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In the last year fibrin glue Tissucol was used for local hemostasis in 21 patients subjected to correction of tetralogy of Fallot (ToF) and in 10 patients subjected to Senning-procedure in transposition of the great arteries (TGA). The postoperative blood loss was compared with the blood loss of 20 ToF-patients and 10 TGA-patients who had undergone correction one year ago without fibrin glue. Between the 2 groups were no differences in age, sex, bodyweight (BW), coagulation state or operative management. Two hours postoperatively the blood loss with fibrin glue was 2.2 ml/hr/kg BW in ToF-patients and 2.4 ml/hr/kg BW in TGA-patients, whereas without fibrin glue it was 4.2 ml/hr/kg BW in ToF (p less than 0.01) and 4.5 ml/hr/kg BW in TGA (p less than 0.01). The same significant difference (p less than 0.01) was found 6 hours postoperatively with 1.4 versus 2.2 ml/hr/kg BW in ToF and 1.9 versus 2.5 ml/hr/kg BW in TGA. Over the following 18 hours the secretion from the chest tubes was identical in both groups. Six patients with ToF and one patient with TGA required reoperation for bleeding. The blood loss per kg BW per hour at reoperation was 6.9 ml with and 8.2 ml without fibrin glue (N.S.). The blood loss of patients who did not require reoperation at the same time was 4.6 times lower with fibrin glue and only 3.7 times lower without fibrin glue. Fibrin glue reduces blood loss after intracardiac repair of ToF and TGA by local hemostasis at patches and suture lines. The application of fibrin glue can facilitate differentiation of surgical bleedings and the indication for reoperations.

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Depan ment 01 Tho rac ic and Card iOYilSCu lal Su rgery 01 the $ urg ieel Clinic. UniYersilV o f Tiibinge n Sum maryThe surgical problems in toul eonecuon of lellalog of Fallol following l»llialio n e ncou nte red in 6S pa tient s after co nstruc tio n o f 'W/IIv ston-Coolq (33) a nd Blo.fock.·TflUss;' ( )2) anastomoses are presented. The Wu e rst on-Coo le y sh u nt was severely angu late d in 9 pa tients, causing underp erfu sion o r occlusion of th e Jeft pulmonary a rte ry. Pulmo nary hype rte nsio n was p rese n t in 3 p atien ts with increased vascular resista nce in one. The Blaloc k-Ta ussig a nas to mosis was oblitera ted in 9 pa tient s, cause d co mple te occ lusion o f th e ri&ht pulmonary a rte ry in one and formation o f an aneurysm o f th e subclavilln u tery a t the site o f th e a nastomosis in one. Tran sannular pa tching o f th e right ven tricul u ce trtow trac t was necessary in 95 "; o f the patient s pallial· ed in th e r...st yeu of life. As some degree o f angu latio n o f the Wate rslo n-Cool ey anastom os is W llS seen in alm ost 60 ,.; of the pat jent s, we have aba ndo ned its transacruc ctosure technique. The right pulmonary a rte ry is no w dissected fro m the aorta and bo th th e ao rt a and p ulmonary artery are sutu red separa tely. The ope rat ive m or talit y rate was 16.9 % and is ma rked ly highe r tha n in ou r non-pafliated paucnts unde rgoing co rrec tio n o f te tr alogy of Palle t. Two ea rly and o ne la te dea th must be a ttribu ted to the previous shu n t procedure.With regard to th e high incidence of co mplica tio ns a nd failu res o f th e aortopulmonary shu nt~we co nclude tha i the ir applica tio n shou ld be restrict ed to iy m p to ma tic ba bies with a h ypo plastic pulm onary valve and annulus req uiring ea rly w rgi<:a1 in te....en tio n beca use o f severe h ypox:emia.KfY-Wo rds: Tetralogy of Falle r -Staged repa ir -Com plleeuc ns o f Wat ersto n-Cool ey anasto mos is -Co mplica lion!' of Blalock -Tau ssig anas to mos is group, particularly if severe hypoxemia and coagulation disorders were present. Recently, however, we were confronted with several complications originating from the previous shunt procedure. The purpose of this communication is to report on the surgical problems encounte red in total correction of tetralogy of Fallct following primary palliation. Materials and method sSince 197 1 we have perform ed total co rrec tio n of tetralos y o f Fa llo l in 16 1 pa tie nt s. Am ong th t se the re were 65 patioe nls who h ad been wbjecled to a p reviou s ao rt o-pul monary shu nl p rocedure. These 65 patient s fo rm the basis o f our study.Thirty-tw o pa tie nts had a BT an d 33 a we type o f anastomo sis. ln th e BT grou p 3 patie n ts had receive d the ir shu nt in th e fint year o f life (mean to.6 t 0.9 m onths). The remaining 29 pa tients had been palliated at the age of 4.2 t 3 year s (r ange 2 to 14 yea rs). Seven tee n pa tien ts of th e WC grou p we re un der on e yea r o f age a t th e time o f aorto-pulmcn ary shu nting (mea ns 6.1 ! 3 mo...

In order to determine the incidence of subendocardial ischemia after open heart surgery, subendocardial blood flow was monitored in 171 patients subjected to mitral and/or aortic valve replacement or coronary revascularization by on-line calculation of Diastolic (DPTI) and Systolic Pressure Time Index (TTI). Body hypothermia with an esophageal temperature of 25 degrees C and magnesium-aspartate-procaine cardioplegia were applied for myocardial protection. Ten patients developed low cardiac output state with two early deaths. In the two patients with fatal low cardiac output DPTI/TTI remained below 0.8. In the remaining 8 patients DPTI/TTI rose to 1.4 after a mean recovery time of 36 hours. In 161 patients (94%) no low cardiac output state evolved and DPTI/TTI rose to 1.3 within 60 min. after termination of cardiopulmonary bypass. Our results indicate that body hypothermia of 25 degrees C combined with magnesium-aspartate-procaine cardioplegia can reduce the incidence of subendocardial ischemia, but does not prevent this complication completely after anoxic times beyond 60-70 minutes.