Straddling atrioventricular valve: two-dimensional echocardiographic diagnosis, classification and surgical implications.

The usefulness of subclassifying the anatomic variations of straddling and overriding atrioventricular (AV) valve by 2-dimensional echocardiographic observation were evaluated. Chordae straddling into a contralateral ventricle were subdivided into type A (chordae inserting into the contralateral ventricle near the crest of the ventricular septum), type B (chordae inserting along the contralateral ventricular septum) and type C (chordae inserting into the free wall or papillary muscles of the contralateral ventricle). Overriding AV valve anulus was described as minor (less than 50% of the anulus committed to the contralateral ventricle), major (about 50% of the anulus committed to each ventricle), and double-inlet ventricle (greater than 50% of both AV valves committed to a single ventricular chamber).

Tetralogy of Fallot with absent pulmonary valve. Early and late results of surgical treatment.

From 1957 through September, 1983, 35 patients with tetralogy of Fallot and absent pulmonary valve underwent operation. Two subgroups of patients were recognized: minimally symptomatic (Group A, n = 21) and markedly symptomatic (Group B, n = 14). Group B patients were symptomatic at an earlier age and were younger at operation.

Survival in atrioventricular discordance.

Limited information is available concerning the long-term survival of patients with atrioventricular discordance, ventriculoarterial discordance, and two ventricles (corrected transposition). The long-term follow-up of 107 patients examined at the Mayo Clinic over a 30-year period between 1951 and 1981 was reviewed. Overall survival from the date of Mayo Clinic diagnosis was 70% at five years and 64% at ten years.

Results of the Damus-Stansel-Kaye procedure for transposition of the great arteries and for double-outlet right ventricle with subpulmonary ventricular septal defect.

From 1975 through 1982, the Damus-Stansel-Kaye procedure was performed on 20 patients with complete transposition of the great arteries (TGA) and on 4 with double-outlet right ventricle (DORV) and subpulmonary ventricular septal defect (VSD). The patients ranged from 6 days to 20 years old (median age, 13 months). Associated anomalies included atrial septal defect (24 patients), VSD (14), and others (25).

Surgical repair of univentricular heart (double inlet left ventricle) with obstructed anterior subaortic outlet chamber.

The results of operation in all patients with univentricular heart and an obstructed anterior subaortic outlet chamber who were operated on utilizing extracorporeal circulation at the Mayo Clinic from 1973 through 1983 were reviewed. Ten of the 18 patients died during the immediate postoperative period and there was one late death. Factors significantly related to operative and immediate postoperative mortality were age at operation, cardiothoracic ratio on X-ray examination, degree of ST depression on electrocardiogram and pressure gradient across the outlet foramen at catheterization.

Late results after Starr-Edwards valve replacement in children.

Selection of types of prosthetic heart valves for children remains controversial. The case histories of 50 children surviving valve replacement with Starr-Edwards prostheses between 1963 and 1978 were reviewed to evaluate the long-term performance of mechanical valves. The 31 boys and 19 girls ranged from 6 months to 18 years in age (mean 10.

Surgery for tricuspid regurgitation late after mitral valve replacement.

Tricuspid valve insufficiency may contribute to a poor hemodynamic result after mitral valve replacement. To determine the role of surgical treatment, we have reviewed the records of 32 adult patients who underwent tricuspid valve repair or replacement 4 months to 14 years after mitral valve replacement. Mild tricuspid valve insufficiency at the time of mitral valve replacement was present in 21 patients (66%); 26 patients (81%) had New York Heart Association class IV disability.

Reoperation for obstructed pulmonary ventricle-pulmonary artery conduits. Early and late results.

Obstruction of pulmonary ventricle-pulmonary artery conduits can result from neointimal peel formation or valvular degeneration and calcification. To determine the risks and outcome of reoperation, we reviewed the records of 100 consecutive patients who had replacement of severely stenotic pulmonary ventricle-pulmonary artery conduits. At reoperation, the 70 male and 30 female patients had a mean age of 13.

Functional single ventricle: cardiorespiratory response to exercise.

The cardiorespiratory response to exercise was measured in 27 children with functional single ventricle. All 27 patients had a significant reduction in exercise time, work performed, maximal exercise heart rate, maximal oxygen uptake and systemic arterial blood oxygen saturation. The reduction in exercise performance increased with increasing age of the patients.

Left ventricle-aortic conduits in pediatric patients.

From August, 1974, to January, 1982, left ventricle-aortic porcine valved conduits were inserted in three patients less than 2 years old (Group 1) and in 10 patients between 2 and 14 years of age (Group 2) for relief of severe left ventricular outflow tract obstruction. The distal anastomosis was made to the ascending aorta in seven patients and to the supraceliac abdominal aorta in six patients. In six patients, the conduit was sutured directly to the left ventricle, and in seven a stented right-angle connector was employed.

Hemodynamic response to positive end-expiratory pressure following right atrium-pulmonary artery bypass (Fontan procedure).

