Interim Results of Single Stage Operation for Coarctation of Aorta with Large Ventricular Septal Defect in Infancy

PURPOSE: There are controversies in the operative methods of aorta with ventricular septal defect in infancy. Recent results of single stage operation for coarctation of aorta with intracardiac defects were regarded as comparable to staged operation. We evaluated our interim results after single stage operation for coarctation of aorta with large ventricular septal defect in infancy. METHODS: Twenty six infants who had received single stage operation for coarctation of aorta with large ventricular septal defect between January 1989 and December 1994 were analyzed retrospectively. Evaluated variables were : age and weight at operation, type of ventricular septal defect, absence or presence of left ventricular outflow tract obstruction, aortic cross clamping time, total circulatory arrest time, methods of coarctoplasty, operative mortality rate, complications and cardiovascular abnormalities on follow up. RESULTS: Age and weight at operation were 2.8+/-2.6 months and 4.0+/-1.2kg respectively. Perimembranous ventricular spetal defect was most common (15 cases; 57.7%). Twelve cases (46.2%) had left ventricular outflow tract obstruction. Aortic cross clamping time was 65.6+/-12.1 minutes and total circulatory arrest time was 51.7+/-14.6 minutes. Coarctation of aorta was corrected with extended resection and end-to-end anastomosis in 23 cases and patch aortoplasty in 3 cases. Among 12 cases of left ventricular outflow tract obstruction, 8 cases received correction and only 1 case of other 4 cases showed significant obstruction on follow up. Early mortality rate was 19.2% (5 cases) and all others survived for the follow up period of 33.5+/-16.6 months. Early complication rate was as high as 71.4% (15 cases), even though all except 3 cases of hypoxic encephalopathy resolved. Statistically significant operative risks were age and weight at operation, especially in cases under 2 month of age and 4.0kg. Aortic cross clamping time and total circulatory arrest time was somewhat longer in expired group, although it was statistically not significant. CONCLUSIONS: Operative mortality rate of single stage operation for coarctation of aorta with large ventricular septal defect in infancy during the study period was not low. In this study, the age and weight at operation was significant factors associated with mortality. However, the results of single stage operation could be improved in case of proper selection of candidates and after some learing period.

Primary intimal fibroplasia of the renal artery

Two cases of primary intimal fibroplasia of the renal artery with renovascular hypertension are described. Case 1 was 27 year old female who was incidentally found to have blood pressure of 210/130 mmHg on routine physical examination. Renal arteriogram revealed tubular narrowing of the mid protion of the left renal artery. Both patients showed lateralization in renin activity at the involved side renal vein. Case 2 was a 10 year old girl who was first noted to have a hypertension of 180/120mmHg after a sudden attack of seizure, vomiting and altered consciousness. Renal arteriogram showed concentric narrowing of the proximal half of the right renal artery. Histopathologic examination of the affected arterial segments from both cases showed essentially same findings, i,e., diffuse fibrous thickening of the intima occluding the lumen, focal fragmentation, duplication and disappearance of the internal elastic membranes. There were no deposit of lipid and inflammatory cells. The media and adventitia remained intact. The blood pressure of both patients became normal, after the surgery and the patients are in good health up to this time.

Aneurysm of the Main Pulmonary Artery-Report of a case and review of the literature

Pulmonary artery aneurysms are extremely rate and are seldom diagnosed during life. In true aneurysms, dilatation tends to be confined to the main trunk of the artery and degenerative changes in the wall are found. In 1971, Williams et al reported the first successful excision and replacement of the main pulmonary artery, including the bifurcation, with a dacron graft. Since then there have been few cases of main pulmonary artery aneurysm treated surgically. However, aneurysm of the main pulmonary artery treated surgically was not reported in our country till now. Recently we have experienced a case of the mainpulmonary artery aneurysm in a 10 years old boy and it was confirmed by echocardiogram, ultrasonogram of the chest, computed tomogram of the chest, radioisotope heart scan, cardiac catheterization and cine-angiogram of main pulmonary artery, aorta & right ventricle etc and patent ductus arteriosus was noted at the indifferent site from aneurysmal sac. Thereafter he underwent surgical correction at our hospital with the aid of total cardiopulmonary by-pass.