Perioperative respiratory compliance in children undergoing repair of atrial septal defects

Children with atrial septal defects (ASD) have less respiratory compliance (Crs) than normal cohorts. There could be implications for anaesthetic management if these children also have decreased compliance during anaesthesia. To examine the changes in Crs before, during and following surgical correction of the atrial defect, Crs was measured in 29 infants and children, 15 undergoing correction of secundum type atrial septal defects, and a group of 14 children of similar weight undergoing non-thoracic surgery. During sedation, Crs was measured using the single breath technique (SBT) and during anaesthesia, both before and after the surgical procedure, an inflation technique was applied to determine Crs. To investigate the aetiology of the difference in Crs, the pulmonary to systemic flow ratio (Qp:Qs) was determined using echocardiography during sedation in the ASD patients. During sedation, Crs in the ASD group was 52.7 +/- 19.5% less than in the control group. The slope of the line of regression of Crs vs height for the ASD group was significantly less (P less than 0.05) than that of the control group during sedation. However, during anaesthesia, Crs in the ASD group was not significantly different from the control group either before or after surgery. The per cent decrease in Crs during sedation in the children with ASD, in comparison with the control group, did not correlate with the Qp:Qs ratio of the ASD group (r2 = 0.012,NS). We conclude that, in spite of lower Crs during sedation, infants and children with ASD do not have lower Crs during anaesthesia and cardiopulmonary bypass than normal controls undergoing non-thoracic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

The use of aprotinin in children undergoing operative repair of isolated atrial septal defects

BACKGROUND: The purpose of this retrospective study was to examine the benefits, risks and costs associated with aprotinin use in children who underwent repair of an atrial septal defect (ASD). The primary aim was to determine whether the transfusion rate is lower in children who received aprotinin compared with those who did not during ASD repair. The use of aprotinin has been shown to reduce transfusion requirements for children undergoing primary or secondary repair of congenital cardiac anomalies. However, past studies have not reported the benefits of this agent during low complexity procedures such as ASD repair. METHODS: All children who underwent ASD repair over 6 years (3 years pre- and postroutine use of aprotinin for all CPB cases in the institution) were identified, and their medical records reviewed. Children with multiple congenital cardiac lesions were excluded. The following data were recorded: demographics and baseline laboratory findings, intraoperative use of aprotinin, cardiopulmonary bypass information including details of ultrafiltration, all intraoperative and postoperative transfusions, postoperative bleeding and relevant laboratory findings. RESULTS: One hundred and fifteen children were included, 66 of whom received aprotinin. Transfusion rates were not different between children who received aprotinin [n = 8 (12%)] and those who did not [n = 3 (6%)]. Furthermore, changes in hematocrit were not different between groups. These findings were similar when children 15 kg. CONCLUSIONS: This study suggests that aprotinin use offers no benefit for children undergoing isolated repair of an ASD.     

Right ventricular size and ventricular septal motion after repair of atrial septal defect in children

An enlarged right ventricle and abnormal ventricular septal motion are characteristic echocardiographic features of atrial septal defect and often persist after the defect has been completely closed, even when the operation clinically is judged to be successful. These features were examined retrospectively 15 to 21 months after operation in a group of children whose atrial septal defect had been closed between January 1976 and July 1979. Despite satisfactory postoperative results in all, about two thirds had an enlarged right ventricular dimension and about the same number had abnormal septal motion when examined echocardiographically an average of 18 months after operation. The best operative strategy seems to be to operate while the right ventricular end-diastolic dimension is still relatively small in echocardiographic terms.     

Results of surgical repair of atrial septal defects in the middle-aged and elderly

Twenty-six patients aged 45 or over at the time of surgical repair of a secundum atrial septal defect have been reviewed with the object of assessing the value of the operation. Pre-operatively 12 were classed as grade IIIA or worse on the basis of their symptoms. There were six deaths in the series, three early and three late. The remaining 20 patients were improved as judged by symptoms, physical examination, and radiographic and electrocardiographic criteria. In 11 patients catheterized pre- and post-operatively, it was found that the pulmonary arterial pressure had fallen following the repair, reaching normal levels in nine. It is concluded that surgical repair of secundum atrial septal defects is of material benefit to patients of this age-group.     

Anaesthesia with hypothermia for closure of atrial septal defects in children

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - This paper deals with a total of 63 cases of atrial septal defect with which one author (A.W.C.) was associated. All patients...     

Early cardiac perforation after atrial septal defect closure with the Amplatzer septal occluder

We report a case of aortic perforation after transcatheter closure of an atrial septal defect by an Amplatzer septal occluder. During emergency surgery, perforations of the dome of the right atrium and the noncoronary sinus of Valsalva of the aorta were repaired. Atrial septal defect was primarily closed. A short anterosuperior rim should be considered a risk factor for aortic perforation in transcatheter atrial septal defect closure.     

Intracardiac hemodynamics after closure of atrial septal defects with the endovascular device, Amplatzer septal occluder

Changed size and forms of the right and left ventricles of the heart and intraventricular hemodynamics were studied in 5 patients after closing the defects of the interventricular septum with an intravascular device. It was found that after occlusion of the defects by the safe and atraumatic endovascular device the right ventricular myocardium of the heart relaxed, the stroke index became less, the ejection fraction became greater, the diastolic diameter of the right ventricle decreased, and of the left ventricle increased. The indices of the regional contraction function of the tri-cuspid and output sectors of the input part and external and pulmonary output sectors of the right ventricle were found to normalize.