[Heart and heart-lung transplantation. 3 years' experience in Timone CHU (Marseilles 1985-1988)]. / Transplantation cardiaque et cardio-pulmonaire. Trois ans d'expérience au CHU Timone (Marseille 1985-1988).

Since December 1985, we have performed 38 transplantations: cardiac (CT) n: 31, cardiopulmonary (CPT) n: 1, or bipulmonary (BPT) n: 6. There were 31 male and 7 female patients, aged 7 to 62, mean 46. In the cardiac group, the cardiomyopathy was primitive in 13, ischemic in 16, valvular in 2. Five patients had undergone one or more previous operations. Three patients had a biventricular assist device (1,6 and 7 days before transplant) for acute cardiac failure. The indication of CPT or BPT was pulmonary artery hypertension (1), silicosis (1), cystic fibrosis (4). There were 4 post-operative deaths in the CT group (12.9%); failure of graft, low cardiac output, pulmonary artery hypertension by multiple pulmonary thrombosis, and 2 deaths in the CPT and BPT groups (28%). The mean post-operative hospital stay was one month. All patients with CT were treated by an initial maintenance bitherapy protocol (cyclosporine, steroids) and observed by myocardial biopsies and echocardiograms. In 40 per cent of the patients, Azathioprine was subsequently added. The patients had 2.1 rejection episode/patient/year, either spontaneously reversed of treated medically. There were two late deaths (2 and 7 months) by refractory rejection. 78 per cent of the patients were alive one year after transplant. All survivors have recovered a normal life, some of them with full-time work.(ABSTRACT TRUNCATED AT 250 WORDS)

[Repair of complete atrioventricular canal before one year of age]. / Correction du canal atrio-ventriculaire complet avant l'âge d'un an.

We report a series of 22 children with complete atrioventricular canal (CAVC) operated upon before the age of one year. The youngest patient was 1 month old and weighed 3 kg. The patients' mean age was 7 months and their mean weight was 5.4 kg. 15 patients had trisomy 21, and in one patient the CAVC was associated with tetralogy of Fallot. The remaining 21 patients had congestive heart failure resistant to medical treatment, with clinical evidence of pulmonary arterial hypertension (PAHT). At the time of surgery, 2 patients had been under artificial respiration for one month. All patients were explored by echocardiography and cardiac catheterization. The mean pulmonary pressure/aortic pressure ratio was 0.92; the mean pulmonary flow rate/systemic flow rate ratio (Qp/Qs) was 2.9/1 and the mean pulmonary resistance/systemic resistance ratio (Rp/Rs) was 0.22. All children were operated upon under deep hypothermia with circulatory arrest (mean 54 min); the patient with tetralogy of Fallot had an additional period of extracorporeal circulation. Fourteen patients had Rastelli's type A CAVC and 8 had type C CAVC. All were operated upon by the classical Rastelli technique, using a single autologous pericardial patch; in none of the patients was the septal "slit" or "commissure" entirely closed. Three patients died within 48 hours of the operation: the first one died of sudden low cardiac output 18 hours after surgery, the second one of persistent PAHT and the third one of malignant hyperthermia. The patient under artificial respiration before surgery could not be disconnected and died on the 30th post-operative day.(ABSTRACT TRUNCATED AT 250 WORDS)

[Plasma determination of lidocaine and bupivacaine after caudal anesthesia in children]. / Dosages plasmatiques de lidocaïne et de bupivacaïne après anesthésie caudale chez l'enfant.

Serum concentrations of lidocaine and plasma concentrations of bupivacaine were measured so as to assess the risk of systemic toxicity following their administration by the caudal route in children, and study their pharmacokinetic profiles according to age. The serum concentrations of lidocaine were measured by immuno-enzymology in 37 children (23 +/- 13 kg) during the first hour after administration of 7 mg . kg-1. The plasma concentrations of bupivacaine were measured by high performance liquid chromatography in 40 children (18.03 +/- 8.90 kg) during the first hour after administration of 2.5 mg . kg-1. The greatest concentrations observed between 15 and 30 min after the injection were of 2.40 +/- 0.86 micrograms . ml for lidocaine and 0.93 +/- 0.44 microgram . ml-1 for bupivacaine. Higher values were observed in infants weighing less than 12 kg where they reached 2.89 +/- 0.72 and 1.52 +/- 0.68 micrograms . ml-1 respectively. These results showed that caudal anaesthesia with lidocaine (7 ml . kg-1) and bupivacaine (2.5 ml . kg-1) was a safe technique for children, giving average plasma concentrations inferior to toxic values. However, it seemed prudent not to give more than the prescribed doses in the small infant.

[Long lasting anaesthesia. Study among the children (author's transl)]. / Les anesthésies de très longue durée. Etude chez l'enfant.

In five years 14 children aged 1 to 15 underwent long lasting anesthesia (9,6 +/- 1,7 hours), excluding cardiac and neuro-surgery. These anesthesias, which are seldom performed are essentially used for the correction of congenital malformations of the cephalic pole (9 patients). Two types of anesthesia were used: neuroleptanalgesia (11 patients), enflurane and narcotic (3 patients). In addition to the usual monitoring in pediatric anesthesiology the insertion of a catheter in the radial artery proved essential. Temperature never went below 35 degrees C. In 8 cases blood loss was higher than the patient blood volume. The average preoperative perfusion was 9,4 +/- 5,4 ml/kg/heure.

[Trial droperidol premedication in infants and children]. / Essai du dropéridol en prémédication chez l'enfant et le nourrisson.

Droperidol premedication for children (0.3 to 0.5 mg/kg) was compared with pentobarbital and Dolosal--promethazine). Results are analyzed using criteria proposed by Burken and Nisbet. Droperidol compared very favourably with the order drugs. However a decrease in efficacy was noted with infants and neuw-born children, even with higher doses. The possible incidence it hypertonic seizures renders this drug unsuitable for ambulatory surgery.