Year: 1954
Type: article
Study design: Observational Study
Abstract: When the operation of pulmonary valvotomy was started by Brock in 1948, one of the difficulties met was understanding the changes in the rhythm and action of the heart.It was thought that continuous electrocardiographic tracings might help in this way and so make it possible to lessen their incidence.Such tracings have generally been taken since then and in the present paper we wish to discuss the findings during 70 direct operations for pulmonary stenosis.The patients fall into five groups: (I) those with Fallot's tetralogy (a) who had valvotomy for a valvular stenosis (13 cases); (b) who had infundibular resection (19 cases); (c) who had both these procedures (8 cases); and (II) those with pulmonary valvular stenosis with a closed ventricular septum (a) who were acyanotic (17 cases); and (b) who were cyanotic from a right-to-left interatrial shunt (13 cases).The records were analysed separately for these five groups, partly because the mortality was greater in groups I(b) and II(b).They were, however, very similar so are all dis- cussed together though any special differences that were observed between the groups are com- mented on.Similar records have been taken in many patients having mitral valvotomy and our findings (Campbell and Reynolds, 1952) will be compared.Although operations for pulmonary stenosis are, on the whole, more dangerous than those for mitral stenosis, probably because the surgical approach is through the right ventricle instead of through the left auricle, we find that the electro- cardiographic changes are in some ways less than those during mitral valvotomy.The continuous tracings during angiocardiography (Reynolds, 1953) are also of interest for comparison. STEPS OF THE OPERATIONAnesthesia has, in general, followed the lines laid down by Rink et al. (1948), and some aspects have been emphasized more recently (Rink, 1952; Hutton, 1952).After induction in the anesthetic room, the patient is moved into the theatre and the first electrocardiogram is taken, usually 20-30 minutes after the induction.The area of incision is infiltrated with 1/400,000 adrenalin, the incision made, and the chest wall opened, using diathermy for hemostasis.The left pleural cavity is then opened and the mediastinal pleura and thymus are dissected off the pericardium.Local anesthetic is injected into the pericardial sac, originally 4 per cent procaine, but more recently 0 25 per cent decicaine.After the nature of the lesion has been identified, procaine is injected into the space between the base of the aorta and pulmonary trunk, and then into the right ventricle at the point where the incision is to be made.At first, stay sutures or forks were inserted on either side of this area to control the bleeding after the incision was made, but now it is controlled entirely by digital pressure.In later cases pressures have been taken with an electrical manometer, either by a needle through the walls of the right ventricle and pulmonary trunk, or by means of a catheter after the incision into the right ventricle.57
Source: Heart
DOI: 10.1136/hrt.16.1.57
Authors: M. Campbell, G. Reynolds
Institution: Guy's Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1964573783