Early and late results of the modified Waterston shunt with PTFE grafts for palliation of complex congenital cyanotic heart disease in neonates.

During a 12 year period from 1978 to 1989, 35 infants under 4 weeks of age underwent palliative surgery for complex congenital cyanotic heart disease with a short (1-1.5 cm) PTFE graft between the ascending aorta and the right pulmonary artery (modified Waterston shunt). Twenty-three infants had pulmonary atresia and 14 had severe pulmonary stenosis. Underlying cardiac lesions were tetralogy of Fallot (n = 11), single ventricle (n = 7), transposition complexes (n = 6), and intact ventricular septum and hypoplastic right heart syndrome (n = 13). There were 4 early deaths (10.7%) in the entire series, 2 of which were shunt related. Three of the 4 occurred during our initial experience with this shunt in 1978 and 1979. They led to the modified Waterston shunt being abandoned for 3 years in favor of other shunt procedures. Since 1983 one early death occurred in 28 infants (3.5% mortality) with no death in the latest 26 patients. All patients were followed up between 6 and 108 months. There were 4 late deaths, one of which was shunt related. We observed a significant difference in the shunt patency rate between 4 and 5 mm grafts: palliation was adequate after 2 years in 52% of the patients when a 4 mm graft was used and in 89% of the 5 mm graft group (p less than 0.005). Reshunting was necessary in 7 infants between 5 and 60 months after primary surgery. Recatheterization was performed in 17 infants for suspected shunt failure (n = 6) or diagnostic reasons (n = 11).(ABSTRACT TRUNCATED AT 250 WORDS)

[Echocardiographic detection of endocarditis vegetations of the tricuspid valve in 2 children with ventricular septal defect]. / Echokardiographischer Nachweis endokarditischer Vegetationen der Tricuspidal-klappe bei zwei Kindern mit Ventrikelseptumdefekt.

Two children with ventricular septal defect and tricuspid valve endocarditis are presented. One of them had ongoing endocarditis with septic pulmonary embolism, the other suffered from florid endocarditis presumably 3 months before the study. M-mode echocardiography showed echodense masses in the right ventricular outflow tract in one and anomalous systolic anterior movement of tricuspid valve tissue in the other patient. Sectorechocardiography demonstrated in both children abnormal masses originating from the tricuspid valve and extending into the right ventricular outflow tract. Surgery confirmed endocarditic vegetations and destructions of the tricuspid valve. After operative closure of the ventricular septal defect and reconstruction of the tricuspid valve both children are well. Our experience underlines the usefulness of echocardiography, especially sectorechocardiography, in demonstrating endocarditic vegetations originating from the tricuspid valve.