Hemodynamic effects of ketamine in children with congenital heart disease.

Pulmonary and systemic vascular responses to ketamine (2 mg X kg-1, intravenously) were studied during cardiac catheterization in 20 children with congenital heart lesions. Pulmonary and systemic resistances (Rp, Rs), ratios between pulmonary and systemic flows (Qp/Qs), and left to right (L----R) and right to left shunts (R----L) were calculated before and after ketamine administration. Statistically significant (P less than 0.05) but clinically minor increases in heart rate (106.8 to 109.9 beats/min), mean pulmonary artery pressure (20.6 to 22.8 mm Hg), and Rp/Rs (0.12 to 0.14) were seen after ketamine. There were no significant changes in systemic arterial pressure, Rs, Qp/Qs, L----R, R----L, or arterial oxygen or carbon dioxide tensions. No patient had any major untoward effects from ketamine administration. It is concluded that the hemodynamic alterations after ketamine administration in children undergoing cardiac catheterization are small and do not alter the clinical status of the patients or the information obtained by cardiac catheterization.

Cardiac surgery under age two years. A review.

To assess the current status and risks of both open and closed cardiac procedures for congenital heart disease in patients under the age of 2 years, we reviewed all cardiac catheterizations and cardiac operations done from January, 1974, through December, 1977, at The Children's Orthopedic Hospital and Medical Center in Seattle, Washington. In this interval 370 patients under 2 years of age were catheterized. Eighty open procedures were performed in patients under 2 years of age, with seven hospital deaths. One hundred twenty-four closed heart procedures were performed on children under the age of 2 years, with eight deaths, for a hospital mortality rate of 6.5 percent. This review of consecutive cases over a 4 year period suggests that the judicious application of palliation or open repair using current techniques can lead to an overall mortality rate of between 6 and 7 percent for both open and closed heart procedures in children under 2 years of age. Since all deaths except one in the open-heart group occurred in patients with the most complex multiple defects, it seems reasonable to suggest that improved intraoperative and postoperative techniques have lowered the time for repair of straightforward congenital heart defects to under 2 years of age.

Radical enlargement of the aortic root and outflow tract to allow valve replacement.

A method of radical enlargement of the aortic root and outflow tract is described. The technique consists of incising the aortic annulus, the anterior mitral leaflet, and the superior aspect of the left atrium. Valve replacement is then possible, with patch reconstruction of the resulting defects.