Thirteen patients were studied in the early postoperative period to determine the hemodynamic response to increasing levels of positive end-expiratory pressure (PEEP) following right atrium-pulmonary artery bypass (Fontan procedure). Hemodynamic data and arterial oxygen and carbon dioxide tensions were measured without PEEP and with PEEP = 3, 6, 9, and 12 cm H2O. Cardiac index decreased progressively with increasing levels of PEEP compared to PEEP = 0 (cardiac index = 2.

Long-term follow-up after palliative operation for univentricular heart.

Data are presented from 84 patients (45 males, 39 females), aged 6 days to 25 years (mean 10 years), with univentricular heart who underwent a palliative surgical procedure. The mean follow-up period was 5 years (range 1 month to 25 years). Of the 84 patients, 33 died and 51 are alive.

Complete atrioventricular canal associated with tetralogy of Fallot. Morphologic and surgical considerations.

Between 1962 and 1979, 14 patients with complete atrioventricular canal and tetralogy of Fallot underwent repair of both anomalies. The ages of the patients ranged from 1 to 12 years. Six patients had Down's syndrome.

Transient atrioventricular block after open-heart surgery for congenital heart disease.

The records of 22 patients with transient atrioventricular (AV) block after open-heart surgery for congenital heart disease from 1972 to 1978 were reviewed to determine the natural history of this entity. Preoperatively, no patient had AV block; 3 had right bundle branch block (BBB), 1 had left BBB and 5 had nonspecific intraventricular conduction delay. Complete AV block developed in 20 patients and Mobitz II AV block in 2.

Reoperation on prosthetic heart valves. An analysis of risk factors in 552 patients.

Five hundred fifty-two patients underwent a total of 617 reoperations for repair or replacement of a prosthetic heart valve. Operative mortality for first reoperation (530 patients) was 5.9% for the aortic position and 19.

Enlargement of the aortic root or anulus with autogenous pericardial patch during aortic valve replacement. Long-term follow-up.

Patch enlargement of the aortic root or anulus is a widely accepted technique when restrictive anatomy is encountered during aortic valve replacement. Patches made of prosthetic material have been used almost exclusively, and patches of autogenous pericardium have not received wide acceptance. Although pericardium is advantageous because of its low cost, ready availability, and ease of handling, its long-term durability has not been fully established.

Two-dimensional echocardiographic--surgical correlation in Ebstein's anomaly: preoperative determination of patients requiring tricuspid valve plication vs replacement.

Two-dimensional echocardiographic features were correlated with surgical findings in 25 patients with Ebstein's anomaly (age 7 days to 71 years). There was excellent agreement between echocardiographic and surgical findings. Echocardiographic observations of anterior leaflet tethering and restriction of motion, as well as small functional right ventricle, were the strongest noninvasively obtained indicators for valve replacement surgery.

Surgical pathology of obstructed, right-sided, porcine-valved extracardiac conduits.

Thirty-seven specimens were available from 39 children and adolescents with congenital heart disease who have had operations at the Mayo Clinic (Rochester, Minn) to replace obstructed Hancock conduits that had been implanted 17 to 93 months (mean, 62 months). Stenosis affected the porcine valve alone in 17 (46%), the synthetic graft alone in 11 (30%), both the valve and the graft in six (16%), and other sites in three (8%). Valvular stenosis resulted from degenerative changes with secondary thrombosis and calcification, whereas insufficiency resulted from cuspid tears, thrombotic adhesions, and endocarditis.

Verapamil for refractory ventricular fibrillation during cardiac operations in patients with cardiac hypertrophy.

Calcium-entry blockers prevent ventricular fibrillation during acute myocardial ischemia in laboratory animals. They may be useful as an adjunct to cold cardioplegia by preserving the myocardium during cardiopulmonary bypass. Their use may limit myocardial infarct size.

Results of reoperation for periprosthetic leakage.

Between 1961 and 1978, 6,602 valves were replaced in 5,660 patients. Reoperation for periprosthetic leakage was performed in 105 patients (1.6% of the valves); early mortality was 5.

Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole.

Despite the use of oral anticoagulation in patients with prosthetic heart valves, persistent thromboembolism over time warrants a search for improved methods of prevention. Thus, patients receiving 1 or more mechanical prosthetic heart valves were randomized to therapy with warfarin plus dipyridamole (400 mg/day) or warfarin plus aspirin (500 mg/day) on the basis of location and type of valve and surgeon, and followed up with a concurrent, nonrandomized control group taking warfarin alone. In 534 patients followed up 1,319 patient-years, excessive bleeding (necessitating blood transfusion or hospitalization) was noted in the warfarin plus aspirin group (23 of 170 [14%], or 6.

Permanent endocardial pacing in pediatric patients.

Improved technology with smaller pulse generators and passive and active fixation endocardial lead systems has the potential for facilitating safe, reliable pacing in pediatric patients. Of 18 pediatric patients (mean age 11.1 years) undergoing permanent transvenous cardiac pacing during the period April, 1977, to January, 1981, two (11%) required reoperation during a mean follow-up of 18.