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Byline: N. Ad, E. Birk, J. Barak, S. Diamant, E. Snir, B.A. Vidne Abstract: Patients who undergo surgical repair of congenital heart defects, characterized by a hypoplastic right ventricle or high pulmonary vascular resistance, are at high risk for the development of postoperative right heart failure. This risk may discourage the surgical team from carrying out a biventricular or complete repair in such patients. To reduce the risk for right heart failure, we developed a one-way, valved, atrial septal patch to serve as an artificial one-way foramen ovale and tested it in an animal model. By permitting right-to-left shunt, this device decompresses the failing right ventricle and maintains systemic cardiac output. The device has been used in 15 patients divided into three different groups: group 1 (n = 8), patients with a hypoplastic right ventricle and pulmonic stenosis or atresia, seven of whom underwent a biventricular repair; group 2 (n = 5), patients with evidence of pulmonary disease after longstanding left-to-right shunt caused by a correctable atrial or ventricular septal defect, all of whom had a complete repair; group 3, two patients with acute right heart failure in whom the device was used as a last option of treatment to wean them from cardiopulmonary bypass. This article presents our data in regard to the use of the one-way, valved, atrial septal patch and the indications for its clinical use. (J THORAC CARDIOVASC SURG 1996;111:841-8) Article History: Received 1 February 1995; Accepted 18 May 1995 Article Note: (footnote) [star] From the Departments of Cardiothoracic Surgerya and Pediatric Cardiology,b Beilinson Medical Center, the Department of Cardiothoracic Surgery,c Tel Aviv Medical Center, and the Sackler Faculty of Medical Sciences, Tel Aviv University, Tel Aviv, Israel., [star][star] Address for reprints: B. A. Vidne, MD, Head, Department of Cardiothoracic Surgery, Beilinson Medical Center, Petach Tikva 49100, Israel., a 0022-5223/96 $5.00 + 0, aa 12/1/66333

An accurate assessment of fluid status in haemodialysis patients presents a significant challenge especially in growing children. Clinical parameters of hydration are not always reliable, and invasive methods such as measurement of central venous pressure cannot be used routinely. We evaluated the usefulness of inferior vena cava diameter (IVCD) measured by echocardiography in the estimation of hydration in children on haemodialysis.

SummaryA trial designed to measure benefits to growth of post—establishment weed control and fertiliser (diammonium phosphate, DAP) application in a young Eucalyptus dunniiplantation was used to test whether young trees benefiting from such silvicultural practices were more resilient to stress from waterlogging and insect damage. Chlorophyll fluorescence (Fv/Fm) was used as the measure of tree stress. Both the weed control and fertiliser treatments had significant beneficial effects on diameter and height of surviving trees. Tree growth response was greater for weed control than fertiliser application. Neither treatment, however, appeared to alleviate the impact of flooding on tree mortality. Insect damage, in particular from the leaf blister sawfly Phylacteophaga froggatti, was negatively correlated with tree size, which in turn was directly influenced by the degree of soil inundation, weed control and fertiliser application. It is argued that growth results from a balance of beneficial conditions and a range of stressful factors. Post—establishment practices such as weed control and fertiliser application can improve tree resilience to stress-inducing factors that cannot be managed easily.