Glen G. Cayler

Surgical Palliation of Hypoplastic Left Side of the Heart

Abstract Hypoplasia of the left side of the heart is the most common cause of death from heart disease in the first weeks of life and has heretofore been considered surgically unapproachable. Cardiac catheterization of a full-term infant in congestive heart failure at eight days of age revealed a hypoplastic left atrium, left ventricle and ascending aortic arch, without coarctation. Adequate mixing of oxygenated blood was provided through a large atrial septal defect while ventricular output was afforded via a right-to-left shunt through a still patent ductus arteriosus. Partial bypass of the left side of the heart was performed by anastomosis of the ascending aorta to the right pulmonary artery followed by banding of both pulmonary arteries distally. Signs of cardiac failure promptly abated, and the infants status remained satisfactory six weeks after operation. Infants with clinical signs of this syndrome deserve detailed study to determine their suitability for similar palliative surgery.

Preoperative Diagnosis and Surgical Correction of Supravalvular Mitral Stenosis and Ventricular Septal Defect

A child with supravalvular mitral stenosis plus ventricular septal defect is reported in whom the correct diagnosis was suspected clinically, confirmed by cardiac catheterization, and successfully treated surgically. Only eight previous cases of supravalvular mitral stenosis have been reported; five of the eight have had associated ventricular septal defects. None was correctly diagnosed before autopsy or surgery. Our patient had a murmur and thrill characteristic of a ventricular septal defect. The pertinent clinical findings suggesting concomitant mitral stenosis consisted of a mitral mid-diastolic murmur that was unusually loud for the magnitude of the left-to-right shunt; a presystolic component to the diastolic murmur; marked left atrial enlargement by x-ray with only moderate pulmonary plethora; and electrocardiographic evidence of left atrial hypertrophy and marked pure right ventricular hypertrophy. Right heart catheterization showed labile passive pulmonary hypertension. Left atrial puncture revealed high proximal and low distal pressure. Surgical correction of both lesions by total cardiac bypass was accomplished through a midline sternal-splitting incision. The supravalvular mitral membrane was excised from the right atrium through an incision in the atrial septum.

Incomplete transposition of the great vessels (Taussig-Bing complex)

Abstract The physiologic studies of 6 cases of the Taussig-Bing type of incomplete transposition of the great vessels are presented. The diagnosis was confirmed at autopsy in 3 cases. The anterior position of the pulmonary artery was noted at surgery in 2 of the other 3 patients. Although most of the previously reported cases were in older children or adults, all of our patients were under 4 years of age and 5 of the 6 were infants. Cyanosis, although present in all the infants, was only of mild degree in contrast to the marked to moderate cyanosis in older children and adults previously reported. The striking clinical feature of the small infants was pulmonary congestion resulting from markedly increased pulmonary blood flow. They masqueraded clinically as patients in congestive heart failure due to acyanotic congenital heart disease with large left-to-right shunts. Angiographic studies arc usually necessary to locate the great vessels accurately and to make an exact diagnosis. Young patients with the Taussig-Bing complex, in contrast to most older patients with this syndrome, show large pulmonary blood flows, low pulmonary vascular resistances and a clinical picture of severe left-sided congestive heart failure. For these reasons, decreasing the pulmonary pressure and flow by pulmonary artery banding seemed a reasonable palliative surgical approach for treatment and was attempted in 3 infant patients. One patient died at surgery. The other 2 survived and have exhibited clinical improvement, and are now 12 and 15 months postoperative.

Ventricular fibrillation during cardiac catheterization: Successfully treated with external defibrillation and closed chest cardiac massage

Abstract A case of ventricular fibrillation in an infant with severe congenital heart disease which occurred during cardiac catheterization and was successfully treated with closed chest cardiac massage and external defibrillation is presented. A satisfactory systemic arterial pressure was maintained by closed chest cardiac massage both before external defibrillation and immediately after defibrillation until effective ventricular contractions occurred at an adequate rate.

New type of catheter tip for retrograde catheterization of the left ventricle in congenital aortic stenosis.

ACCURATE assessment of congenital aortic stenosis before and after operation requires simultaneous measurement of the systolic-pressure gradient between the left ventricle and aorta and the output ...