Secundum atrial septal defects in children. A postoperative evaluation of 65 cases

Atrial septal defects of secundum type in patients less than 40 years of age. A follow-up study

The series comprised 479 consecutive patients from all parts of Norway operated on in the period 1955-1976. Only 8% were less than 7 years at surgery. Dominating preoperative symptoms were dyspnea and increased fatigue. The follow-up period ranged from 2 to 21 years, mean 10,28 years. There were 4 early deaths (within 30 days after surgery), and at follow-up further 5 patients had died. Excluding a man who died in a traffic accident the total mortality is 1,7%. Of the 470 surviving patients 81,7% were improved, 17% were unchanged and 1,3% had deteriorated. In patients with symptoms dyspnea and palpitations were common complaints. Different types of arrhythmia were found in 31 patients. One third were paroxysmal tachy-arrhythmias, and 9 patients had atrial fibrillation. Only 3 of the 31 patients had some type of preoperative arrhythmia, and 26 were more than 20 years of age of surgery. Seven patients were reoperated because of a residual left to right shunt, 5 of them were initially operated in hypothermia dn inflow occlusion. During the follow-up period 10 patients had late cardiovascular disorders.

The Southern Thoracic Surgical Association 50th anniversary celebration: the impact of STSA pediatric cardiothoracic surgery manuscripts on surgical practice

BACKGROUND

Members of the Southern Thoracic Surgical Association (STSA) have presented important pediatric cardiothoracic surgery papers at the annual meetings over the last 50 years. In order to determine the influence of these presentations on the practice of surgery, a review was undertaken. Early papers were characterized by emerging advances in open-heart surgery, anatomic congenital heart studies, and electrophysiologic discoveries that extended life with pacemakers. Later years were characterized by innovative myocardial preservation methods, improved cardiopulmonary bypass techniques, expanded homograft availability, emphasis on accurate repairs, intraoperative transesophageal echocardiography, and cardiopulmonary transplantation.

METHODS

All but one of the scientific programs of the annual meetings (that of 1964) were located. The programs were reviewed and 180 presentations were identified on topics in congenital heart disease, pediatric thoracic disease, and pediatric thoracic wall abnormalities. Of those 180 oral presentations, 155 manuscripts (86%) were eventually published or in press and available for critical review and analysis. Manuscripts were grouped by diagnosis or therapeutic intervention. We determined a "cumulative citation frequency" (CCF), which measures the number of times an article is cited in the bibliography of related papers in the universe of participating journals. The selected manuscripts were compared with the historic landmark contributions and the existing trends at the time, and the number of articles both by individual authors and from institutions were tallied.

RESULTS

Grouping by authors and institutions showed that 100 of 155 pediatric cardiothoracic manuscripts (65%) originated from 13 institutions. The CCF for the 20 leading articles ranged from 26 to 93.

CONCLUSIONS

This historical STSA 50-year record of pediatric cardiothoracic advances was accomplished in a milieu of collegial respect and camaraderie. Our annual meetings over the years have provided a venue for thoracic surgeons to share their ideas, innovations, and scientific inquiry. These contributions have significantly affected the practice of pediatric cardiothoracic surgery. The STSA has worked for 50 years and we trust that it will work for another 50 years and beyond.

Long-term follow-up of patients with malformations for which definitive surgical repair has been available for 25 years or more

The results of long-term follow-up studies of patients with five common congenital heart defects are reviewed. The lesions included are ventricular septal defect, atrial septal defect, patent ductus arteriosus, pulmonary stenosis and coarctation of the aorta. A definitive, rather than palliative, operation has been available for each of these lesions for more than 25 years. Therefore many patients who have undergone operation for one of these lesions are now reaching adulthood. Although most of these postoperative patients live a normal life, many have residuae or sequelae that require close observation or treatment. Other persistent abnormalities of the physical examination, electrocardiogram and chest radiogram are obvious but call for no precaution or treatment. We have drawn on our own experience and the published experience of others to identify those findings and historical factors that best reflect the long-term prognosis of these patients. In addition, recommendations concerning the need for continued prophylaxis against infective endocarditis, and the problems of insurability and employability of these postoperative patients are discussed.

His-Purkinje responses and refractory periods during atrial extrastimulation in children with heart defects

During atrial extrastimulation, split His potentials, prolonged His-to-ventricular (H2V2) intervals and block distal to the His bundle deflection were observed in both preoperative and postoperative children with heart defects. His-Purkinje responses and refractoriness were identified in 31 of 78 (40%) pediatric patients (20 of 51 preoperative and 11 of 27 postoperative) during atrial extrastimulation coupled to sinus and/or paced cycle lengths. Split His potentials were found in 14 patients (eight preoperative and six postoperative) and His bundle relative refractory periods ranged from 250--490 msec. Prolonged H2V2 intervals were found in these and in an additional 16 patients (11 preoperative and five postoperative) and the relative refractory period of the His-Purkinje system ranged from 230--500 msec. Block distal to the His deflection occurred in seven patients (five preoperative and two postoperative) and the effective refractory period ranged from 230--510 msec. Split His potentials, long H2V2 intervals and block distal to the His bundle deflection produced by atrial extrastimulation were found in peroperative as well as postoperative children. These responses probably represent functional electrophysiologic characteristics of the pediatric cardiac conduction system.