ABSTRACT
In 25 patients, aged eight months to 31 years, with ventricular septal defect (VSD; isolated in 15, the others with atrial septal defect, PDA, coarctation or patent ductus arteriosus + coarctation), each with severe pulmonary artery hypertension (pulmonary artery systolic pressure [Ppa] at least 75% of systemic and an elevated pulmonary vascular resistance), we related morphologic and morphometric data from open-lung biopsy to hemodynamic measurements obtained at cardiac catheterization during the same hospital admission. Of the hemodynamic features measured, only the ratios of pulmonary-to-systemic flow and pulmonary-to-systemic resistance correlated significantly with structure. Neither pulmonary artery pressure (Ppa) nor pulmonary vascular resistance correlated significantly with any structural feature studied. The increased external diameter of respiratory bronchiolar arteries in those with the more advanced Heath-Edwards grades reflects dilatation and suggests that it is in the small arteries of the distal arterial bed that the changes of pulmonary hypertension are most significant. Neither age nor body weight correlated significantly with the degree of structural or hemodynamic abnormality. In the ten patients who underwent VSD closure, Ppa was measured postoperatively. The Heath-Edwards grade (no more than one grade-III lesion) and arterial density (at least one-half that normal for age) were the best correlates of the difference between preoperative Ppa and Ppa immediately after corrective surgery. The presurgical catheterization data, including pulmonary resistance and the resistance ratio, did not correlate significantly with change in Ppa following VSD closure.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Heart Septal Defects, Ventricular/complications , Hypertension, Pulmonary/pathology , Pulmonary Alveoli/blood supply , Pulmonary Artery/pathology , Pulmonary Heart Disease/etiology , Acute Disease , Adolescent , Adult , Age Factors , Arteries/pathology , Biopsy , Child , Child, Preschool , Heart Septal Defects, Ventricular/surgery , Humans , Hypertension, Pulmonary/complications , Infant , Pulmonary Wedge PressureABSTRACT
This paper reviews the initial experience of radical correction of truncus arteriosus in the Soviet Union. The anatomy, hemodynamics, diagnosis and surgical technique are described in detail. Five patients were operated on; three survived. The two deaths in this series were due to mistakes in evaluating the indications for the operation.
Subject(s)
Truncus Arteriosus, Persistent/surgery , Aortography , Bioprosthesis , Blood Vessel Prosthesis , Child , Child, Preschool , Female , Follow-Up Studies , Heart Valve Prosthesis , Heart Ventricles/diagnostic imaging , Hemodynamics , Humans , Male , Truncus Arteriosus/surgery , Truncus Arteriosus, Persistent/diagnostic imagingABSTRACT
Twenty-five patients with malseptation of the aortopulmonary trunk resulting in aortopulmonary septal defect (window) were evaluated in a unique combined surgical series assembled from two institutions participating in the USA-USSR Health Exchange Program. Typical aortopulmonary septal defect or window (type I) with the connection between the ascending aorta and main pulmonary artery was found in 21 patients. Four had a more cephalad defect (type II) between the ascending aorta and the origin of the right pulmonary artery. Hemodynamics were the consequence of a large left-to-right shunt (mean ratio of pulmonary to systemic flow, 3.0) with right ventricular hypertension (mean right ventricular pressure, 86 mm Hg) and increased pulmonary vascular resistance (mean, 7.4 U) (mean ratio of pulmonary to systemic vascular resistance, 0.33). Angiography may provide patterns that allow preoperative distinction between the two types of aortopulmonary septal defect and provide information important in planning the details of corrective operation. Operative techniques included ligation, direct suture, and patch closure of the aortopulmonary septal defect. The best method appeared to be patch closure by the transaortic approach; real and potential problems were associated with other techniques.
