SUMMARY . 1 . A technique has been presented for transcatheter closure of a patent ductus arteriosus . 2 . A 3 .5-kg infant has been treated successfully in this manner . 3 . The method should be considered in high-risk patients . 4 . Further miniaturization of the system should make it suitable for use in premature infants critically ill as a result of ductal patency . 5 . Increased experience will likely indicate that the technique is applicable to most patients who require ductus closure .
KEY WORDS : Patent ductus arteriosus -Transcatheter closure deviceIn 1907, Munro proposed an operation for closing a ductus arteriosus and described the procedure in detail [3] . It was nearly 30 years before a bona fide attempt was made at surgical closure . Graybiel et at [1] intended to ligate the ductus in a 22-year-old girl with infectious endocarditis, but were able only to apply plicating sutures and did not achieve a lasting success . In 1938, the modern era of surgery for congenital heart disease was inaugurated when Gross et al [3] performed the first successful ductus ligation, Within a few years, many surgeons were duplicating this feat . ; and ductus surgery became commonplace, safe, and effective . Porstmann et al [4] first proved the clinical applicability of trans-
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been recognized to occur following treatment with vincristine. None of the reports have provided information regarding its potential for recurrence on further challenge with vincristine (VCR), an agent generally required for repeated use in patients with malignancies. Symptomatic hyponatremia and SIADH that occurred 8 days following administration of VCR in a child with acute lymphatic leukemia was documented with specific radioimmunoassay of urinary ADH levels. The further occurrence of recurrent elevations in ADH excretion 8–10 days following repeated treatment with VCR was also observed. However, SIADH was prevented by prophylactic rigorous fluid restriction. The occurrence of SIADH following VCR therefore does not preclude the further safe usage of this drug.
Long-term clinical and laboratory findings in three children who required mitral valve replacement below age four years are reported. In each instance a second valve replacement was necessary approximately 8 1/2 years after the initial one, following a two and one-half fold increase in body weight. Inadequate mitral valve orifice size was found in each instance, producing a hemodynamic picture equivalent to mitral stenosis: congestive heart failure, pulmonary hypertension and atrial fibrillation. A second valve was placed without mortality in each instance and relieved the mitral valve obstruction. Pulmonary vascular resistance increased postoperatively in two patients and failed to decrease in the third. Pulmonary arterial hypertension and left ventricular hypertrophy persisted as long as 13 to 37 months after the second valve placement in all patients. The consequences of increasing body size and the long-term interposition of a rigid prosthesis in a growing heart introduce additional complications to mitral valve replacement in childhood. Frequent hemodynamic observations and the use of a prosthesis other than the ball-cage variety is recommended for improved management.
The first successful stage I palliation for hypoplastic left heart syndrome (HLHS) in a four-day-old female in the Philippines is reported, along with a discussion of the particular dynamics and challenges of performing this kind of surgery in a developing nation. Challenges met were not limited to the preoperative and perioperative period but involved the interstage period as well. In the face of such challenges, our experience, reported here, is the cause for cautious optimism.
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