Robert E. Stanton

Percutaneous Heart Catheterization in Infants and Children: II. Prospective Study of Results and Complications in 127 Consecutive Cases

In this prospective study of 150 consecutive heart catheterizations, the percutaneous method of right and left heart catheterization was used in 127 patients. In infants and children weighing more than 10 pounds, the percutaneous method was found to be an effective technic associated with a 3% incidence of diminished arterial pulses in the catheterized limb. All patients in this weight group, except one, had left heart catheterization by this technic. The method was deemed time-saving compared to a cutdown, and complications related to the use of end-hole catheters and guide wires were minimal.With regard to venous catheterization, a previous femoral vein cutdown contra-indicated application of the percutaneous method to the same vein, while a previous saphenous vein cutdown did not interfere. A vessel catheterized percutaneously may be recatheterized without difficulty.Thrombi in the arterial catheter and small size of the patient were two factors which had significant correlation with the delay in return of distal pulses to normal. Palpation of distal pulses before and at intervals following the catheterization was found to be the most satisfactory way of detecting arterial complications.

Escherichia coli Endocarditis after Repair of Ventricular Septal Defects

Abstract Therapy of two children with ventricular septal defects who were successfully treated for postcardiotomy Escherichia coli endocarditis included ampicillin, kanamycin and reoperation, with removal of the patch in one child and removal of infected sutures in the other. An additional complication was an aneurysm of the right ventricle that was secondary to the infection and that required resection. This child had two additional ventriculotomies in addition to the original corrective surgery during the six and a half months in the hospital. This child also had a Candida albicans bloodstream infection that was successfully eradicated with amphotericin B. A review of the pertinent literature indicates that although the incidence of postcardiotomy endocarditis is relatively low at 0.1 to 2.7 per cent, the mortality varies from 40 to 100 per cent. A combined approach to therapy with appropriate antibiotics in resistant postcardiotomy endocarditis, followed by reoperation, with removal of foreign material...

The Surgical Repair of Endocardial Cushion Defects

he incidence of endocardial cushion defects in a surgical series is not high. In our series of more than 1,300 open-heart operations T for congenital cardiac defects, this anomaly has been encountered 39 times. The surgical repair of these defects is attended by a significant mortality rate-26% of 256 cases as reported by the Committee on Cardiovascular Surgery of the American College of Chest Physicians [Z]. The problems of persisting mitral valvular incompetence [ 1, 10, 171 and surgical heart block [Z, 6-81 continue to be a challenge to the cardiac surgeon, as does the quest for completely satisfactory operative techniques to repair the more severe forms of endocardial cushion defects. This report analyzes our experience with the 39 cases of endocardial cushion ,defects that we have operated upon.

Surgical Correction of Tetralogy of Fallot with Previous Systemic to Pulmonary Artery Shunts

Fifty-four patients with previous Blalock (32) and Potts (22) systemic artery-pulmonary artery shunts and subsequent total correction for tetralogy of Fallot are reported. A separate posterolateral approach was employed to obliterate the Potts shunt. There were seven operative deaths and two late deaths. Infundibular stenosis with a normal pulmonary valve gave the best results. In comparison with our concomitant series without a shunt, the presence of a Blalock or Potts anastomosis did not affect the over-all result. Postoperative bleeding was a major complication, requiring reoperation in seven. An excellent result with probable cure was obtained in 30, and there was good improvement in ten of the 54 patients.