Leonard M. Linde

Growth in children with congenital heart disease

A longitudinal study was made of height and weight growth in children with cyanotic and acyanotic congenital heart disease. Values were compared to a group of children without heart disease, which included siblings of the children with heart disease. Retardation in height and weight was noted in all children with cardiac disease but was more pronounced in those with cyanosis. This retardation appeared to be associated with the presence of rather than the degree of cyanosis. Weight retardation was more frequent and more marked than retardation in height. Delayed and retarded development was of greater severity in boys than in girls. A relationship between the degree of physical incapacity and extent of growth retardation was demonstrated.

LONGITUDINAL STUDIES OF INTELLECTUAL AND BEHAVIORAL DEVELOPMENT IN CHILDREN WITH CONGENITAL HEART DISEASE

This is the final paper in a series (5, 6, 9) which reports the results of a five year developmental study comparing the intelligence and adjustment of children with cyanotic congenital heart disease, those children with acyanotic cardiac disease and normal children. Previous papers have not dealt with changes during the five year study period. Possible effects of intervening cardiac operation upon the development of children with congenital heart disease are of primary interest. More than 40% of the children in the cardiac group underwent operation during the course of the investigation, and so we were able to compare the developmen; of operated and nonoperated children. We studied changes in physical capacity, intelligence and adjustment of the child and also changes in the mothers attitude toward her child, the extent of her anxiety and her need to protect and pamper him.

Mental development in congenital heart disease

Intellectual development of cyanotic and acyanotic children with congenital heart disease was compared to that of both their normal siblings and randomly selected well babies. Cyanotic patients scored lower at all ages, particularly in the earlier years, with tests involving gross motor abilities in Gesell and Cattell developmental examinations. Correlation of low test scores to physical incapacity tended to disappear at later ages when Stanford-Binet tests were given. Early motor performance deficit in the handicapped child may cause underestimation of intellectual potential.

Relation Between Lung Volume and Pulmonary Vascular Resistance

Ten experiments were conducted on anesthetized dogs ventilated with a Starling pump and breathing oxygen. While tidal volume, respiratory rate, and arterial pH and pCO2 were kept constant, lung volume was varied by using either a negative, zero, or positive end-expiratory pressure, leading to average changes in lung volume of −32, 0, and +75 per cent. Pulmonary vascular resistance (PVR) increased with either decreased or increased lung volume, indicating that the relationship between resistance and lung volume is a U-shaped curve. Since the transmural distending pressures of large pulmonary vessels either increased or remained unchanged during these procedures, changes in PVR cannot be ascribed to changes in systemic circulatory dynamics, such as cardiac output. It was noted that cardiac output increased with negative end-expiratory pressure (effectively, negative-pressure breathing) and decreased with positive end-expiratory pressures (effective, positive-pressure breathing), as previously reported. A hypothesis is presented for explaining the U-shaped curve relating resistance and lung volume.

Abnormal Rhythms Associated with Persistent Left Superior Vena Cava

Extract: The electrocardiograms of 26 patients with persistent left superior vena cava (SVC) draining into the coronary sinus were reviewed. Left axis of P waves between +15 and −29 degrees was observed in nine cases, including two of three cases of persistent left SVG with absent right SVC. Isorhythmic A-V dissociation with interference was observed in one subject.The study of the P wave in five groups of patients with presumably normal caval drainage revealed that frontal P wave axis fell usually between +20 and +70 degrees.Speculation: Left axis of the P waves, if present in patients with congenital heart defects, may suggest persistent left superior vena cava draining to the coronary sinus. Further pathologic and histologic study is needed to clarify the pathogenesis of these abnormal cardiac rhythms and the possible embryologic relation between persistent left superior vena cava and an ectopic pacemaker.

The effects of meperidine, promethazine, and chlorpromazine on pulmonary and systemic circulation

Abstract The effects of meperidine, promethazine, and chlorpromazine (Demerol, Phenergan, and Thorazine) were studied in the intact, unanesthetized dog. MPC caused significant pulmonary vasoconstriction and systemic vasodilation in this preparation. If MPCs pharmacologic properties in humans are equivalent to those found in the present study, its suitability as a precardiac catheterization agent in some forms of cardiac disease may be open to question.

Pulmonary Artery Stenosis Associated with Ductus Arteriosus Following Maternal Rubella

Nine patients with pulmonary artery stenosis associated with patent ductus arteriosus following maternal rubella are described.Five of the patients had bilateral pulmonary artery stenosis and four cases involved only the right pulmonary artery. Mild pulmonary valvular stenosis was present in five and a ventricular septal defect in one.The persistence of a systolic murmur transmitted to the lateral chest wall, after ligation or division of a patent ductus arteriosus, should arouse suspicion of the presence of pulmonary artery stenosis.This report supports the recently described implication of maternal rubella as a cause of pulmonary artery stenosis. Careful auscultation in patients with history of maternal rubella may discover the presence of such an arterial anomaly, but cardiac catheterization and angiocardiography are necessary for substantiation of diagnosis.The natural history of these lesions is not known.

Situs inversus totalis associated with complex cardiovascular anomalies

Abstract Two cases of situs inversus totalis complicated by complex cardiovascular anomalies are presented. In Case 1 the associated cardiovascular abnormalities consisted of an anteriorly located aorta and systemic ventricle, ventricular septal defect, pulmonic stenosis, and partial anomalous pulmonary venous drainage, while in Case 2 a ventricular septal defect and an absent inferior vena cava with functional replacement by the azygous vein were diagnosed. Cardiac catheterization and angiocardiography were utilized in order to obtain accurate preoperative anatomic and functional data. Embryologic aspects and the various cardiac anomalies associated with situs inversus totalis are discussed.

Abnormal P wave axis in congenital heart disease associated with asplenia and polysplenia.

Summary The electrocardiograms of six patients with asplenia syndrome and four patients with polysplenia syndrome with left-sided heart were reviewed. Vertical frontal plane P wave axes between +80° and +105° were seen in four of six patients with asplenia and coronary sinus rhythm was seen in all four patients with polysplenia. Left atrial rhythms indicated by inverted P waves in left chest leads and dome and dart P wave in midchest leads were two alternate rhythms in the polysplenia syndrome group. Vertically downward P wave vector, if present in patients with cyanotic congenital heart disease and left-sided heart, may be a part of the asplenia syndrome. Superior leftward P wave vector in patients with congenital heart disease is often seen with the polysplenia syndrome. A possible embryologic relation between splenic syndromes and abnormal P waves is suggested. Further histologic study may clarify the pathogenesis of these cardiac rhythms.

The significance of late-phased dart T wave in the electrocardiogram of children

Abstract Pattern criteria of the precordial ST-T complex in childhood were presented. Some characteristics of new patterns were evaluated as to their specificity, sensitivity, and quantitativity from a hemodynamic viewpoint in a variety of congenital cardiac lesions. Analyses of bifid T waves in normal controls and in patients with cardiac defects revealed a characteristic and consistent distribution of their time phases. A second peak proved to be exaggerated in right ventricular overload. A peculiarly shaped bifid T wave was observed in a significant number of patients with ventricular septal defect. This was termed “dome and dart T wave” in view of its configuration. In atrial septal defect, where the only positive deflection of ST-T complex was the late “dart T wave”, the height of the dart T wave closely correlated with the shunt rate at the atrial level, independent of coexisting mild-to-moderate pulmonary hypertension. Although it is difficult to provide a thorough and experimental basis for mechanisms at present, some probable explanations involving proximity effect are offered and discussed.