The Heart Club by Tom Treasure

Author:Tom Treasure [Tom Treasure]
Language: eng
Format: epub
ISBN: 9781911525851
Publisher: Clink Street Publishing
Published: 2017-04-05T04:00:00+00:00

* This study of 45 longer follow-up patients was published in the BMJ.103

February 1955

At a meeting of the Peacock Club on Tuesday, February 22nd, 1955, there were present 14 members. Pathological specimens were shown in the Gordon Museum and the meeting then adjourned to the Warden’s House.

It was suggested that the next meeting would be on May 3rd, when Sir Russell Brock would talk about the Detroit Conference. It was decided that Dr Neil, Dr Dow and Dr Rheinhoff* should be invited to become members of the Club.

Dr Campbell opened the discussion on Coarctation of the Aorta. The seriousness of the condition is indicated by the finding that 70% of patients are less than 20 years old and only 10% over 30. Coarctation is seldom associated with other congenital abnormalities. Heart failure is the commonest mode of death but cerebral haemorrhage and rupture of the aorta also occur. Operative mortality, except in complicated cases, is not high. The indications for operation are not yet firmly established. To decide prognosis after operation will require a long term follow-up.

Dr Bayliss† [sic] stressed the importance of changes in the medial coat of the aorta. It is still undecided whether hypertension or congenital aneurysms at the base of the brain are more important in the causation of cerebral haemorrhage. Examples of Turner’s syndrome with coarctation prove on skin biopsy to be males.

Sir Russell Brock’s opinion was that coarctation should always be corrected surgically unless there are good reasons against doing this. The object of the operation is to prevent progressive hypertension and this has been done in all but one of 52 patients. In this series there were 6 deaths closely connected with operation, the first death being the 24th case operated on. In most big series of cases the operative mortality was about 6%. His own opinion was that aortic grafting should only be done when absolutely necessary but he had had to do it in 15 of 42 cases. Constriction of the aorta is not the only fault in coarctation, for the aorta is also hypoplastic. The distinction between adult and infantile coarctation is a very fine one. He had not noticed aortic valve disease in any of the patients on whom he had operated.

Hypotension is a great help in operative technique but after operation reactive hypertension may often be troublesome. The etiology of this condition is not known.

Operation should be done at as early an age as possible and Crafoord had shown that the anastomosis will grow with the child.

Dr Baker asked about the danger of bacterial endocarditis after operation.

Mr Ian Hill agreed with the value of controlled hypotension at operation and the advisability of operation at an early age. No restriction of activity was necessary afterwards.

In answer to a question of Dr Suzman, Dr Baylis replied that of 22 patients with aortic diastolic murmurs only 4 had a wide pulse pressure.

The general opinion was in favour of operation before puberty.

The meeting adjourned at 11.20 pm.

March 29th 1955

Maurice Campbell

* This is probably Dr W.

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