Total anomalous pulmonary venous connection: surgical treatment in 35 infants.

From 1973 through December 1980, 41 children with total anomalous pulmonary venous connection (TAPVC) were seen in our hospital, and 35 underwent surgery. The supracardiac type of TAPVC was found in 19 cases (46%), the intracardiac type in 6 infants (15%), the infracardiac type in 15 cases (37%), and the mixed type in one child (2%). Clinical and cardiac catheterization data demonstrated that children with the infracardiac type of TAPVC were referred very early in life and had the highest pulmonary artery pressures. Operation was performed in 35 cases, 15 of supracardiac, 6 of cardiac, 13 of infracardiac, and 1 of mixed type of TAPVC. Total in-hospital mortality was 39%, and was 28% in the operated children. The initial operative mortality of 71% in the years 1973 to 1975 has decreased to 18% in the last 5 years. Twelve of the surviving infants underwent re-catheterization showing excellent results. Only in one case, with additional aplasia of the left lung, did half-systemic pulmonary artery pressure persist. Corrective surgery offers the only chance of survival in most children with TAPVC. The operative risk can be reduced by increased surgical experience supported by optimal medical preparation of the patient. After adequate surgical correction long-term results appear to be excellent.

Experimental coronary air embolism. Assessment of time course of myocardial ischemia and the protective effect of cardiopulmonary bypass.

In 74 mongrel dogs 0.02 ml air/kg of body weight was injected into the left anterior descending coronary artery (LAD). Forty-three dogs were studied without (group I) and 31 with (group II) extracorporeal circulation (ECC). Time course and extent of myocardial ischemia were assessed by continous thermographic measurements as well as by fluorescence techniques. Coronary air embolism resulted in an immediate decrease of myocardial temperature associated with transmural ischemia. In 31 surviving dogs (72%) of group I this phenomenon was fully reversible within 8.7 minutes as compared with 5.4 minutes in 100% of the surviving dogs from group II. No postembolic death occurred in the group II animals. In group II the postembolic temperature decrease was significantly less than that in group I, and, in addition, the myocardial area involved was significantly smaller. The results indicate that the extent of myocardial ischemia following coronary air embolism and its time course can be well-documented by means of thermocardiography; using extracorporeal circulation survival can be improved and myocardial damage minimized.