Kirklin, John W.

Daily water metabolism of 21 patients was studied for 3 days after intracardiac surgery and whole-body perfusion. The average obligatory water losses of these patients were approximately 500, 750, and 750 ml. per M. 2 of body surface per day on the first, second, and third postoperative day, respectively. A simple system, which combines knowledge of the estimated postoperative water requirement with the known daily change in body weight, was devised to manage accurately water metabolism after intracardiac surgery.

Each of 21 patients was noted to have a low concentration of water in the serum immediately after whole-body perfusion. This indicated a loss of water either by the patient or the pump-oxygenator. Investigation suggested that the patient, and not the pump-oxygenator, was the source of water loss. Two of the 21 patients had a profuse, short-lived solute diuresis in the immediate postperfusion period. These phenomena are apparently benign and they require no specific treatment.

Anomalous connection of the right pulmonary veins to the superior vena cava associated with an interatrial communication in an unusually cephalad location has been diagnosed at cardiac catheterization in 8 patients. These patients had the clinical features seen in patients who have atrial septal defects in the region of the fossa ovalis. Differentiation was accomplished by (1) the roentgenographic position of the catheter in the right superior pulmonary vein, (2) demonstration of an abnormally high oxygen saturation of the blood in the superior vena cava, (3) the presence of a small right-to-left shunt from the superior vena cava and the absence of such a shunt from the inferior vena cava, and (4) demonstration of similar drainage of blood from the right superior pulmonary vein and superior vena cava. The syndrome is considered to be an anomaly of pulmonary venous development while the atrial septum forms normally.

Manifestations of left ventricular failure have been reported in the literature in some patients after surgical closure of atrial septal defects. The authors present their experience in their series of 85 cases and detailed hemodynamic measures in 16 patients.

Obstruction to pulmonary blood flow may occur in the pulmonic valve, in the infundibulum or in both. Cardiac catheterization aids in the determination of the site of obstruction. Criteria for the differentiation at operation of valvular and infundibular pulmonic stenosis are enumerated, and the usefulness of accurate pressure tracings during operation is emphasized. The accurate identification of the site or sites of obstruction to pulmonary blood flow is essential to proper surgical management. A correctly selected operation must be carried out in as complete a manner as possible.

In a necropsy study of 50 cases of ventricular septal defects, the anatomic position and relations of ventricular septal defects, the causes of and ages at death, and association of ventricular septal defects with other cardiovascular malformations were determined. The present availability of surgical closure of ventricular septal defects makes this information of practical significance.

The combination of patent ductus arteriosus and coarctation of the aorta poses special anatomic, physiologic and surgical problems. An experience with 14 such cases is presented, which suggests that pulmonary hypertension occurs frequently in these cases. Physiologic data in cases having coarctation of the aorta, patent ductus arteriosus and pulmonary hypertension that underwent cardiac catheterization are presented. Clinical, anatomic, physiologic and surgical implications of this combination are discussed.

An experience with surgical treatment for atrial septal defects in 59 patients has given evidence as to the safety and efficacy of the procedure utilizing the atrial-well technic. Data from the first 33 cases of this series are presented in detail, to allow analysis by others of the basis for these conclusions.

On the thoracic roentgenograms of patients with mitral stenosis, costophrenic septal lines are frequently seen. These lines are a sign of pulmonary venous hypertension. They were not seen in a representative group of patients with pulmonary arterial hypertension but without pulmonary venous hypertension.