Surgical treatment for adult congenital heart disease.

A total of 1,408 adult congenital heart disease patients (age over 13 years) underwent surgery between 1979 and 1995 at Siriraj Hospital, contributing 33.75 percent to the overall number of congenital heart disease cases (4,172) who underwent surgery in that period. This finding is similar to statistics in the West. The ages ranged from 13.3 years to 72 years, with a mean of 24.06 years. The oldest patient was a 72 year-old man with coronary cardiac chamber fistula. The most common diagnoses in descending order were: atrial septal defect (41.05 per cent), patent ductus arteriosus (16.19 per cent), tetralogy of Fallot (14.06 per cent) and ventricular septal defect (10.87 per cent). These four categories covered 82 percent of the cases. The overall surgical mortality was 1.78 per cent, compared with 3 per cent in patients who had undergone surgery during childhood. Only patients with double outlet of the right ventricle and congenital aortic stenosis, or left ventricular outflow tract obstruction, showed increased risk of death (20 per cent), compared with 5.77 per cent in those cases who had undergone surgery during childhood. The conclusions drawn from the study are that surgical treatment for adult congenital heart diseases showed a low average of surgical mortality of less than 2 per cent in almost every category except double outlet of the fight ventricle and congenital aortic stenosis, for which early surgery is recommend.

The management of single brain death donor for the successful five organs transplantation.

The demand of organs for transplantation in Thailand has been increasing enormously since the successful transplantation became well established. However there is the limited number of available cadaveric donors. One of the solutions for this problem is the maximal use of the organs from a single donor. The proper assessment and care of donor, good surgical techniques and well-organized coordination system could make significant contributions to successful multiorgan retrievals. We report the management of the first single cadaveric donor to bring five organs i.e., heart, lung, liver and both kidneys for the successful transplantations.

Cardiac surgery at Siriraj Hospital, B.E. 2522-2532.

An eleven year retrospective analysis of patients being treated for heart disease at Siriraj Hospital, during 1979-1989, was carried out in order to find out the epidemiological characteristics of disease and the results of surgical treatment. There were 4289 patients encountered during the period of study. Of these patients, 2565 (60 percent) had congenital heart disease while the rest had the acquired ones. 40 percent of these patients were 13 years and below. Among patients with congenital heart disease, PDA, ASD, Tetralogy of Fallot, and VSD were encounted in 25, 22, 20 and 15 percent respectively. Valvular heart disease, coronary artery disease and pericardial disease were encountered in 56, 15 and 12 percent respectively. The opened heart surgery was carried out in 2753 patients (64 percent) while only 1536 patients (36 percent) had the closed one. The overall mortality following surgery was 3.1 percent. The mortalities among patients with the congenital and the acquired heart disease were 2.03 and 5.22 percent and for those underwent opened and closed surgery were 3.92 and 2.21 percent respectively.

Open lung biopsy in patients with pulmonary infiltrations.

A retrospective study is composed of 23 patients with pulmonary infiltrations whose hospital records were available who underwent open lung biopsy at Siriraj Hospital from January, 1982, to December, 1986. The patients were separated into two broad groups. The first, there were those patients who were in clinically stable condition. The second group identified patients who were systemically ill and whose course was rapidly deteriorating. Time delayed in diagnosis was critical in these patients whose urgent and correct treatment was necessary. Open lung biopsy revealed correct diagnosis in all patients. The prospective diagnosis was changed in 60.87 percent of all patients and the biopsy results altered therapy in 56.52 percent. Hence open lung biopsy appears to be a valuable procedure with low morbidity and mortality in patients who have otherwise undiagnosable pulmonary infiltrations.