though loss of lung function and stridor have been described.14 The diagnosis and management of this syndrome have been comprehensively discussed in a recent report.5We report a new variant of this syndromenamely, bronchial obstruction resulting from swallowing solid food. We believe that oesophageal dilatation from a solid food bolus compressed the left main bronchus which was encased within a fixed space formed by the vertebral column, aortic arch, and great vessels. This variant probably results from an additional thoracoplastic chest wall deformity causing more than the usual postpneumonectomy anatomical derangement. In this patient a small dilatation of the poorly motile postpneumonectomy lower oesophagus from a solid food bolus appeared to cause significant left main bronchus compression.His treatment has consisted of an exclusion diet. Whilst mediastinal repositioning and intrathoracic placement of mammary prostheses can correct the anatomical displacement in the postpneumonectomy syndrome,`7 it was judged too hazardous in this patient because of his previous thoracoplasty and pleural infections False aneurysm following modified Blalock-Taussig shunt J Valliattu, P Jairaj, T Delamie, R Subramanyam, S Menon, H Vyas Abstract A nine month old infant with life threatening tracheal compression due to a Blalock-Taussig shunt aneurysm is described. Successful surgical management is discussed. (Thorax 1994;49:383-384) The Blalock-Taussig shunt is now a well recognised procedure for treating cyanotic congenital heart disease in infancy. The original operation consisted of anastomosis of the subclavian artery to the pulmonary artery,' but the use of polytetrafluoroethylene grafts to produce a communication between systemic and pulmonary circulation has simplified the procedure.2 False aneurysm formation following a modified Blalock-Taussig shunt is a rare and potentially fatal complication.-5 We report a false aneurysm presenting with tracheal compression in a nine month infant with tetralogy of Fallot who had undergone a modified Blalock-Taussig shunt in the neonatal period. The aneurysm was successfully repaired with complete relief of the tracheal compression.Case report Shortly after normal full term delivery a female infant was noted to be cyanosed. Echocardiographic evaluation revealed a normal visceroatrial arrangement (situs solitus), a large atrial septal defect, and a large inlet ventricular septal defect with an overriding aorta. In addition, the baby had infundibular and valvar pulmonary stenosis. The aortic arch 383 on 12 May 2018 by guest. Protected by copyright.

To assess whether simultaneous invasive arterial pressure monitoring of right upper and lower limbs in neonatal aortic coarctation with or without arch hypoplasia has an impact on surgical decision-making and outcome, data of 140 newborns who underwent emergency surgical repair over 15 years were analyzed retrospectively. The 36 who had simultaneous right arm and lower limb arterial pressure monitored intraoperatively were assigned to group 1. The other 104 who had blood pressure monitored invasively at a single site (either upper or lower limb) were allocated to group 2. In group 1, a residual gradient across the repaired segment was detected intraoperatively in 13% of patients, and corrected at the same sitting. In group 2, 6% needed subsequent balloon angioplasty. In all babies with arch hypoplasia in group 1, the proximal aortic cross clamp was readjusted at least once to avoid compromise of carotid blood flow. Simultaneous right upper and lower limb invasive pressure monitoring has an impact on the overall outcome in these sick neonates.

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The aim of this study was to assess whether postoperative cardiac troponin T levels could predict ventilation requirements in infants undergoing the arterial switch operation. Cardiac troponin T was measured 6 hours after aortic cross clamping and prior to tracheal extubation in 20 consecutive patients; 10 had simple and 10 had complex (with ventricular septal defect) transposition of the great arteries. The mean plasma troponin T level prior to extubation did not differ significantly in patients who were re-intubated and those who were successfully extubated. The initial cardiac troponin T levels in the complex defect group was significantly higher than in the simple transposition group. There was no correlation between initial cardiac troponin T levels and the duration of mechanical ventilation. There was no difference in mean duration of ventilation between the 2 groups. It was concluded that the postoperative cardiac troponin T level is not a predictor of successful extubation or prolonged artificial ventilation in this subset.

No abstract