Valvular heart surgery in infants and children

454

ABSTRACTS

red in the weakest part of the sternum, not in the portion pulled on by the diaphragm. A steel truncated cone was made to simulate the thoracic cavity and a segment of its wall replaced with a rubber membrane and the internal pressure reduced. The point of maximum concavity was always at the metacentre of the membrane. It is concluded that funnel chest deformity is due to a primary weakness of the anterior thoracic wall, acted on by the normal negative intrathoracic pressures of respiration. -R. C. M. Cook

HEART AND GREAT VESSELS Valvular Heart Surgery dren. J. W. Kilman,

in Infants and Chil-

T. E. Williams, Jr., G. S. Kakos, M. Schiller, and H. D. Sirak.

Arch. 1971.

Surg.

103:656-652

(November),

successfully treated using cardiopulmonary bypass in children weighing less than 8 lb. (3.6 kg). Mitral valve replacement in older children has been rewarding and no heart was encountered that would not take an adult-size valve. Other lesions are discussed.-E. I. Berman Cardiopulmonary Bypass in Infants: Indications, Methods, and Results in 32 Patients. W. S. Pierce, R. C. Raphaely, J. J.

Downes,

and J. A. Waldhausen. (December),

Surgery

1971.

This report from the Children’s Hospital of Philadelphia reviews experience with cardiopulmonary bypass in the surgical treatment of 32 patients with congenital heart lesions. These patients weighed less than 10 kg. Their mean age was 18 mo, and they were operated upon during the last 4 yr. Details of anesthesia administration and cardiopulmonary technique are presented. Seven of the 32 patients died. Deaths were usually due to the severity of the heart lesion.-IV. K. Sieber Indications for Surgery in Infants with Left to Right Shunts. J. Aubert, V. Dor, D.

and M. Carcassonne.

The

indications

for

surgery

1971. in

infants

with left to right shunts are the following: left to right shunt with pulmonary hypertension and increased pulmonary flow resistent to long-term medical treatment; left to right shunt in a critical state, serious acidosis, sometimes even after cardiac arrest. There are two types of malformation: that which cannot be completely cured (single ventricle, tricuspid atresia with increased pulmonary flow and truncus arteriosus) ; and that which can be cured completely (patent ductus arteriosus with or without interventricular communication, coarctation of aorta with interventricular atrioventricular communication, canal, ventricular septal defect with transposition of large vessels, and isolated ventricular septal

A total of 130 children undergoing surgery for isolated valve lesions from 1960 to 1970 are reviewed. There were ten operative deaths (7.7%). Aortic stenosis was

70:639-647

Unal, A. Pannetier,

Ann. Chir. Infant. 12:265-295,

Hsu

defect.-F.

Management of Aorta-Right Pulmonary Artery Anastomosis During Total Correction of Tetralogy of Fallot. P. A. Ebert, W. A. Gay, Jr., and H. W. Oldham. Surgery 71:231-234 (February), 1972. Waterston artery) shunt

is

(aorta-right pulmonary favored to increase pul-

monary artery flow in infants with Fallot’s tetralogy. Angulation or rotation of such a shunt may occlude the proximal right pulmonary artery allowing flow to the right lung only. This report presents two patients in which this situation was encountered during total correction of the cardiac anomaly. The technique of patrial aortic occlusion, takedown of the anastomosis, closure of the aorta, and pericardial patch reconstruction of the right pulmonary artery are described. The authors emphasize the importance of angiography preoperatively for diagnosis of this complication of the Waterston-type anastomosis. -W. K. Sieber Surgical Treatment of Congenital Coronary Artery Fistula. D. Liotta, G. L. Ha//man, R. J. Hall, and D. A. Conley. Surgery 70:65M64 (December), 1971.

with congenital Seventeen patients coronary artery fistula were operated upon