[Deep hypothermia for the correction of a congenital cardiac defect complete with atrioventricular block].
The techniques of deep hypothermia for correction of congenital cardiac defects are well known in many cardiac centers and many cases can be treated even if there are pre-existing rhythm troubles. Our patient had the following diagnosis: left atrial isomerism, dextrocardia; left sided azygos continuation of inferior vena cava; left and right superior venae cavae, hepatic veins, pulmonary veins, all draining into a common atrium; d-loop with normally related ventricles; ventriculo-arterial concordance, small VSD. In addition complete a-v block was present. The patient, 40 days old and 3.4 kg., in heart failure, was paced with a temporary transvenous catheter at 130/min and, afterwards, catheterized. Surgery was undertaken three days post-catheterization using surface deep hypothermia. A Mustard operation, including enlargement of the new left atrium with PTFE (Goretex), was performed during total circulatory arrest. At the end, a permanent pacemaker was positioned in the abdomen and epicardial wires were left on the right ventricle. The postoperative period was uneventful and the patient is doing well 3 months latter. The interest of the case is that even in a complex congenital cardiac malformation with complete a-v block, the technique of surface deep hypothermia can be used because all the physiological parameters remain stable during the procedure in spite of the very low heart rate.