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The use of valve prosthesis in childhood
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
primum defects with cleft atrioventricular valves; type III--ostium primum defects with ventricular septal defects; type I V - same as type III, but with pulmonary hypertension (systemic levels); Type O--miscellaneous (left ventricular to right atrial shunts), Seven patients had type I with no operative mortality. Twenty patients had the most common type II, with one death. Four patients were classified type III with one death. Only 2 patients with type IV were operated upon. One was repaired and died, and one was only explored and remains in the same condition as before surgery. The operative technic is described. Permanent heart block occurred in 2 patients treated by pacemaker implantation. Persistent mitral stenosis was present in 66 per cent of the surviving patients having corrective surgery despite closure of the cleft valves. In spite of this, these patients are doing well elinically.--WiUiam L. Biker. TIlE UsE OF VALVE PROSTHESIS IN CHILD-
HOOD. E. A. Smeloff, G. G. Kayler, and D. F. Smith. J. Thorac. Cardiovas. Surg. 51:839-843, June, 1966. Fortunately, most congenital valve diseases can be treated without the use of prosthesis. The greatest deterrence to the use of prosthesis in the child is the smallsize valve that must be used, and the probability of having to replace the valve as the child grows. In the mitral region this is not so important, since the ventricle and atrium as well as the valve ring are greatly dilated and will accept a large size prosthesis. Aortic replacement, however, usually poses the problem of a small annulus. The authors report 2 cases: One, a 12 year old and one, 8 years old in whom surgery for aortic stenosis was performed. At operation it was thought that the valve could not be opened well enough unless it was completely excised and replaced by a prosthesis. In both instances a Smeloff-cutter valve was inserted. This prosthesis was used because it gives a larger useable opening than the Starr-Edwars valve. Both cases survived: the first for 24 months and the second for 10 months, and apparently were doing well. No postoperative cardiac
605
catheterization results were given.~WiUiam L. Biker. SUPRAVALVULAIt AORTIC STENOSIS. Wm. P.
Cornell, Ronald C. Elkins, ]. Michael Gritey and David C. Sabiston. Thor. & Cardiovasc. Surg. 51:484-492, April 1966. The authors review the English literature and found 50 patients with supravalvular aortic stenosis. Six of their own cases are presented with details of physical findings, angiograms and catheterization findings. Physical and mental retardation were found in 4 patients, along with peculiar facial characteristics typical of many patients with this syndrome. Two children were operated upon, incising the aorta through the area of narrowing and sewing on an oval patch of woven teflon to enlarge the channel. Both children did well and seemed relieved of their pressure gradient,---William L. Riker. SURGICAL TREATMENT OF SUPRAVALVULAR AORTIC STENOSIS. REPORT OF 16 CASES AND REVIEW OF TIlE LITERATURE. J.
Thorac. C. C. Bastelli, Dwight C. MeCoon, P. A. Ongley, H. P. Mankin and J. W. Kirklin. Cardiovas. Surg. 51:873882, June, 1966. In this scholarly and well illustrated paper, 16 patients with supravalvular aortic stenosis are presented that were operated upon, and a review of the literature yielded 51 more cases that were surgically treated. Thirteen of the patients had localized, congenital supravalvular stenosis, with not only narrowing of the aorta above the valve but also an internal ridge of tissue which contributed to the stenosis. The remaining 2 patients had diffuse supravalvular aortic stenosis with hyperplasia of the descending aorta and aortic arch. Detailed data are given on the cardiac catheterization preoperatively, and the surgery. Thirteen of the 14 patients with localized stenosis did well, and postoperative catheterization data on 3 patients from 2 to 4 years showed no gradient between the aorta above the valve and the aortic arch. Of the 2 patients with diffuse supravalvular aortic stenosis, one patient died after surgery and the other maintained the same gradient after repair. The
primum defects with cleft atrioventricular valves; type III--ostium primum defects with ventricular septal defects; type I V - same as type III, but with pulmonary hypertension (systemic levels); Type O--miscellaneous (left ventricular to right atrial shunts), Seven patients had type I with no operative mortality. Twenty patients had the most common type II, with one death. Four patients were classified type III with one death. Only 2 patients with type IV were operated upon. One was repaired and died, and one was only explored and remains in the same condition as before surgery. The operative technic is described. Permanent heart block occurred in 2 patients treated by pacemaker implantation. Persistent mitral stenosis was present in 66 per cent of the surviving patients having corrective surgery despite closure of the cleft valves. In spite of this, these patients are doing well elinically.--WiUiam L. Biker. TIlE UsE OF VALVE PROSTHESIS IN CHILD-
HOOD. E. A. Smeloff, G. G. Kayler, and D. F. Smith. J. Thorac. Cardiovas. Surg. 51:839-843, June, 1966. Fortunately, most congenital valve diseases can be treated without the use of prosthesis. The greatest deterrence to the use of prosthesis in the child is the smallsize valve that must be used, and the probability of having to replace the valve as the child grows. In the mitral region this is not so important, since the ventricle and atrium as well as the valve ring are greatly dilated and will accept a large size prosthesis. Aortic replacement, however, usually poses the problem of a small annulus. The authors report 2 cases: One, a 12 year old and one, 8 years old in whom surgery for aortic stenosis was performed. At operation it was thought that the valve could not be opened well enough unless it was completely excised and replaced by a prosthesis. In both instances a Smeloff-cutter valve was inserted. This prosthesis was used because it gives a larger useable opening than the Starr-Edwars valve. Both cases survived: the first for 24 months and the second for 10 months, and apparently were doing well. No postoperative cardiac
605
catheterization results were given.~WiUiam L. Biker. SUPRAVALVULAIt AORTIC STENOSIS. Wm. P.
Cornell, Ronald C. Elkins, ]. Michael Gritey and David C. Sabiston. Thor. & Cardiovasc. Surg. 51:484-492, April 1966. The authors review the English literature and found 50 patients with supravalvular aortic stenosis. Six of their own cases are presented with details of physical findings, angiograms and catheterization findings. Physical and mental retardation were found in 4 patients, along with peculiar facial characteristics typical of many patients with this syndrome. Two children were operated upon, incising the aorta through the area of narrowing and sewing on an oval patch of woven teflon to enlarge the channel. Both children did well and seemed relieved of their pressure gradient,---William L. Riker. SURGICAL TREATMENT OF SUPRAVALVULAR AORTIC STENOSIS. REPORT OF 16 CASES AND REVIEW OF TIlE LITERATURE. J.
Thorac. C. C. Bastelli, Dwight C. MeCoon, P. A. Ongley, H. P. Mankin and J. W. Kirklin. Cardiovas. Surg. 51:873882, June, 1966. In this scholarly and well illustrated paper, 16 patients with supravalvular aortic stenosis are presented that were operated upon, and a review of the literature yielded 51 more cases that were surgically treated. Thirteen of the patients had localized, congenital supravalvular stenosis, with not only narrowing of the aorta above the valve but also an internal ridge of tissue which contributed to the stenosis. The remaining 2 patients had diffuse supravalvular aortic stenosis with hyperplasia of the descending aorta and aortic arch. Detailed data are given on the cardiac catheterization preoperatively, and the surgery. Thirteen of the 14 patients with localized stenosis did well, and postoperative catheterization data on 3 patients from 2 to 4 years showed no gradient between the aorta above the valve and the aortic arch. Of the 2 patients with diffuse supravalvular aortic stenosis, one patient died after surgery and the other maintained the same gradient after repair. The