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July 1978

Surface Cooling (20 °C) and Circulatory Arrest in Infants Undergoing Cardiac SurgeryResults in Ventricular Septal Defect, Complete Atrioventricular Canal, and Total Anomalous Pulmonary Venous Connection

Author Affiliations

From the Department of Surgery, Section of Cardiology (Drs Lamberti, Replogle, and Anagnostopoulos), the Department of Anesthesiology, Section of Pediatrics (Dr Lin), and the Section of Pediatric Cardiology (Drs Cutilletta and Arcilla), The University of Chicago Pritzker School of Medicine.

Arch Surg. 1978;113(7):822-826. doi:10.1001/archsurg.1978.01370190044007

• During a six-year period, 46 severely symptomatic infants (average age, 5.1 months) underwent correction of ventricular septal defect (22 patients), total anomalous pulmonary venous connection (13 patients), and complete atrioventricular canal (11 patients), with the use of surface cooling to 20 °C. Cardiac repair was performed during circulatory arrest, and rewarming was performed with a pump oxygenator. Ten patients undergoing repair of ventricular septal defects were studied hemodynamically at 21 °C, before repair and at 37 °C after rewarming. Heart rate, left ventricular systolic pressure, maximum dp/dt, cardiac index, stroke work, and oxygen consumption were reduced substantially at 21 °C. Systemic vascular resistance was increased at 21 °C. All changes were reversible with repair and rewarming. A protocol for hemodilution and crystalloid volume loading was devised to maintain urine output after early patients were noted to demonstrate renal dysfunction. With this protocol, survival rates were 89% for patients with ventricular septal defects, 67% for those with atrioventricular canal defects, and 85% for those with total anomalous pulmonary-venous connection.

(Arch Surg 113:822-826, 1978)

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