ABSTRACT
Repair of pulmonary atresia with an extra-anatomic conduit has been difficult in patients with absent central pulmonary arteries. Although several methods have been employed successfully, each has inherent problems. Our technique uses a staged approach to complete pulmonary revascularization using the systemic-pulmonary collateral arteries for reconstruction of the involved lung. In our patient, this type of repair was associated with excellent late postoperative symptomatic and hemodynamic results. Complete revascularization of both lungs during correction of pulmonary atresia may improve the surgical management of this condition.
Subject(s)
Pulmonary Artery/abnormalities , Pulmonary Valve/surgery , Adolescent , Aorta/surgery , Cardiac Catheterization , Cardiopulmonary Bypass , Collateral Circulation , Follow-Up Studies , Graft Survival , Humans , Male , Pulmonary Circulation , Pulmonary Valve/abnormalities , Pulmonary Wedge Pressure , Time Factors , Vascular ResistanceSubject(s)
Carotid Arteries/physiopathology , Pulmonary Artery/surgery , Subclavian Artery/surgery , Adolescent , Auscultation/instrumentation , Carotid Arteries/surgery , Child , Child, Preschool , Diastole , Electrocardiography , Heart Rate , Humans , Infant , Infant, Newborn , Systole , Time Factors , UltrasonographyABSTRACT
We have carried out a quantitative analysis of the force-interval relationship of the human left ventricle and compared it to previous studies done in both intact subjects as well as isolated muscle. The characteristics of the force-interval relationship of the normal patient resembed those of normal isolated mammalian muscle (except when exposed to high levels of catecholamines). The relationship in group 2 (patients with increased left ventricular dimensions and normal pressure indices) resembled those obtained from isolated muscles from hypertrophied hearts. The relationship from group 3 (patients with increased left ventricular EDDs and depressed pressure indices, two of whom were in clinical heart failure) resumbled those induced in normal muscles exposed to high levels of catecholamines, and those obtained from experimentally induced heart failure. The force-interval relationships of the four patients who fell into the third group were strikingly different from the other groups. This suggests that the force-interval relationship may be useful to describe changes in the inotropic state of the patient's heart.