Wednesday Morning, April 26, 1961

9:00 A.M. Scientific Session: REGULAR PROGRAM Grand Ballroom

31. The Anatomy and Embryology of Endocardial Cushion Defects

L. H. S. van mierop (by invitation), Ralph D. Alley

Harvey W. Kausel, and Allan Stranahan, Albany, N. Y.

We have re-examined the relevant embryology in 21, closely graded, serially sectioned human embryos ranging in size from 5 to 40 mm. in length. This has resulted in a clearer definition of the precise contribution of the endocardial cushions to adult heart structures. The normal embryology of the endocardial cushion derivatives was correlated with anomalous derivatives found in abnormal hearts. A classification of endocardial cushion defects will be provided.

32. The Surgical Management of Complete Common Atrioventricular Canal

James V. Maloney, Jr., Samuel A. Marable (by invitation),

and Donald G. Mulder (by invitation), Los Angeles, Calif.

Our experience comprises six patients. The first two succumbed post-operatively even though the repair seemed technically satisfactory at autopsy. The others have survived complete repair of the lesion. There have been no instances of persistent heart block or of overt evidence of the low cardiac output syndrome. All are in satisfactory condition after follow-up periods ranging from one to 17 months. The anatomical variants of this defect and the required surgical maneuvers will be discussed. The factors in preoperative evaluation of prognostic significance will be enumerated.

33. Surgical Considerations for Treatment of Congenital Tricuspid Atresia and Stenosis

Raymond K. Bopp (by invitation), Parry B. Larsen (by invitation),

Joan L. Caddell (by invitation),

James R. Patrick (by invitation), and William W. L. Glenn,

New Haven, Conn.

Disappointment in the correction of this deformity has forced a re-examination of its basic nature and led to the present approach to management consisting of an anastomosis between the superior vena cava and the right pulmonary artery. This has been applied in three cases with successful follow-up of 3 to 13 months. Our clinical, pathological and operative experience with this condition will be reported.

34. Surgical Correction of Congenital Supravalvular and Valvular Aortic Stenosis Using Deep Hypothermia and Circulatory Arrest

Archer S. Gordon (by invitation), Bertrand W. Meyer,

and John C. Jones, Los Angeles, Calif.

Deep hypothermia (8°-10° C.) without an extracorporeal oxygenator provides an uncomplicated technic for unhurried (approximately one hour) repair of congenital Supravalvular and valvular aortic stenosis. The necessity for anoxic arrest of the heart or perfusion of coronaries is obviated. During the past one and one-half years we have used this method clinically for all cases without evidence of brain damage or serious acidosis. Postoperative results in this series have been excellent. The most important aspects of management are: (1) Careful attention to details of the deep hypothermia system and circulatory arrest, (2) adequate correction of stenosis without creating any insufficiency.

35. An Improved Transatrial Approach to the Closure of Ventricular Septal Defects

Allen S. Hudspeth (by invitation), A. Robert Cordell (by invitation),

Jesse H. Meredith (by invitation),

and Frank R. Johnston, Winston-Salem, N. C.

An approach that allows better visualization of the defect, avoids division of ventricular myocardium, and affords more accurate suture placement has been developed. It utilizes: (1) Antero-posterior incision of the right atrium near the atrio-ventricular groove, (2) circumferential detachment of the septal leaflet of the tricuspid valve near the annulus; (3) closure of the ventricular septal defect; (4) closure of the incision in the tricuspid valve; (5) closure of the atriotomy. Clinical experience to date will be reported. A short movie will demonstrate the method.

36. Aortic-Cardiac Fistulas Following Corrective Operations for Ventricular Septal Defect and Tetralogy of Fallot

M. Weinberg, Jr., M. H. Agustsson (by invitation),

B. M. Gasul (by invitation), E. H. Fell, J. P. Bicoff (by invitation),

Z. Steiger (by invitation), T. Iwa (by invitation),

and R. Arcilla (by invitation), Chicago, Ill.

Five aortic-cardiac fistulas produced during surgical correction of ventricular septal defects and tetralogies of Fallot are presented. These include two cases of aortic valvular insufficiency, two cases of sinus of Valsalva-right ventricular fistula, and one case of coronary artery-right ventricular fistula. The following points are emphasized: (1) These defects may be unrecognized causes of death, or, if asymptomatic, may be missed if careful follow-up is not maintained over a long period; (2) the anatomic relationships of the aortic valves and sinuses to the ventricular septal defects must be appreciated if these fistulas are to be avoided; (3) when congestive heart failure occurs postoperatively the complications described here must be considered; (4) retrograde aortography is the procedure of choice in establishing diagnosis; (5) reoperation is mandatory for survival in those patients in congestive heart failure.

37. Cardiac Surgery in the Newborn

John L. Ochsner (by invitation), and Denton A. Cooley,

Houston, Tex.

In 300 infants less than one year of age congenital malformations of the heart and great vessels have been treated surgically. The defects in order of decreasing frequency are: Patent ductus arteriosus, tetralogy of Fallot, complete transposition of the great vessels, ventricular septal defect, coarctation of the aorta, tricuspid atresia, aortic stenosis, total anomalous pulmonary venous drainage, pure valvular pulmonic stenosis, and aortic vascular ring. The survival rate ranged from 64% to 100%, the over-all survival being 81%. Results of necropsies performed on 110 infants who had not received surgical therapy will be compared with the surgically treated cases. The indication for and technics of operation in these infants will be presented.