Arno R. Hohn

RETROGRADE ARTERIAL CATHETERIZATION OF THE LEFT HEART. EXPERIENCE WITH 500 INFANTS AND CHILDREN.

HISTORICALLY, retrograde catheterization of the arterial circulation appears to have been the first method employed in the study of the left heart. Cournand1 cites the physiologic studies of Chauveau and Marey. They recorded pressure tracings obtained from the left ventricle of the erect, unanesthetized horse in 1861.2 3 Almost 100 years later, in 1950, three groups of workers reported application of this approach to man. Zimmerman, Scott, and Becker4 were first to publish. However, they were successful only in patients with aortic regurgitation, being unable to pass through the normal aortic valve. Furthermore, one of their 11 patients succumbed from ventricular fibrillation during the procedure and another died 4 days later. Limon, Rubio, and Bouchard5 were the first to establish this method as a safe, effective approach in man, allowing passage of the catheter across the normal aortic valve in 17 patients without complications. Later in that year Sodi-Pallares 6 and his group confirmed Limons success in 25 patients stud-

Percutaneous right and left heart catheterization in children. Experience with 1,000 patients.

One thousand patients, ranging in age from 4 months to 26 years, underwent percutaneous catheterization of the femoral artery and femoral vein. Cardiac catheterization was combined with selective angiocardiography in all patients.The catheter entered the right ventricle in 972 of 990 patients (98%) and the left ventricle in 832 of 856 (97%), including 82 of 89 patients (92%) with aortic stenosis.There were no deaths, perforations of the heart, or loss of tissue. The peripheral pulse was decreased in 6% (49 of 856) and absent in 2% (17 of 856). Other complications included two uneventful perforations of the aortic arch, two lacerations of the femoral artery, three lacerations of the femoral vein, a false aneurysm of the femoral artery, and a cerebrovascular accident.Our findings indicate that, in children more than 2 years old and weighing more than 10 kg, the percutaneous method is safe, informative, and associated with less arterial circulatory complications than the approach from the surgically exposed artery.

Supravalvular mitral stenosis in a patient with tetralogy of Fallot

Abstract Supravalvular mitral stenosis was found in association with tetralogy of Fallot in an 8 year old boy who died of an intercurrent respiratory infection. This association was not diagnosed during life. However, the electrocardiographic features of right ventricular strain combined with left atrial enlargement should have suggested mitral obstruction. The relatively high pulmonary artery pressure in a patient with a tetralogy and the angiographic findings of large branch pulmonary arteries and a left atrium with prolonged emptying should also lead one to suspect this combination. Surgical correction in such cases must include an attack on the mitral valve.

Detection of Small Ventricular Septal Defects Comparison of Selective Left Ventricular Cineangiography with Indicator-Dilution Techniques

The value of selective left ventricular cineangiography in the detection of small ventricular septal defects was assessed in 23 patients in whom no shunt was detected by blood oxygen saturation change. A comparison was made with selective indocyaninegreen indicator-dilution curves in 10 of these patients. A ventricular septal defect was demonstrated by both methods in 10. However, in one case, the indicator curve showed a left-to-right shunt whereas selective left ventricular cineangiography failed to demonstrate it. Conversely, in two other cases, selective left ventricular cineangiography demonstrated a small ventricular septal defect while a normal curve was obtained by indicator-dilution technique.Comparing our experience with cineangiography with that of others, using hydrogen ion and indocyanine-green indicator-dilution techniques for the detection of small left-to-right intracardiac shunts, it seems there is little difference in the sensitivity of the three methods. Each is capable of detecting ventricular septal defects which cause left-to-right shunts too small to produce measurable blood oxygen saturation variations.

The pediatrician and congenital heart disease.

Cooperation between the pediatrician and the cardiologist is essential if patients with congenital heart disease are to be well cared for and adequately supervised during infancy and childhood. The purpose of this article is to elaborate on the role of the practicing pediatrician in recognizing and caring for the child with this disease and to set forth the required facts for his effective participation.

Correction of complete atrioventricular canal defect: In patients with previous pulmonary artery banding∗

Abstract Two patients with complete atrioventricular canal defects who had pulmonary artery banding in infancy and subsequent successful total correction of this defect are presented. Despite the reported high mortality for pulmonary banding in patients with complete atrioventricular canals, our experience would indicate that significant palliation can be achieved in some of them. Pulmonary banding procedure should, therefore, be seriously considered in patients in severe heart failure not controlled by stringent medical therapy.