EXCISION OF THE SEPTAL LEAFLET OF THE ATRIOVENTRICULAR TRICUSPID VALVE: AN EXPERIMENTAL STUDY.
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Biomedical subjects
Publications and source records attributed to W T MUSTARD.
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In 28 infants and children with complete transposition of the great vessels, atrial septal defects were created utilizing an open technique with inflow caval occlusion and moderate hypothermia. Of the 12 infants for whom operation was necessary during the first two weeks of life only two survived, suggesting that this technique is not adequate for infants at this age. Only four of the 16 children operated on between the ages of two weeks and three years failed to survive. Two of these died because of pre-existing non-cardiac conditions. Seven children with associated systemic-to-pulmonary shunts survived; the open technique may be preferable in this particular group. Despite the initial improvement afforded by this procedure, three sudden late deaths occurred. For this reason, and because of the danger of early development of pulmonary vascular disease, total operative correction of the malformation should be performed early.
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Forty-seven infants and children, aged from one month to 15 years, were operated upon during the past six years at the Hospital for Sick Children, Toronto, using extracorporeal circulation. Retrograde cardiac catheterization of the left ventricle with a pull-through tracing across the valve is important in selection of candidates for operation. Patients with a pressure gradient of over 45 mm. Hg require operation. In this series, valvular stenosis was the condition most commonly encountered; subvalvular membranous stenosis was present in eight patients, and muscular subvalvular stenosis in four. There was one operative death in an infant with multiple anomalies, and one late death from subacute bacterial endocarditis two years after operation. It is suggested that early operative treatment in cases of aortic stenosis in infancy and childhood might lessen the incidence of calcific aortic stenosis in adult life.
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Over an 11-year period, 22 children have been operated upon at the Hospital for Sick Children, Toronto, for vascular compression of the trachea and esophagus. Thirteen had a double aortic arch; three, a right aortic arch and left ligamentum arteriosum; three, an anomalous innominate artery; and one, an aberrant right subclavian artery. An unusual case of right aortic arch, aberrant left subclavian artery and left ligamentum arteriosum is reported for the first time. One child with an anomalous left pulmonary artery producing emphysema of the right lung is also described. One death occurred during the process of intubation, and three patients died postoperatively despite tracheotomy. These children were in serious condition, and the importance of rigid preoperative and postoperative care, avoiding tracheotomy if possible, is emphasized.
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