238 The Annals of Thoracic Surgery Vol 28 No 3 September 1979

lems during this procedure with retraction of the heart or the pulmonary arteries, we don’t see any need for bypass.

I did not mention in the discussion that the most critical time to us has been the postoperative period. It is of paramount importance to keep these patients sedated so that they have very quiet, calm, restful respirations. As for any patient with a tracheal obstruction that is not completely relieved, labored agitation and respiration will compromise the trachea. In this respect, we wonder whether car- diopulmonary bypass with its inherent respiratory insufficiency may make respiration more difficult afterward.

Dr. Ferguson, we do not have preoperative perfu- sion scans but we do have the preoperative arterio- grams, showing patency with no kinking of the left pulmonary artery in each patient.

Dr. Sade, I thank you for correcting us in the definitions of the main and left pulmonary arteries. We chose to define them from an anatomical view- point rather than embryologically, and decided that the main pulmonary artery ends where it divides into a left and right pulmonary artery.

We have not done bronchograms for patients pre- operatively as you have done. We abstain from this procedure for several reasons: First, we believe that bronchography is not a benign procedure in an in-

fant and the tracheal inflammation that it might pro- duce may be counterproductive in terms of our long-term goal of an early repair. Second, we have backed off on any type of bronchial or tracheal repair in infancy, and because of that we don’t think that the bronchogram is absolutely necessary at this early time.

Our entire experience includes 3 other patients re- ported by Mr. Waterston previously. Of those 3 pa- tients, l infant was explored. Reanastomosis of the left pulmonary artery was not performed in that pa- tient. A ductus was divided, and the trachea and esophagus were freed as much as possible. This patient-who was moribund preoperatively-died postoperatively. The other 2 patients are both alive, but we have not been able to get them back for perfu- sion scans. Since this paper concerns patency, we did not include these 3 patients.

Dr. Grillo, we have not attempted to divide the trachea in any of these patients. I believe there are early reports of tracheal division as opposed to pul- monary artery division in the management of this lesion, and in those early reports mortality was the rule.

Dr. Davila, I really cannot comment on your pa- tient with the tracheal stenosis as well as the pulmo- nary artery sling. We have had no experience with these two lesions together.

Erratum

In the article “Prolonged Intraaortic Balloon Pumping in Klebsiella-induced Hypodynamic Shock” by Roberts et a1 (Ann Thorac Surg 28:73, 1979), the legends for Figure 8 (p 81)

and Figure 9 (p 82) are incorrect. In both in- stances, the (A) portion should be applied to the (B) portion and vice versa.