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The relationship of exercise-induced electrocardiographic changes to severity of obstruction in congenital aortic stenosis was studied in 44 children. Twelve subjects, with ST segment depression of 1 mm or more lasting 0.08 seconds after the J Point, had left ventricular-aortic peak systolic pressure differences (gradients) ranging from 54 to 112 mm Hg. The remaining 32 children had less than 1 mm or no ST segment depression. Thirty-one of these had gradients ranging from 10 to 48 mm Hg and one had a gradient of 52 mm Hg. Vectorcardiograms, electrocardiograms, and chest roentgenograms were not useful in the identification of the severity of the lesion. The study suggests that children with severe gradients develop electrocardiographic ST segment changes with exercise, thereby helping to select those patients who should have catheterization studies to delineate the severity of the lesion. In those with a normal exercise test, cardiac catheterization may be safely delayed, but the exercise test should be repeated to identify those who develop progressive obstruction.

We determined the penicillin compliance rates in school year 1974-75 for 235 children with rheumatic fever through analysis of urine specimens collected at school. Patients relatively low on compliance during the first year of sampling were divided into two equal size groups for a second year sampling study. One-half (N = 44) of these second year study patients and their parents were readvised regarding the need for penicillin prophylaxis and one-half (N = 44) served as controls. We related eductional data, behavioral ratings, and family information to compliance rates in both study years. The overall compliance for the children during the initial sampling year was 64.6 per cent. Factors found to be significantly related to compliance in year one were: 1) male sex, 2) large sibship, 3) increased number of behavior problems, 4) relatively poor academic progress, 5) lower maternal educational level, and 6) recurrence of rheumatic fever. Compliance rates for reinforced patients did not differ significantly from controls during the second year sampling.

In 20 children without shunts or valvular insufficiency, duplicate dye dilution and impedance cardiac outputs (ICO) were carried out. The duplicate dye dilutions had a standard deviation 0.259 L/min/m2, while duplicate ICO had a standard deviation 0.192 L/min/m2 (F = 1.82, p < 0.05). Of 53 sequential estimates, cardiac outputs measured by both indicator dye dilution and ICO had a 5.5% mean difference. In 21 subjects with left to right shunts, the ICO related well with pulmonary blood flow (r = 0.92) rather than systemic flow (r = 0.21). In 13 subjects with aortic insufficiency, sequential Fick and ICO had a 50% mean difference; the impedance measurement was found to be higher in every case. These data indicate that the impedance cardiograph can provide a noninvasive measure of cardiac output when there are no shunts or valvular insufficiencies. In subjects with left to right shunts the impedance cardiograph provides a measure of the pulmonary blood flow. When aortic insufficiency exists the impedance cardiograph is distorted such that it is consistently higher than Fick cardiac output.

In 1966, Rashkind and Miller1 described a non-surgical technique for palliation of transposition of the great arteries by using a balloon-tipped intracardiac catheter to create an atrial septal defect. This method has been frequently employed, as reported by several [see pdf for the Figure] authors2,3. The purpose of this report is to describe a patient with intra-abdominal hemorrhage as a complication of this procedure. Case Report A 2-week-old male infant was seen at The University of Iowa Hospitals with the chief complaint of intermittent cyanosis since birth. Physical examination, electrocardiogram, and chest x-ray were compatible with the clinical diagnosis of transposition of the great arteries.

MMPI elevations for adolescent and adult groups (N = 162) who had experienced rheumatic fever (RF) were generally lower than Mayo Clinic norms, particularly on scales K, 1, 2, 3, and 6. Significant age effects on Scales F, 3, 4, 8, and 9 confirm previous findings that adolescent groups score higher on the MMPI. Contrary to expectation, patients who had not experienced carditis as part of their RF scored significantly higher than carditis patients on scales 2, 3, and 4. The results are discussed from a chronic disease perspective.

When an alternating current of high frequency is applied to the thorax, the first derivative of the impedance to this current is affected by the cardiac cycle resulting in a characteristic wave form. Phonocardiograms, electrocardiograms, and first derivative thoracic impedance cardiograms were recorded simultaneously in 91 subjects. The first derivative thoracic impedance cardiograms were found to have sharply demarcated points which occur synchronously with the first heart sound, aortic second sound, pulmonic second sound, mitral opening snap, third heart sound, and fourth heart sound. The first derivative thoracic impedance cardiogram may thus be used not only as a reference tracing to help identify heart sounds on the phonocardiogram, but also for directly timing the intervals within the cardiac cycle.