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Digital subtraction angiography (DSA) permits high-resolution cardiac imaging with relatively low doses of contrast medium and reduced radiation exposure. These are potential advantages in children with congenital heart disease. Computer-based DSA (30 frames/sec) and conventional cutfilm angiography (6 frames/sec) or cineangiography (60 frames/sec) were compared in 42 patients, ages 2 months to 18 years (mean 7.8 years) and weighing 3.4 to 78.5 kg (mean 28.2 kg). There were 29 diagnoses that included valvular regurgitant lesions, obstructive lesions, various shunt abnormalities, and a group of miscellaneous anomalies. For injections made at a site distant from the lesion and on the right side of the circulation, the mean dose of contrast medium was 60% to 100% of the conventional dose given during standard angiography. With injections made close to the lesion and on the left side of the circulation, the mean dose of contrast medium was 27.5% to 42% of the conventional dose. Radiation exposure for each technique was markedly reduced in all age groups. A total of 92 digital subtraction angiograms were performed. Five studies were suboptimal because too little contrast medium was injected; in the remaining 87 injections, DSA and conventional studies resulted in identical diagnoses in 81 instances (p less than .001 vs chance). The remaining six injections made during DSA failed to confirm diagnoses made angiographically by standard cutfilm angiography or cineangiography. We conclude that DSA usually provides diagnostic information equivalent to that available from cutfilm angiography and cineangiography, but DSA requires considerably lower doses of contrast medium and less radiation exposure than standard conventional methods.

His bundle electrograms were recorded in 348 patients aged 2 months to 24 years following routine diagnostic cardiac catheterization. Among 41 children found to be free of anatomic or hemodynamic abnormality the following mean values were obtained: P-H interval, 93.4 +/- 15.3 msec; P-A time, 21.2 +/- 7.1 msec; A-H interval, 72.2 +/- 15.9 msec; and H-V interval, 39.8 +/- 5.2 msec. The remaining 307 patients were analyzed by diagnosis of congenital heart disease. The mean P-H interval was found to be significantly increased in both ostium primum and secundum atrial septal defect (ASD) with A-H prolongation in primum ASD and P-A prolongation in secundum ASD. The mean H-V interval was significantly prolonged in ostium primum ASD and in patients with severe aortic stenosis, aortic insufficiency. and mitral regurgitation. Grouping of the patients physiologically revealed that patients with moderate-to-severe right ventricular volume overload had P-H prolongation, and patients with severe left ventricular volume or pressure overload had H-V prolongation. The clinical implications of these findings are discussed.