André J. Moulaert

The ductus arteriosus in the preterm infant: histologic and clinical observations.

In order to elucidate some of the unexplained phenomena in prolonged patency of the ductus arteriosus in preterm infants, the histology of the ductus was studied in 27 cases. Some of the infants had been treated with indomethacin. Four morphologic maturation stages are distinguished. There was no strict relation between gestational age or birth weight and histologic maturation. Therefore, one cannot predict whether a ductus is likely to be mature at the time of birth. In all infants with clinically diagnosed prolonged patency of the ductus beyond the first week, the immature maturation stage or the permanent patent type was observed. In both stages, reopening after initial closure with indomethacin occurred.

Histology of the persistent ductus arteriosus in cases of congenital rubella.

Histologic study of the persistent ductus arteriosus in case of a congenital rubella syndrome revealed that this persistency is probably due to an arrest in the development of the ductus. Histologically, it resembles a very immature ductus and not the most common type of persistent ductus arteriosus. The earlier finding, that in the human ductus arteriosus, the presence of an extensive subendothelial elastic lamina is incompatible with anatomic sealing, still holds.

Muscular ventricular septal defects: A reappraisal of the anatomy

Among 79 autopsy specimens of heart with an isolated ventricular septal defect, there were 29 cases of muscular defect. Among 60 hearts with complete transposition of the great arteries and a ventricular septal defect, there were 13 cases with a muscular defect. All muscular defects could be classified in three different types, based on the specific pathologic anatomy of the ventricular septum. The central and posterior defects were usually large and single, the marginal defects were frequently small and multiple. In hearts with transposition, central muscular defects were extremely rare, whereas these defects were by far the most frequent muscular defects in isolated ventricular septal defect. Alternatively, the posterior type was more common in cases of transposition. Marginal muscular defects were rare in both groups of malformations.

Histopathology of the ductus arteriosus after prostaglandin E1 administration in ductus dependent cardiac anomalies.

The histology of the ductus arteriosus was studied after prostaglandin E1 (PGE1) administration in 4 infants with ductus dependent cardiac malformations. Pronounced pathological changes were found in each instance. The changes consisted of oedema of the media with separation of medial components by clear spaces, pathological interruptions of the internal elastic lamina, and intimal lacerations, some of which extended into the media. The findings suggest that PGE1 administration has a profound weakening effect on the structure of the wall of the ductus arteriosus, rendering the vessel prone to laceration.

CARDIAC RHABDOMYOMA IN INFANCY

Abstract. Harinck, E., Moulaert, A. J. M. G., Rohmer, J. and Brom, A. G. (Departments of Paediatric Cardiology and Thoracic Surgery, University Hospital, Leiden, The Netherlands). Cardiac rhahdomyoma in infancy. Acta Paediat Scand, 63:283, 1974.–The clinical picture of three cases of cardiac rhahdomyoma is presented. Surgical removal was attempted in two cases. One of them is still alive 9 years after the operation hut has a severe mental retardation due to the associated tuberous sclerosis. Particular attention is given to the frequent association of cardiac rhabdomyoma and tuberous sclerosis. With the progress of cardiac surgery rhabdomyomas of the heart often can be removed successfully but a surgical intervention is justified only in the absence of tuberous sclerosis or brain damage.

Two-Dimensional Contrast Echocardiography in the Study of Ventricular Septal Defects

Isolated ventricular septal defects (VSDs) can usually be diagnosed under normal circumstances by physical examination, electrocardiogram, phonocardiogram, and chest X-ray. If necessary, confirmation is obtained by cardiac catheterization and angiocardiography. The exact location of the defect may be obtained by angled left ventricular angiocardiography [1]. To achieve angiocardiographic localization several X-ray films are often necessary.

Ultrasonic Assessment of Cyanotic Heart Disease in Newborns: The Current State of the Art

Cyanotic cardiovascular lesions often lead to urgent intensive care admission early in life. Less than 1 decade ago, emergency cardiac catheterization and angiocardiography were necessary for diagnostic confirmation before commencing, or abstaining from, certain therapeutic actions. At present, the structural pathology can be visualized noninvasively by two-dimensional echocardiography (2-D echo); additional or confirmative information can be gained by the detection of abnormal blood flow patterns with pulsed Doppler echocardiography (pD). It is important to exclude an abnormality with precision equal to diagnosing it. For instance, in the hypoxic newborn, persistent fetal circulation must be rapidly differentiated from structural heart disease. This presentation deals with the ultrasonic diagnosis of the different types of life-threatening cyanotic cardiovascular diseases in the neonatal period.