Repair of neonatal aortic coarctation.

From 1981 to 1991, 146 infants under 1 month of age underwent repair of aortic coarctation. Forty-two had isolated coarctation, 53 had associated ventricular septal defect, and 51 had complex cardiac defects. The principal mode of presentation was congestive heart failure.

Intraoperative transesophageal echocardiography of coronary artery fistulas.

Coronary artery fistula is a rare abnormality but one with substantial surgical importance, as operation abolishes the fistulous shunt volume, progressive coronary dilatation, and potential coronary steal. Prior reports emphasize the utility of direct inspection on cardiopulmonary bypass, with visualization of drainage of blood or cardioplegia from the fistulous connection, to define the drainage site. We report 3 patients in whom intraoperative transesophageal echocardiography was used for precise localization of the fistulous drainage site, selective demonstration of vessels feeding the fistulas, and documentation of abolition of fistulous flow, all without need for cardiopulmonary bypass.

Femoropopliteal bypass with externally supported knitted Dacron grafts: a follow-up of 200 grafts for one to twelve years.

Purpose: This article reports our experience with externally supported, preclotted knitted Dacron grafts in femoropopliteal bypass.

Methods: This is a retrospective analysis of a consecutive series of 154 patients who received 200 grafts (175 above knee and 25 below knee). Follow-up extended to 12 years (mean 59 1/2 months).

Left ventricular outflow tract obstruction: an indication for intraoperative transesophageal echocardiography.

Transesophageal echocardiography (TEE) provides detailed anatomic imaging of both discrete and complex forms of left ventricular outflow tract (LVOT) obstruction, and Doppler techniques provide additional information regarding the site, mechanism, and severity of the obstruction. Because the transaortic surgical approach to LVOT obstruction often provides limited direct visualization during surgery, we sought to evaluate the utility of intraoperative TEE during surgery for LVOT obstruction. We tested the hypotheses that intraoperative TEE would (1) be useful in defining the level and nature of LVOT obstruction, (2) serve to direct the surgical approach, (3) define the adequacy of relief of LVOT obstruction, and (4) detect surgical complications.