Pulmonary sequestration causing congestive heart failure in infancy: a report of two cases and review of the literature.

Congestive heart failure as a presenting symptom in infants with pulmonary sequestration is rare, and the cases of only 3 such patients have been reported. The clinical features, hemodynamics, and management of two additional patients are described. Both were seen in severe congestive heart failure in the absence of any associated cardiac anomalies.

The present status of heterotopic cardiac transplantation.

In the period November, 1974 to May, 1980, 30 patients underwent heterotopic heart transplantation at Groote Schuur Hospital. One patient subsequently underwent retransplantation for rejection. There were no operative deaths.

Carcinoma of the oesophagus.

A survey of carcinoma of the oesophagus at Kalafong Hospital revealed a greater incidence of the disease in males, being highest in the age group 50 - 59 years, with the middle third of the oesophagus the most prevalent site and with oesophagotracheal or oesophagobronchial fistulae a common complication.

Annular subvalvular idiopathic left ventricular aneurysms in the black African.

The case of a Black African patient with an annular subvalvular left ventricular aneurysm of unknown origin is described, and the pathological findings in this condition together with a review of the literature is presented. We have operated on 12 patients with this condition between 1958 and 1978. Ventricular aneurysm in the Black African is extremely rare; aneurysms resulting from ischemic heart disease have not been encountered in this racial group, and contrary to earlier reports in the literature, syphilis is not the most common cause of left ventricular aneurysms in this group.

A review of experience with cardiac transplantation.

Despite the hazards of rejection and the complications of immunosuppression, cardiac transplantation is the only available treatment for myocardial disease that is refractory to medical therapy and in which no other form of surgery can be offered. There are disadvantages to orthotopic cardiac transplantation, which have led to the development by this department of the heterotopic cardiac transplant, which functions as a natural left-heart and right-heart assist device. The results of 19 cases are presented.

Heterotopic versus orthotopic heart transplantation.

Since November 1974, heterotopic cardiac transplants have been performed at this unit in preference to orthotopic transplants. A number of reasons have led us to prefer this technique, namely donor malfunction in the immediate postoperative period and during rejection; right ventricular failure of the donor heart in the orthotopic position in patients with pulmonary hypertension; the ease of patient management; and the use of the donor heart as a temporary method of cardiac support. Disadvantages are the later recognition of rejection and the difficulty in performing transvenous endomyocardial biopsies.

Pelvic displacement of a cardiac pacemaker following trauma. A case report.

The rate migration of an implanted cardiac pacemaker from the subrectus area anterior to the peritoneum to the pelvis following a motor vehicle accident is reported. Discovery of dislodgement was made by observing a marked increase of pacemaker impulse amplitude in the three standard limb leads as measured on an oscilloscope.

Intraoperative posterior left ventricular wall rupture associated with mitral valve replacement.

An unusual but often lethal complication of mitral valve replacement is rupture of the left ventricle. The two recognized types of rupture are discussed, and the literature and pathology are reviewed. It is stressed that this complication can be prevented, and the factors involved in prevention are outlined.

Left innominate vein (brachiocephalic) monitoring of central venous pressure after cardiac operations.

Pre-operative insertion of a central venous pressure monitoring line may be difficult when superficial veins are lacking. Groin cannulations predispose to bacterial endocarditis, and are difficult to keep from becoming obstructed by hip flexion. Internal jugular lines are precarious and tend to be unreliable.

Trans-septal monitoring of left atrial pressure after cardiac surgery. An alternative method.

A simple, safe method for trans-septal insertion of a left atrial pressure line in 25 patients is presented. Complications have not been noted. Monitoring of left atrial pressure is often desirable after cardiac surgery.

Heterotopic cardiac transplantation with a xenograft for assistance of the left heart in cardiogenic shock after cardiopulmonary bypass.

One of the indications for the use of the heterotopic cardiac transplant is temporarily to support a failing heart in the anticipation of its recovery when all other measures of support have been unsuccessful. Human donors are not always available when required and we decided to use a xenograft for this purpose when the need arose. This report details our experience with a baboon and a chimpanzee cardiac xenograft transplant in the heterotopic position.

The advantage of heterotopic cardiac transplantation over orthotopic cardiac transplantation in the management of severe acute rejection.

The major problems with organ transplantation are rejection of the allograft and the side effects of antirejection therapy. This report describes the successful treatment of a patient in whom rejection of the donor heart developed 10 months after implantation. The recipient's own heart had been left intact and was able to support the circulation during the period of rejection.

[The heterotopic heart transplantation: first clinical experiences (author's transl)].

Ten patients, all men, have been operated of heterotopic heart transplantation since the end of 1974. Ages ranged from 59 to 24 years with an average of 38 years. Six of them suffered from ischaemic heart disease, two from cardiomiopathy and two from rheumatic heart disease.

Osseous manifestations of congenital syphilis.

The re-emergence of syphilis as a medical problem in most parts of the world makes it necessary to reinstate the congenital osseous manifestations as an important element in the differential diagnosis of the disease in infancy. The previously well-known snuffles, pseudoparalysis and bizarre radiological changes should now be brought to the attention of perhaps more than one generation of physicians who underwent their medical training at the time when the disease was a rarity.