Total anomalous pulmonary venous connection in infancy: influence of age and type of lesion.
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Biomedical subjects
Publications and source records attributed to P A Ebert.
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The evaluation, surgical repair, and follow-up are described in an asymptomatic 27-year-old man with unilateral total anomalous pulmonary venous return from the left lung through an innominate vein and a patent foramen ovale. The anomalous vein was divided and anastomosed directly to the left atrium using a vascular technique that produced an orifice larger than the vein diameter. Radionuclide scanning accurately identified the anomaly before operation and allows periodic noninvasive reevaluation after operation. Correction is recommended in all patients with unilateral anomalous pulmonary venous return because disease in the one normal lung could be fatal.
Extracellular space (ECS), water, and intracellular ion concentration were determined in the normal and hypertrophied rat myocardium. Theoretical measurements of myocardial ECS based on a mathematical model (9.31%) closely approximated the observed results in the normal myocardium (12.8%) and hypertrophied myocardium (11.7%). Observed results confirmed theoretical considerations of no change in ECS with hypertrophy. ECS and water content were higher in the right ventricle than the left ventricle, but intracellular electrolytes remained unchanged. Myocardial hypertrophy did not alter these relationships.
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The long-term effects of cold potassium cardioplegic arrest was examined in 40 patients who underwent myocardial revascularization. Comparisons between resting ejection fraction (EF), end diastolic volume (EDV), and segmental wall motion were made between the preoperative and postoperative catheterization (mean postoperative recatheterization, 6 months). A 2.93 graft per patient ratio was found in this group of patients, with 108/117 grafts visualized at the time of recatheterization. The EF was 60% +/- 3% before surgery and 62% +/- 3% after surgery. A correlation coefficient of 0.91 was determined for the entire series. The EDV was 151 +/- 16 cc before coronary artery bypass graft (CABG) and was unchanged post CABG at an end diastolic volume of 137 +/- 15 cc. Analysis of preoperative wall motion of 33 patients demonstrated 111 depressed segments, 68 normal, and 52 hypercontractile; at recathetrization, there were 100 depressed, 66 normal, and 65 hypercontractile segments. Although there was essentially no deterioration of myocardial function for 37 out of 40 patients, three demonstrated a reduction in EF, the largest reduction being 15%. These three patients had a cardioplegic arrest time greater than 70 minutes. An inverse relationship between percent change in EF and the length of cardioplegic arrest was observed, with an r value o - 0.57 (p less than 0.01). These data suggest that prolonged cardioplegic arrest times may be associated with mild dysfunction. Cold potassium cardioplegic arrest up to 70 minutes was associated with no change in EF, EDV, or wall motion in this series of patients.
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Myocardial performance was evaluated intraoperatively in 20 patients undergoing myocardial revascularization when hypothermic potassium cardioplegic arrest was used. High concentrations of potassium (20 mEq/L) were compared to normal concentrations of potassium (5 mEq/L) in hypothermic cardioplegic solutions. The cardioplegic arrest period averaged 53 +/- 3 minutes in the high potassium group and 54 +/- 4 minutes in the low potassium group, Intraoperative calculation of ejection fraction and end-diastolic volume was accomplished by the technique of radiocardiography. All data were grouped according to end-diastolic volume index (EDVI) for both high (HK) and low (LK) potassium comparisons. Comparisons between high and low potassium groups demonstrated no significant differences in ejection fraction (HK = 66%, LK = 61%), cardiac index (HK = 2.74 L/min/m2, LK = 3.0 L/min/m2), stroke work (HK = 36 gm.m/m2, LK = 30 gm.m/m2), oxygen consumption as measured by left heart double product (HK = 9,438; LK = 9,209), and myocardial compliance (HK = 2.8 cc/torr, LK = 4.2 cc/torr at the post-cardioplegic arrest period). The role potassium plays in producing a rapid cardiac arrest is well accepted. Its protective effect on the preservation of high-energy phosphate stores is postulated, but its addition to perfusion hypothermia does not appear to enhance the protective effect observed with perfusion hypothermia alone.
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