Surgical treatment of left ventricular outflow obstruction in the neonate: profound hypothermia and circulatory arrest.

In the 1950s, Sealy and his co-workers developed an improved technique for inducing cardiac and total body hypothermia using a pump oxygenator and heat exchanger. These techniques have been gradually adopted, and now markedly facilitate the repair of some congenital cardiac malformations presenting in infancy. In this paper, I discuss two forms of congenital cardiac lesions: an interrupted aortic arch and critical aortic stenosis. For both of these congenital malformations, operation in infancy using closed techniques has resulted in a very poor outcome. Using cardiopulmonary bypass, induced hypothermia, and circulatory arrest, accurate arch repair and aortic valvotomy can be performed together with repair of associated lesions. Improved results can be expected from the use of the more precise repair techniques afforded by a dry and bloodless field.