[Clinical, hemodynamic and angiographic results of total cavo-pulmonary connection]. / Résultats cliniques, hémodynamiques et angiographiques après dérivation cavo-pulmonaire totale.

The aim of the study was to assess the short and medium term results of total cavo-pulmonary connection based on analysis of the functional status, the cavo-pulmonary circulation and the surgical techniques, and the hepatic consequences. Fifteen patients with congenital defects beyond repair were treated by total cavo-pulmonary connection at Tours between March 1st 1992 and July 30th 1996. There were 12 children (mean age: 6.3 years) and 3 adults aged 25 to 28. Results were assessed by clinical examination, hepatic function tests and cardiovascular investigations including right heart catheterisation with angiography in 14 patients. There were no fatalities. Seven patients were in functional Class I and 8 in Class II at medium term (average follow-up of 33 months). Hepatic function was mildly abnormal in all patients with an increase in serum bilirubin and gamma GT, and a decrease in the coagulation factors. The mean pressures in the atrial channel were 12 mmHg (9-16 mmHg), in the superior vena 13.2 mmHg (10-18 mmHg), in the right pulmonary artery 9.5 mmHg (7-15 mmHg) and 11.6 mmHg (8-16 mmHg) in the left pulmonary artery. Significant residual stenosis of a pulmonary branch was observed in 2 cases. The cavo-pulmonary anastomoses were out of line, one from the other, in all cases. The atrial channel was tubular in 9 cases and dilated with slight stagnation of the contrast medium in its inferior region in 5 cases. Total cavo-pulmonary connection transformed the clinical status of these patients but was associated with minor abnormalities of liver function. The quality of the cavo-pulmonary circulation and the surgical anastomoses was estimated to be satisfactory in the majority of cases.

[Treatment of congenital heart diseases with pulmonary artery cerclage. Immediate and medium term results in 51 patients]. / Traitement des cardiopathies congénitales par cerclage de l'artère pulmonaire. Résultats immédiats et à moyen terme chez 51 patients.

The aim of this study was to assess the results of pulmonary artery banding in a retrospective study of 51 consecutive children treated from January 1980 to December 1993. The study population was 24 girls and 27 boys with an average age of 6.2 months, of average weight of 4.01 kg. The cardiac conditions treated were ventricular septal defects in 24 cases (isolated and associated with one or more cardiovascular malformations or multiple), complete atrioventricular canal in 12 cases (isolated or associated with several cardiovascular malformations), single ventricle in 7 cases, double outlet right ventricle in 3 cases, transposition of the great arteries with ventricular septal defect in 2 cases, tricuspid atresia in 2 cases, and a complex lesion with double discordance in one case. The average duration of banding was 2.35 years (n = 49). Hospital morality of banding was 1.9% (1/51). Late mortality was 14.8% (7/47). Twenty-one patients (42.8%) had complications of banding. The survival rates of children who underwent banding was 86.8% at 1 year and 80.6% at 11 years. The low hospital mortality leaves a role for pulmonary artery banding as a palliative procedure in congenital heart disease in which early correction is impossible or carries and unacceptable risk. Complications of banding justify attempts to improve the technique, by making adjustable bands.