Gotsman Ms

Mitral valve replacement in childhood. A report of 51 patients.

Abstract The mitral valve was replaced in 51 children under the age of 16 years. A Starr-Edwards ball valve was used in 32, a mounted inverted homograft in 16, and other lateral flow orifice valves in 3. Four had congenital mitral valve incompetence, one had a cardiomyopathy while the other had chronic rheumatic heart disease; there was pure mitral incompetence in 34, mixed mitral valve disease in 8, and dominant stenosis in 4. They were Grade 3 or 4 disable before operation. The severity of their disease was noteworthy. Six patients died in relation to the operation and there was one late death. The improvement in clinical status was dramatic. Only 5 have mild residual disability, a consequence of the progression of the rheumatic process, further deterioration of aortic-valve function, or unexplained left ventricular myopathy. Half the patients with a Starr-Edwards replacement were treated with anticoagulants for 3 months only. One embolic episode occurred. Mitral valve replacement is indicated in patients with severe symptoms from mitral valve disease and age should not be a contraindication to operation.

Mitral valvotomy in childhood.

Gotsman, M. S., van der Horst, R. L., le Roux, B. T., and Williams, M. A. (1973). Thorax, 453-457. Mitral valvotomy in childhood. During the seven-year period 1965 to 1972 mitral valvotomy for mitral stenosis was undertaken in 72 children aged 15 years or less. Excellent results were achieved from closed transventricular instrumental valvotomy unless the valve was calcified, there was a jet of mitral incompetence or a second valvotomy was being undertaken. Severe pulmonary arterial hypertension was present before operation and regressed after a successful valvotomy. There was a low incidence of overt antecedent rheumatic fever.

Abnormalities of atrial depolarization in infradiaphragmatic interruption of inferior vena cava.

The P wave of the electrocardiogram was analysed in 8 patients who had infradiaphragmatic interruption of the inferior vena cava with azygous continuation. If regard was taken of atrial situs, one patient had normal sinus rhythm, one had a P wave vector which was a mirror image of normal, four had coronary sinus rhythm, and two had left atrial rhythm. There was no simple relation between the P wave vector and abnormalities of the interatrial septum, systemic, or pul-

Pericardiectomy in pregnancy

Details are presented which relate to a patient in whom constrictive pericarditis developed during pregnancy. Successful pericardiectomy was performed at 24 weeks gestation and a normal infant was delivered at term. The results of medical and surgical treatment of cardiac patients during pregnancy, the results of pericardiectomy, and the risk to the foetus are discussed.

Giant left atrium

Radiographic evidence of asymmetrical enlargement of the left atrium without atrial infarction is presented. Giant atrial enlargement is rarely symmetrical, the atrial appendage can contribute to the enlargement, and the giant atrium can be effectively trimmed. This will reduce its size and, therefore, the space which it occupies, and will restore the anatomical relations of neighbouring structures such as the main bronchi.

The cineangiocardiogram in constrictive pericarditis

Selective cineangiocardiographic patterns were studied in 60 patients with constrictive pericarditis. The venae cavae were dilated, the right atrium had a vertical, straight immobile right border, the atrio-ventricular ring was hypermobile and the apex of the right ventricle was obliterated. The pulmonary artery was normal but the pulmonary veins were distended, particularly those draining from the upper lobes. The left atrium was normal in size, but the left ventricle was small and constricted, with a visible ventricular filling halt and a normal ejection fraction. The procedure of cine-angiocardiography was simple, uncomplicated and diagnostic.

Haemolysis related to mitral valve replacement with the Beall valve prosthesis

Henderson, B. J., Mitha, A. S., le Roux, B. T., and Gotsman, M. S. (1973).Thorax, 28, 488-491. Haemolysis related to mitral valve replacement with the Beall valve prothesis. Experience of valve replacement with the Beall compressed Teflon disc valve in 59 patients confirms that the incidence of clinically significant late red cell destruction is high. An apparently previously unrecorded high incidence of early haemolysis, so severe in one patient as to be directly the cause of death, is reported. In 29 patients there was massive haemolysis in early convalescence, not recognized in urine from some hours after the end of bypass and never encountered with other designs of prosthetic valve or homograft valve.

The left atrial lift

Abstract In severe mitral incompetence, a left parasternal lift is palpable. It has a high amplitude and a late peak at the time of aortic valve closure and a collapsing descent to the third heart sound. It is produced by rapid atrial expansion causing forward displacement of the heart. It disappears immediately after mitral valve replacement.

Aneurysms of the thoracic aorta

Selected radiographs from 40 patients with thoracic aortic aneurysm serve to illustrate most of the radiographic features of this disease. Surgical techniques are outlined and were used to modify the natural course of the disease in 14 patients, with three postoperative deaths. The remaining 26 patients were either moribund on admission and died shortly afterwards or declined operations and died later.

Drainage of left hepatic vein into coronary sinus associated with other systemic venous anomalies.

This report describes a case with double hepatic venous drainage into the right atrium. The right hepatic veins, the inferior cava, and the pulmonary veins drained normally. The left hepatic veins drained into the coronary sinus and via the coronary ostium into the right atrium. A persistent left superior vena cava, draining the left upper half of the body into the coronary sinus and right atrium, was also present, and the right superior vena cava drained the right upper half of the body. Associated defects were a sinus venosus atrial septal defect and valvular pulmonary stenosis.