[Experimental evaluation of the atrio-pulmonary shunt technic in the presence of excess pulmonary flow].
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Biomedical subjects
Publications and source records attributed to P Fantidis.
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A new surgical procedure is presented for palliation of hypoplastic left heart syndrome. The first palliative technique consists of creation of an extraatrial interatrial duct and the second, reestablishment of the aortopulmonary communication by enlarging the aortic arch with a "conduit patch". Both procedures avoid having to clamp small systemic vessels and pulmonary veins and extracorporeal circulation is not needed. Extraatrial interatrial ducts were created in 10 dogs and the effectiveness of the procedure was evaluated. Reestablishment of the aorto-pulmonary communication and enlargement of the aortic arch was done in 7 specimens from patients with hypoplastic left heart syndrome who had died in the first hours of life and in 8 dogs. The surgical procedures, their advantages and the results obtained are described.
A new surgical technique for total correction of complete common atrioventricular canal was evolved from study of 34 specimens from affected infants who had died in the first year of life. An interventricular patch was fashioned to reconstruct the interventricular septum and the atrioventricular valves. The patch had two distinct components, one superior or atrial and the other inferior or ventricular. The division was made by inserting a lateral support at different levels on either face of the patch, to which the anterior and posterior atrioventricular cusps were sutured. The interatrial defect was closed with a patch that, together with the atrial component of the interventricular patch, produced a foramen ovale type closure mechanism. The authors present the pathologic observations which served as a basis for development of the surgical technique.
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A new technique is presented for surgical correction of tricuspid atresia, univentricular heart, pulmonary atresia with intact ventricular septum and hypoplastic ventricle, and hypoplastic left heart syndrome. The procedure consists of an angled right atriotomy, creation of an interatrial septal defect and a right neoatrium that is anastomosed to the pulmonary artery, and creation of a left neoatrium communicating with the left atrium through the interatrial septal defect. The technique was evaluated in 28 mongrel dogs. In 15 of these experimental procedures, the objective was to acquire skill in performing the technique. In the remaining 13, the procedure was executed with cardiopulmonary bypass. Hemodynamic studies were made at 30, 60, 120, and 180 minutes after operation. The results and advantages of the procedure are discussed. We consider it feasible for clinical application.
We review 109 patients with congenital heart disease under (two year of life, surgically treated between June 1978 and October 1981; 44% were under six months and 71% were under one year. Fifty six patients were operated under cardio-pulmonary by-pass, in 41 we used deep hypothermia with total cardio-respiratory arrest, 21% of them were under three months of life an 53% under one year. We present the morbidity and mortality together with the pulmonary management. Eighty five percent of the cases remained intubated postoperative by for less than 12 hours. The postoperative pulmonary evolution was quite similar for different types of congenital heart disease, such as T. Fallot, A-V canal, transposition, etc., and there was no statistically significant difference between them in terms of respiratory assistance and pulmonary complications. Eleven patients died (19%), all of them under six months of life. In 53 patients operated, without extracorporeal circulation, 38 had total correction and 15 palliative procedures. The mortality in this group was 9% (5 cases), all of the under one month of life. The global mortality was 14%. We discuss our present surgical indications in view of our results.
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An experimental model for right ventricle free wall infarct associated with double ventriculotomy and tricuspid insufficiency was created to evaluate whether right ventricle failure can cause profound refractory heart failure or whether modifications in right ventricular afterload are more influential in this regard. In our model, the left ventricle, interventricular septum and right atrial wall were maintained intact and pulmonary banding made it possible to modify right ventricular afterload during the experiment. The results of our study showed that pure right ventricular failure does affect the hemodynamic state negatively, but it is not itself, a cause of death in dogs. A slight increase in the dysfunctional right ventricular afterload produced a profound deterioration in the hemodynamic state that required pulmonary artery debanding within no more than 10 minutes.
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