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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]

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]

A case of cardiac tamponade secondary to a late, loculated pericardial effusion after open pulmonary valvotomy is described. Percutaneous drainage of the effusion was aided by the infusion of intrapericardial streptokinase. [ABSTRACT FROM PUBLISHER]

In two children with the haemolytic uraemic syndrome dilated cardiomyopathy occurred in the absence of hypertension, or fluid or electrolyte disturbance. These cases presented with acute left ventricular failure. Echocardiography showed left ventricular dilatation and reduced contractility. There was also ventricular wall thickening, which persisted. Twelve other children with haemolytic uraemic syndrome had prospective echocardiography. Eleven of them showed no evidence of cardiomyopathy and in one transient dilatation and reduced contractility developed without clinical signs. Dilated cardiomyopathy is a rare but important extrarenal manifestation of the haemolytic uraemic syndrome and is best demonstrated by echocardiography. [ABSTRACT FROM PUBLISHER]

Four-hundred and twenty-eight school leavers of 3 ethnic groups (white, black and Asian) were screened for blood pressure, resting pulse rate and general anthropometric characteristics. Asian pupils were both shorter and lighter than the other two groups whilst black males were heavier and taller. There was no significant difference in the mean systolic or diastolic blood pressure between the 3 groups, although the black pupils had a stronger family history of hypertension, particularly on the mother's side. These observations differ in some respects from other ethnic blood pressure studies and establish values for the local population. [ABSTRACT FROM PUBLISHER]

Six weeks after cardiac catheterisation via the right femoral vein an infant underwent an anatomical correction for transposition of the great vessels and closure of a large ventricular septal defect. The patient died intraoperatively as a result of severe left ventricular dysfunction. Necropsy showed an old myocardial infarction associated with thrombosis of the circumflex coronary artery. Electron probe x ray analysis showed that foreign refractile material within the thrombus contained bismuth, an element used in the construction of some cardiac catheters. This is believed to be the first report of "paradoxical" coronary embolisation of catheter-derived material and highlights the usefulness of electron probe x ray analysis. [ABSTRACT FROM PUBLISHER]

Reports on the first transcatheter closure of an aorto-left ventricular tunnel via a percutaneous catheter procedure, although this may depend on the size and morphology of the tunnel and patient size. Use of an amplatzer duct occluder device from AGA Medical Corp.

Unlabelled: The 3-year survival after small bowel transplantation (SBTx) has improved to between 73% and 88%. Impaired venous access for parenteral nutrition can be an indication for SBTx in children with chronic intestinal failure., Aim: To report our experience in management of children with extreme end-stage venous access., Subjects: The study consisted of 6 children (all boys), median age of assessment 27 months (range, 13-52 months), diagnosed with total intestinal aganglionosis (1), protracted diarrhea (1), and short bowel syndrome (4), of which gastroschisis (2) and malrotation with midgut volvulus (2) were the causes. All had a documented history of more than 10 central venous catheter insertions previously. All had venograms, and 1 child additionally had a magnetic resonance angiogram to evaluate venous access. Five of 6 presented with thrombosis of the superior vena cava (SVC) and/or inferior vena cava., Methods: Venous access was reestablished as follows: transhepatic venous catheters (5), direct intra-atrial catheter via midline sternotomy (4), azygous venous catheters (2), dilatation of left subclavian vein after passage of a guide wire and then placing a catheter to reach the right atrium (1), radiological recanalization of the SVC and placement of a central venous catheter in situ (1), and direct puncture of SVC stump(1). Complications included serous pleural effusion after direct intra-atrial line insertion, which resolved after chest drain insertion (1), displacement of transhepatic catheter needing repositioning (2), and SVC stent narrowing requiring repeated balloon dilatation., Outcome: Four children with permanent intestinal failure on assessment were offered SBTx, 3 of which were transplanted and were established on full enteral nutrition; the family of 1 child declined the procedure. In the remaining 2 children in whom bowel adaptation was still a possibility, attempts were made to provide adequate central venous access as feeds and drug manipulations were undertaken. One of them received liver and SBTx nearly 3 years after presenting with end-stage central venous access, because attempts to achieve independence from parenteral nutrition had failed. The other child died immediately after a transhepatic venous catheter placement, possibly from a nutritional depletion syndrome as no physical cause of death was found. Direct intra-atrial catheters in transplanted children proved to be adequate for the management of uncomplicated transplantation, although the usual infusion protocol had to be modified considerably, and the lack of access would have been critical if massive blood transfusion had been required during the transplant procedure., Conclusion: It was possible to reestablish central venous access in all cases. However, this was time consuming and difficult to assemble a skilled team consisting of one of more: surgeon, cardiologist, interventional radiologist, and transplant anesthetist. Small bowel transplantation is easier and safer with adequate central venous access, and we advocate liaison with an SBTx center at an early stage.

Two dogs, one immature and one adult, were presented with a history of progressive ascites. In a third, immature dog, increasing exercise intolerance had been noted. Echocardiography demonstrated a partition in the right atrium (cor triatriatum dexter) and echocontrast studies documented normal flow from the cranial vena cava into the right atrium and ventricle. A saphenous vein contrast study demonstrated flow from the caudal vena cava into an accessory right atrial chamber (sinus venarum). The sinus venarum communicated with the true right atrium via a small defect in the atrial membrane in one dog, and additionally with the left atrium via a right-to-left shunting foramen ovale in the other dogs. All defects were visualised on angiographic studies by selective catheterisation of the caudal vena cava via the femoral vein. Balloon dilatation of the defect was then performed using a small followed by a larger balloon angioplasty catheter to enlarge the defect in the atrial membrane. Clinical signs improved within days and were sustained in the long-term in all cases.