths in previous series have occurred before the age of two. It is important to make both the diagnosis and to perform a correction early. The authors consider that the feasibility of direct clamping and division is increased at the early age without the use of the pump oxygenator. which in inself presents a real problem in this age group.-Neville K. Connolly. EBSTEIN’S ANOMALY. FURTHER EXPERIENCE WITH DEFINITIVE REPAIR. K. L. Hardy and B. B. Roe. J. Thorac. Cardiovasc.
Surg. 58:553-560,
(October)
1969.
Six patients are presented, who underwent repair of Ebstein’s anomaly by Hardy’s technique, one dying from brain damage and one dying 2% months postoperative of a sudden arrhythmia. The remaining four are alive and well 1% to six years after operation, with good functional results, improved to excellent exercise tolerance and normal right atria1 pressures, with only one patient showing significant tricuspid insufficiency. Hardy’s repair includes sutures to bring the annulus at the junction of the atrium and the atrialized ventricle down to the level of the tricuspid valve, obliterating the atrialized ventricle. In so doing, the surgeon narrows the new valve ring to produce an eccentrically closing tricuspid valve or a monocusp valve (if the septal and posterior
82 Winship, 1. R. Quantrill and M. S. Gotsman. S. Afr. Med. J. 43:1085-1087,
(August)
1969.
Only 18 well-documented cases of anomalous pulmonary venous drainage from the left upper lobe have been reported in the English literature. The case reported had anomalous drainage into a left superior vena cava and then into the innominate vein. Pulmonary valvular stenosis and a patent foramen ovale were also present. The child was studied at 31 months of age at which time she was clinically well. The diagnostic workup and differential diagnosis is described. The pertinent embryology is commented upon and the necessary surgical correction outlined. Surgery has thus far been deferred due to the good condition of the child and the presence of only a moderate gradient across the pulmonary valve.-Hugh V. Firor. AORTIC VALVE REPLACEMENT WITH AUTOGENOUS TISSUE. W. S. Edwards. Ann.
Thor. Surg. 8:126131,
(August)
1969.
A method is described of tailoring a threeleaflet valve from autologous pericardium or fascia lata, which has been used in five patients. One patient died postoperatively without evidence of aortic stenosis or insufficiency; four are free of signs or symptoms of aortic valular dysfunction four to nine months postoperative. No emboli have occurred; no anticoagulants have been used postoperatively. If this method works over the long term it might well be used for the management of congenital aortic stenosis, where valvulotomy leaves a stenotic valve and for pulmanic valve replacement in tetralogy of Fallot where adequate relief of obstruction leaves an incompetent pulmonic valve.-lens G. Rosenkrantz. THE SURGICAL MANAGEMENT OF VALVULAR AORTIC STENOSISDURING INFANCY. A. G. Coran and W. F. Bernhard. J. Thorac.
Cardiovasc. ber) 1969.
Surg. 58:401-408,
(Septem-
The authors review 24 children one week to 24 months of age who were operated upon for aortic stenosis, seven on the pump (five died), two with hypothermia (both died) and 15 with inflow occlusion at a
normothermic temperature at two atmospheres (two died). Two of the 15 survivors died later and two required reoperation, one for severe aortic insufficiency and one for residual stenosis. Unfortunately, no postoperative physiologic data are presented.Jens G. Rosenkrantz. AORTICOPULMONARYSEPTAL DEFECT. CH~LLENGE OF CORRECTION IN THE NEWBORN INFANT. M. F. Lynch, H. Katkov, N. K. Jensen and C. A. Peterson. Amer. J. Surg.
117:748-753,
(May)
1969.
A two-and-a-half-year-old female infant was admitted for dyspnea and failure to thrive, and after study, including angiocardiograms and retrograde cineaortograms, the infant was proved to have an aorticopulmonary septal defect. This was closed through a median sternotomy incision by dividing the defect between clamps and oversewing. It is pointed out that eight of 21 nonoperative deaths in previous series have occurred before the age of two. It is important to make both the diagnosis and to perform a correction early. The authors consider that the feasibility of direct clamping and division is increased at the early age without the use of the pump oxygenator. which in inself presents a real problem in this age group.-Neville K. Connolly. EBSTEIN’S ANOMALY. FURTHER EXPERIENCE WITH DEFINITIVE REPAIR. K. L. Hardy and B. B. Roe. J. Thorac. Cardiovasc.
Surg. 58:553-560,
(October)
1969.
Six patients are presented, who underwent repair of Ebstein’s anomaly by Hardy’s technique, one dying from brain damage and one dying 2% months postoperative of a sudden arrhythmia. The remaining four are alive and well 1% to six years after operation, with good functional results, improved to excellent exercise tolerance and normal right atria1 pressures, with only one patient showing significant tricuspid insufficiency. Hardy’s repair includes sutures to bring the annulus at the junction of the atrium and the atrialized ventricle down to the level of the tricuspid valve, obliterating the atrialized ventricle. In so doing, the surgeon narrows the new valve ring to produce an eccentrically closing tricuspid valve or a monocusp valve (if the septal and posterior