D. N. Ross

REPLACEMENT OF AORTIC AND MITRAL VALVES WITH A PULMONARY AUTOGRAFT

Abstract The finding of late degenerative changes in a proportion of aortic homografts prompted the use of the patients own pulmonary valve as a replacement. As a living autograft, the transplanted pulmonary valve has the prospect of long-term or permanent survival, whilst retaining the advantages of an aortic homograft. Similarly it can be used to replace the mitral valve. The excised pulmonary valve is replaced with a homograft.

HEART-VALVE REPLACEMENT WITH AUTOLOGOUS FASCIA LATA

Abstract In a search for a better substitute for diseased heart-valves a technique of using autologous fascia-lata grafts mounted on to a support frame was developed. Since April, 1969, such grafts have been inserted into 70 patients in the mitral, aortic, or tricuspid area, with good immediate results. No systemic emboli have occurred, although anticoagulants have not been used.

SURGICAL CORRECTION OF TRICUSPID ATRESIA

Abstract Correction of tricuspid atresia now becomes a practical possibility following the method advocated first by Fontan. The principle is to convert the right atrium into a closed unidirectional pumping chamber by means of homograft valves and closure of the atrial septal defect. Blood from this chamber is directed through a conduit to the pulmonary arteries. The method is applicable to tricuspid atresia with and without transposition.

Aorta to Right Pulmonary Artery Anastomosis (Waterston's Operation) for Cyanotic Heart Disease

Thirty patients with cyanotic heart disease, including Fallots tetralogy, transposition of the great arteries, and tricuspid atresia had Waterstons anastomosis for gross effort intolerance or cyanotic attacks. The results were good in 28. Spontaneous closure of the anastomosis occurred in one patient. There was a tendency for preferential perfusion of the right lung, and unilateral pulmonary edema occurred in nine patients. Congestive heart failure appeared when the stoma was too large. Surgical technic to avoid kinking of the right pulmonary artery has been modified, and the importance of limiting the size of the anastomosis has been emphasized. Transaortic closure of the anastomosis through the aorta at the time of definitive correction was simple in three patients.