Improved patient survival following surgery for coarctation of the aorta.

BACKGROUND: We conducted a retrospective review of children undergoing surgery for coarctation of the aorta in our institution over the last ten years with the aim of evaluating overall patient survival as well as detecting factors affecting it. We tried to identify the risk factors for mortality. METHODS AND DATA: Between January 1992 and December 2001, 201 patients with aortic coarctation were operated on at the Department of Cardiac Surgery of the Children's University Hospital, Bratislava. The three classes of aortic coarctation were represented: isolated coarctation, coarctation with ventricular septal defect (VSD) and coarctation with complex cardiac anomalies. Patients' preoperative, operative and immediate postoperative medical records were carefully studied with special attention paid to the type of lesion, patients' preoperative state, type of surgical technique employed, as well as the period of operation. For comparison, two equal time periods of follow-up were reviewed--1992 to 1996 and 1997 to 2001. The overall postoperative conditions of patients were also regularly monitored. Patient data were statistically analyzed using the JMP program version 4.04. RESULTS: An overall survival of 90% was recorded over the period of follow-up, ranging between one and ten years. A further break down showed a statistically significant difference between the various types of aortic coarctation, p=0.0001. Patients with simple or isolated coarctation had a survival rate of 100%, those with ventricular septal defect (VSD) in addition to coarctation had a survival rate of 80% while patients with associated complex cardiac anomalies had a survival rate of 65%. An improvement on overall patient survival was recorded in the period between 1997 and 2001--96% as against 86% for the period between 1992 and 1996. On univariate statistical analysis, the following variables were identified as significant risk factors for death: 1) Complex cardiac anomalies (p<0.0001), 2) Age at operation less than one month (p<0.0001) and 3) Treatment prior to the year 1997 (p=0.02). CONCLUSION: A considerable improvement on patient survival following surgery for coarctation of the aorta was recorded over the last five years. This could be attributed to new measures in preoperative, operative and postoperative care for patients with aortic coarctation. (Tab. 4, Fig. 5, Ref. 8.).

[Vectorcardiographic features of right ventricular dilatation]. / Vektorokardiografický obraz dilatácie pravej komory.

Axial McFee-Parungao lead system vectorcardiograms were obtained in 55 patients with type atrial septal defect, aged 3-24 years, prior to and in average 3 years after surgical repair of the defect. Changes of the QRS loop observed after intervention led to the conclusion that the vectorcardiographic signs of right ventricular dilatation consist of a rightward shift of the posteriorly orientated horizontal plane vectors at 50-70 ms of QRS, decrease of the magnitude of vectors around the 40th ms, no changes in the magnitude and orientation of the initial (10-30 ms) QRS vectors as well abnormal departures of the spatial VCG loop from its preferential plane even in the absence of other signs of right ventricular conduction impairment. The above abnormalities vanished after normalization of hemodynamics.

[The hypereosinophilic syndrome in a child with endomyocardial fibrosis treated surgically]. / Hypereozinofilný syndróm dietata s endomyokardiálnou fibrózou riesený operacne.

The authors describe the case-history of a 12-year-old patient with hypereosinophil syndrome, endomyocardial fibrosis of the left ventricle and dominating mitral valve insufficiency. By correction of the insufficiency, using a Carpentier ring, the authors achieved substantial improvement of the haemodynamics. One year after operation the patient is cardially compensated.

[Anomalies of venous drainage of the left lung]. / Anomálna venózna drenáz l'avých pl'úc.

The authors present their experiences with diagnosis and surgical treatment of anomalous venous drainage of the left lung into the left innominate vein. The anomaly was found only in four out of 704 patients operated on for atrial septal defect. In three patients in whom leftsided anomalous pulmonary venous drainage was associated with atrial septal defect, the derangement was corrected by using extracorporeal circulation. The patient who had no atrial defect was operated on without extracorporeal circulation on applying leftsided thoracotomy. The mean age of the patients was 26.25 years. After correcting the defect, drainage of the left lung into the left atrium was found satisfactory in all operated patients. Exact assessment of the possibility of an associated intracardiac defect is being emphasized, as it is crucial for selecting the appropriate surgical approach.