[Balloon atrioseptostomy (B.A.S.) in the management of neonates and infants with transposition of great vessels (author's transl)]. / Doswiadczenia wlasne w stosowaniu zabiegu Rashkinda w leczeniu calkowitego przelozenia wielkich pni tetniczych

From June 1969 to April 1973, B.A.S. was carried out in 2-day to 6-month-old 65 infants at the Institute of Paediatrics of the Academy of Medicine in Warsaw. There were 16 infants up to one week old, 39 infants--up to one month, and 10 infants more than one month old. There were 43 boys and 22 girls among them. Cardiac catheterization and B.A.S. were carried out in most children up to 24 hours following hospitalization under local anaesthesia and premedication with robenzperidol and dolantin. In 11 of the 65 infants after B.A.S. the saturation with oxygen in the right atrium under-went no significant changes; in 54 cases it increased by 10 to 49 per cent. Of the 65 infants in whom B.A.S. was performed, 37 are alive, 28 had died. In 20 children under constant outpatient cardiological follow up the observation period has amounted from 6 months to 3 years. Their motoric development and growth is retarded, there is moderate cyanosis, but no symptoms of congestive failure were found. All these children are administered digitalis in chronic maintenance doses. Respiratory infections occured frequently in these patients. As mentioned above, 28 infants died at the age of 2 days to 6 months. Post mortem examination revealed that the B.A.S. was unsufficient in 14 cases. However, 14 infants died in spite of the satisfactority performed atrioseptostomy. Pulmonary oedema or haemorrhagic-and-inflammatory changes in the lungs as well as generalized thrombosis were the most frequent causes of death. On the basis of their own experience the authors elaborated indications and instructions for B.A.S. in neonates and infants with congenital heart diseases. These directives are based on the Team Work of cardiologists, anaesthesiologists, cardiac surgeons and paediatric radiologists. Because ever greater numbers of neonates are being sent to the Institute of Paediatric of the Academy of Medicine from all over Poland, the authors organized continuous cardiological emergency service to carry out B.A.S. procedures as soon as possible, without delay.

Rashkind's operation in treatment of complete transposition of the great vessels in the newborn and infants.

The study is a result of many years investigations of a large pediatric team consisting of physicians from various specialities on the methods of management in cases of transposition of greater arterial vessels. Trials of surgical treatment requiring thoracotomy in the newborn with severe cardiorespiratory failure gave no good results. In recent years 65 operations of atrioseptostomy without thoracotomy were carried out during cardiac catheterization. In nearly half the cases improvement of the general condition was obtained with survival for several months or even over one year, but close supervision was required and the children were being prepared for more radical cardiosurgical operations.