Surgical Treatment of Coarctation of the Aorta in the First Year of Life. Immediate and Late Results in 35 Patients

✓ A boy born with coarctation of the aorta developed postmeningitic hydrocephalus associated with aqueductal stenosis in the first year of life; a ventriculoatrial shunt was performed. When 11 years old, following an operation on the coarctation, he developed neurogenic intermittent claudication superimposed on a preexisting spastic weakness of his legs. Investigations disclosed the intraspinal collateral vessels to be stealing blood through the anterior spinal artery to the aorta below the incompletely relieved coarctation. Revision of the coarctation repair and diversion within the thorax of the main collateral channel from the anterior spinal artery to the distal aorta relieved the intermittent claudication.

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THE DYNAMICS OF THE LENGTH OF THE ANTERIOR-POSTERIOR EYE AXIS FOLLOWING THE EXTRACTION OF UNILATERAL CONGENITAL CATARACTS WITH THE IMPLANTATION OF INTRAOCULAR LENSES IN THE CHILDREN DURING THE FIRST YEAR OF LIFE

Russian Pediatric Ophthalmology ◽

10.18821/1993-1859-2017-12-1-6-10 ◽

2017 ◽

Vol 12 (1) ◽

pp. 6-10

Author(s):

L. A Katargina ◽

T. B Kruglova ◽

N. S Egiyan ◽

O. B Trifonova

Keyword(s):

Surgical Treatment ◽

Pediatric Population ◽

Optical Power ◽

Intraocular Lenses ◽

First Year ◽

Congenital Cataracts ◽

Before And After ◽

First Year Of Life ◽

Anterior Posterior ◽

Anterior Posterior Axis

Introduction. Unilateral congenital cataracts in the children account for up to 16.0% of the total number of congenital cataracts diagnosed among the pediatric population. Aphakia is considered to be the most physiological method for the surgical treatment and correction of unilateral congenital cataracts in the combination with the implantation of intraocular lenses. The optical power of the lenses is calculated based on the results of evaluation of the dynamics of the length of the anterior-posterior eye axis in individual patients. Aim. The objective of the present study was to analyze the dynamics of the length of the anterior-posterior axis of the eyes in the children presenting with pseudophakia following the extraction of unilateral congenital cataract. Materials and methods. The study included a total of 77 children with unilateral congenital cataracts examined before and after the surgical treatment. Phacoaspiration in the combination with the implantation of intraocular lenses was performed in the patients at the age varying from 3 to 11 months. The infants underwent the ultrasound biometric study and the evaluation of the dynamics of the length of the anterior-posterior axis in the affected eye in comparison with that in the contralateral eye before they reached the age of 7 years. Results. The results of this study give evidence of marked variability of the dynamics of the length of the anterior-posterior axis of the eyes following the early surgical treatment of the children presenting with unilateral congenital cataracts. Conclusion. The differences in the tendency toward the change in the length of the anterior-posterior axis of the eyes following the surgical treatment of unilateral congenital cataracts in the children during the first year of life suggest the necessity of further in-depth investigations and the need for the regular follow-up of such patients for the purpose of choosing the proper approach to the correction of the refraction error and ametropia.

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COARCTATION OF THE AORTA IN INFANTS

PEDIATRICS ◽

10.1542/peds.26.1.109 ◽

1960 ◽

Vol 26 (1) ◽

pp. 109-121

Author(s):

Irving H. Glass ◽

William T. Mustard ◽

John D. Keith

Keyword(s):

Blood Pressure ◽

Septal Defect ◽

Operative Mortality ◽

Ductus Arteriosus ◽

Coarctation Of The Aorta ◽

First Year ◽

Great Vessels ◽

Sick Children ◽

First Year Of Life ◽

Symptoms And Signs

A review of 108 cases of coarctation of the aorta diagnosed under 1 year of age, and admitted to The Hospital for Sick Children, Toronto, over a 12-year period, is presented. Preductal coarctation accounted for 90% of the fatalities under 1 year. Patency of the ductus arteriosus occurned in 98% of cases in the first 6 months of life. Forty-nine per cent of cases of coarctation of the aorta under 1 year of age have major cardiac anomalies other than patent ductus: ventricular septal defect, 33%; transposition of great vessels, 10%; and atrial septal defect, 6%. Problems in diagnosis occurred when blood pressure readings were equivocal. Operative mortality for coarctation of the aorta in the first year of life was 41%, while after 1 month of age it was only 29%. Mortality in patients not operated on during the first year of life was 50%, while for those less than 1 month of age with symptoms and signs of decompensation and not operated on, the mortality was 87%. In dealing with coarctation of the aorta in the first year of life the following are recommended: 1) When blood pressure readings in the arms and legs are equivocal, the readings should be repeated frequently until the diagnosis is clarified; 2) aortogram should be performed on patients difficult to diagnose; 3) babies presenting with symptoms in the first month of life should be operated on promptly unless they show a dramatic response in a 12-hour trial of treatment with digitalis; 4) babies after 1 month of age who respond to digitalis may be kept on this medication until adequate adjustment in circulatory hemodynamics has taken place and surgery can be performed at the optimum age.

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