Tuesday Afternoon, May 4,1954
2:00 P.M. Executive Session. (Limited to Active and
Senior Members).
3:00P.M. Scientific Session: REGULAR PROGRAM.
Address of the President, Emile Holman, San Francisco,
Calif.
28. The Surgery
of Infundibular Pulmonic Stenosis with Intact Ventricular Septum. (A Type of
"Pure" Pulmonic Stenosis.)
Robert P. Glover, Hugo Gontigo (by
Invitation),
Thomas C. McAuliffe (by invitation), Thomas J. E. O'Neill and
Robert E. Wells (by invitation), Philadelphia,
Pa.
The term pulmonary stenosis has been loosely applied to
all obstructions of pulmonary artery blood flow, be they due to pulmonary
valvular stenosis, obstructing malformations of the infundibulum proximal to
the valve, pulmonary artery stenosis or combinations of these defects.
True pulmonary stenosis is a valvular lesion
recognizable clinically, easily confirmed by physiologic studies and readily
relieved by surgical means. The condition is not associated with a ventricular
septal defect and does not produce cyanosis except in rare instances (patent
foramen ovale with high right atrial pressure).
A fact little realized clinically and scarcely referred
to except in pathological treatises is that this same syndrome not infrequently
is reproduced by an infundibular stenosis in which the pulmonary valve is
normal. This condition is recognizable if not clinically then certainly by
physiologic means (catheterization) and can be treated with equal satisfaction
by surgical methods.
Six of our 25 cases of "pure" pulmonic stenosis were of
the infundibular variety-a startling and rather significant finding. Their
management, catheterization data, technic of surgery and eventual result are
detailed. There was no mortality in the entire series. Illustrated by slides
and moving pictures in color.
29. Pulmonic Valvular
Stenosis: Technic of Open Valvuloplasty and Results.
Henry Swan, Henry C. Cleveland (by
invitation), Helmut Mueller
(by invitation) and
S. Gilbert Blount (by
invitation), Denver, Colorado
Pure pulmonic valvular stenosis has been treated almost
universally by the trans-ventricular incision procedure of Brock. The operation
is of low risk and is followed by apparent clinical improvement. However,
objective physiologic studies, when made some months postoperatively, have been
disappearing in the majority of instances, and serious elevations of right
ventricular pressures remain. The long term outlook of such individuals would
seem to be far from normal.
Hypothermia has allowed visual exploration of the valve
and direct valvuloplasty via the pulmonary artery. Under direct vision, the
funnel-shaped deformity is converted to a bicuspid valve with commissures
extending the entire distance to the valve ring.
Postoperative studies on
patients undergoing this procedure have to date been most gratifying. The
dynamics of the right circulation have returned essentially to normal. The
evidence is good that the valvular stenosis has been entirely relieved.
Complete data on five patients will be presented. Eight patients have been
treated by this method and there have been no deaths.
The techniques of the operation and the significance of
pulmonary regurgitation, should it occur, will be discussed. A colored sound
movie illustrating the surgical procedure will be presented.
30. Experiences in the
Surgical Treatment of Aortic Stenosis.
William H.
Mueller, Jr., Albert A. Kattus (by invitation),
J. Francis Dammann, Jr. (by
invitation) and Rodney T. Smith
(by invitation), Los Angeles, Calif.
The importance of developing a method for surgically
treating aortic stenosis cannot be overemphasized, because it is the second
most common acquired stenotic valvular deformity. Many investigators have
helped to establish methods for the treatment of this defect on a sound
clinical basis. Bailey and co-workers demonstrated the blunt dilatation of the
valve with the usual tear along the commissural fusion areas. At present this
is the most satisfactory procedure for opening the valve but yet preventing
significant regurgitation.
We have used a method which employs the introduction of
a dilating instrument through a stab wound in the wall of the left ventricle to
engage the aortic valve and open it. If an additional deformity such as mitral
stenosis is present, this valve is also opened in the usual manner.
We have performed aortic valvulotomy on 16 patients.
Their ages range from 14 to 61. All had acquired deformities except one who had
a congenital lesion. Six had comcomitant mitral stenosis which was relieved
simultaneously, and one had a coarctation of the aorta which was resected also.
The oldest patient died during an operation in which the dilating instrument
was being passed retrogradely through the innominate artery into the valve. Two
others died, one three days after operation and one five days after operation.
A cardiac pace-maker was used for 60 hours on one patient who developed
complete heart block just after the aortic valve was opened and who later
developed cardiac arrest. He subsequently regained a sinus rhythm.
Technical considerations, pressure studies, and
problems encountered in dealing with these patients will be presented.
6:30 P.M. Cocktails,
Dinner and Dancing, Sheraton-Mt. Royal Hotel.
Address by Guest of Honor, Dr. F. Cyril James,
Principal and Vice-Chancellor, McGill University, Montreal.
Attendance limited to Members of the Association and their ladies,
Invited Speakers and their ladies.
Dinner Dress.
