[Pacemakers in children]. / Les pacemakers chez l'enfant.

This is a study of pacemakers in 32 children with permanent pacemakers, 7 of them for congenital block, and 25 for post-operative block, representing a total of 69 pacemaker implantations. After a brief survey of the results, there is a discussion of the problems of the indications, relative for the congenital blocks, and absolute for the surgical blocks after a short period of observation. The choice of type of pacemaker rests upon three essential features: minimum inconvenience, a good length of active life, and the facility of an increased rate. Recent technical progress has allowed these features to be combined. The pacemakers currently available are shown on a table. The results are to a large extent determined by extreme care being taken over the implantation; meticulous asepsis, a low threshold on the electrode test, a pacemaker which is "comfortable" in its site, all these are essential if the serious complications are to be avoided, namely infection and pacemaker failure. The best route for the child, as for the adult, is by way of an epigastric approach with an abdominal pocket. In the very small infant, it seems better to implant by left thoracotomy, and to site the pacemaker intrapleurally.

[Anantomical aspects and surgical treatment of pulmonary stenoses and atresias with intact interventricular septum in the newborn and the infant under 6 months]. / Aspects anatomiques et traitement chirurgical des sténoses et atrésies pulmonaires á septum interventriculaire intact du nouveau-né et du nourrisson de moins de 6 mois

The series presented consists of 25 babies (18 of which were neonates), seen between 1972 and 1974. The anatomical and angiographic study revealed 5 anatomical types, according to whether the pulmonary orifice was patent or atretic, and according to the size of cavity of the right ventricle, which may be normal or reduced (perhaps almost totally). The diagnostic clinical features and findings on angiography are recalled. The operative procedure in all 25 cases was pulmonary valvotomy carried out with a brief normothermic period of cirulatory arrest. The technique is described briefly. The results, which vary widely with the anatomical type, were as follows: out of the 25 operated cases there were 12 deaths during or immediately after surgery. The figures are none-the-less encouraging, given the grave natural history of this condition in the baby. The best results were seen in cases in which there was a right ventricular cavity of normal or at least acceptable size. The maximum postoperative follow-up period was 3 years. Most of these children have a persistant pulmonary stenosis and hypertrophic right ventricle, and require a second operation in early infancy.

[Catheterization of the left heart by retrograde arterial pathway in children. Apropos of 100 explorations by femoral arteriotomy]. / Cathétérisme des cavités gauches par voie artérielle rétrograde chez l'enfant. A propos de 100 explorations par artériotomie fémorale

A study has been made of 100 cases in which a surgical technique has been used to carry out aortography in the child. The patients were aged between 12 days and 14 years. 20 per cent of the subjects were infants. The technique which was used was that of arteriotomy of the common femoral artery; the artery was repaired by interrupted sutures. The advantage of this technique is that it allows prolonged arterial catheterisation, and therefore seems to be indicated in the complex cardiopathies and also in cases of stenoses about the aortic outflow. The complications and local problems were 6 in number. They occurred either in the youngest subjects, or in those with aortic stenosis. Taken as a whole, the results were very satisfactory. It would appear that in a paediatric cardiology unit, this technique has a place alongside that of Seldinger, with its slightly different indications.

[Congenital cardiopathies appearing during the neonatal period. The view points of the cardiologist, the hemodynamics specialist, the surgeon, and the anesthetist]. / Cardiopathies congénitales à révélation néo-natale. Point de vue du cardiologue, de l'hémodynamicien, du chirurgien et de l'anesthésiste réanimateur

The best chances of survival for a new-born depend on the following factors: the possibility of clinical and haemodynamic diagnosis of the malformation, adequate reanimation and surgery. All this must be carried out as early as possible. Although catheterization is very risky it should be complete and as fast as possible, under monitoring of ventilation and haemodynamies. Reanimation is very important before, during and after surgery; it should be more preventive than curative. Very often, surgery is only palliative at this age. Taking into account progress in surgical techniques, the authors report their experience in anaesthesia and ressuscitation of 100 patients under 10 days old. They were all operated on in Laennec in Professor MATHEY's department but only some of them were catheterized there.