ABSTRACT
In order to facilitate for the general physicians the making of a suitable selection of babies who are in the most urgent need of specialized treatment at cardiac centres, simple methods for diagnosing and qualifying congenital cardiovascular diseases were elaborated. The following "minor" criteria were taken for suspecting a CHD: 1) cardiorespiratory distress following birth, 2) sequentially repeated Apgar score below normal, 3) "pneumonia" symptoms with respiratory distress, dyspnoea and cyanosis, attacks of unconsciousness, 4) feeding difficulties, failure to thrive, inexplicable irritability, 5) presence of other congenital anomalies. The almost certain presence of serious heart disease should be recognized in children, showing the following "major" symptoms: 1) permanent cyanosis, pallor or greyish colour, 2) cardiorespiratory failure (resembling usually symptoms of pneumonia), 3) ECG patterns indicating ventricular hypertrophy signs, 4) other significantly abnormal ECG patterns (e.g. AV and intraventricular conduction disturbances), 5) cardiac enlargement and lung vascularity abnormalities in chest X-rays, 6) weak, or impalpable arterial, particularly femoral pulses, femoral arterial pressures significantly lower, than at upper extremities, bounding pulses and high-pressure amplitude in arms and legs, 7) abnormal heart sounds and pathologic heart and vascular murmurs. A diagnostic "key", based upon evaluation of the "major criteria" facilitates the diagnosis and differentiation of the most important CHD's at neonatal and infantile age. When using this "key" one should keep in mind the relative frequency of incidence of particular lesions. The initial diagnoses by the above "key" were verified in 354 patients by cardiovascular catherisation, angiocardiography, surgical exploration, and for by autopsy. The diagnoses were perfectly accurate in 83.6% cases, in further 11.3% cases being also accurate but were supplemented by some details, and had to be corrected in only 5.1% cases.
Subject(s)
Heart Defects, Congenital/diagnosis , Age Factors , Aortic Coarctation/diagnosis , Apgar Score , Diagnosis, Differential , Heart Defects, Congenital/mortality , Heart Defects, Congenital/surgery , Humans , Infant , Infant, Newborn , Tetralogy of Fallot/diagnosisABSTRACT
Surgical corrections of some serious cardiovascular anomalies in infants and small children were attempted within the last 2 years; 12 severely ill infants and children below the age of 3 years were operated. All, but one, were below 10 kg of body weight, and in all of them there was a considerable weight deficit, more than 30%. The risk of operation was undertaken because of the ineffectiveness of medical treatment and very bad prognosis. The following cardiovascular lesions were operated: large aortopulmonary septal defects, localized just above the valvular rings in 2 patients with severe pulmonary hypertension, with very good effect in both; tetralogy of Fallot - in 2 babies, in one with good effect; congenital mitral obstruction with pulmonary hypertension in one case, with good effect; total anomalous pulmonary venous return of supracardiac type in one child, decreased 1 week following operation; type 1 complete transposition of great arteries in one baby, deceased one day following operation; large ventricular septal defects, with systemic or nearly systemic pulmonary hypertension in 5 children, in one with long-term good effect. A modification of the Barrat-Boyes, Neutze and Simpson method, based upon a combination of surface and core cooling was applied. Thoracotomy was performed after surface cooling to 34-32 centigrades, and then a single venous cannula was inserted into the right atrium and an arterial cannula -- into the aorta. Deep cooling was obtained during perfusion, using a heat exchanger. The duration of cooling perfusion was, on an average, 20 min., and the patients were cooled to a temperature of 23-21 centigrades. The corrections were performed on relaxed and bloodless heart, during the circulatory arrest lasting for 20-65 min. (40 min. on an average). Following repair the patients were rewarmed to temperatures of 36-37 centigrades by warming perfusion lasting on the average 40 min., including assisted circulation, until a haemodynamically sufficient cardiac output was present. Silicated ACD-blood, diluted to a hematocrit value of 28-30 Vol. % by a polyelectrolyte buffered solution was used for priming and perfusion. During all the procedures any pH and HCO3 deviations were balanced currently. At the time of cooling perfusion, when the patient's rectal temperature fell down to 30-25 centigrades, the heart started to fibrillate. At temperatures above 26 degrees C ventricular fibrillation was sometimes preceded by sinus bradycardia, or sinoatrial block/arrest, with an AV nodal rhythm and gradually increasing intraventricular conduction slowing. In some cases high degree AV block appeared. At temperatures of 25-23 centigrades - slow fibrillation appeared, followed usually by a complete cardiac arrest.
