John Reid

Long-term results of surgical treatment for pulmonary valve stenosis.

109 children who survived surgical treatment for isolated pulmonary valve stenosis were followed for up to 17 years. In all the postoperative status was assessed as satisfactory. Cardiac catheterization repeated in 43 gave a resting valve gradient below 40 mmHg. The 22 children whose pulmonary valves had been excised were as healthy as the 87 who had undergone pulmonary valvotomy. Consideration was given to the desirable length of postoperative review. Except for the few children with symptoms before operation, a postoperative increase in exercise tolerance was not a feature.

Coronary artery fistula: report of three cases.

Three children are described with a right coronary artery fistula communicating with a right heart chamber. Each had a continuous murmur like that of a patent ductus arteriosus but situated at a lower level. Aortography established the diagnosis and excluded any accompanying malformation. It is concluded that to prevent complications surgical treatment should be recommended.

Blalock-Taussig anastomosis in 126 patients with Fallot's tetralogy

The long-term results of Blalock anastomosis in 126 patients (1954-71) for Fallots tetralogy are presented. The operative mortality was 10% and the overall mortality 38%. The 78 survivors were reviewed after periods of surveillance ranging from six months to 17 years. Complications were few. It is concluded that although total correction as a primary procedure has become the treatment of choice in most, it may in some instances never be technically feasible because of extreme underdevelopment of the right ventricular outflow tract. In the very young with urgent symptoms and rapid deterioration total correction would be considered hazardous. In the infant a high operative mortality reflected the inadequate calibre of the vessels used in the shunt operation.

Pulmonary hypertension accompanying ventricular septal defect and patent ductus arteriosus. Management in infancy and early childhood.

Forty-one infants and children with the combination of patent ductus arteriosus (PDA) and ventricular septal defect (VSD) were encountered over 20 years. Twenty-four presented in infancy with congestive cardiac failure. Pulmonary hypertension was present in 32, the cause in 19 being increased pulmonary blood flow. Increased pulmonary vascular resistance (PVR) was detected in 13 (indicated by a pulmonary to systemic resistance ratio (Rp : RS) greater than 0.24:1 and PVR greater than 4 units). Thus 22% had a pulmonary artery systolic pressure less than 30 mmHg and 68% had a pulmonary vascular resistance below four units, indicating an unusually mild form of the combined condition in these patients. Surgical management is discussed, and in particular the question of simultaneous closure of the defects during infancy. Cardiac failure, resistant to drug treatment, and increased PVR are indications of operation. The PDA should be closed and only if there is no substantial fall in pulmonary artery pressure is the VSD repaired.

Management of Congenital Aortic Stenosis

72 patients with congenital aortic stenosis whose ages ranged from 1 month to 15 years were under supervision for periods ranging from several months to more than 9 years. The obstruction was subvalvar in 3. Additional malformations were aortic regurgitation, persistent ductus arteriosus, coarctation of the aorta, ventricular septal defect, partial anomalous pulmonary venous drainage, and mitral stenosis. Bacterial endocarditis complicated 3. Of 5 deaths unrelated to operation, 3 were sudden. Surgical treatment was carried out in 12 patients (commissurotomy, valve replacement with or without previous commissurotomy, subvalvar resection) with 2 deaths. 52 patients remained symptom-free. Detailed investigation to assess the patient for surgical treatment is indicated if symptoms are present or electrocardiographic evidence of severe left ventricular hypertrophy appears. Commissurotomy is, where possible, deferred until an age at which valve replacement can be undertaken if the stenosis cannot be adequately relieved without causing substantial regurgitation.