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Cross sectional echocardiographic studies were assessed prospectively in 58 infants in whom right ventricular outflow obstruction was subsequently shown angiographically. A subcostal cut was used to display simultaneously the short axis of the aortic root and the long axis of the right ventricular outflow tract. This facilitated the differentiation of the common right ventricular outflow tract obstructive lesions. Tetralogy of Fallot was diagnosed correctly in 22 of 26 infants; pulmonary atresia with intact septum in all of 14 neonates; isolated severe pulmonary valve stenosis in all of nine infants; and pulmonary atresia with ventricular septal defect in eight of nine infants. The subcostal approach is the technique of choice for evaluating right ventricular outflow tract obstruction as it is more reliable than the left parasternal approach. [ABSTRACT FROM PUBLISHER]

The use of lignocaine in the prevention of ventricular fibrillation among patients admitted to a coronary care unit has been reviewed over the 12-year period 1967 to 1978 inclusive. The practice of suppressing warning ventricular ectopic activity has gradually been abandoned with the result that whereas in 1967 to 1968 33 per cent of all patients received lignocaine therapy, in 1972 to 1973 the number had fallen to 15 per cent, and in 1977 to 1978 to 4 per cent. The incidence of ventricular fibrillation was not significantly changed at 9.1, 7.7, and 7.8 per cent, respectively. Approximately 80 per cent of all patients suffering ventricular fibrillation within the coronary care unit were initially resuscitated and approximately 50 per cent survived hospital admission. Death was rarely a result of recurrent ventricular fibrillation and for the most part took the form of pump failure or late unexpected death. Experience suggests that the use of lignocaine to suppress ventricular ectopic activity observed in the first few hours of admission to hospital with acute myocardial infarction has no therapeutic value. [ABSTRACT FROM PUBLISHER]

Twenty six cases of bacterial endocarditis in infancy and childhood were treated with a mortality of less than 8%. Twenty two had recognised congenital heart disease and four had previously normal hearts. Thirteen out of the 24 cases with positive blood cultures had staphylococcal infection. Appropriate antibiotics were identified by measurement of the minimum bactericidal concentration as an indicator of antibiotic sensitivity. The bactericidal activity of the patient's serum during treatment was monitored by back titration against the causative organism to assess the optimal antibiotic combination and dosage. Treatment was continued for six weeks in most cases, comprising intravenous treatment for at least the first three weeks, but then being substituted with oral treatment in some. Twenty one cases were successfully treated medically. Five developed complications requiring surgery, two of whom died. [ABSTRACT FROM AUTHOR]

Prostaglandin E2 was given orally to 59 infants with ductus dependent congenital heart disease, and intravenous infusions were substituted for varying periods in 27 of them. An additional three neonates received intravenous treatment alone. Mean oral maintenance dose was 27 micrograms/kg per hour and the mean intravenous dose was 0.005 micrograms/kg per minute. Mean duration of treatment was 49 days (range 16 hours to 272 days). Oral treatment was almost always effective and was especially suitable for long term use. Low dose intravenous treatment was readily substituted when indicated. Complications were usually 'minor'. Growth of the infants and of their pulmonary arteries facilitated later surgical management. [ABSTRACT FROM AUTHOR]

OBJECTIVES--To assess the medium-term results of total cavopulmonary shunt operations in children with left atrial isomerism, interrupted inferior vena cava, and complex congenital heart defects. BACKGROUND--Creation of a total cavopulmonary shunt provides very good interim palliation for children with interrupted inferior vena cava and complex congenital heart disease; however, longer term results after this operation have not been reported. METHODS--Detailed follow up of six children who underwent creation of a total cavopulmonary shunt at a tertiary referral centre. RESULTS--There were no early or late deaths. Oxygen saturations at discharge ranged from 89% to 92% (mean 90%). At last follow up (mean 4.7 years) saturations at rest ranged from 73% to 81% (mean 77%) (P < 0.05). All patients underwent exercise stress testing. At peak exercise oxygen saturations ranged from 62% to 87% (mean 71.5%) and during recovery from 68% to 85% (mean 78%). Cardiac catheterisation was performed in five patients with saturations of less than 80% at rest or peak exercise. No patient had pulmonary arteriovenous fistula. Systemic venous to hepatic venous collaterals were documented in four patients. These were localised below the diaphragm in three and above the diaphragm in one patient. The collateral vessel was successfully embolised in three of these patients, with a rise in resting oxygen saturations from 6 to 10% (mean 7%). CONCLUSIONS--The development of systemic venous to hepatic venous collaterals is a common complication in patients who undergo a total cavopulmonary shunt operation. This can lead to significant desaturation at rest and during exercise. Detailed angiographic studies of the infradiaphragmatic system veins is required for diagnosis. Transcatheter embolisation of such vessels gives good relief. [ABSTRACT FROM PUBLISHER]

OBJECTIVES--A combined atrial and arterial switch procedure was performed in selected patients with congenitally corrected transposition to establish the morphological left ventricle as the systemic ventricle. Immediate and early follow up results are presented. BACKGROUND--Progressive right ventricular dysfunction and tricuspid regurgitation are common in patients with congenitally corrected transposition who undergo repair of associated lesions. A surgical procedure which re-establishes the left ventricle as the systemic ventricle should improve functional results. METHODS--Four symptomatic children aged from 9 months to 3 years 1 month (mean 2 years 3 months) with congenitally corrected transposition and ventricular septal defect underwent both an atrial and arterial switch procedure and were followed up for a mean of 12 months (range 6-21 months). RESULTS--There were no early or late deaths. Conduction abnormalities worsened in two patients. Hospital stay ranged from 8 to 17 days (mean 13 days). The cardiothoracic ratio decreased from a mean (range) of 0.65 (0.6 to 0.71) to 0.58 (0.52 to 0.6). Currently, three patients are in functional class I and one child is in functional class II. CONCLUSIONS--The combination of an atrial and an arterial switch procedure in symptomatic children with congenitally corrected transposition establishes the left ventricle as the systemic ventricle. The initial experience is encouraging with excellent immediate and early follow up results. [ABSTRACT FROM PUBLISHER]