Willis J. Potts

Bronchial Obstruction Due to Pulmonary Artery Anomalies I. Vascular Sling

A left pulmonary artery, coursing anomalously above the right bronchus and behind the trachea en route to the left lung, can produce disabling respiratory symptoms. Three cases observed by the authors are presented in detail and 5 similar cases, previously reported, are reviewed. The clinical features are those of tracheobronchial obstruction, occurring early in life, associated with endoscopic evidence of extrinsic pressure on the right bronchus and posterior wall of the trachea. The importance of the clinical recognition of this anomaly is stressed, since it appears to be amenable to surgical correction.

Lobar emphysema in infants and children

Summary Lobar emphysema secondary to bronchial cartilage abnormalities, intrathoracic vascular abnormalities, and unknown causes is reported in five infants and children. The incidence, diagnosis, etiology, and treatment are considered.

Long-Term Results of Aortic-Pulmonary Anastomosis for Tetralogy of Fallot An Analysis of the First 100 Cases Eleven to Thirteen Years after Operation

The first 100 consecutive patients with a diagnosis of tetralogy of Fallot upon whom an aortic-pulmonary anastomosis could be performed were subjected to a clinical and physiologic evaluation 11 to 13 years after operation. At this long-term follow-up 92 patients were traced. Nine patients died at the time of surgery and, in the period from 1946 to 1959, 10 patients died, most often from congestive heart failure. To our knowledge only three patients have required a second shunt operation to relieve recurrent cyanosis. The clinical results were considered good or excellent in 68 per cent of the survivors, fair in 30 per cent, and poor in 2 per cent. The long-term poor results and mortality were usually associated with too large an initial anastomosis leading to either left ventricular overwork and congestive heart failure or severe pulmonary hypertension and progressive pulmonary vascular obstruction. Right heart catheterization studies indicated that in a group of 18 patients in whom the pulmonary vascular bed could be evaluated, 15 patients had a normal pulmonary vascular resistance after 11 to 13 years of a clinically adequate aortic-pulmonary shunt. The role of the shunt procedures as a valuable salvage operation at the present time for a select segment of patients with tetralogy of Fallot and certain other complex cyanotic lesions is reemphasized.

A new technic for complete correction of transposition of the great vessels. An experimental study with a preliminary clinical report.

A procedure for complete anatomic correction of transposition of the great vessels is described. The technic is based on the concept of isolating an aortic segment containing both coronary ostia and turning the segment over to fit the outflow stump of the left ventricle. Experimental work and two clinical trials are presented and discussed. We believe that this operation provides an anatomic and physiologic correction of the great vessels and coronary arteries in transposition. In spite of two clinical failures, we think this operation is worthy of further trials.

Bronchial Obstruction Due to Pulmonary Artery Anomalies: II. Pulmonary Artery Aneurysm

In a previous publication attention was drawn to the occurrence of pulmonary artery anomalies as conditions causing tracheobronchial obstruction. In the present report 2 infants are presented in whom a large aneurysm of the pulmonary artery pressed upon the walls of the left bronchus, producing severe respiratory symptoms.

Pediatric Cardiac Dysrhythmias

The authors have succeeded in writing a clear and concise text on all aspects of pediatric cardiac dysrhythmias, including electrophysiological studies. In the past ten years, pediatric cardiologists have demonstrated increased interest and understanding of the intricacies of complex dysrhythmias that have long been considered the province (and stepchild) of adult electrocardiographers. In keeping with the increased sophistication in the field of pediatrics, it is of interest to note that this text is written by pediatric cardiologists primarily for pediatric cardiologists. The editors have brought a unified and consistent approach to the subject. Almost all of the contributors were trained in the same institution, Texas Childrens Hospital, Houston, which has largely drawn on its own extensive experience in formulating diagnostic and therapeutic approaches to various dysrhythmias. This provincial approach can have its disadvantages, but in general the book analyzes divergent approaches to diagnosis and therapy and has avoided the repetitive

Management of Respiratory Obstruction in the Newborn Period

Cyanosis and dyspnea are the cardinal signs of respiratory obstruction in the newborn. Obstructions in the respiratory system include lesions in the upper respiratory tract and the pulmonary alveoli, structural deformities in the tracheobronchial tree, extrapulmonary lesions compressing the lung, and aspiration of secretions into the respiratory tract. Treatment is determined by the type of obstruction present.