[Auricular communication and partial anomalous drainage of the pulmonary veins. Report of 30 surgical cases].
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Biomedical subjects
Publications and source records attributed to J Pliego.
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Thirteen patients with congenitally corrected transposition of the great arteries underwent cardiac surgery between May 1964 and May 1984. Eleven cases underwent corrective surgery and two palliative treatment. Four cases had closure of the ventricular septal defect two had pulmonary valvotomy, two closure of atrial septal defect and three tricuspid valve replacement. Two patients developed atrioventricular dissociation, requiring pacemaker insertion. Two patients died, one in the immediate postoperative period in pulmonary edema, and another due to bacterial endocarditis 3 years after surgery. Our observations suggest that surgical treatment of corrected transposition can be achieved with acceptable risks. The long-term follow up in the survivors was excellent.
Four hundred patients with atrial septal defect treated surgically were reviewed. Thirty five (8.7%) developed arrhytmias post-surgery which persisted for over a year. Sinus bradycardia was found in 10 patients, nodal rhythm in 21, and atrial fibrilation and flutter in 4 patients. Thirty five per cent of the patients with late arrhythmias developed related symptomatology. In 14 patients the function of the sinus node was studied with electrical stimulation of the atrium and with His registry. The interatrial conduction time, AV node and His Purkinje were analized employing various stimulation frequencies. All the cases studied had normal intra-atrial conduction; the response of the atrio-ventricular node to increasing frequencies was normal, an the intraventricular conduction remained constant. In 8 patients (52%), alterations of the sinus node were found; these consisted of prolonged post-stimulation pauses, Wenckebach's type sinoatrial block and suppression of sinus automatism employing vagal procedures or through electrical stimulation. A patient with severe bradycardia detected by dynamic electrocardiography had to be treated with a permanent pacemaker. We confirm that these arrhytmias are not produced by lesions of the internodal tracts, and that an alteration of the sinus node is frequent without a concomitant lesion of the intraventricular pathway. The lesion to the nutrient artery could be due to trauma and/or surgically induced. The response to anticholinergic drugs was good. Prolonged observation of these patients could increase the morbility of these arrythmias and raise doubts of the surgical indications in cases with moderate hemodynamic repercussion.