Alois R. Hastreiter

Right ventricular volume in congenital heart disease

With use of the Frank lead system, still loop and timed vectorcardiograms were recorded in more than 5,000 patients subjected to complete right and left heart catheterization and selective coronary cineangiography. Data so obtained demonstrated clinical superiority of the vectorcardiogram over the standard 12 lead scalar electrocardiogram. Specific advantages of the vectorcardiogram include (1) recognition of undetected atrial and ventricular hypertrophy, (2) greater sensitivity in identification of myocardial infarction, and (3) superior capability for diagnosis of multiple infarctions in the presence of fascicular and bundle branch blocks. The timed biplane vectorcardiogram is as useful as any number of simultaneously recorded electrocardiographic leads for the analysis of complex arrhythmias and beat to beat changes in intraventricular conduction. Since the validity and usefulness of this technique have been established, it should become part of the routine noninvasive evaluation of patients with cardiovascular disorders.

Changes of atrioventricular conduction with age in infants and children

Analysis of 100 His bundle electrograms obtained in infants and children revealed that all A-V conduction events, that is, the P-R, P-H, P-A, A-H and H-V intervals were age-dependent. A constant relation was observed in the various age groups when these intervals were expressed as a function of the P-R interval. The variability of the A-V conduction intervals within the various age groups and their cycle to cycle variability also remained constant with age. Since the variations of the P-R interval with age in infants and children are known, simple formulas can be derived that permit the calculation of the average value, “normal” range and cycle to cycle variability of the P-H, P-A, A-H and H-V intervals at any age.

Gestational age and indomethacin elimination in the neonate.

The disposition of oral indomethacin was studied in 9 premature infants with significant patent ductus arteriosus (sPDA) with birth weights ranging from 800 to 1,960 gm and gestational ages of 28 to 36 wk. Peak plasma concentrations in most of the subjects were not observed until 3 to 4 hr after administration and ranged from 0.027 to 0.31 µg/ml. Plasma half‐life (t½) of indomethacin ranged from 11 to 20 hr and correlated with gestational age. Plasma protein binding studies, in samples from the premature infant using radiolabeled indomethacin, showed no difference in binding from values obtained with adult plasma (>98%). Absorption of orally administered indomethacin appears to be incomplete and plasma clearance much longer than in the adult.

Serum levels of digoxin in infants and children

Serum digoxin levels during maintenance therapy in children of three different age-weight groups were determined by radioimmunoassay. During the postabsorptive interval (1 to 2 hours after an oral dose), infants in the 5 to 9 Kg. group were found to have significantly higher serum digoxin levels than children in the 9 to 18 Kg. group, who in turn had higher levels than older children. Serum levels were comparable for all groups during equilibrium (5 to 9 hours after an oral dose). Since digoxin is primarily eliminated unchanged in the urine, our data suggest that infants and young children may have relatively more rapid rates of excretion than do older children and adults.

Discordant situs of thoracic and abdominal viscera

Abstract Two instances of levocardia with thoracic situs solitus and abdominal situs inversus, and one of their mirror image counterpart are described. No intracardiac defects were present in 2 cases, and the third had a fossa ovalis type of atrial septal defect with partial anomalous pulmonary venous connection. The course of the inferior vena cava was unusual in that the vein switched abruptly from one to the other side of the abdomen at the liver to connect with the venous atrium located on the opposite side. The cases described are thought to represent a specific type of anomaly of visceral situs, characterized by complete thoracic and abdominal discordance. A similar anatomic relationship of the heart and viscera, and course of the inferior vena cava, may occur in more complex types of heterotaxia associated with severe cardiac anomalies, and asplenia or polysplenia. Analysis of these cases reveals that continuity between the inferior vena cava and morphologic right atrium appears to be the most reliable method for atrial localization.

Clinical forms of atrial flutter in infancy

On the basis of the four present case reports and analysis of previous cases from theliterature, two distinct clinical forms of atrial flutter in infancy are recognized. One is a chronic congenital arrhythmia, which is refractory to treatment; it usually subsides spontaneously during the first year of life. The second is paroxysmal and occurs several weeks or months after birth; it is usually responsive to treatment but tends to recur.

Pulmonary atresia with obstructed ventricular septal defect

SummaryTwo patients with pulmonary atresia had a loud holosystolic murmur and an obstructed ventricular septal defect. Case 1 simulated pulmonary atresia with intact ventricular septum, presenting at 3 months of age with venous congestion, severe tricuspid regurgitation, and suprasystemic right ventricular pressure. Case 2 had a right ventricular systolic pressure that was initially at the systemic level but had increased to a suprasystemic level by 3 years of age. Autopsy showed that the ventricular septal defect was large in each case but was obstructed by tricuspid valve tissue in case 1 and by a hypertrophied septal band in case 2.

Aorticopulmonary septal defect and interrupted aortic arch: A diagnostic challenge☆

Abstract A report of a rare case of aorticopulmonary septal defect and interrupted aortic arch is presented with cardiac catheterization, cineangiocardiographic and autopsy findings. Emphasis is placed on the masking of the Interrupted arch by the presence of an aorticopulmonary septal defect and patent ductus arteriosus.

Prostaglandin E1 infusion in newborns with hypoplastic left ventricle and aortic atresia.

SummaryProstaglandin E1 (PGE1) infusion was used in 7 infants with hypoplastic left ventricle and aortic atresia. Of 5 non-operated patients, 4 died shortly after the onset of PGE1 infusion and 1 survived for 30 hours. Of the 2 infants who had surgery, 1 died during the operation and 1 survived for 38 days. In 6 infants, a transient metabolic and/or circulatory improvement could be demonstrated following PGE1 infusion. The lack of response of other infants may be related to the advanced deterioration of their clinical status at the time of study. In the light of recent surgical developments for infants with aortic atresia, support with PGE1 may nevertheless play an important role in their management if started early.

Accidental Digoxin Overdose in an Infant: Postmortem Tissue Concentrations

We report the digoxin concentration in various tissues of a seven-week-old infant who died 45 min after receiving an accidental intravenous overdose of digoxin. The digoxin content of various organs was calculated and expressed as a percentage of dose administered. The literature of accidental massive digoxin overdose in infants has been reviewed. Data on tissue concentrations and distribution of digoxin in this age group is scarce. The concentration of digoxin in myocardium, kidney, liver, and other organs observed in our case rank among the highest ever reported in human tissues.