New forceps delivery technique for coil occlusion of patent ductus arteriosus.

We remain very enthusiastic about transcatheter coil occlusion of the PDA. However, surgical ligation has been performed successfully and with relatively low risk of complications. Therefore, an alternative nonsurgical technique must demonstrate comparable success and safety. We believe that this new forceps delivery technique has significant advantages over previously reported PDA coil occlusion techniques and should warrant further clinical investigation.

Surgery without angiography for neonates with aortic arch obstruction.

Traditional diagnostic assessment of the neonate and infant with congenital abnormalities of the aorta causing left ventricular outflow tract obstruction has required catheterization and angiography. However, these patients frequently present critically ill and invasive diagnostic procedures may be associated with significant risks. Two-dimensional echocardiography has been used for aiding diagnosis of aortic arch abnormalities, but there has been little information concerning its use as the definitive imaging technique for preoperative assessment. We reviewed neonates who required urgent surgery for congenital obstruction of the aorta. The diagnosis was made using two-dimensional echocardiographic imaging and Doppler techniques for hemodynamic assessment in lieu of catheterization and angiography in all. Anatomic detail provided by the noninvasive approach was both sensitive and specific in guiding surgery in all but one case. We conclude that echocardiography eliminates the need for invasive preoperative diagnostic procedures in selected neonates with congenital aortic arch obstruction.

Massive upper gastrointestinal hemorrhage in an infant following cardiac surgery.

This is a case of massive upper gastrointestinal hemorrhage and hematoma formation in a 32-day-old infant following uneventful repair of congenital heart disease. Stress ulcers and gastrointestinal hemorrhage are rare complications of cardiac surgery in the young. Conservative management often fails and early surgery can be lifesaving. The etiology of this problem remains unknown and more work is needed so that effective preventive measures can be developed.

Surgical treatment of midgut nonrotation in the adult patient.

For a period of four years, five adult patients with nonrotation of the intestine and midgut volvulus have been treated. Two distinct clinical presentations were encountered. The chronic presentation is that of colicky abdominal pain, often present for many years, which is corrected by surgical intervention. The acute presentation with strangulation of the intestine may occur without pre-existing symptoms. Knowledge of this entity and a high index of suspicion are necessary for the diagnosis because massive gangrene of the intestine may result from a delay in treatment. Prophylactic surgical treatment in the asymptomatic patient is recommended to prevent this catastrophic occurrence.