[Clinical and surgical observations on 14 cases of total anomalous pulmonary venous drainage (author's transl)].
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Biomedical subjects
Publications and source records attributed to L Parenzan.
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The angiographic and intraoperative findings are described in two children with imperforate tricuspid valve with atrioventricular and ventriculoarterial concordance who underwent a successful Fontan operation. It is important from a surgical point of view to distinguish this rare variant of tricuspid atresia from the more classic form with absent atrioventricular connection. The characteristic feature of hearts with imperforate tricuspid valve is the presence of a normally formed right ventricle which, in the presence of ventriculoarterial concordance, can be used to support the pulmonary circulation. When the imperforate valve is large, it may be possible to remove it, and restore atrioventricular continuity. Alternatively, an atrioventricular type of Fontan repair using a valved conduit should be considered as the treatment of choice in the presence of a suitable pulmonary arterial tree and pulmonary valve.
Anatomical, clinical radiographic and electrocardiographic aspects in 12 cases of left ventricle-right atrial communication are described. The usual severity and precocity of symptoms are outlined. At cardiac catheterization the level of the shunt was not found to be exactly correlated with the anatomic type of the defect; the mean QP/QS was 2,7 (1,4-5,8); only one case of pulmonary hypertension was detected and the mean RP/RS was 0,19 (0,06-0,83). Contrastographic aspects are emphasized and the importance of having two orthogonal projections is outlined. 9 patients underwent surgical repair with good results, except for the patient with pulmonary hypertension, who died soon after the operation: this patient shouldn't have been operated on. In all cases only right atriotomy was made, and the defect was closed by a dacron patch; no patient had a tricuspid plastic; one perforation and one cleft of the septal leaflet of the tricuspid valve were sutured directly. In view of the simplicity of surgical correction, wide indications are possible, considering, too, that there have been no reports on the spontaneous closure of the defect.
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