Four cases of H-type tracheoesophageal fistula are reported. The patients all had chronic aspiration from the esophagus. Although serious symptoms were present in all, definitive diagnoses were not made until the patients had reached 1, 6, 12, and 50 years of age, because ordinary radiologic methods failed to establish the diagnosis. The angulation of the fistula usually prevents contrast medium in the esophagus from entering the trachea, especially with the subject upright. On the other hand, air easily passes from the trachea to the esophagus, eventually producing megaesophagus which may be confused with the picture of achalasia. An ill-advised Heller esophagomyotomy was done on 1 patient. All 4 patients eventually had successful closure of the fistulas. Three operations were by the transthoracic route, and 1 high fistula in an infant was closed through a cervical approach.

Adult↗

PubMed1978

Late results of atrial septal defect repair in adults.

Repair of secundum atrial septal defects in 75 patients older than age 40 years was associated with a good long-term result, from five to 21 years postoperatively, in 89% of patients who were class I and II preoperatively and in 86% of those in normal sinus rhythm preoperatively. Functional class III or IV, atrial fibrillation, a higher pulmonary artery mean pressure and higher pulmonary vascular resistance affected the prognosis adversely. Repair of atrial septal defect in adults did not reverse existing atrial fibrillation and did not protect against the onset of new atrial fibrillation.

Adult↗

PubMed1978

Symptomatic anomalies of the aortic arch.

Twenty-eight patients with anomalies of the aortic arch producing compression of the trachea and the esophagus have undergone surgical correction at this hospital since 1949. Of the vascular rings encountered, 15 had a double aortic arch and eight, a right aortic arch with a constricting ligamentum arteriosum. Five had an aberrant right subclavian artery passing posterior to the esophagus producing dysphagia. The patients with the double aortic arch were all infants. Two of the patients with a right arch and constricting ligamentum arteriosum and one patient with a retroesophageal subclavian artery were adults. Stridor from pressure on the trachea was the common symptom in the infants. The diagnosis was confirmed by esophagograms; aortography was less helpful. The surgical approach was the same for all of the anomalies, through a posterolateral incision in the left fourth interspace. For the double arches, the smaller limb, usually the anterior, was divided. Division of the ligament relieved the constriction of the right aortic arches, and the anomalous right subclavian artery was divided near the aorta. There were no hospital deaths, but one infant with a double aortic arch operated upon at the age of two weeks and with a tracheostomy died at home seven months later.

Adult↗

PubMed1976

A safe technique for closure of the recurrent patent ductus arteriosus.

In an early series of 73 operations for patent ductus arteriosus, closure was by the triple ligation method. Over a short period, recurrence of patency was observed in 2 cases and after that the technique of division and suture rather than ligation became standard. For closure of the recurrent ductus, a modification of the usual technique is necessary to minimize danger of injury to the recurrent nerve and the great vessels. A safe method was devised which involves an intrapericardial approach to the superior aspect of the ductus and dissection inferiorly which avoids denudation of the aorta. This technique was used with satisfaction in 6 cases of recurrent patent ductus arteriosus.

Adult↗

PubMed1975

Fatal air embolism during thoracotomy for gunshot injury to the lung. Report of a case.

Fatal coronary air embolism occurred during thoracotomy in a patient with a gunshot wound involving the hilum of the right lung. Embolism was observed during a second period of failure of heart action. Evidently, air entered the pulmonary veins from the bronchus, which was receiving positive-pressure ventilation. The literature contains reports of only 3 similar cases, but we suspect that air embolism may be responsible for death and morbidity in additional cases in which accidental or iatrogenic lung trauma has produced a pathway between the bronchial tree and the pulmonary veins.

Adult↗

PubMed1975

Recurrent ulcer of the thoracic stomach penetrating the heart. Report of a case and review of the literature.

Recurrent and severe gastrointestinal bleeding caused the death of a 67-year-old man who had had resection of carcinoma of the cardiac end of the stomach. The hemorrhage was eventually found to be due to perforation of the wall of the left ventricle by a benign ulcer in the region of the esophagogastric anastomosis. At first, resection of the ulcer appeared to be successful, but recurrence of the penetrating ulcer caused fatal hemorrhage 4 1/2 months later. In our review of the literature, we found only one other instance in which an ulcer on an anastomosis perforated the heart. There were reports of 24 other cases of benign ulcers of the stomach or esophogus which penetrated the heart.

Adenocarcinoma↗

PubMed1973