[Emergency operation of neonates and infants with congenital heart diseases].
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Biomedical subjects
Publications and source records attributed to M Aoshima.
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A new technique of adjustable pulmonary artery banding is presented. A tourniquet system has been used in eight consecutive infants with complex congenital cardiac anomalies during the past 2 years. They had severe congestive heart failure, and six of them required inotropic support preoperatively. All survived the banding procedure and there were no hospital deaths. Four of the eight infants required additional adjustment of the band to improve hypoxemia or persistent congestive heart failure 3 hours to 4 months postoperatively. Each adjustment was made easily via a small skin incision without thoracotomy. This technique allows fine adjustment by gentle and delicate tightening and loosening of the band during and after operation, so that the technique avoids most mortality and morbidity related to an inappropriate banding and brings satisfactory symptomatic palliation.
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Effects of cardiopulmonary bypass (CPB) and hypothermic circulatory arrest on brain morphology were evaluated by computed tomography (CT). Of 57 children undergoing cardiac operations, 45 (4.5 +/- 2.8 years of age) were operated upon with the use of CPB with high-flow, mildly hypothermic perfusions. Twenty-seven of them were perfused with bubble oxygenators and 18 with membrane oxygenators. In the bubble oxygenator group, all 14 with 20 mu filters in the arterial line showed no postoperative CT changes, whereas four of 13 (31%) with 40 mu filters or without filters showed decreases in brain mass on CT scans. Three of these four patients underwent perfusion for more than 80 minutes. There were no CT changes in the membrane oxygenator group. Twelve infants (10.4 +/- 4.5 months of age) were operated upon with the aid of deep hypothermia and circulatory arrest (core temperature below 20 degrees C). Ten of 12 who had circulatory arrest for less than 60 minutes showed no CT changes, but two infants who had circulatory arrest for more than 60 minutes showed changes similar to those described above. All six children with CT changes had no clinical manifestation of the brain damage, and their CT abnormalities recovered within 6 to 11 months after operation. The specific cause of these changes remains undetermined, but microemboli or hypoxia during operation could be implicated.
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