Transatrial repair of tetralogy of fallot

490

ABSTRACTS

therapy, and by histologic examination

when

Holcomb

indicated.-George

Results

Following

cuspid Atresia.

Physiological

C. J. Takx&s,

Repair

for

Tri-

R. G. Ardekcmi, R. A.

Mitter, and M. Seroffo. Ann Thoroc Surg 22:578-

HEART

AND GREAT

Neonatal

Pneumopericardium.

Kleinberg,

R. R. Hottery,

Clin Proc 51:101-106

583 (December),

VESSELS D. S. Moodie, F.

and R. H. Feldt. Mayo

(February), 1976.

Three cases of neonatal pneumopericardium are presented. The literature on this subject is reviewed. Based on that review and the three presented cases, guidelines for managing these patients are given. If pneumopericardium causes cardiac temponade, immediate pericardiocentesis may be life saving. Details of monitoring and supportive treatment are provided.--S L. Cans Surface-Induced

profound

fant Cardiac Operations: Vidne and A. Subramonion.

572-577

Hypothermia A New

System.

in

In-

8. A.

Ann Thorac Surg 22:

(December), 1976.

This article discusses the use of a new air refrigerated “isolette” system for surfaceinduced profound hypothermia used in infants. Experimental work with 22 dogs has determined that the apparatus cools efficiently and at a stable rate, with satisfactory maintenance of acid-base equilibrium. The device has its advantage in that the infant is entirely visible during the procedure. Cooling can easily be maintained under anesthesia. The apparatus has been used in IO patients with a quite satisfactory result.--Keith W. Ashcraft Permanent

Cardiac

Pacemakers

Technical Considerations.

in

Children:

J. S. Donohoo, 1. A.

Halter, S. Zonnebelt, C. Neilt, V. 1. Gott, ond R. K. Brcrwtey. Ann

Thorac

Surg

22:584-587

(De-

cember), 1976.

Twenty-seven permanent cardiac pacemakers were implanted in I3 children. The technical considerations are a two-incision approach. One is a submammary thoracotomy for access to the left ventricular apex where they prefer to put in a unipolar implanted electrode. The other is a transverse abdominal incision with muscle-splitting and properitoneal placement of the battery pack. They have discussed a preference, however, for the rechargeable “pacesetter” pacemaker which they have used in patients since 1971 with satisfactory results. They allude to the experience of other surgeons who are using these rechargeable pacemakers in children with quite satisfactory results.Keith

W. Ashcraf

1976.

This report of I4 patients is an update of the previously reported experience from the Cook County Hospital, having to do with variations on the Fontan procedure for tricuspid atresia. Of the I4 patients operated upon, 7 were long term survivors. Survival appears to be related to the pulmonary vascular resistance. In the discussion of this paper, several other variations of this Fontan procedure are described which are interesting. These include the placement of a valved conduit between the right atrium and the rudimentary right ventricle, then, either patching the pulmonary outflow tract or letting the flow go through the naturally occurring outflow tract after closure of the ventricular septal defect. Several patients with this anatomic and physiological arrangement have survived operation.--K&h W. Ashcraft Tmnsatrial

Repair

of Tetralogy

of Pallot.

1. H.

Edmunds, Jr., N. C. Saxeno, S. Friedman, W. J. Roshkind, and P. F. Dodd. Surgery 80:681-688 (December), 1976. This report from the Children’s Hospital of Philadelphia concerns the surgical correction of 25 patients with tetralogy of Fallot by a transatrial repair without resorting to ventriculotomy. The authors have avoided ventirculotomy pointing out that this causes decreased myocardial contractibility, necrosis of adjacent myocardium and that the infundibular outflow patch further impairs right ventricular pumping efficiency. The technique followed is described in detail with appropriate drawings. One of the 25 patients died during an arrythmia on her third postoperative day. Twenty-three of the patients developed right bundle branch block but all have sinus rhythm. Mild tricuspid insufficiency is present in only one child. The authors indicate that while the procedure is possible in many patients with tetralogy of Fallot, in small infants exposure through the tricuspid valve is limited as is the case in those patients with severe degrees of infundibular hypoplasia.- William K. Sieber kllot’s

Tetralogy.

R. G. O’Donovan, R. H. Kin&y,

F. Hitchcock, and R. Girdwood. 211-214

S. Afr J Surg 13:

(December), 1975.

A series of 40 cases of complete repair of Fallot’s Tetralogy undertaken over a 2 yr pe-