Correction of tetralogy of Fallot after Waterston shunt.

The authors have reviewed their experience concerning twenty-seven patients who underwent intracardiac repair of Fallot's Tetralogy after a previous Waterston shunt. They are divided into 4 groups according to the classification of Shinebourne, Anderson and Bowyer. The risk factors are analyzed in group 1 patients in whom primary total correction is contra-indicated and in whom the mortality at repair is high in presence of kinking of right pulmonary artery. The type of surgery is still debatable. For the symptomatic patients of the other groups, primary total correction at any age seems, at this time, to be the treatment of choice. The contra-indications are an anterior descending coronary artery arising from the right coronary artery or associated complex anomalies which would make total correction difficult.

[Circulatory arrest under deep hypothermia in the correction of the interventricular communication in the newborn (author's transl)]. / L'arrët circulatoire sous hypothermie profonde dans la correction de la communication interventriculaire chez le nourrisson.

The technique of circulatory arrest under deep hypothermia has completely changed the therapeutic outlook of some congenital heart malformations in the newborn. The authors have tried this method particularly in neonate cases of the interventricular communication. This experience bears on ten newborn cases aged 3 to 11 months. Surgical indication was mandatory because of global heart failure, unresponsive to conservative treatment. Intracardiac correction is realized under optimal conditions of operative technique by means of the circulatory arrest. In six cases, the interventricular communication is large and isolated; in four cases there were multiple interventricular communications. The immediate postoperative is favourable in all cases. One was reoperated for a residual shunt. Evolution is satisfactory in nine cases. There was one late death. Hemodynamic controls prove the soundness of this method of treatment. Favourable results up to 2 1/2 years after the procedure encouraged the authors to extend the indications for deep hypothermia and circulatory arrest to other congenital anomalies of the newborn.

Comparative haemodynamic effects of glucagon and isoprenaline in the early postoperative period in cardiac surgery.

In order to study the haemodynamic effects of isoprenaline and glucagon in the immediate postoperative period, 16 patients who had single or multiple valve replacement or coronary artery bypass grafts were investigated. Measurements of cardiac index, stroke index, heart rate, arterial and right atrial mean pressures were made either before, during, or after the administration of both drugs. With the doses used, the inotropic effects of both drugs are similar, while the chronotropic action is statistically higher during isoprenaline infusion than after glucagon administration. This fact explains the greater increase in cardiac index after isoprenaline administration. Mean arterial pressure shows no significant changes after either drug, while right atrial mean pressure decreases significantly. Peripheral vascular resistance remained mostly constant. The activity of glucagon injected as a single bolus seems to be maximal 10 to 15 minutes after the injection and dissipates about 30 minutes later. The ideal dose of isoprenaline is between 0.8 and 2 mug/min. Within this range, the inotropic effect is maximal and the chronotropic and bathmotropic effects are limited. Above 2 mug/min, cardiac index and stroke index decrease, and arrhythmias become more frequent.