Biomedical subjects
Publications and source records attributed to F M Stone.
Operative mortality for 262 infants with interruption of the aortic arch repaired from 1982 to June 1993 has remained constant at about 35%. Major coexistent cardiac malformations, type B interruption, or staged repair are risk factors for mortality.
A quality assessment system for analyzing the results of inpatient care of children with cardiac abnormalities is described. Three Minnesota institutions (the Mayo Clinic, Minneapolis Children's Medical Center, and the University of Minnesota) participate with 15 other similar centers elsewhere in the United States in this system. Patient data are analyzed and adjusted for case mix to allow for differences in patient populations and referral patterns. The statistical methods used are shown for two conditions: ventricular septal defect and aortic valvotomy. Data presented show reduction in length of stay for cardiac catheterization. This change occurred as physicians annually reviewed and discussed the data and, as a result, instituted changes. This physician-directed program seeks improvement in patient care through physician education.
A total of 31 pediatric cardiac patients (mean age 19 1/2 months) who required surgery for repair of various congenital heart defects were prospectively studied in the postoperative period to determine potassium (K) dose-response characteristics. All patients received supplementary K when the serum K was less than 4.0 meq/liter. A total of 100 administrations of intravenous potassium chloride (KCl) were evaluated. KCl, 0.5 meq/kg, was infused over 2 h by syringe pump. This infusion was repeated as necessary to achieve a serum K greater than or equal to 4.0 meq/liter. The KCl was administered in addition to the K in the patients' maintenance solution. Blood samples for serum K determination were collected 15-30 min before and after the KCl infusion. The mean K dose administered was 0.72 +/- 0.23 meq/kg. This produced a mean rise in serum K of 0.61 +/- 0.48 meq/liter. Of 100 administrations, 11 resulted in no change or a decrease in serum K. Four of 100 administrations resulted in serum K greater than 5.0 meq/liter. Intravenous KCl supplementation in a dose of 0.5 meq/kg administered over 2 h is safe and effective for pediatric postoperative cardiac patients. Serum K should be measured to monitor therapy, due to variable response.
A 6-month-old female infant was seen with heart failure secondary to severe aortic and mitral regurgitation. As a neonate the infant had undergone an aortic valvotomy for congenital aortic stenosis. Subsequently the infant had aortic and mitral regurgitation with an infarcted papillary muscle. Double valve replacement was carried out with the St. Jude valve. The first approach was by the Manouguian procedure with extension of the aortotomy out between the left coronary cusp and the noncoronary cusp. The posterior mitral apparatus was resected, and a 19-mm St. Jude aortic valve was sewn into the mitral position. Because the enlarged aortic valve annulus was still inadequate to accommodate a 19-mm St. Jude valve, a Konno procedure was carried out to enlarge the aortic ring anteriorly. Atrial, septal, and aortic repair and right ventricular outflow tract reconstruction were carried out with bovine pericardium. Bypass was carried out with standard techniques of hypothermia, aortic cross-clamping, and cardioplegia. Postoperative anticoagulation therapy was initially with aspirin and dipyridamole (Persantine); however, clotting of the mitral prosthesis necessitated treatment with urokinase and heparin, which completely resolved the clot. Sodium warfarin (Coumadin) therapy was then begun. One year postoperatively, the child is developing normally.
A detailed electrophysiologic study in a 7 year old boy with incessant atrial tachycardia revealed the presence of an atrioventricular pathway conducting only in the ventriculoatrial direction. The results indicate a reentrant mechanism with the retrograde limb of the circuit entering the atrium in the region of the proximal to mid coronary sinus. The accessory pathway exhibited relatively long conduction times and conduction properties suggesting decremental conduction. Thus, an electrophysiologically atypical anomalous conduction pathway may be responsible for the occurrence of incessant atrial tachycardial in some children.
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