摘要:

The effects of age, type of return, presence of pulmonary venous obstruction, obstruction to left heart filling, systemic arterial oxygen saturation (Ao O2%), pulmonary-to-systemic flow ratio (Qp/Qp), pulmonary-to-systemic resistance ratio (Rp/Rs%), and mean pulmonary artery-to-mean systemic arterial pressure ratio (MPAP/MSAP%) in 35 cases of total anomalous pulmonary venous return seen in the last 5 years, were studied in relation to prognosis and management. The surgical mortality was increased in patients with anomalous venous return to the right common cardinal system (right superior vena cava and azygos vein) regardless of age and was significantly lower in patients over 6 months of age and in those who had preoperative intensive medical management. No relation was found between surgical mortality and Ao O2%, Rp/Rs, MPAP/MSAP%, or the presence of pulmonary venous obstruction. The small size of the left atrium rather than the small size of the left ventricle is felt to be one of the reasons for operative failure. The importance of obstruction to left heart filling at the atrial level was stressed. Until technics for surgical treatment of this group of anomalies in early infancy become more successful, we recommend balloon atrial septostomy in combination with intensive medical management as effective palliative treatment for most of these patients in the first 6 months of life.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

One hundred and twenty patients with transposition of the great arteries (TGA) were encountered over a decade. Survivors have been followed until after definitive repair, and 39% were alive when reviewed.The majority (69%) had no significant communication between the pulmonary and systemic circulations. Of 48 patients in this poor-mixing group who had an atrial septectomy, 23 (48%) survived to have an atrial baffle repair at an average age of 37 months, and 37% were alive at the time of review. In contrast, 18 of 22 (82%) patients with poor mixing who had a balloon septostomy had a definitive operation at an average age of 13 months, and 17 (77%) survived.Twenty patients (17%) had good mixing between the two circulations due to the presence of a large ventricular septal defect (VSD) or patent ductus arteriosus, and presented with mild cyanosis and heart failure. Of this group, 35% were alive when reviewed. Four of the five patients who had a successful atrial baffle repair and correction of associated lesions were less than 4 months of age when this was performed. Where TGA was associated with VSD and pulmonary stenosis, 36% survived.Definitive operation at an early age has been made possible by the introduction of a surgical technic using profound surface-induced hypothermia and limited cardiopulmonary bypass.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

The diagnosis of interstitial pulmonary edema can be made only on the basis of the chest roentgenogram. This often is the first sign of left heart failure, which may be completely unsuspected clinically in the absence of alveolar edema. Kerley lines, or septal lines, are the most familiar roentgen sign of this condition. Other, more common findings include: perivascular and peribronchial cuffing, subpleural thickening, perihilar haze, and a generalized loss of translucency of the lung. Meticulous roentgen technic is essential for recognition of these subtle signs.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID