Tetralogy of Fallot with absent pulmonary valve: a case complicated by bilateral relapsing pneumothorax.

We report a case of a neonate with tetralogy of Fallot with aneurysmal dilatation of the pulmonary artery, complicated by bilateral relapsing pneumothorax. The relapsing air leak made it necessary to place up to five chest drains and to switch from conventional ventilation to high frequency ventilation. In the course of 30 days, all drains were removed. Once other anatomical and functional malformations of the respiratory system had been appropriately excluded and reasonable haemodynamic stability had been achieved, the patient underwent successful radical corrective heart surgery in hypothermia and cardioplegia. We emphasize the advantage of resolving respiratory failure preoperatively to guarantee the success of corrective heart surgery and treatment of other surgically severe cases.

Serum enzyme activities in premature infants with bronchopulmonary dysplasia.

Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltranspeptidase (gamma-GT) and lactate dehydrogenase (LDH) activities were measured in 26 premature infants with bronchopulmonary dysplasia (BPD) (group 1), and in 24 premature controls, matched for gestational age and birth weight (group 2). Blood samples were taken serially on 3, 10, 20, 30 and 60 postpartum days. Group 1 and group 2 premature infants showed statistically higher LDH activities on the 3rd postpartum day. These differences disappeared later and LDH activities progressively decreased with time in both premature groups. Mean AST values of group 1 and group 2 premature infants were also significantly higher on the 3rd postpartum day. Subsequently, in all groups, AST showed a postpartal decrease, and a stabilization from the 10th day of life until the 2nd postnatal month. Mean ALT values were instead, comparable on the 3rd postnatal day and subsequently increased, although not significantly. Like the AST, gamma-GT of group 1 and group 2 premature infants were slightly more elevated on the 3rd postpartum day. The subsequent decrease was however transitory, and at 1 and 2 postnatal months a noticeable, significant progressive increase in mean values was found. It is concluded that serum ALT, AST, LDH and gamma-GT measurement of sick premature infants within the first 2 months of life are not significantly altered by the occurrence of BPD.