Surgical repair of anomalous origin of the coronary artery from the pulmonary artery in children.

OBJECTIVE: To evaluate surgical management of children with coronary artery anomalies, including patients with rare abnormalities (left anterior descending artery or right coronary artery originating from the pulmonary artery). METHODS: A retrospective review of eight patients (aged 2 months--10 yr; median 3.5 yr), treated for coronary artery anomalies between 1989 and 1999. Coronary vessels were reimplanted to the aorta in four children, while the remaining four were subjected to the Takeuchi procedure. RESULTS: All children survived. None required mechanical circulatory support. In six patients significant mitral valve insufficiency developed, nevertheless, no intraoperative mitral valvuloplasty was performed. Follow-up was 2 months--10 yr. All patients developed normally and are currently in NYHA class I. Echocardiography revealed normal FS and EF values within 1--17 months postoperatively. CONCLUSIONS: In children with coronary artery anomalies, the best results are achieved with an early diagnosis and aggressive management. In our opinion coronary vessel reimplantation and the Takeuchi procedure yields comparable results.

[Results of surgical treatment of congenital heart defects in infants below 2500 grams]. / Wyniki operacyjnego leczenia wrodzonych wad serca u dzieci z masa ciala ponizej 2500 g.

We present a review of our recent experience of operating on infants below 2500 g suffering from congenital heart disease. A retrospective review was performed in 73 children who had undergone cardiac operations at our institution from 1990 to 1999. There were 43 (59%) females and 30 (41%) males; the mean age at operation was 28 days (range 4 to 92). The mean gestational age was 34.7 weeks (range 24 to 41), mean birth weight--1899 g (range 700 to 2450) and mean weight at operation--2013 g (range 640 to 2500). Cardiac diagnoses included patent ductus arteriosus (PDA) (N = 21, 28.7%), ventricular septal defect (VSD) (N = 9, 12.3%), transposition of great arteries (TGA) (N = 10, 13.7%), tetralogy of Fallot (TOF) (N = 7, 9.6%), double-outlet right ventricle (DORV) (N = 4, 5.5%), truncus arteriosus communis (TAC) (N = 4, 5.5%), hypoplastic left heart syndrome (HLHS) (N = 4, 5.5%), coarctation of aorta (CoAo) (N = 6, 8.2%), total anomalous pulmonary venous return (TAPVR) (N = 2, 2.7%), aortic stenosis (AoVS) (N = 3, 4.1%), interrupted aortic arch (IAA) (N = 1, 1.4%), pulmonary atresia (PA) (N = 1, 1.4%) and common atrioventricular canal (CAVC) (N = 1, 1.4%). Hospital mortality was 16.4%. There were 6 early deaths (8.2%) and 6 late deaths (8.2%). A higher mortality rate was noted in premature children and in children who had undergone palliative procedures. At a 1-116-month follow-up (mean 39 months), of 57 (93.4%) patients, 46 (80.7%) were in NYHA class I and 11 (19.3%) in NYHA class II. In conclusion the authors believe that early intervention can be performed in infants below 2500 g, and the associated mortality and morbidity rates are low.

[Various immunological phenomena in myasthenia gravis. Preliminary report]. / Badania niektórych zjawisk immunologicznych w miastenii. Doniesienie wstepne.

The proportions of subsets of T and B lymphocytes and their counts were determined in the peripheral blood in 15 patients with myasthenia. The blastic transformation of these cells was studied after stimulation with mitogens: PHA, Con A and PWM. The serum immunoglobulin level was determined as well. In five thymectomized patients these investigations were repeated during up to two years after the operation. The comparison of the results of these tests in the patients and healthy controls showed differences only in the ability to respond with blastic transformation of the lymphocytes to PHA and Con A. This ability was reduced in some patients with myasthenia. Investigations repeated after thymectomy failed to demonstrate changes in the proportions and counts of T and B lymphocytes, degree of blastic transformation and immunoglobulin levels in relation to prethymectomy values.