Biomedical subjects
Publications and source records attributed to A Simcha.
The repair of ventricular septal defect (VSD) in corrected transposition of the great arteries has presented many technical problems and was associated with a high mortality. Transatrial closure of the VSD in this malformation obviates many of the hazards and offers good exposure. The operative procedure in such a case is described in detail, and its merits are discussed.
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Explore the source record for details and available documents.
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Explore the source record for details and available documents.
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Blood-free-fatty acids (F.F.A.) and growth-hormone levels were determined in 9 children subjected to cardiac catheterization and angiography. A significant rise of growth-hormone level was recorded immediately after angiocardiography, followed by a marked increase of F.F.A. levels 2--4 hours after termination of the catheterization. These results may indicate that the high levels of F.F.A. sustained after cardiac catheterization and angiography are probably due to the increase of growth -hormone secretion during the procedure.
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Severe pathological changes in the cardiac valves are often observed at an early age in children in the developing countries. Mitral stenosis is best managed by closed commissurotomy. However, mitral insufficiency, aortic insufficiency and tricuspid lesions may lead to life-threatening hemodynamic effects which necessitate valve replacement. This differs from experience in the developed countries where surgery for rheumatic valvular disease is limited to the adult. Our experience includes 33 children aged 5 to 16 years. Twenty-four children underwent single valve replacement, eight had two valves replaced and one had triple valve replacement. All were classified Grade IV or late Grade III (New York Heart Association). Four children had to be operated on despite known rheumatic activity. Two children in shock and pulmonary edema underwent emergency operation. There were two hospital deaths and eight late deaths. Patients have been followed for up to eight years. Twenty children are now classified as Grade I and lead completely normal lives and the remaining three are classified as Grade II. Postoperative catheterization studies have documented improvement from severe preoperative hemodynamic changes to near normal values at rest after operation. The cardiothoracic ratio has decreased impressively. We conclude that the natural history of rheumatic heart disease in children with severely damaged heart valves is favorably modified by valve replacement.
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Rheumatic valvular disease in children is common in underprivileged countries and often damages the tricuspid valve (in addition to the mitral and aortic valves). Fifteen children aged 12 to 16 years underwent tricuspid valve surgery. Fourteen were graded as Class IV disability; five were operated during rheumatic activity. The tricuspid valve was replaced in ten patients, four had annuloplastic procedures and one underwent tricuspid commissurotomy. There was one operative death and four late deaths. Eight of the ten long-term survivors are in Class I and the remainder in Class II functional ability. It may be concluded that in children who can be protected from additional bouts of carditis and thromboembolism, the surgical treatment of advanced multivalvular disease including the tricuspid valve is most rewarding, and dramatic clinical improvement with return to normal or near-normal hemodynamics may be expected.