Lessons learned from 119 consecutive cardiac transplants for pediatric and congenital heart disease.

Background: This manuscript reviews all patients who underwent orthotopic heart transplantations (OHT) at our program (116 patients underwent 119 OHT) to describe their diagnostic characteristics and to assess risk factors for mortality.

Methods: Median age at OHT was 179 days (mean, 1,446.6 ± 188.

Pediatric cardiac transplantation in children with high panel reactive antibody.

Background: Elevated panel reactive antibody (PRA) may be considered a risk factor precluding pediatric orthotopic heart transplantation. We retrospectively reviewed our management strategy and outcome data for children undergoing heart transplantation with high PRA (> 10%).

Methods: Sixty consecutive children (median age = 130.

Outcomes in patients with interrupted aortic arch and ventricular septal defect. A multiinstitutional study. Congenital Heart Surgeons Society.

Among 183 neonates with interrupted aortic arch and ventricular septal defect entering a multiinstitutional study between 1987 and 1992, nine died before repair was accomplished. Among the remaining 174, survival at 1 month and 1, 3, and 4 years after repair was 73%, 65%, 63%, and 63%, respectively. The risk factors for death were low birth weight, younger age at repair, interrupted arch type B, outlet and trabecular ventricular septal defects, smaller size of the ventricular septal defect, and subaortic narrowing.

Allograft replacement of the aortic valve versus the miniroot and valve.

Between February 1986 and April 1992, 27 patients ranging in age from 8 to 65 years (median, 18 years) underwent allograft replacement of the aortic valve with one death (operative mortality, 3.7%). The indications for operation were aortic regurgitation in 14 patients, aortic stenosis in 7, aortic stenosis/regurgitation in 4, and endocarditis in 2.

A frequency-time domain signal processing system.

A digital signal processing system for time series analysis with two modes of usage--the first a rapid, hands-on exploratory method, and the second an automatic, printed, labeled graphic output method--is described. The system utilizes a Time Data 1923C system with integral PDP-11 minicomputer, and a console. Major error problems have been contained and a large-volume graphic analysis capability has been developed.

Antimicrobial vs placebo prophylaxis in noncardiac thoracic surgery.

A prospective, double-blind evaluation of the efficacy and safety of prophylactic cephalosporins was done in 57 patients undergoing noncardiac thoracic surgery. Twenty-eight received cephalosporin therapy, and 29 received placebo. Overall, the incidence of postoperative infections was the same; infections developed in five (17.

Intraoperative Doppler coronary artery finder.

Time-consuming difficulty is occasionally encountered in finding coronary arteries or previously placed vascular grafts during coronary revascularization procedures. A catheter-tipped, continuous-wave Doppler ultrasonic probe with simple audio output has been shown to be capable of expediting the search for these vessels.

Post-traumatic intracardiac shunts. Report of two cases and review of the literature.

Intracardiac shunts consequent to penetrating thoracic injury have been reported in 94 patients. Two additional cases are reported emphasizing the frequently complex anatomic abnormalities, the variability in clinical course, and the favorable outcome of repair. From a review of the literature, it is apparent that most such lesions should be corrected, since patients are at a continual risk of symptomatic cardiac dysfunction and repair offers an excellent prognosis with minimal morbidity.

Tag-along pacemaker.

In a R-wave-inhibited pulse generator, an increased interval between pacing artifacts giving an apparently slow rate was not indicative of impending battery failure in two patients. The pacing artifacts appeared as a tag-along phenomenon following a slow idioventricular rhythm as the result of an exit block due to (1) hyperkalemia and (2) perielectrode fibrosis. Simple tests demonstrated a normally functioning R-wave sensing circuit and pacemaker.

Blood as a potential vehicle for the cytomegaloviruses.

This study analyzed transfused blood as a potential vehicle for infectious cytomegalovirus (CMV) particles. A total of 207 patients who received a total number of 897 units of blood were monitored. A complement-fixing antibody titer of 1:8, as determined by micro-titer technique, was observed in 14.

Palliative treatment of carcinoma of the esophagus.

In a ten-year period 139 patients with epidermoid carcinoma of the esophagus were treated by palliative feeding procedures, palliative radiation therapy, radiation therapy for cure, or resection. Analysis of the results of these modes of therapy indicates that long-term palliation is best achieved when resection is the primary method of therapy. Radiation therapy improved survival in the first 12 months of disease; however, no patients treated with radiation therapy alone were cured.

Chylopericardium with cardiac tamponade after cardiovascular surgery in two patients.

Two patients developed postoperative chylopericardium leading to acute cardiac tamponade. Delayed diagnosis and urgent throacotomy did not prevent death in three-month-old patient after the Glenn anastomosis of the superior vena cava to the right pulmonary artery, whereas early recognition of chylopericardium following repair of an interrupted aortic arch in an 11-week-old patient was successfully treated by tube pericardiostomy. The literature is reviewed, and an anatomic predisposition for post-surgical chylopericardium is proposed.

Effects of hemodilution on hypotention during cardiopulmonary bypass.

Arterial pressure, systemic vascular resistance, and viscosity measurements were made on 20 patients, during cardiopulmonary bypass with hemodilution to an average hematocrit reduction of 48 plus or minus 12 percent. The arterial pressure and blood viscosity decreased an average of 56 plus or minus 16 percent and 40 plus or minus 12 percent, respectively. The total peripheral resistance following the start of bypass was significantly below normal (p smaller than 0.

Changes in arterial pressure, viscosity and resistance during cardiopulmonary bypass.

Large changes in arterial pressure and systemic vascular resistance are frequently observed at the onset of and during cardiopulmonary bypass, particularly when hemodilution is employed. In order to assess the extent to which these changes are induced by changes in blood viscosity, we measured viscosity, pressure, and flow in a series of 17 patients. Hemodilution was used in Group A (12 patients) but not in Group B (5 patients).