George R Sutherland

Truncus arteriosus with type B interrupted aortic arch: Correction in the neonate

SummaryTwo neonates with truncus arteriosus (TA) and type B interrupted aortic arch are reported. In both, a homograft was used to connect the right ventricle to the pulmonary artery, while the arch continuity was established by direct anastomosis of the aortic arch to the descending aorta.

Open heart surgery in the first 24 hours of life

SummaryThe results of open heart surgery in infants have steadily improved. The performance of corrective surgery very early in life has thereby been encouraged. We report four patients who underwent successful surgical correction within 24 h of birth. Two patients with total anomalous pulmonary venous drainage and one patient with pulmonary atresia and intact septum were corrected with the aid of profound hypothermia by the combined surface and bypass cooling technique. Cardiopulmonary bypass alone was used for the fourth patient with aortic stenosis. The usual surgical techniques can be applied successfully to infants even within 24 h of life.

Analysis of left ventricular function in patients with myocardial infarction

Reduced left ventricular function is a major determinant of prognosis after myocardial infarction, so many acute interventions including thrombolysis are directed at preventing or reversing acute left ventricular damage. Assessment of the outcome of such therapies is necessary both for clinical decision making and for research, and requires accurate and reproducible methods of identifying or localising regions of abnormal function and of quantifying left ventricular function. Traditionally, the standard for such measurements has been biplane left ventricular cineangiography, but this is neither feasible in all patients in the acute phase after myocardial infarction nor applicable for repeated use during recovery and convalescence.

Contrast M-Mode Echocardiography, the Suprasternal Notch Approach

The combination of contrast echocardiography and the suprasternal approach offers a very reliable method for the evaluation of right to left shunts and ventriculoarterial connections in infants and children with complex congenital heart disease to the clinician who does not have real-time two-dimensional echocardiography.

Contrast Echocardiography in the Neonate

One of the major problems of neonatal medicine is the differentiation of complex congenital heart disease from severe lung disease. The neonatologist faces three potential diagnostic groups; 1. the critically ill child with a congenital cardiac lesion who requires early catheterisation and surgical intervention; 2. the child with complex congenital heart disease who does not require emergency cardiac catheterisation or immediate surgical intervention, and 3. the child with severe respiratory or systemic disease and a structurally normal heart in whom medical supportive therapy is indicated. The signs and symptoms of respiratory disease, metabolic derangement, sepsis and other neonatal ailments may mimic exactly those of congenital heart disease and great difficulty can be encountered in reaching a correct diagnosis. If, after clinical examination, chest X-ray, 12 lead electrocardiogram, blood gas estimation in air and high oxygen concentration, the diagnosis is still uncertain, cardiac catheterisation has in the past been mandatory despite its small but important risk. Frequently, these critically ill infants are in Neonatal Units which may be distant geographically from Regional Cardiothoracic Services, and they do not travel well. Thus, a reliable method which can be taken to the infants and which can identify the cardiac cases for transfer is obviously of great value. Echocardiography has a very exciting and valuable application in this situation. It can provide anatomic information enabling the first two groups to be accurately diagnosed and with the help of chamber measurement and contrast echocardiography, it can play a significant role in all three groups in determining the cardio-respiratory pathology.