Persistent left superior vena cava communicating with the left atrium through a systemic-pulmonary venous malformation.

A 14 year old white girl who presented with a brain abscess was discovered to have a left pulmonary vascular malformation on a chest roentgenogram. Angiograms revealed a left superior vena cava that drained into a venous malformation within the left lung, then communicated with the left atrium by way of the left superior pulmonary vein. The right superior vena cava was functionally absent and was anatomically an atretic cord. There was mild systemic arterial hemoglobin desaturation, but no evidence of cyanosis. The embryology, physiology and surgical repair of this rare lesion and the complication of a postoperative superior vena cava syndrome are discussed.

Cost containment via expense rationalization in open-heart surgery.

Hospital costs and the fees of the surgeon, assistant, anesthesiologist, and cardiologist were reviewed in a community hospital doing 425 cardiac operations in the year 1977. Each item of the bill was analyzed and discussed with each department of the hospital. Changes made in the routine saved approximately $1000 per patient--16% for patients having mitral valves replacement (MVR), 15% for those having aortic valve replacement (AVR), 21% for those having saphenous vein bypass grafts (SVBG), and 23% for pediatric cases. The areas most likely to yield economic reductions without alteration of the quality of care are operating room, patient room, respiratory therapy, and pharmacy. Making the nurses, scrub technicians, surgical assistants, residents, and staff surgeons aware of the cost of each item and periodically discussing the alternatives could yield surprisingly large savings.