BACKGROUND: Atrioventricular (Bjork) connection used for the correction of tricuspid atresia has become of little more than historical interest. However, the optimal form of management of patients undergoing this repair still requires continued assessment of the long-term outcome. We review our experience with valveless atrioventricular connection focusing on the morphological changes seen in the heart chambers. METHODS: Between October 1978 and March 1986, seven patients with tricuspid atresia having concordant ventriculoarterial connection underwent atrioventricular connection. Configuration of the surgical connection included Dacron extracardiac conduit without valve insertion. End-diastolic volumes were calculated in the respective heart chambers. A group of patients undergoing atriopulmonary connection was used as control subjects. RESULTS: The diminutive right ventricle showed conspicuous growth at 1.1 +/- 1.1 years after the initial repair, with the end-diastolic volume index increasing from 25.0 +/- 8.7% of normal value at a preoperative state to 80.4 +/- 31.1% of normal value postoperatively. Further operation was done in three patients because of the obstructive atrioventricular pathway. At reoperation, reconstruction of the connection with an addition of either atriopulmonary or cavopulmonary anastomosis afforded clinical improvement in our series. CONCLUSIONS: This study suggests that volume load resulting from the widely patent atrioventricular connection combined with backward regurgitation affects the development of young heart muscle of the right ventricle. The optimal choice of surgical strategy should be made at reintervention through recognition of the particular postsurgical anatomy.

Adolescent↗

PubMedDate not supplied

Post-transfusion graft-versus-host disease following open heart surgery. Report of six cases.

Six cases of post-operative erythroderma after open heart surgery are described. About 10 days after seemingly uneventful recovery, all patients developed fever, erythroderma, liver enzyme elevation, pancytopenia, and an aplastic bone marrow. Their condition rapidly deteriorated, and they died within 20 days of the onset of symptoms. Skin biopsy specimens from two patients showed mild leukocytic infiltration in the epidermal basal layer and upper dermis. Immunostaining by the ABC method showed that most of these infiltrating cells were suppressor/cytotoxic T cells. HLA study of peripheral lymphocytes from two patients and their families revealed that the patients' HLA phenotypes were incompatible from their children's HLA findings. Y chromatin was present in the lymphocytes of the skin biopsy specimen of a female patient. Based on the clinical picture, skin biopsy, HLA study, and Y chromatin study, the authors strongly suspect post-transfusion GVHD as the etiology of postoperative erythroderma, although these patients lacked any known immunodeficiency.

Adult↗