Search

From March 26, 1954, to July 19, 1955, 45 patients with major cardiac malformations not previously correctable underwent open repair utilizing cross-circulation between patient and donor without donor deaths. All operations were carried out at normothermia with lowered flow rates based on azygos flow studies. Twenty-seven patients, more than half of them infants, had ventricular septal defects closed. There were 8 hospital deaths, and there have been only 2 late deaths in 30 years. Fourteen (87.5%) of 16 who underwent recatheterization have closed defects. The 17 30-year-survivors are all in New York Heart Association Functional Class I. Five patients 4 months to 10 years old were operated on for atrioventricular canal (complete form). All had intractable failure, and 4 had pulmonary hypertension. Two of the 3 hospital deaths were due to heart block. The long-term survivor, a 15-month-old infant at the time of operation (severe pulmonary hypertension, 90/50 mm Hg), underwent repair 31 years ago and is now married with 3 children. Recatheterization disclosed normal pulmonary pressure (20/4 mm Hg), no shunts, and mild mitral regurgitation. Ten cyanotic tetrads 13 months to 14 years old were operated on with 5 hospital deaths. Of the 3 late deaths, 1 was accidental at 17 years, 1 occurred suddenly at home 13 years after operation in infancy for atresia, and the third occurred at reoperation 10 years later. The 2 remaining patients (1 the first patient operated on) are in excellent health. The surgical methods used and the physiological advantages of cross-circulation (temporary placenta) that made these results possible at a time when surgical knowledge was primitive are described.

In patients undergoing open cardiac surgery there are substantial differences in acidbase balance, preoperatively, between acyanotic and cyanotic patients. Metabolic studies on patients undergoing total body perfusion by means of a bubble oxygenator show the arterial pH values for all 84 acyanotic patients were within the range of normal at the termination of the bypass, and in 31 cyanotic patients the arterial pH remained at the control level—somewhat acidotic. Other physiological responses have been measured to achieve the goal of providing for the patient an optimum perfusion volume plus a margin of safety to allow for biological variations. This goal is obtained by monitoring each bypass procedure by means of a continuous recording of the patient's electroencephalogram and systemic blood pressure, and adjusting thereafter the perfusion rate to keep these variables normal or near normal.