A five-year-old girl underwent surgery for tetralogy of Fallot and complete persistent atrioventricular (AV) canal. At operation, severe dysplasia of the right side of the common AV valve was found, with an accessory orifice and muscularization of a leaflet. Repair was carried out by closing the AV defect, through a combined right atrial and right ventricular approach, by a pericardial patch with a large anterior extension. Closure of the resulting mitral cleft, resection of anomalous muscle bundles and pulmonary valvotomy were also performed. Postoperatively the patient presented severe tricuspid regurgitation. Repair of the valve was deemed impossible and valve replacement was considered to have a very high risk due to the age of the patient, the small size of the right ventricle, and the previous repair of the AV defect. A modified Fontan operation was, therefore, considered preferable and successfully carried out. After the second operation, mediastinal infection developed and was successfully treated by local irrigation of diluted providone-iodine solution.

Child, Preschool↗

PubMedDate not supplied

Renal and hemodynamic effects of dopamine in infants following cardiac surgery.

The renal and hemodynamic effects of dopamine were measured during the immediate postoperative period in six infants following repair of congenital cardiac defects. Dopamine was infused at rates of 5, 10, and 15 micrograms/kg/min. Cardiac index (CI) increased significantly at a dopamine infusion rate of 15 micrograms/kg/min. The glomerular filtration rate (GFR) and urine output increased at dopamine infusion rates of 5 and 10 micrograms/kg/min and returned to baseline at 15 micrograms/kg/min. No significant changes occurred in right atrial pressure (RAP), left atrial pressure (LAP), systemic artery pressure, systemic vascular resistance (SVR), or pulmonary vascular resistance (PVR). Heart rate (HR) increased slightly at a dopamine infusion rate of 15 micrograms/kg/min. Pulmonary artery pressure (PAP) increased significantly in only one patient. These data demonstrate that infants require high doses of dopamine to produce the hemodynamic effects seen in adults and that these higher doses may be used without adverse renal effects.

Blood Pressure↗

PubMedDate not supplied

Cardiopulmonary autotransplantation in primates.

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Animals↗

PubMedDate not supplied

Surgical treatment of cardiac valvular disease.

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Heart Valve Diseases↗

PubMedDate not supplied

L-malposed great arteries with situs solitus and concordant atrioventricular connection.

Reports on surgical repair of cases with L-malposition of the great arteries with situs solitus atrialis and concordant atrioventricular connection are uncommon. A review of the anatomical characteristics of these cases has shown several peculiarities that may have considerable important in planning operation. Among them we emphasize the morphology of the ventricular septal defects, possible outflow tract obstructions and coronary artery course, anomalies of the atrioventricular valves and the course of the conduction system. Each of these aspects is reviewed from a surgical viewpoint in the light of our combined previous surgical and anatomical experience and of a review of previous reports by other authors.

Aorta↗