PubMed · 14238387
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C G DURAN, A J GUNNING, T MCMILLAN. 1964. A SIMPLE VERSATILE PULSE DUPLICATOR.. https://doi.org/10.1136/thx.19.6.503
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OBJECTIVES: The goal of this study was to assess a new approach to stent the arterial duct in neonates with a duct-dependent pulmonary circulation. BACKGROUND: Previous attempts to stent the neonatal arterial duct were unsatisfactory. Learning from these failures, we speculated that covering the complete length of the duct with current low-profile stents might avoid previous problems. METHODS: Ten neonates with duct-dependent pulmonary circulations through a short straight duct were treated with stent implantation. The duct was crossed with an atraumatic 0.014-inch wire. A low-profile premounted coronary stent (outer diameter <4F, length 13 to 24 mm, diameter 3.0 to 4.0 mm) was positioned within the duct, not protected by a sheath; care was taken to cover the complete length of the duct from the aortaductal junction until well within the pulmonary trunk. RESULTS: All stents could safely be deployed with adequate pulmonary flow at early- and medium-term follow-up. There were no procedure-related complications; one patient died early from sepsis. All patients had adequate relief of cyanosis for at least three to four months. During follow-up, the pulmonary vasculature bed had grown without distortion. Acute occlusion of a stented duct was not observed. Ductal flow progressively decreased slowly over several months by luminal narrowing, until the stented duct had either become redundant or was dilated/restented or until elective staged surgery was performed. CONCLUSIONS: With current technology, complete stenting of a short straight duct is a safe and effective palliation, allowing adequate growth of the pulmonary arteries.
OBJECTIVES: To determine 18-month neurodevelopmental outcome of survivors of complex open heart surgery at </=6 weeks of age through an interprovincial program and to explore preoperative, operative, and postoperative outcome predictors. Study design Of 85 children from this inception cohort (21% mortality), 67 18-month-old survivors received multidisciplinary assessment including the Bayley Scales of Infant Development-II. Cumulative risk for adverse outcome was determined through univariate and multivariate analyses. RESULTS: Survival of the 85 children included 23 of 23 after arterial switch, 16 of 26 after Norwood, six of six after total anomalous pulmonary venous drainage repair, and 22 of 30 after miscellaneous repair. Outcomes were as follows: in-hospital death, 14 (16%); postdischarge death, four (5%); motor/sensory disability, three (4%); motor/mental delay (<70), 21 (25%); and intact survivors, 43 (50%). Cohort mental (84+/-17) and motor (80+/-22) scores were lower for those with chromosomal abnormalities, 67+/-16 and 61+/-17, respectively. Fifty-five percent of the outcome variance was explained by duration of preoperative ventilation, 18%; genetic anomaly, 5%; intraoperative variables, 18%; and postoperative variables, 14%. CONCLUSIONS: Risk for adverse outcome is cumulative, with preoperative determinants contributing significantly to total variance. Potentially modifiable variables should be sought in an attempt to improve outcome.
A modified infarct-exclusion technique for postinfarction ventricular septal perforation is presented. The perforation is closed directly by a small patch next to the conventional patch, and biological glue is applied between the patches to induce stable polymerization. The patch stuck to the infarcted septum, and no residual shunt was observed in any patient because the wide adhesion prevents excessive pressure on the suture line. Seven of 9 patients in whom this method was used had good results. This technique appears suited for repair of ventricular septal perforations, especially those with extensive fresh infarction.