Physiological Correction Research Articles

The surgical management of tricuspid atresia.

Since Fontan in 1971 described a physiological correction for tricuspid atresia few successful operations have been reported. Two patients corrected 20 and 10 months ago at the Brompton Hospital are presented. These patients exhibit many of the problems in the management of tricuspid atresia. The first aged 20 having previously undergone three palliative operations, and therefore, presented a number of operative problems. The second, aged 8, had had no previous surgical treatment and was found at operation to have a partial atrial ventricular canal. The operative procedures, and the post operative course are described, the criteria for selection of patients for the Fontan operation are discussed as are the possible long term hazards of homograft failure, atrial dysrhythmias and hepatic dysfunction. The successful outcome of these two patients suggest that palliative surgery in infancy should allow for this form of correction in later life.

Coronary artery anatomy in transposition of the great vessels in relation to anatomic surgical correction

Because of the inadequacies of physiologic correction of transposition of the great arteries (TGA), we have been experimenting with direct anatomic correction of the anomaly. The procedure involves switching the aorta (with the coronary arteries attached) and the pulmonary artery. Studies in preserved infant hearts have indicated the technical feasibility of this operation. Results with the reverse of the procedure, to create a laboratory model of TGA in dogs, have been encouraging as well.

A simple method of perfusion for refashioning the intraatrial baffle after physiological correction of transposition of the great vessels : C.P. Clarke, S.T. Bath, K. Curtis, and T.C.K. Brown. Aust. NZ J. Surg., 42:238–241 (February), 1973

A simple method of perfusion for refashioning the intraatrial baffle after physiological correction of transposition of the great vessels : C.P. Clarke, S.T. Bath, K. Curtis, and T.C.K. Brown. Aust. NZ J. Surg., 42:238–241 (February), 1973

Toward a Rational Operation for Transposition of the Great Arteries

Current methods for physiological correction of transposition of the great arteries are well established. Continuing morbidity is associated with them, however. The development of hypothermic open-heart surgery and the perfection of microsurgical techniques coupled with our observations of favorable coronary anatomy in many patients with transposition lead us to suggest that the time is ripe for attempts at complete anatomical correction. Our experimental background and several alternatives are suggested.

A simple method of perfusion for refashioning the intraatrial baffle after physiological correction of transposition of the great vessels.

The intraatrial baffle used in physiological repair of transposition of the great arteries can fibrose and alter its shape, producing venous obstruction, so that refashioning may become necessary as a secondary procedure. Reopcration under these circumstances is difficult, and can be made easier by using a simple perfusion technique requiring a minimum of dissection for cannulation. A technique is described utilising a “left atrial” to femoral artery bypass combined with core cooling, and two illustrative cases are presented.

Physiologic correction of transposition of the great arteries. Indications for and results of operation in 32 patients.

The total management of a group of 32 patients with transposition of the great arteries (TGA) is reported. All but one had required creation of an atrial septal defect in infancy. Eighteen patients had no associated cardiac defects, and physiologic correction was performed between 8 months and 9½ years of age. The only death in this group occurred 9 months after operation. Eight of nine patients with TGA and an associated ventricular septal defect (VSD) had required pulmonary artery banding in infancy. Physiologic correction was performed between 2¼ and 6 years of age. Three of these patients died during the postoperative period, and one died 9 months after operation. Two patients had TGA and pulmonary stenosis (PS). Physiologic correction was performed at 2 1/3 and 3¾ years of age. Both patients have done well. Three patients had TGA, VSD, and PS. Total correction was performed between 2 1/3 and 3½ years of age. All three patients died in the postoperative period. The over-all operative mortality was 19%. Our present plan of management has evolved from the experience reported above. All infants with TGA have balloon atrioseptostomy. If no VSD is present, physiologic correction is performed between 1 and 2 years of age. Patients with TGA and a VSD are catheterized at 8 months of age, and pulmonary banding is performed if pulmonary artery hypertension is present. Physiologic correction is performed at about 4 years of age. Patients with TGA, VSD, and PS may require systemicpulmonary artery anastomosis. Correction at 5 years of age with the use of a homograft from the right ventricle to the pulmonary artery, as described by Rastelli and his associates, is recommended because of the poor results obtained with an intra-atrial baffle in this group.

Transposition of the Great Arteries

Thirty-seven critically ill infants and children were seen over a ten-year period with the diagnosis of complete D transposition of the great arteries. Since 1967, balloon atrial septostomy has been performed at the original diagnostic cardiac catheterization. Previously, palliative treatment was surgical. Considerable improvement immediately followed balloon septostomy, and eight of the ten infants seen since 1967 are alive and doing well. Death occurred following attempted banding of the pulmonary artery in two infants with ventricular septal defects. One, a 7-day-old, also had an associated coarctation of the aorta. The use of balloon septostomy has greatly improved the outlook for infants with transposition of the great arteries, and allows more of them to grow to an age and size when total physiological correction (Mustard operation) may be safely undertaken.

