Eric Harinck

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.

Air Travel and Adults With Cyanotic Congenital Heart Disease

BACKGROUND Concern has been expressed that a reduction of partial oxygen pressure during flight in commercial aircraft may induce dangerous hypoxemia in patients with cyanotic congenital heart disease. METHODS AND RESULTS To evaluate the validity of this concern, the transcutaneous SaO2 was measured in 12 adults with this type of heart disease and 27 control subjects during simulated commercial flights of 1.5 and 7 hours in a hypobaric chamber. Ten of those patients and 6 control subjects also were evaluated during two actual flights of approximately 2.5 hours in a DC-10 and an A-310, respectively. During the prolonged simulated and actual flights, the capillary blood pH, gases, and lactic acid were analyzed in the patients and during one of the actual flights also in the control subjects. During the simulated flights the SaO2 was at all times lower in the patients than in the control subjects. However, the maximal mean actual percentage decrease, as compared with sea level values, did not exceed 8.8% in either patients or control subjects. During the actual flights, this maximal decrease in the patients was 6%. In-flight reduction of the capillary PO2 was considerable in the control subjects but not in the patients. It is our hypothesis that the lack of a significant decrease of the PO2 in the patients might possibly be due to a high concentration of 2.3 diphosphoglycerate in the red cells. The flights had no influence on the capillary blood pH, PCO2, bicarbonate, or lactic acid levels in either patients or control subjects. CONCLUSIONS Atmospheric pressure changes during commercial air travel do not appear to be detrimental to patients with cyanotic congenital heart disease.

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.

Comparison of Light and Electron Microscopic Studies of the Normal and Persistent Ductus Arteriosus in Humans and Dogs

The physiologic closing process of the ductus arteriosus (DA) has been mainly investigated in animal models [1]. Several studies indicate that the pharmacologic and physiologic behavior of the animal ductus is similar to that of the DA in humans [2]. Light microscopic investigation of the human DA revealed a seemingly obligatory sequence of changes during maturation and closure. Most of these changes take place between the 16th week of gestation and the first days postnatally (Figure 1) [3].

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.