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Results in Ventricular Septal Defect, Complete Atrioventricular Canal, and Total Anomalous Pulmonary Venous Connection

John J. Lamberti, MD; Chung-Yuan Lin, MD; Anthony Cutilletta, MD; Constantine E. Anagnostopoulos, MD; Rene A. Arcilla, MD; Robert L. Replogle, MD

Arch Surg. 1978;113(7):822-826.

Abstract
• During a six-year period, 46 severely symptomatic infants (average age, 5.1 months) underwent correction of ventricular septal defect (22 patients), total anomalous pulmonary venous connection (13 patients), and complete atrioventricular canal (11 patients), with the use of surface cooling to 20 °C. Cardiac repair was performed during circulatory arrest, and rewarming was performed with a pump oxygenator. Ten patients undergoing repair of ventricular septal defects were studied hemodynamically at 21 °C, before repair and at 37 °C after rewarming. Heart rate, left ventricular systolic pressure, maximum dp/dt, cardiac index, stroke work, and oxygen consumption were reduced substantially at 21 °C. Systemic vascular resistance was increased at 21 °C. All changes were reversible with repair and rewarming. A protocol for hemodilution and crystalloid volume loading was devised to maintain urine output after early patients were noted to demonstrate renal dysfunction. With this protocol, survival rates were 89% for patients with ventricular septal defects, 67% for those with atrioventricular canal defects, and 85% for those with total anomalous pulmonary-venous connection.

(Arch Surg 113:822-826, 1978)

Author Affiliations
From the Department of Surgery, Section of Cardiology (Drs Lamberti, Replogle, and Anagnostopoulos), the Department of Anesthesiology, Section of Pediatrics (Dr Lin), and the Section of Pediatric Cardiology (Drs Cutilletta and Arcilla), The University of Chicago Pritzker School of Medicine.

Footnotes
Accepted for publication Feb 21, 1978.

Read before the 25th annual scientific meeting of the International Cardiovascular Society, Rochester, NY, June 17, 1977.

Reprint requests to Department of Surgery, Box 152, The University of Chicago Hospitals and Clinics, 950 E 59th St, Chicago, IL 60637.