Francisco A. Hernandez

The intracavitary electrocardiogram in the diagnosis of Ebstein's anomaly☆

Abstract The simultaneously recorded intracavitary electrocardiographic patterns and pressures in three cases of Ebsteins anomaly of the tricuspid valve have been described. The following findings are diagnostic of Ebsteins anomaly: 1. (1) Typical right ventricular intracavitary patterns with simultaneously obtained low atrial type pressure curves. 2. (2) Intracavitary right ventricular monophasic waves produced by pressure of the catheter tip against the wall of the distal portion of the low pressure chamber. The production of right ventricular extrasystoles by pressure of the catheter tip against the wall of the distal portion of the low pressure chamber is highly suggestive of this condition.

Rarity of coarctation of the aorta in the American Negro

Summary One hundred and seventy-seven cases of coarctation of the aorta were reviewed. Among patients having coarctation, only 4 per cent were American Negroes, whereas of the general pediatric cardiac population, Negroes made up 20 to 30 per cent (p Until the accumulation of further evidence,we must conclude that coarctation of the aorta is rare in the American Negro. A similar observation has been noted in the population of Southeast Asia.

Congenital bilateral subclavian steal: ductus-dependent symptoms in interrupted aortic arch associated with ventricular septal defect.

There are two types of congenital bilateral subclavian steal. The first type is accompanied by severe coarctation or interruption of the aorta in which both the right and left subclavian arteries have their origin distal to the obstruction in the aorta. In most cases with complete interruption of the aorta there is a large ventricular septal defect. The second, less common type of steal is associated with isolated atresia of the proximal segment of the subclavian arteries. In the first type of steal, the anatomic predisposition for the steal is present from birth but clinical symptoms frequently do not appear until childhood or adolescence. In the newborn the presence of a widely patent duclus arteriosus and its capacity to transmit the flow and pressure from a hypertensive pulmonary artery to the descending aorta and thus to the subclavian arteries prevents cerebral symptoms and angiographic signs, but in the older infant and child, the internal diameter of the ductus has usually decreased, leading to symptoms of the subclavian steal syndrome.

Conditions clinically confused withthe rheumatic state

Summary Case records of 2,045 outpatientssuspected of having rheumatic or congenital heart disease were reviewed. It was found that 46.8 per cent had no heart disease, 23.5 per cent were in the “rheumatic state”, and 23.6 per cent had congenital lesions. “Nonrheumatic” conditions, inwhich prolonged fever, joint pain, and heart murmur were part of the picture, were mistakenly diagnosed as rheumatic fever or rheumatic heart disease in 117 cases (5.7 per cent). The signs and symptoms which confused these conditions with the rheumatic state and those which determined the final diagnoses were tabulated and discussed, with special emphasis on methods of preventing such mistaken diagnoses.

Wedge Pulmonary Arteriography in Congenital Heart Disease

The importance of angiocardiography in the study of the pulmonary vascular tree is generally accepted. Peripheral or selective angiocardiography has been fruitful in furnishing a panoramic view of the pulmonary artery and its main branches and the pulmonary veins. It has indications and advantages, but unfortunately the superposition of other parenchymal vessels in the frontal projection makes accurate information about the small pulmonary vessels impossible. While in some cases abnormalities occur at the main pulmonary artery or its large branches, in others the lesion involves primarily the small arteries or arterioles. To obtain better details, injection has been made in the pulmonary artery branches in “free” (1–9) or in “jammed” (10) position. The latter has proved the best method to date of delineating the anatomical status of the small arteries, arterioles, and capillary network. Correlation between the roentgenographic pattern and the microscopic picture of the segment injected has been accurately...

Five and ten year follow-up study of rheumatic patients: Role of climate and environment

Abstract 1. (1) Five- and ten-year studies were completed on 102 and 48 expatients of the National Childrens Cardiac Hospital, Miami, Florida, to determine whether or not the lives of these subjects were influenced by a period of convalescent care in this tropical area. 2. (2) Data were available on 92 of the five-year group, and 41 of the ten-year patients. In the total 133, the death rate was less than 7 per cent. 3. (3) Of the 124 survivors on whom we have information, 16 per cent had recurrences. 4. (4) Heart damage, more than minimal, was observed in only 31 per cent of the 124 survivors. 5. (5) The death rate, frequency of recurrences, and heart damage, all compare very favorably with similar reports from other centers.

