The authors analyze the pre and post-operative hemodynamic picture of 30 children and adolescents with mitral valve replacement, which corresponds to a group of 106 patients operated on from 1964 to 1974. At variable time periods, between 9 days and 48 months (average 28 months) from the valve replacement, a new catheterization was done. The majority of the studies were done in the period between 13 and 36 months. Of the 30 cases, 21 were carriers of the Starr-Edwards valve, and the rest of different types. The Starr-Edwards valves produced a lawering of the CVP from 23.0 to 11.0 mm. Hg (average values) whereas with the other types the average pre-operative figure was 21.0 and in the post-operative period it fell to 11.0 mm. Hg. In the group with SE valves, pre-operative SPP was an average of 64.3 and in the post-operative period it was 32.0 mm. Hg. In the cases of SE valves the pre-operative total pulmonary resistances were 12.3 units and post-operatively they fell to 3.7 units. With the other types of valves the pre-opeative average was 10.9 units and post-operatively it was 5.3 units. The hemodynamic results obtained over a period of time with valvular substitution were similar in the distinct types of valves. However in the SE the benefits resulted more constant. The value of radiological and electrocardiographic study in order to predict the early post-operative hemodynamic changes is discussed. These studies serve essentially for a long range evaluation, whereas the hemodynamic, and clinical improvement maintained a strict relationship. This work shows that, in children and adolescents, the presence of severe venous-capillary and arterial pulmonary hypertension, and the elevated pulmonary resistences, are not contraindications for surgical treatment. It equally proves the eficacy of the valvular replacement, when the surgical indication and the control of the patients are handled in the proper way.

Child↗

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[Mitral valve replacement in children and in adolescents. Surgical indication and long-term results in 86 cases].

1. The authors present 86 children and adolescents with rheumatic heart disease of the Pediatric Cardiology Service of the Instituto Nacional de Cardiologia who received valve replacements in the period between September, 1964 and April, 1973, a series which is more numerous and of longer follow-up than any published up to the present 2. In order to obtain comparable results, patients with mitral heart disease of other origen and aortic replacement as well as those subjected to double or triple exchange, were omitted from the study. 3. The symptomatology, the presence of compensated heart failure, the progression of cardiomegaly, the radiologic and electrocardiographic changes, the presence of atrial fibrillation, the mean venocapilary, pulmonary arter, and left right ventricle telediastolic pressures, the pulmonary resistence figures and the results of cineangiocardiography were the fundamental elements used to establish the surgical indication. 4. None were operated with clinic or laboratory data suggesting rheumatic activability. The shortest period between the last bout of rheumatic fever and surgery was 10 months. 5. The clinic improvement was remarkable. Half of the cases receiving digitalis and diuretics were released without this prescription and only 10% continue to take digitalis. With the exception of five patients, the physical capacity is normal and most play sports. The postoperatory radiologic and electrocardiographic changes were remarkable, most were obtained a few months after surgery. With the exception of one case, atrial fibrillation disappeared (in 58% before six months in a group of 31 patients). 6. The later complications attributed to the valve replacement as well as the 15 deaths in the total lot were analyzed. It was pointed out that the hospital death rate was 12.6% and the later was 5.3%, extraordinarily low figures if it is taken into account that the material corresponds to nine years of work and the problems inherent to the initial period are included. It gains still greater importance if compared to the series published up to the date. The global mortality rate of 17.9% is small in relation to the only comparable publication, -30 and if only the results of the last three years are compiled (61 cases equals 70 of the series), the global death rate was 9.8%. 7. It was noted that the results are due to the system adopted for establishing the surgical indication, to the good state of the myocardial fiber...

Adolescent↗

PubMedDate not supplied

[Tricuspid atresia: A therapeutic problem].

1. The authors present 80 cases of tricuspid atresia of the Children's Cardiology Service of the Instituto Nacional de Cardiología de México. They propose their own classification based on the position of the visceral suits and of the great arteries and the possible existance of a persistent truncus arteriosus. 2. The requirements that should be fulfiled to establish an anatomic and hemodynamic diagnosis are determined; and the need to know in detail the anatomy of the right ventricle; of its exit chamber, of the pulmonary valve and of the pulmonary truncus is emphasized; as well as the measures in the auricles and the left ventricle. 3. They insist upon the need, when the pulmonar arterial pressure cannot be measured directly, to introduce a catheter in a pulmonar vein, because the pressures obtained are quite similar to the pressure in the pulmonar arterial territory. 4. The fundamental data of the anatomic and hemodynamic study are discussed and illustrated. They confirm the close relation that exists between the diameter of the exit chamber of the right ventricle and of the valvular ring, the pulmonary truncus and its branches. 5. In all cases of tricuspid atresia with AQRS deviated to the right and downwards in the frontal plane; transposition of the great arteries should be thought of when it deviates to the left and upwards, in patients with crossed great arteries. 6. In the cases operated with sistemic-pulmonary fistula, there was an intrahospital mortality range of 25%, similar to that obtained by most authors. 7. The paliative surgical procedures are analyzed, and those that at present could be considered as "corrective" such as Fontan and Kreutzer's operations. The need, to gather several diagnostic parameters. To establish the surgical indication in the sistemicpulmonary and venus shunts, is emphasized.

Angiocardiography↗

PubMedDate not supplied