PULMONARY FUNCTION IN ADULTS WITH INTRACARDIAC SEPTAL DEFECT

Pulmonary function has been assessed in 45 patients with atrial or ventricular septal defect. Moderate and severe dyspnea occurred almost exclusively in patients with high pulmonary artery pressure irrespective of whether this was due to high pulmonary blood flow or high pulmonary vascular resistance.

Evidence is presented suggesting that this raised pulmonary artery pressure causes lung damage shown by a low compliance and high nonelastic resistance. These findings suggest an abnormal alveolar-capillary membrane and an abnormality of ventilation-perfusion relationships, which in turn cause a relatively low pulmonary diffusing capacity requiring excessive hyperventilation on exercise to maintain oxygen requriments. In patients with moderate or severe dyspnea, the abnormally high minute volume of ventilation during mild exertion is associated with a high work of breathing, the dual abnormality separating them from patients with only slight dyspnea on exertion.

PALM-PRINT PATTERN IN CONGENITAL HEART DISEASE

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THE RESULTS OF OPEN-HEART OPERATIONS PERFORMED ON CHILDREN

From December 1, 1959, to January 1, 1965, a total of 166 children have undergone 168 open-heart operations at The Children's Hospital in Winnipeg, Manitoba.While this series is not a large one, the defects encountered include most of those cardiac abnormalities which are amenable to open-heart correction in children.For all operations a Kay-Cross disc oxygenator was employed. In 42 of the 168 operations, hypothermia (25-30 degrees C.) was also used and was obtained by a Brown-Harrison heat exchanger incorporated into the arterial line.The smallest infant survivor in this series of patients weighed 8 lb. 14 oz. at the time of her operation.Of the 166 children operated upon 149 have survived, an overall survival rate of 89.8%.

PALLIATIVE PROCEDURE FOR TREATMENT OF TRANSPOSITION OF THE GREAT VESSELS

1. Extreme efforts at palliation seem indicated in the very young infant with transposition of the great vessels and no accompanying defects of note since good candidates for later total correction may thereby be preserved.

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2. A palliative procedure is presented wherein an atrial septal defect is created, and the blood flow from the inferior vena cava is diverted through the defect.

3. Presented are nine patients less than two months of age and with arterial oxygen saturations less than 35% who underwent the described procedure.

4. There were two early and two late deaths. The survivors are all doing well clinically and have required no further procedure.