The Pulmonary Artery Segment in Normal and in Valvular Pulmonary Stenosis

1. The length and arrow or the PAS of 130 normal cases were measured, respectively. The BSA (m2) ranged between 0.30--2.05, and the ages between 6 months and 40 years. 2. Seventy-three cases VPS were divided into four groups according to the peak SPRV: Group 1, less than 50 mm Hg; Group 2, from 50--75 mm Hg; Group 3, from 75--150 mm Hg; and Group 4, with more than 150 mm Hg. The length and arrow of the PAS was measured. The age of the patient ranged from 4--38 years. 3. In normal cases, the PAS was a straight line or presented a slight concavity in 30% of the cases. 4. In cases of VPS all of them had a slight or marked bulging of the PAS, except one in Group 1 (6.6%); two in Group 2 (11%); three in Group 3 (10%); and one in Group 4 (8.3%). Marked convexity (more than 10 mm of arrow of this segment) was found one time in Group 1 (6.6%); three times in Group 2 (16%); three times in Group 3 (10%); and twice in Group 4 (16%). 5. In normal cases the length and the arrow of the PAS tend to have greater values when the BSA is higher. When the arrow of the segment is above 5 mm and the length higher than 50 mm, irrespective to the patients age, we must be facing an abnormal finding and all those diseases capable of giving an abnormal PAS should be considered. 6. We want to stress the importance of obtaining a proper roentgenogram to assess, with accuracy, the quantitative and qualitative data needed to do a correct interpretation of the cardiac silhouette.

Angiocardiographic measurement of the right main pulmonary artery in congenital heart disease.

aFrom the National Children’s Cardiac Hospital, 1475 N.W. 12th Avenue, Miami, Fla. bSupported by Grant HE-06514 from the National Institute of Health, Dept. of Health, Education, and Welfare, Public Health Service, Bethesda, Md.; the Heart Association of Greater Miami; and the Heart Association of Broward County, Fla. cPresent address: Variety Children’s Hospital, 6125 S.W. 31st Street, Miami, Fla. dSenior scientist, National Children’s Cardiac Hospital; Honorary Fellow of the American College of Radiology; formerly Professor of Pediatrics, Havana School of Medicine, Havana, Cuba. eAssociate Professor, Department of Pediatrics, and Associate Professor, Dept. of Medicine, University of Miami School of Medicine; Clinical Director, National Children’s Cardiac Hospital. The performance of the vena cava pulmonary artery shunt in the treatment of certain congenital defects of the heart has focused attention on the right main (RPA) and left main (LPA) pulmonary arteries.~~ 2 Only since angiocardiography has been widely used have the normal pattern and abnormalities of the main pulmonary artery (MPA) been known. This vessel, rising from the MPA, goes horizontally throughout the right hilium, where it divides into different branches. The RPA courses inside the

Angiographic Determination of the Size of the Descending Aorta in Congenital Heart Disease

The medical literature concerning the size of the descending aorta at its different levels is very scanty and the few papers published so far are due to the use of the contrast medium for opacifying it. The late phase of the venous angiocardiography as well as the left ventriculogram and the retrograde or selective aortogram are capable of sharply outlining this artery. With the dense opacification of the descending aorta, obtained by the above mentioned methods, the size of this artery may be accurately measured during systole and diastole. Two requirements should be fullfilled to make possible a valuable study of the anatomic conditions of the descending aorta in congenital and acquired diseases: (1) the normal value for a variable (age, weight, body surface area (m2), etc.; (2) an agreement about the site where the measurement is to be made.

Angiographic Determination of the Size of the Ascending Aorta in Congenital Heart Disease

The size of the aorta is considered to play an important role in the differential diagnosis of congenital heart disease. Conventional roentgenograms and fluoroscopic examination are helpful in ascertaining aortic size, but several conditions make their interpretation difficult. In infancy the size of the aorta cannot be estimated with certainty when the thymus is hypertrophied, a frequent occurrence. Mild dilatation of the ascending aorta is often missed on routine roentgenograms. Even when the esophagus is filled with barium to outline the aorta, the index of accuracy for evaluating its size is not high. Moreover, if a single telecardiogram is taken, the exposure may sometimes be made in diastole when the caliber of the vessel is less than in systole. When serial angiocardiograms are performed with very rapid film changers, however, the aorta is always outlined, not only in diastole but in systole, and even mild systolic dilatation of the ascending aorta may be detected. This paper is concerned with the ...