Angiographic and catheterization findings in patients with difficulties after total correction of tetralogy of Fallot.

Tetralogy of fallot is an anatomically complex intracardiac defect resulting in right-to-left or bidirectional shunts at the ventricular level and decreased pulmonary blood flow. The peripheral arterial unsaturation varies with the size of the interventricular defect and its anatomic relationship to the enlarged aortic root, as well as with the severity of the right ventricular outflow obstruction. The muscular hypertrophy of the right ventricle may be pronounced. Total repair of the anomaly achieves physiologic correction by separation of the intracardiac streams and by relief of the pulmonic stenosis. The repair may or may not result in perfect anatomic or entirely normal intracardiac pressure relationships. Of 124 patients operated upon, there were 102 long-term survivors in this series. Twelve of these were restudied by cardiac catheterization and angiocardiography performed from two months to ten years after total correction of the defects. The most common indication for re-examination was the presence of a loud systolic murmur over the pulmonary area suggesting significant residual pulmonary stenosis. Other indications were a loud diastolic murmur or parasternal systolic murmur, cardiac enlargement and failure, a bulge along the left upper cardiac border on the chest roentgenogram suggestive of right ventricular outflow tract aneurysm, and electrocardiographic evidence of increasing right ventricular hypertrophy. Table I summarizes the catheterization and angiographic findings in these patients as well as their subsequent course. Three have had repeat operations with good results. Examples of the lesions found in seven patients are described in the following brief case reports and illustrated in the accompanying figures. Case Reports Case I (N. R): The diagnosis of tetralogy of Fallot was established in this boy at three years of age. Preoperatively a bidirectional shunt was found at the ventricular level. No atrial septal defect was diagnosed. The right ventricular systolic pressure was 88 mm Hg, and there was a 76 mm Hg gradient across the pulmonary valve. One of the views from the lateral angiocardiogram is shown in Figure 1, A. At operation, a moderate amount of infundibular stenosis was encountered and resection was done. The stenosed pulmonary valve was opened by incising two of the commissures, and the ventricular septal defect was closed with a Teflon patch. After surgery, digitalization was necessary because of congestive heart failure, and systolic and diastolic murmurs persisted over the pulmonic area. The electrocardiogram revealed complete right bundle branch block. The child was recatheterized at five years of age because of the persistent murmurs and cardiac failure. At this time the systolic right ventricular pressure was 110 mm Hg in the inflow tract.

Bone chip plastic repair of congenital chest deformities

In the year 1594, Bauhinus described in the early medical literature a seven-year-old boy with a marked depression of the sternum and ensiform cartilage. 1 This was the first clinical treatise on the congenital and developmental deformities of the anterior chest wall which have since been generally classified into two categories: the depression deformity (pectus excavatum) and the protrusion deformity (pectus carinatum). Not until 1911 was surgical repair of this malformation attempted, 2 and only in recent years have adequate surgical corrective techniques been developed. This paper presents bone chip plastic reconstruction as a simplified operative procedure for an anatomical, physiological, and functional correction of these congenital chest deformities. Classification and Etiology Pectus excavatum is a funnel-shaped depression of the anterior chest wall whose deep apex is the xiphoid and whose walls are the posteriorly displaced sternum and attached costal cartilages. Its pattern can be symmetrical or asymmetrical in which

A new technic for complete correction of transposition of the great vessels. An experimental study with a preliminary clinical report.

A procedure for complete anatomic correction of transposition of the great vessels is described. The technic is based on the concept of isolating an aortic segment containing both coronary ostia and turning the segment over to fit the outflow stump of the left ventricle. Experimental work and two clinical trials are presented and discussed. We believe that this operation provides an anatomic and physiologic correction of the great vessels and coronary arteries in transposition. In spite of two clinical failures, we think this operation is worthy of further trials.

The chromatic aberration of the human eye and its physiological correction.

The chromatic aberration of the human eye and its physiological correction.

Passage of the Blue Dye T-1824 from the Blood Stream into the Lymph.

Summary1. Blue dye T-1824, used in the determination of blood plasma volume, passes from the blood stream into the thoracic and cervical duct lymph of normal dogs within the first hour following its intravenous injection. 2. Under normal physiological conditions correction for the escape of dye from the vascular bed can probably be approximated by extrapolating the curve of dye disappearance. Under abnormal and varying conditions application of this correction may be difficult.