A limited experience with an initial series of nine patients operated upon for tricuspid atresia using a modified superior vena cava to right pulmonary artery anastomosis is presented. The modified technique is described and illustrated. It avoids permanent disruption of pulmonary artery continuity and the high incidence of superior vena cava syndrome. In short, the right pulmonary artery is not severed, the azygos vein is always ligated, the superior vena cava is not mass ligated and is subjected to delayed interruption.Analysis of the results shows an operative and overall mortality of 33 %. The advantages of this modified surgical approach are outlined.
The peripheral blood vessels of infants and children are difficult to cannulate and to repair. The lumen will accommodate only small bore catheters and these are harder to manoeuvre, and impair the quality of angiograms. Lengthening of the procedure and an increase in the amount of contrast medium which is needed both contribute to the morbidity. To our knowledge, cannulation of the internaljugular vein and/or carotid artery for purpose of heart catheterization in humans has never been reported. The technique of this approach is described in detail and illustrated. A brief outline of the advantages and disadvantages of the procedure is given. The fact that the technique requires an operator experienced in handling major vessels is stressed. In all, 705 approaches to the great vessels of the neck have now been performed, and both the potential complications and those encountered are listed. With strict adherence to andfamiliarity with the technique the procedure is safe and offers, we believe, decided advantages.Cannulation of arteries and veins for cardiac catheterization in the adult is usually easy. In the newborn and infants, however, it may be very difficult and time consuming. In the first two months of life mortality rates are very high, of the order of 6 per cent (Burchell and Ongley, I968). The duration of the procedure is directly related to the mortality and morbidity in this category of patient (Banyai and Gordon, i966), and the investigation should, in general, seek only those data essential to an accurate diagnosis. Because of the patient's size, difficulties are posed by the length-gauge ratio of the catheter and the amount of dye in relation to body weight to be delivered in unit of time (Banyai and Gordon, I966).The technique we describe was developed between I965 and I966 by one of us (G.A.) and it has proved to be useful in the newborn, in infants, and in children up to the age of 3 to 4 years. We have often used it in children between 4 and 7 years of age, and occasionally in young adults. The approach is strongly indicated when previous catheterizations or other procedures have been carried out at or in the vicinity of the usual areas of venous or arterial cannulation. This is often the case in our patient population.To our knowledge open cannulation of the internal jugular vein and/or the common carotid artery
Sum maryA modification of Senn ing 's procedure for correctio n of transpos ition of the great arteries is described which has been ap p li ed in 3 children up to now.Th e incis ion of th e atrial septum is made in a ver tical f ashio n and the atrial gap is closed by use of a portion of the invaginated left auricle . Th us, implan ta tio n of prosth et ic o r non-viabl e bio logica l material is avoided .Key -Word s: Tr ansp osit ion of great arte ries -Senni ng' s procedu re -Surgical modi f ication Definitive surgical corre ctio n of t ranspo sition of th e great arterie s may aim at anato mic recons t ruction of a malform ed hea rt (a rterial switch) or phy siological (no n-anato mical) correction which will transform an essentially "i n parallel" circulation to an "i n series" or sequential circulation.
Ta ble I Hemody nam ic data from cardiac cathet.,iza tion on admission rib at the m ida. \illary line wilhoul dislocat io n. A h "<: lure of the middle lhird of lhc left femur withou t d isloca liun was also pre sen t. T he patie nt was co nscio us a nd alerl. ECG sho wed sinus tach ycard ia o f I SO/ min, e1ee llical axh in equilihriu m. biatrial and ri#1 1ventric ular ovcrtoad, R ighI and k fl ca rdiac cathcterizatlcn and seleclive le ft vent ricul ar ungioca rdiography were perfo rmed (Table I). Marke d mitral regurgita tio n. an apical VS D, dyskinesia and uncu rysm atic enlargemen t of thc apcx of Ihe left ventricle were demons tr ated !Fig. 21. 11e was imm,'d ia te ly o perated upon. On o pening th e chest , through a med ian slern o to my, abse nce o f left pericardium was foun d. Ascen d ing aor ta and caval veins were ca nnulated and ex tr aco rpc rca l cir culation (EeG) was start, 'd with mild core hypcte tmia (J2°C) and card iop legia. The apex o f lhe hearl appeared yellow ta n in ecto r. ..d ...mal ou s and shoW\' d mulli ple ecc hy moses. =lI anc...-: k Libo fat or ics tn c.. 46 33 E La Pa lma Ave : Ana h...im, Ca. 9 211 0 7, USA 1Sauvag<' F ilam" nltlU ' Da"o' ron Fa hr ic, usn, Diviso n of C R. Ba rd In" .. Ma.... USA Th ere was a "c oo ked mea l" ap peara l1~e of the vi'i hle myoc urdial tissue in and a rou nd this a rea. El:l:hy nm .....s were pre sent along but h , ides o f the po sterio r de scending co ro nary artery. The left venlriele was ind scd in lhe nccrouc a rea ami lhe len venlr icular cavily was ln-pcc ted. The pa pillary mu wle vappcascd necru tk-. Th ere: wa' a ccmmunicaucn betw een the ventricles atthe ap< •x. 2 em in sit e. wilhi n th e trabec ula r po rtio n uf Ihe in lerv ent riculol r sep tu m. The: kft "'Iriu m was upc ocd a nd th... mitral vain ' "' '''' repl;ICed with 1I I1aoctx. •k pro 'jhe' i" , ize 2S 1 , The VSD Was d o....d with a Dacr on pat ch and in tctru p tcd pledgeI ' ulu n:s pla.. red in nor mal-appe aring myoc a rd ial tis\De. The ventrj c uloto m y "' as dose d in muscle appcar ing viable with in k lf u p k d-utch.... be twe en 2 Tenon lap" ,,"wel ing onl y a mini mu m o f fran kly necronc tissue. Aft er d ecla mping regula r sinus rhYlhm appe ar...d spo n ta rlo,:Ously.
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