Ventricular dysfunction, elevated pulmonary vascular resistance, and residual distal artery distortion contribute to early mortality after a Fontan operation; they may be transient or reversible. A baffle fenestration, allowing right-to-left shunting, maintains cardiac output limits right atrial pressure. fenestration was surgically created at the time of modified repair in 20 consecutive patients. Risk factors included pressure 18 mm Hg more, end-diastolic 12 valvar regurgitation,...

Fifty patients with congenital heart disease, ages 2 days-30 years (median 12 months) at cardiac surgery, underwent lung biopsy to assess pulmonary vascular disease (PVD). Twenty-six had ventricular septal defects (VSD), 17 d-transposition of the great arteries (D-TGA), and seven, atrioventricular canal (AVC). Quantitative morphologic data was correlated hemodynamic data. Three new grades PVD were observed. Abnormal extension muscle into peripheral (grade A) found in all patients; increased...

BACKGROUND The "fenestrated Fontan" (surgical baffle fenestration followed by transcatheter test occlusion and permanent closure after postoperative recovery) was adopted in an effort to reduce perioperative mortality morbidity. This study assesses the effect of on outcome. METHODS AND RESULTS Patients having a modified Fontan operation with cavocaval cavopulmonary anastomosis were retrospectively selected for study. Those (n = 91) compared those without 56) respect preoperative risk...

At the time of surgical repair, a lung biopsy was performed on patients with congenital heart defects who either had pulmonary hypertension or in whom it would be likely to develop if lesion were not corrected. Pulmonary vascular changes, assessed morphometrically and also according classification Heath Edwards (Circulation 18: 533, 1958), correlated postoperative hemodynamic findings: mean arterial pressure day after correction resistance measured 1 year later. On first day, increased...

BACKGROUND As the probability increases that arterial switch operation is optimal treatment for transposition, detailed information about outcomes and circumstances in which they are suboptimal becomes important. METHODS AND RESULTS A multi-institutional prospective study with annual follow-up included 513 neonates simple transposition or ventricular septal defect entering diagnosis at < 15 days of age undergoing an repair. The 1-month 1- 5-year survivals were 84%, 82%, respectively....

Between 1973 and 1985, 220 infants (age 1 day to 18 months, mean = 7 months) underwent repair of tetralogy Fallot (TOF) or TOF/pulmonary atresia with 17 early deaths. Follow-up status was ascertained for 184 203 survivors (91%) at a postoperative interval 2 185 months (mean 60 months). Significant residual hemodynamic lesions included ventricular septal defect in three, right outflow gradient excess 40 mm Hg 24. Reoperation interventional catheter procedures were performed 31 (17%) patients....

Left ventricular (LV) work-function curves were used to assess LV performance in eight postoperative tetralogy of Fallot (TOF) patients who underwent repair before 2 years age (group 1) and 12 after 2). All without significant residual shunts or pulmonary stenosis. Results compared with those seven control patients. Left- right-heart hemodynamics measured at various levels afterload induced by methoxamine while heart rate was maintained constant. Cardiac output serially measured. The slope...

BACKGROUND Patients with tetralogy of Fallot, pulmonary atresia, and diminutive arteries are a high-risk group for whom there is no consensus on the correct approach to medical management. The purpose this report review 14-year experience in treatment these patients comparing management schemes. METHODS AND RESULTS Between January 1978 August 1988, 91 Fallot atresia had an adequate evaluation their artery anatomy before any surgical Forty-eight (38 104 mm2/m2) supplied by aortopulmonary...

Balloon aortic valvotomy (BAV) is an alternative to surgical in infants and children. We compared BAV 16 consecutive neonates (1985-1988) a prior group of (1978-1984). Both groups were comparable terms age, weight, hemodynamic data, left ventricular size, associated lesions. There six early one late deaths after surgery. Five out requiring second operation died. Left size (measured 13 neonates) had some influence on survival surgery: three with small or hypoplastic ventricles 10 normal-sized...

The pathogenesis of paradoxical hypertension after resection coarctation the aorta was investigated by comparing course seven children undergoing repair with five acyanotic elective cardiovascular surgery. During first 24 hours surgery, all patients demonstrated a rise in systolic blood pressure (35 +/- 15.5 mm Hg; P less than 0.001), significant depression cold pressor test response, and only slight elevation plasma renin activity. In next 24-72 hours, developed diastolic (26.8 10.6...

Despite current medical and surgical therapy, infants with symptomatic congenital mitral stenosis (CMS) continue to have high rates of morbidity mortality. Catheter balloon dilation has been successful in relieving symptoms a few older children CMS but not evaluated infants.We reviewed the records 85 assess severity CMS, associated cardiac lesions, echocardiographic morphological appearance valve, treatment, outcome. There were five valve morphologies identified: "typical" hypoplastic...

Between January 1983 and December 1987, 62 patients underwent an arterial switch operation for transposition of the great arteries with ventricular septal defect or double outlet right left ventricle. There were three hospital deaths (4.8%), no occurred in neonates (less than 1 month age, n = 18). late deaths, one due to coronary obstruction two pulmonary vascular obstructive disease. One child has been lost follow-up. We have prospectively evaluated remaining 55 survivors by clinical...

Left ventricular dimensions, wall thickness, stress, and indexes of afterload, preload, contractility, early diastolic function, as well regional motion, were determined by echocardiographic methods in patients with transposition the great vessels after arterial switch operation age-matched normal controls. In evaluated surgery, body surface area-adjusted left dimensions smaller, thickness was increased compared Ventricular performance (fractional shortening) most but abnormally low 10%....