PRE- AND POSTOPERATIVE GROWTH PATTERNS IN CONGENITAL HEART DISEASE AS SHOWN BY THE WETZEL GRID

[摘要] A. Patent ductus arteriosus:1. Of 9 cases of patent ductus arteriosus, 5 were below the 67th percentile of the Wetzel grid at the time of operation.2. Of these 5 cases, 2 improved past the 67th percentile, 2 showed definite improvement in this direction, 1 (#9) showed only slight improvement, but is believed to have an additional cardiac abnormality. Of the other 4 cases, 3 showed definite acceleration of growth from a greater than 67% auxodrome (pre-operative). The fourth was not followed long enough for evaluation. Therefore of 9 cases, 7 showed moderate to marked improvement in rate of growth after surgery, 1 was slightly improved, and 1 was lost to follow-up.3. Channel positions shifted to the left in 6 cases, remained the same in 1, and shifted to the right in 1 case.4. No definite correlation could be made between the size of the ductus and the degree of growth retardation or of postoperative growth acceleration in this small series.5. Only one patient had severe growth retardation, and the mother of this patient had rubella during the pregnancy (#2).B. Tetralogy of Fallot:1. Of 7 cases, 4 were below the 67th percentile of the Wetzel grid at the time of surgery, and only 2 (#3 and #7) were severely stunted. This is a surprising fact in view of the generally accepted idea that marked retardation is the rule in these patients.2. In 2 cases a moderate improvement in the speed of growth followed surgery, and in the other 5 progress continued at the pre-operative rate or deceleration occurred.3. Channel positions shifted to the right in 4 cases, and stayed the same in 3, in contrast to the general shift to the left or stocky side in the ductus group.4. Clinical results were good in all cases with respect to increased exercise tolerance and absence of overt cyanosis. Case 7 had cardiac enlargement and decompensation.5. No correlation was observed between the oxygen saturation before surgery and the degree of growth retardation.6. Insufficient data are available to attempt a correlation of improvement in oxygen saturation after surgery and postoperative growth.7. The theory is proposed that the poor growth response following surgery in these cases may be due to the fact that although surgery relieves the anoxemia, it produces an arteriovenous shunt in the form of an artificial ductus, and thus growth retardation continues through a different mechanism after operation.

[学科分类] 儿科学