Tuesday Afternoon, May 17, 1966

2:00 P.M. Executive Session (Limited to Active and Senior Members)

Ballroom

3:00 P.M. Scientific Session: REGULAR PROGRAM

Ballroom

Address by the President

Herbert C. Maier, New York, N.Y.

"The Pulmonary and Pleural Lymphatics:

A Challenge to the Thoracic Explorer"

Address by Honored Guest

Ronald Belsey, M.S., F.R.C.S.

Senior Consulting Cardio-Thoracic Surgeon

to the South West Regional Thoracic Unit

Bristol, England

"Functional Diseases of the Esophagus and

their Surgical Management"

28. Long Term Results of Valvuloplasty for Mitral Insufficiency in Children

Donald R. Kahn*, Aaron M. Stern*, Joan M. Siomann*,

Marvin M. Kirsh*, Ann Arbor, Mich., Stuart Lennox*†,

London, England, and Herbert Sloan, Ann Arbor, Mich.

Twenty patients, age two to eighteen years, were operated upon for mitral insufficiency using cardiopulmonary bypass with one death. Eleven were rheumatic and nine were congenital. All patients were severely symptomatic with gross cardiac enlargement, left-sided failure, marked persistent dyspnea, or growth retardation. At operation a dilated annulus with thickened leaflets was present in the rheumatic group. This was corrected by armuloplasty. In the congenital patients all had dilated annulus associated with other manifestations, as cleft valve, elongated or shortened chordae tendineae. Annuloplasty was performed and, in addition, the cleft was sutured when indicated. Of the nineteen surviving patients, fourteen are asymptomatic, three improved and two were temporarily improved but subsequently required re-operation three and five years later. Both of these children are now improved. Seventeen of the nineteen patients have been followed over two years with the longest seven years. Most children showed a marked decrease in heart size but have persistent, less intense, systolic murmurs. There have been no late deaths. One embolic episode was associated with conversion of rhythm. This study indicates that satisfactory long term results can be obtained with valvuloplasty techniques in most children with mitral insufficiency, and prosthetic valve replacement is not indicated,

29. The Tricuspid Valve: A Surgical Challenge

Pierre Grondin*, Gilles Lepage*, Y. Castonguay*, and

Claude Meere*, Montreal, Quebec

Sponsored by Edouard D. Gagnon

The correction of advanced multivalvular heart diseases has revived interest in the pathological disturbances of the tricuspid valve, often underestimated in the past. Significant tricuspid malfunction was present in 40 of our cases of multivalvular corrections. In our early group of 13 patients, the tricuspid lesion was not corrected and poor results were observed. Correction, was undertaken in 27 with gratifying results. This includes annuloplasty in 14, prosthetic replacement in 7 and commissurotomy in 6. Decision to correct the tricuspid malfunction was entirely based upon surgical exploration. When the leaflets appeared intact, an antero-inferior annuloplasty improved competence in most cases. Prosthetic replacement was performed for severe valvular lesions or when annuloplasty was inadequate. In pure stenosis, direct incision of the fused commissures is by far preferable. Pre-operative and operative assessment of the tricuspid valve are discussed. Techniques for annuloplasty or prosthetic replacement are illustrated. The authors strongly believe that significant tricuspid involvement should not be ignored in the correction of multivalvular deficiencies. Because of its tremendous impact on the immediate post-operative course, severe tricuspid insufficiency, even if deemed functional and reversible, must be corrected. Prosthetic replacement has obvious disadvantages and annuloplasty provides an adequate restoration of function in a good number of cases.

30. The Role of the Papillary Muscle: Chordal Mechanism in Mitral Valve Replacement

C. Walton Lillehei, and Randolph M. Ferlic*, Minneapolis, Minn.

During the past four years, 149 consecutive patients with advanced mitral valve lesions have been operated upon with a total valve prosthesis inserted in each. Analysis of the 37 hospital deaths indicated an interesting dichotomy in these patients. The 93 cases in whom the papillary muscle had been preserved sustained a 13% hospital mortality, while a comparable, concomitant group of 56 patients without papillary muscle preservation suffered a 45% hospital mortality. The incidence of the "low output" picture was rare in the group of patients with papillary muscle preservation despite a fairly advanced disease state. The incidence of renal failure was 2% in this group against the 11% encountered in the patients without papillary muscle preservation. This further suggests the contribution of the intact papillary muscle-chordal mechanism to an effective cardiac output. Recatheterization data on both groups of patients will be presented. The contribution of the papillary muscles to isometric ventricular contraction has been observed physiologically and borne out clinically.

*By Invitation

†Evarts A. Graham Memorial Traveling Fellow, 1964-65

Tuesday Evening, May 17, 1966

7:00 P.M. Reception

Reception Room

8:00 P.M. Banquet and Dancing

Ballroom

Attendance limited to Members of the Association and their ladies, Invited Speakers and their ladies, Invited Guests and their ladies

Dinner dress preferred