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PubMed1982

Reconstruction of the pulmonary outflow tract without prosthetic conduit.

New techniques of correction of complex congenital anomalies, avoiding the use of prosthetic conduits, are presented. In transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis, the technique comprised the resection of infundibular septum, the suturing of an intraventricular baffle directing blood from the left ventricle to the aorta, and the reconstruction of the pulmonary outflow tract by direct implantation of the posterior rim of the pulmonary arterial trunk on the right ventricle, completed by an anterior patch. In most cases, the pulmonary bifurcation was translated anterior to the ascending aorta. This technique was feasible even in infants and in patients with a small VSD. Thirteen patients, from 3 months to 8 years of age, were treated by this technique, with four deaths, one residual VSD (reoperated), and eight good results (4 to 16 months). A similar repair was used in three cases of double-outlet right ventricle (DORV) with subpulmonic VSD and pulmonary stenosis or pulmonary artery banding, with two operative deaths and one good result. The same technique of pulmonary outflow tract reconstruction was used in four cases of truncus arteriosus. Two deaths were attributed to severe pulmonary regurgitation, a complication which should be prevented in future cases by a reliable method of inserting a valve in the pulmonary outflow tract. In pulmonary atresia with VSD and absent pulmonary trunk, the continuity between the right ventricle and the pulmonary branches was established via an arterial tube resected from the ascending aorta. This technique was successfully used in one child with extremely small pulmonary branches. These preliminary results led us to conclude that many complex congenital cardiac anomalies can be effectively treated without a prosthetic conduit.

Child, Preschool↗
PubMed1982

[Surgery of truncus arteriosus in the first 2 years of life. Analysis of a consecutive series of 22 patients].

At the Laennec Hospital in Paris, between 1976 and 1980 twenty-two children with Truncus Arteriosus Communis (TAC) underwent primary total repair during the first twenty-four months of life, according to the technique described by McGoon in 1968. All infants operated before the age of three months (group A: 7 patients) were in severe cardiac insufficiency with respiratory distress. Eleven patients (group B) were electively operated between four and nine months of age. Only four patients (group C) underwent surgical treatment after twelve months and before twenty-four months of age. The hospital mortality was very high in group A, because of the severity of the preoperative conditions. In three patients who underwent total repair at eight and eighteen months of age respectively, irreversible pulmonary hypertension (stage IV according to Edwards classification) was the cause of death. In our experience, severe postoperative myocardial ischemia was often associated with complete atrio-ventricular block (BAV): the possible causes are discussed. Furthermore, all patients, to a variable extent, had some manifestations of left ventricular (LV) insufficiency, which was always reversible after medical treatment. For several days, almost systematically, mechanical ventilation is necessary after a total repair of TAC. The result in the nine surviving patients is excellent: they had a strictly normal life, without any therapy. In conclusion, we believe that elective surgery for TAC can be performed more safely between six and nine months of age: if medical treatment cannot control heart failure, surgery must be performed urgently in order to avoid severe ventilatory disturbances. After twelve months of age, total repair is performed only if a pulmonary biopsy confirms the possibility of regression of the pulmonary vascular lesions.

Age Factors↗
PubMed1978

Surgical treatment of complex congenital heart defects: recent developments with valved external conduits.

The use of valved external conduits has majorly expanded the place of corrective operations for children with a variety of congenital cardiac defects. Initially they were employed to correct patients with congenital pulmonary atresia and ventricular septal defect and subsequently placed between the venous ventricle and pulmonary artery for a number of other complex malformations. More recently they have been placed between the right atrium and pulmonary artery and between the systemic (left) ventricle and aorta. Surgical techniques, early and late results of these procedures are discussed.

Aorta, Thoracic↗
PubMed1981

Structural congenital heart disease in the newborn. Its differentiation from nonstructural cardiac or pulmonary disease.

This article discusses structural congenital heart disease in the newborn. Emphasis is given to the clinical and laboratory diagnosis including the indication for cardiac catheterization and angiography. The discussion includes the group of cyanotic, noncyanotic and other structural congenital heart diseases, as well as the group of neonatal cardiopulmonary distress without structural heart disease. An outline of the general management of these entities is included in the presentation.

Angiocardiography↗
PubMed1981

[Radiological patterns of truncus arteriosus on X-ray plain film (author's transl)].

Fifteen cases of truncus arteriosus have been studied on frontal and lateral views of thoracic X-ray plain film in infants and children. In infants (12 radiological records), the left middle segment is concave or straight, mainly at the lower part and this pattern is typical if associated with an active pulmonary hypervasculature. Cases without marked pulmonary hypervasculature are very difficult to diagnose. On 7 lateral X-ray films we noted three patterns of empty retrosternal space which were visible at birth. In children from 2 to 6 years, a pattern of cardiomegaly with right aortic arch and pulmonary hypervasculature is very typical. In children older than 6 years, we noted a typical Eisenmenger syndrome. The pattern of empty retrosternal space was marked. In our experience, association of right aortic arch with pulmonary hypervasculature is very typical.

Adolescent↗