Cardiovascular surgery in a Children's Hospital: II. Cyanotic lesions. A review of 193 operations

Abstract

A review has been presented of 193 cardiovascular operations on cyanotic children. The mortality was 20 per cent. In 164 operations on cyanotic children with potentially operable lesions, there were 19 deaths (11.6 per cent). There were 10 operations on cyanotic children with valvular pulmonary stenosis and intact ventricular septum, with one death. Excellent clinical results have been obtained in the survivors. A shunt procedure was used in allbut 3 of the 126 patients in whom a definitive operation was performed for tetralogy of Fallot. The operative mortality was 8 per cent and the late deaths constituted 7 per cent. Eighty per cent have obtained a good clinical result. Time alone will tell whether correction of this lesion under direct vision will improve these results. A shunt procedure was performedon 11 children with tricuspid atresia. In two an atrial defect was also created. There was one operative death and 4 late deaths. The survivors show a greater degree of cyanosis than is usually seen in the child with tetralogy of Fallot. Only 4 of 17 infants remain aliveafter various operations for correction of transposition of the aorta and pulmonary artery. An atrial septal defect was created in each of these survivors. Our experience would indicate that it is difficult, or impossible, to correct total transposition of the pulmonary veins fully without cardiopulmonary bypass, although considerable improvement was obtained in 3 of 5 patients on whom a pulmonary vein was anastomosed to the left atrial appendage under hypothermia. A right lower lobectomy was performedon a very cyanotic girl with pulmonary arteriovenous fistula, resulting in immediate disappearance of cyanosis. A review has been presented of 193 cardiovascular operations on cyanotic children. The mortality was 20 per cent. In 164 operations on cyanotic children with potentially operable lesions, there were 19 deaths (11.6 per cent). There were 10 operations on cyanotic children with valvular pulmonary stenosis and intact ventricular septum, with one death. Excellent clinical results have been obtained in the survivors. A shunt procedure was used in allbut 3 of the 126 patients in whom a definitive operation was performed for tetralogy of Fallot. The operative mortality was 8 per cent and the late deaths constituted 7 per cent. Eighty per cent have obtained a good clinical result. Time alone will tell whether correction of this lesion under direct vision will improve these results. A shunt procedure was performedon 11 children with tricuspid atresia. In two an atrial defect was also created. There was one operative death and 4 late deaths. The survivors show a greater degree of cyanosis than is usually seen in the child with tetralogy of Fallot. Only 4 of 17 infants remain aliveafter various operations for correction of transposition of the aorta and pulmonary artery. An atrial septal defect was created in each of these survivors. Our experience would indicate that it is difficult, or impossible, to correct total transposition of the pulmonary veins fully without cardiopulmonary bypass, although considerable improvement was obtained in 3 of 5 patients on whom a pulmonary vein was anastomosed to the left atrial appendage under hypothermia. A right lower lobectomy was performedon a very cyanotic girl with pulmonary arteriovenous fistula, resulting in immediate disappearance of cyanosis. ErratumThe Journal of PediatricsVol. 54Issue 4Preview Full-Text PDF