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Present state of operative techniques in children with congenital cyanotic heart defects is described as well as the early and late results after open heart operations-based on own experiences of many years.

Since 1977, the Department of Anesthesiology of the University of Graz has had a preoperative clinic. Since August 1988 we have processed current data using a personal computer (PC). We have adapted an IBM-compatible PC and a commercial data-processing program (dBase III plus) for the special requirements of the preoperative clinic. The procedure is directed by menus and is also easy to learn for non-professionals. Important functions have been executed automatically by the current program, such as loading the software or securing the data on a floppy disk. No additional work is necessary for data input. Every test result can be supplied immediately by a printer, whereby important parameters are denoted as such. After 13 months of testing, we could see that the use of a PC offers an inexpensive possibility for processing medical data with the help of electronics. The installation was not destined to remain a short trial, but will become a permanent system at our clinic.

From April 1980 to June 1985 7.3% (15) of 205 PTCA-treated patients required emergency operations. The spectrum of PTCA-induced ischemia included anginal pain alone (2/1, 13%) or transmural infarction (13/15, 87%) with hypotension (8/15), cardiac arrest (4/15), and severe cardiogenic shock (3/15, 20%). 14 patients underwent saphenous-vein-bypass-graft operation (ACBG) with a mean of 1.7 grafts performed per patient. The average time from onset of symptoms to completed revascularisation was 166.5 (110 to 290) minutes. Inspite of the use of IABP one hospital death (6.6%) occurred prior to the institution of ECC in a patient with previous ACBG surgery. No late death was observed during a mean follow up of 11.1 (1 to 33) months with 13/14 patients free of anginal symptoms. Retrospective assessment of postoperative serum enzyme levels of CPK and CK-MB showed evidence of myocardial infarctions in 7/14 (50%) patient. The incidence on ECG of Q-wave infarctions was 35,7% (5/14). With the exception of one patient, IABP was not used pre- or postoperatively. In patients with acute myocardial ischemia following PTCA-attempts immediate restoration of myocardial blood flow can stabilize left ventricular function and reduce the incidence and size of myocardial infarctions. The availability of emergency ACBG-surgery and facilities remain an important prerequisite of PTCA-programs due to the unpredictable natural course of PTCA-induced myocardial ischemia.

Antithrombin III activity was evaluated preoperatively, intraoperatively and postoperatively in the plasma of 54 children with congenital heart disease undergoing open heart surgery. The patients were divided into an acyanotic and a cyanotic group. A comparison of these two groups indicated a significantly decreased AT III activity in cyanotic children as compared to acyanotic children throughout the perioperative phase. AT III levels decreased in the cyanotic group from 71.9 +/- 3.77% preoperatively to 61.5 +/- 2.15% (p less than 0.01) postoperatively and rose to 69.6 +/- 2.36% (p less than 0.01) on the first and to 78.9 +/- 2.24% (p less than 0.01) on the second postoperative day. In the acyanotic group AT III levels decreased from 84.3 +/- 1.98% to 73 +/- 2.97% (p less than 0.01) postoperatively and increased to 78.5 +/- 2.96% (p less than 0.01) on the first and to 90.2 +/- 3.06% on the second postoperative day. A few acyanotic patients, too, showed decreased values of AT III. However, they were never found to be as low as in the cyanotic group. Preoperative AT III values as well as the severity of underlying disease, the success of corrective surgical treatment and postoperative complications proved to be the predominant influencing factors of AT III activity.

Unlabelled: As a result of their interpretation of the Bible, members of Jehovah's Witnesses do not accept blood transfusions under any circumstances. Consequently, they present moral and ethical problems to surgeons and anesthetists, especially in cardiac surgery. PATIENTS and METHODS. From November 1978 to November 1988, 66 members Jehovah's Witnesses were scheduled for cardiac surgery; 57 patients were operated upon (mean age 33.3 years, 14 days to 70.4 years; mean body weight 51 kg, 0.7 to 95.5 kg); 21 were younger than 14 years. Patients with hematocrit (Hct) less than 35%, expected high intra- and postoperative blood loss, compromised left ventricular function, ST-segment alterations, critical aortic stenosis, severe unstable angina pectoris, complex heart defects, especially in children, extreme body weight, severe diabetes, renal insufficiency, coagulopathies, severe pulmonary disease, and heavy smokers were excluded from operation. Whereas in nonbypass patients no special blood-saving techniques were used, in bypass patients a modified version of isovolemic hemodilution, with a hypothermic, bloodless priming technique of extracorporeal circulation (ECC) was performed after induction of anesthesia. At the end of the ECC all blood collected in the pericardial and pleural cavities was returned to the oxygenator and the entire content of the extracorporeal circuit was infused into the patient through the aortic cannula. All patients receiving ECC were ventilated for 24 h postoperatively and received dopamine (2-5 micrograms/kg) and antibiotics routinely., Results: Due to the above mentioned contraindications, 9 patients were not accepted for surgery, 10 were operated upon without cardiopulmonary bypass or blood-saving techniques. In 47 patients open heart surgery with ECC and moderate or deep hypothermia was performed. In the adult patients (n = 36) Hct values decreased from 44.4% (35-70%) preoperatively to 32.1% (21-46%) after hemodilution, reached their lowest levels during cardiopulmonary bypass at 17.9% (9.9-43%), and increased to 33.7% (22%-43%) at the end of the operation. Hct averaged 28.2% (20%-39%) on the 3rd and 33.2% (23%-46%) on the 12th postoperative day. In children (n = 11) Hct decreased from 47.2% (36.9%-70%) to 33.6% (27.2%-49.1%) after hemodilution, during bypass to 16.1% (10.5%-25.5%) and increased to 32.1% (24.4%-37.4%) at the end of the operation. On the 3rd postoperative day Hct was 25% (21.4%-39%) and increased to 29.4% (25.1%-40%) on the 12th postoperative day. No statistical differences in Hct values were found between both groups. (ABSTRACT TRUNCATED AT 400 WORDS)

Patients who are Jehovah's Witnesses present a special problem when undergoing open heart surgery since they refuse blood transfusion. We performed 15 open heart operations for both acquired and congenital heart disease using a modified version of isovolaemic haemodilution and bloodless prime technique of extracorporeal circulation. Two patients died. One death might have been at least indirectly related to the regimen which excludes blood substitution. We believe that our experience demonstrates the feasibility of open heart procedures in Jehovah's Witnesses, although the mortality risk is increased in these patients.