Between May 1976 and January 1981 a two-stage anatomic correction was performed in 25 patients with simple transposition of the great arteries, ranging in age from 41/2 to 46 1/2 months (mean 14.8). A first-stage operation, consisting of banding of the pulmonary artery to redevelop the left ventricle, including a Blalock-Taussig-anastomosis in 4 patients was performed prior to anatomic correction. Of 33 patients, who underwent first-stage correction there were 3 early deaths (9%). The interval between the first and second stages was 5 weeks to 9 months (mean 4.3 months). After the first-stage operation, the peak systolic left ventricular pressure rose from 34 +/- 11 mmHg to 80 +/- 16 mmHg with no significant change in enddiastolic pressure. After anatomic correction there were 5 early deaths (20%) of whom 4 were due to left heart failure. There was no correlation between death and the age of the patients at the time of anatomic correction. By our current criteria the ventricles were not adequately prepared for correction in these four patients. The coronary arteries, with different types of origin, could be reimplanted to the posterior vessels without kinking, tension or torsion in all cases. After correction, the ECG and vectorcardiogram rapidly changed toward normal. The arterial oxygen saturation was higher than 95% in all patients. Recatheterization performed in 11 patients, 3 weeks to 27 months after correction, showed normal left ventricular pressure at rest in all children, except in 2 recatheterized early after correction, who had moderately elevated left ventricular enddiastolic pressure. Right ventricular peak systolic pressure decreased to normal limits. The aortic and coronary anastomoses showed normal growth in cineangiography. Although the two-stage corrections of simple TGA may have its own problems, investigation suggests that results are encouraging.
Eight cases of carcinoid heart disease associated with primary ovarian carcinoid tumour have been previously reported. A case is described in which rapid relief of all symptoms followed removal of an ovarian carcinoid argentaffin tumour. A diagnostic finding was the provocation offlushing by pressure on the ovarian mass on vaginal examination. Cardiological investigations, performed two and a half months after operation, are presented. A peculiar angiocardiographic feature was the loss of trabeculations of the right ventricle.
An automated videoangiocardiographic system has been developed and used for the study of dynamic internal left ventricular geometry, in 53 patients (12 normals, 20 patients with different degrees of left ventricular [LV] pressure-, and 8 with LV volume overload. 9 patients had different types of cardiomyopathy and 4 atypical or failing LV). From the measurements of ejection phase parameters of contraction, the degree of endsystolic and enddiastolic excentricity of the LV, the ejection fraction, and the circumferential fiber shortening or shortening velocities it has been shown that there are no signs of impaired left ventricular function in mild and moderate left ventricular hypertrophy due to pressure or volume overload.
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