ABSTRACT
Mitral valve replacement and bypass are high-risk operations in the infant with severe mitral stenosis. A palliative approach is presented that obviates the need for valve replacement in infancy.
Subject(s)
Heart Defects, Congenital/surgery , Mitral Valve Stenosis/congenital , Catheterization , Humans , Infant, Newborn , Male , Mitral Valve Insufficiency/therapy , Mitral Valve Stenosis/surgery , Palliative CareABSTRACT
Aortic balloon valvuloplasty was performed on a three-year-old girl with severe valvar aortic stenosis. This case demonstrates excellent, nonsurgical relief of stenosis without significant complications. A new technique of simultaneous caval balloon inflow occlusion is described.
Subject(s)
Angioplasty, Balloon/methods , Aortic Valve Stenosis/therapy , Child, Preschool , Female , HumansABSTRACT
Two patients are presented who illustrate unusual venous anatomy allowing right-to-left shunting at the atrial level after Fontan repair.
Subject(s)
Heart Atria/abnormalities , Heart Septal Defects, Atrial/etiology , Heart Ventricles/abnormalities , Pulmonary Valve Stenosis/surgery , Tricuspid Valve/abnormalities , Cardiac Catheterization , Child, Preschool , Coronary Vessel Anomalies/surgery , Female , Heart Atria/surgery , Heart Septal Defects, Atrial/surgery , Heart Ventricles/surgery , Humans , Infant, Newborn , Male , Tricuspid Valve/surgeryABSTRACT
23 premature infants were placed on a randomized double-blind study to evaluate the effectiveness of indomethacin in closing a patent ductus arteriosus. Infants received 0.2 mg/kg indomethacin or placebo by gavage. In the treatment group, 7 patients responded out of a total of 12, while in the placebo group, 2 responded out of a total of 11. Indomethacin plasma levels were obtained in 6 patients in the treatment group. Plasma levels showed marked variability in peak level (60-3,100 ng/ml), time to peak level (0.5-6 h) and t1/2 (1 to greater than 24 h).
Subject(s)
Ductus Arteriosus, Patent/drug therapy , Indomethacin/therapeutic use , Clinical Trials as Topic , Double-Blind Method , Female , Follow-Up Studies , Humans , Indomethacin/adverse effects , Indomethacin/blood , Infant, Newborn , MaleABSTRACT
Thirty consecutive infants undergoing hypothermia and circulatory arrest for repair of ventricular septal defect, transposition of the great vessels, or atrioventricular canal defects were alternately selected for conventional high flow nonpulsatile perfusion or pulsatile perfusion during core cooling and rewarming. All received morphine anesthesia, 30 mg/kg of Solu-Medrol, and 10 to 15 mcg/kg of phentolamine. Those receiving nonpulsatile flow were perfused at a rate of 160 to 180 cc/kg/min with a roller pump and oxygenator with arterial pressure of 50 to 55 mm Hg. In the pulsatile flow group, a roller pump and oxygenator were used, and an especially constructed Datascope PAD (pulsatile assist device) was interposed in the arterial line to provide pulsatile perfusion with 75/40 mm Hg pressure at slightly reduced flow (150 cc/kg/min). The average rectal, esophageal, and tympanic membrane temperatures were reduced to approximately 16 degrees C prior to circulatory arrest. Following repair, perfusion was resumed until these temperatures returned to 37 degrees C. Cooling and rewarming were enhanced by pulsatile perfusion, with over 30% reduction in total pump time. Additionally, the larger patients in the pulsatile group cooled almost as rapidly as the smaller. The rates of decline and subsequent rise of rectal, esophageal, and tympanic membrane temperatures were equal in the pulsatile group, but the rectal temperature lagged far behind in the nonpulsatile group. Urine production during bypass was 100% greater in the pulsatile group. The plasma free hemoglobin was similar in both groups. The average postrewarming pH was 7.31 in the nonpulsatile group and 7.42 in the pulsatile group. Infants receiving pulsatile flow awakened more quickly, were more alert, and required less postoperative mechanical ventilation. We suggest that pulsatile perfusion for core cooling and rewarming of infants is safe and is more rapid and physiological than conventional high-flow nonpulsatile perfusion.
