A new atrial septostomy technique

Balloon atrial septostomy is usually ineffective if the atrial septum is thickened. A technique for incising the atrial septum is described. A no. 6 French catheter was modified to enclose a tiny surgical blade. The distal end of the blade was pivoted to the catheter tip, and the proximal end was attached to a guide wire in the catheter lumen. Advancing the guide wire protruded the blade through a slit in the long axis of the tip of the catheter. Atrial septostomy was performed in five newborn lambs in vivo and in adult dog hearts and human hearts in vitro by advancing the catheter tip across the atrial septum with the blade retracted and withdrawing it to the right atrium with the blade extended. Eight to 12 mm lacerations of the atrial septum were produced and could be extended by subsequent balloon septostomy. The technique may be useful when balloon septostomy has been ineffective.

Anomalous origin of the left coronary artery from the pulmonary artery. A new method of surgical repair

Anomalous origin of the left coronary artery from the pulmonary artery has been surgically corrected by means of a technique that avoids direct suturing of the coronary artery itself. The anomalous left coronary artery is removed from the pulmonary artery with a cuff of pulmonary artery tissue about its orifice. In a five-and-one-half-year-old patient the anomalous coronary artery was anastomosed directly to the aorta using this technique. In another patient, seven months of age, the anomalous coronary artery could not be anastomosed directly to the aorta and a segment of the patient's subclavian artery was interposed between the left coronary artery and the aorta to complete the anastomosis. In the latter patient, profound hypothermia and circulatory arrest were used during construction of the anastomosis in an attempt to minimize further myocardial damage. The establishment of a two coronary artery system has been demonstrated to be feasible in the infant or young child with this anomaly.

Systolic time intervals in infants with congestive heart failure

Using the apexcardiogram as a time reference for opening and closure of the aortic valve, systolic time intervals (STI) in infants were determined in 150 normal infants ranging in age from 1 day to 1 year. Thirty infants with congestive heart failure secondary to a variety of congenital and acquired heart diseases were studied in a similar manner for comparison. The data revealed that heart failure in the infant is not marked by any one pattern of STI. In specific disease entities associated with congestive heart failure, the STI appear to be consistent. In infants with congestive heart failure due to congenital heart disease, the STI do not correspond with values reported in the adult with hypertensive or arteriosclerotic disease. The differences are explained by viewing STI in infants primarily a function of hemodynamic alterations dictated by an underlying cardiovascular anomaly rather than a result of a primary myocardial derangement. The findings in the infant with chronic heart failure due to primary myocardial disease tend to parallel data previously reported in the adult with arteriosclerotic disease and chronic heart failure.