Cardiac surgery-challenges and surprises in a country at war

The challenges and results of cardio-vascular surgery at the American University of Beirut Medical Center [AUBMC] during the civil strife in Lebanon are presented. Dependence on local resources is emphasized. Temporary interruption of open-heart surgery in a university setting may be the product of absence of essential materials and/or personnel. Ingenuity and team approach have contributed to the success and survival of the open-heart program. The operative results and mortality rate were indirectly related to the intensity of fighting in the vicinity of a Medical Center that served as a field hospital

Delayed primary colorectostomy after endorectal abdominoperineal pull through for Hirschsprung's disease

A personal experience with 40 consecutive patients undergoing 41 delayed primary colo-rectostomy [DPCR] after endorectal abdomino-perineal pull-through [ERAPP] for the treatment of Hirschsprung's disease [H.D.] between 1978 and 1983 is presented. Three patients underwent a rectal myectomy before the [ERAPP]. Twenty-three of 38 patients [58%] had the decompressive preliminary colostomy performed in the first month of life. The ERAPP was done under cover of colostomy in two of 38 patients, the remainder having had their colostomy resected at the time of pull-through. Three patients were recolostomized in the immediate post-DPCR period to permit adequate healing of the pulled-through segment. The DPCR was practised 5 to 7 days after the ERAPP in all patients. One patient had evidence of postoperative hypoganglionosis of the pulled-through colon requiring a redo of the ERAPP. Two patients developed postoperative enterocolitis which led to the death of one infant six weeks postoperatively. The functional results indicate complete fecal continence for 30 patients, i.e. a rate of 76%, within two years after operation. This rate Increased to 90% during the subsequent two years. The variability in the age at which complete fecal continence was acquired is noted

Tetralogy of fallot

The management and results of 72 consecutive patients with TOP during a 4-year period at the AUBMC are presented. Thirteen patients had a systemic to pulmonary artery shunt performed prior to total repair. Fourteen other patients required shunts during the same period, of whom 5 were done on an emergency basis after a cardiac catheterization. The operative mortality rate in 27 patients during the last 2 years of this survey was 7%, whereas the previous mortality rate in 45 patients during a comparable period was 11%. The operative mortality rate in shunted patients was 15% after total repair vs. 10% in non-shunted patients. The indications for shunt procedures in this retrospective survey were: anomalous LAD crossing RVOT, repeated cyanotic spells in infants less than 2 years of age, hypoplastic pulmonary arteries, unavailability of open-heart facilities, or a rare blood group rendering open-heart operation practically not safe. Eight patients [11%] had an associated anomaly of the coronaries, of whom two succumbed after total repair. Mediastinal bleeding was noted post-repair in 1 of 13 shunted patients [7.6%] versus 7 of 59 non-shunted patients [11.8%]. The use of properly tailored Gore-Tex to patch the VSD and reconstruct the right ventricular outflow tract has yielded satisfactory results. The optimal age of about one year for total primary repair of TOF is presently favored