We determined independent predictors for in-hospital and midterm mortality for the whole context of thoracic surgery. Zubrod and ASA scores affect both early and midterm mortality.

A nationwide survey of institutions in the United States that perform congenital heart disease surgery was conducted to obtain an overview of the current use of myocardial protection in pediatric patients (aged 0-16 years). One hundred and one (55%) of 183 institutions responded, completing a 4-page questionnaire about pediatric cases in 1989. A total of 12,072 cases were represented. Caseloads ranged from 7 to 498 at these institutions (mean 124, median 30). Cardioplegia was used by 100 institutions (44 blood, 45 crystalloid, 11 both). Administration was guided by formulas alone in 69 and by clinical criteria alone in 32. A wide variety of compositions of cardioplegic solutions was found with no preference for any particular type. No correlation between caseloads and cardioplegic solutions was found. Hypothermia was used by all institutions, with a mean of 25.8 +/- 3.5 degrees C for a simple ventricular septal defect closure. Deep hypothermia and circulatory arrest were used in 3048 cases (25.2%). A clear trend indicated that circulatory arrest was used more frequently in larger institutions (p less than 0.0001). Fibrillation as a strategy was used in 45 institutions. Twenty-five institutions changed cardioplegia technique during 1989. The findings suggest that, even though no consensus exists about its ideal composition, cardioplegia in conjunction with hypothermia is currently the strategy most often used for pediatric myocardial protection.

In this series of 30 consecutively operated patients, two were probably dead from their cardiac wounds on arrival at hospital and two suffered extrapericardial large vessel injury. These four patients died. Among the remaining 26 patients who arrived alive in the emergency room with intrapericardial wounds, 23 (89%) survived during the four-and-a-half years covered by this report. These included five survivors in a subgroup of six patients with serious left ventricular wounds.The use of initial pericardiocentesis in 13, sternotomy in 10, and extracorporeal circulation in 7 of these 30 patients is emphasized.

A case is reported of a child with Down's syndrome having a hypoplastic left first rib and an endocardial cushion defect. To our knowledge, a similar entity has not been reported.Congenital anomalies of the ribs have been an area of interest for the thoracic surgeon, orthopaedic surgeon, paediatrician, and radiologist. Fusion of adjacent ribs and bifid ribs are a common radiographic finding, but absence or rudimentary formation occurs less frequently (Ehrenhaft, Rossi, and Lawrence, 1966). The incidence of absence and rudimentary formation of lReprint requests to: