Recent results of cardiovascular surgery in infants in the first year of life

Airway obstruction in aortic arch anomalies

Tracheoesophageal compression by aortic arch anomalies is rare. Nevertheless, one must keep this entity in mind because it is associated with significant morbidity. Although it is generally agreed that the barium swallow shows when an abnormal vessel is compressing the esophagus, the literature disagrees on whether a bronchoscopy is needed in the evaluation of these patients. Not uncommonly the symptoms of airway obstruction persist after surgery resolves the anatomic defect. To provide a basis for postoperative comparison, we propose that all patients with suspected aortic arch anomalies undergo endoscopy just before their operation. A series of 26 cases of aortic arch anomalies affecting the airway, seen over a period of 29 years, is presented. A discussion of the clinical presentation, the diagnostic and bronchoscopic findings, and the results of surgical treatment are presented in addition to a brief embryologic and anatomic discussion. A case illustrating the value of preoperative and postoperative bronchoscopy is presented.

The medical and surgical management of patients with congenital heart disease. A survey of current knowledge and practices

Today, techniques for diagnosis,medical preparation, and definitive surgical repair are available for most cardiac anomalies, if needed. These permit successful treatment and carry a low mortality. Such children can now be expected to lead normal and meaningful lives as contributors to society. When serious symptoms occur in infancy, as discussed herein, an emergency exists and prompt diagnosis and treatment are mandatory for survival.

Correction of transposition of the great vessels with previous Baffes procedure

Twenty-four patients with transposition of the great vessels who underwent a Baffes procedure in infancy were totally corrected by a modified Mustard procedure. There were three postoperative deaths and one major complication. All survivors have been followed from 2 to 8 yr and have done well except for one patient who required a tricuspid valve replacement because of tricuspid insufficiency. It is our conclusion that this group of patients can be corrected with a relatively low mortality and a favorable outcome.

Survival after systemic to pulmonary arterial shunts in infants less than 30 days old with obstructive lesions of the right heart chambers

Ninety-seven infants less than 30 days old with obstructive lesions of the right heart chambers underwent palliative surgery from 1950 through 1972. The diagnosis was made at cardiac catheterization and confirmed at operation or subsequent autopsy. Because of unavailability of complete preoperative studies and sufficient blood gas data, 36 patients presenting between 1950 and 1965 (Group I) were analyzed for surgical risk only. In 61 patients who underwent palliative procedures between 1966 and 1972 (Group II) a more detailed analysis was done. In this group, 31 had a Potts shunt, 29 a Waterston shunt and 1 a Blalock-Taussig shunt. The most frequently encountered malformation was severe tetralogy of Fallot (30 percent) with or without pulmonary atresia, followed by pulmonary atresia with intact ventricular septum (25 percent). The overall surgical mortality rate in patients seen after 1965 (Group II) was 34 percent compared with the 78 percent mortality rate in patients seen earlier (Group I). The surgical mortality in infants operated on during the 1st week of life was double that of those operated on in the 2nd through 4th weeks. Survivors were compared with nonsurvivors for timing of surgery, age at presentation and clinical profile. Only two significant differences were found. Preoperative continuous murmurs were more common in those who survived operation (13 of 40 patients) than in those who died (2 of 21). Arterial pH during cardiac catheterization was the best predictor of subsequent survival, nonsurvivors having significantly greater metabolic acidosis. Palliation of these severe lesions still carries a high mortality rate to which must be added the risk of subsequent repair. Our data suggest that primary repair is to be preferred if it can be undertaken with a risk approximating that of palliative procedures.

Surgical correction of aortic valve stenosis with persistent ductus arterious and servere pulmonary hypertension

This is a report of a case in which the unusual association of severe aortic valve stenosis with persistent ductus arteriosus complicated by severe pulmonary hypertension, was diagnosed and correction of the anatomical lesions carried out in one stage. Re-investigation after one year showed that the duct was closed, the pulmonary artery pressure was lower than before the operation and the gradient across the aortic valve reduced. A modern approach to treatment based on full cardiac assessment is stressed. Problems arising during the operation are discussed.