Early diagnosis and surgical treatment of children with congenital vascular rings and accompanying heart lesions.

Methods of early diagnosis, operative treatment and postoperative care are described in children with congenital vascular rings. The ring types were grouped according to Cooley's classification. Among 42 recognized vascular rings 34 children required surgical treatment because of severe or noticeable compressive symptoms of esophagus and trachea. In the postoperative period early respiratory care is especially important.

[Frequency and natural history of several types of transpositions of the great arteries (TGA) in children (author's transl)]. / Czestosc wystepowania i przebieg kliniczny poszczególnych typów przelozenia duzych naczyn Tetniczych (TV)

The frequency and clinical differences between several types of TGA have been estimated. In a group of 52 patients with TGA three anatomic types were distinguished on the basis of the classification of Nadas (Fig. 1). The correlation between TGA type and sex, weight at birth, predominating clinical symptoms, most frequent clinical complications and survival time in children with this congenital malformation were investigated (Fig. 1-6). Type I was found almost five times more frequently in boys who had a higher than average weight at birth (Fig. 1-3). The most frequent clinical symtpoms were: cyanosis, early congestive heart failure and paroxysmal anoxemia (Fig. 4). Infants with this TGA type died much earlier than infants with other TGA types (Fig. 6). The frequency of type IIA was the lowest, similar in both sexes (Fig. 1). Among clinical symptoms cyanosis, paroxysmal anoxemia and systolic murmurs prevailed. No congestive heart failure was observed in this type (Fig. 4). Type IIC was more frequent in boys, but simultaneously it was the most frequent TGA type noticed in female infants (Fig. 1). Almost in all children heart murmurs were found, but only one of the examined cases with this type was affected by congestive heart failure (Fig. 4). The above-mentioned differences between clinical symptoms of several types of transposition of great arteries can be helpful when the adequate treatment is chosen.

[A study of the mortality of children with transposition of the great arteries treated at the Institute of Pediatrics, Medical Academy of Cracov, in 1966-1973 (author's transl)]. / Analiza smiertelnosci dzieci z przelozeniem duzych pni tetniczych, w latach 1966-1973, w Instytucie Pediatrii Akademii Medycznej w Krakowie

The mortality of children with transposition of the great arteries treated at the Institute of Pediatrics in 1966-1973 was assessed. The number of deaths among 52 observed children, 5 days to 8 years old, was analysed according to the sex and age of the children treated during 8 subsequent years (Fig. 1). It was shown that this congenital heart malformation occurred three times more frequently among boys than among girls, but mortality was the same in both groups examined (Table I). The period of 8 years was divided into 2 four-year periods because the surgical treatment of that condition was introduced only after 1970. According to the authors' observations all children who were treated conservatively during the first period (1966-1970) have died. During the second period (1970-1973) this malformation of the heart was diagnosed twice as often, in 35 cases, and there were only 21 deaths among these children (Table II). During that period the diagnosis of this malformation greatly improved, because in half of the cases observed the proper diagnosis was made in the first two weeks of life. This is a positive fact, because the possibility of successful septostomy is greater if the surgery is performed on younger infants.