Raymond R. Fripp

Pulsed Doppler and two-dimensional echocardiographic findings in aortico-left ventricular tunnel

Two-dimensional echocardiography was used to make the anatomic diagnosis of aortico-left ventricular tunnel in a 1 day old infant. Pulsed Doppler echocardiography allowed directional flow to be determined within the tunnel. The findings were confirmed by cardiac catheterization and by direct visualization at the time of surgical repair. Aortic valve insufficiency was excluded before and after surgery using pulsed Doppler echocardiography. The anatomy and physiology of aortico-left ventricular tunnel can thus be documented using noninvasive techniques.

Ductus arteriosus aneurysm presenting as pulmonary artery obstruction: diagnosis and management

The occurrence of pulmonary artery obstruction in an 8 day old infant as a complication of an aneurysm of a nonpatent ductus arteriosus is reported, together with the echocardiographic and angiographic findings. To relieve the obstruction, the aneurysm and an intrapulmonary thrombus were successfully removed with the use of cardiopulmonary bypass when the infant was 3 months old.

Anomalous Mitral Arcade: Echocardiographic and Angiographic Recognition

SummaryA patient with sudden onset of hemiplegia was noted to have an anomalous mitral arcade at cardiac surgery. Echocardiographic and angiographic data are correlated with the anatomic findings. The clinical significance of this anomaly is discussed.

Transcatheter occlusion of large pulmonary arteriovenous fistula

We describe the compound transcatheter occlusion of a large and symptomatic pulmonary arteriovenous malformation in a 58‐yr‐old man. Pre‐ and postintervention clinical and laboratory data support the impression of an excellent outcome. Cathet. Cardiovasc. Intervent. 51:220–222, 2000.

Oral hydralazine in patients with pulmonary vascular disease secondary to congenital heart disease

Two patients with pulmonary vascular obstructive disease secondary to congenital heart disease were evaluated hemodynamically before and during oral hydralazine therapy. Both patients were assessed postoperatively and had no significant residual shunts. Pulmonary vascular resistance failed to decrease, and an increase in pulmonary arterial pressure occurred because of increased cardiac output secondary to systemic arteriolar dilatation. These responses were sufficiently consistent to warrant a warning against the use of oral hydralazine except under controlled conditions in patients with secondary pulmonary vascular obstructive disease.

Evaluation of the pediatric surgical patient with congenital heart disease.

Children with cardiac disease who undergo noncardiac surgical procedures may encounter risks beyond those usually associated with surgical procedures. In this article, several complicating factors seen in children with heart disease are discussed, including arrhythmias, cyanosis, congestive heart failure, pulmonary hypertension, and subacute bacterial endocarditis.

Arterial hyperoxia in a newborn infant with transposition of the great vessels

clear to auscultation, and the liver palpable 2 cm below the right costal margin. Blood glucose concentration was 141 mg/dl, serum calcium 7.3 mg/dl, hemoglobin 14.6 gm/dl, and hematocrit 40.6%. Blood from the descending aorta had pH 7.42, Paco 2 20.5 torr, and Pa% 41 torr while the infant was being mechanicalIy ventilated with 100% oxygen. A simultaneous blood sample from the right radial artery had a Pa% 40 torr. A chest roentgenogram revealed marked hyperinflation with a normal cardiac silhouette and normal pulmonary vascular markings. Subsequent roentgen- ograms confirmed that the umbilical catheters position was maintained just above the aortic bifurcation throughout the infants hospital course. The electrocardiogram was within normal limits and echocardiography identified four cardiac valves, an intact septum, good left ventricular contractility and the left ventricular pre-ejection period to ejection time ratio was 0.34. However, the anterior great vessel anatomy could not be well defined because of hyperinflation of the lungs.

HEAD GROWTH IN INFANTS WITH CONGENITAL HEART DISEASE (CHD)

We studied patterns of head and somatic growth (height-ht, weight-wt and head circumference-OFC) in 30 infants with CHD. Infants referred in the first 3 mos of life for CHD requiring chronic medical or surgical therapy were enrolled if they had no recognizeable syndrome, intrauterine infection or chromosomal anomaly. Measurements of ht, wt, OFC and were made at 3, 6, 12, 15, and 24 mo of age. 8 initially were cyanotic, 3 have died, and 22 have undergone surgery at a mean age of 15 mos. As a group, the infants developed normally but grew poorly, with wt (20th percentile-%-at 18 months) affected more than OFC and ht (30th % at 18 months) .11 of the 30 showed no growth failure; 2 of those 11 were cyanotic, 1 has died and 6 are post-op. Of the 19 with growth failure, 10 were cyanotic, 2 have died and 16 are post-op. Therapy made no impact on growth patterns of 12 of the 19; but 7 of the growth failure group exhibited catch-up growth (wt> ht>OFC) following surgery at a mean age of 8 months. Mean OFC increased from the 10th to the 25th S> following surgery, even though OFC fell below the 5th % in 4 subjects. Catch-up head growth can accompany catch-up growth in ht and wt following successful surgery in some children with CHD; in others, normal or delayed growth patterns are unaffected by therapy.

THE UNNATURAL HISTORY OF AORTIC STENOSIS

We report on the clinical course and serial hemodynamic studies of three patients with severe valvar aortic stenosis diagnosed in the neonatal period. None of the subjects was symptomatic in the first year of life. In each case, a conservative initial management approach was adopted. Between the time of initial study (mean age 1.8 months) and the follow up at 12-27 months of age (mean 14.3 months), mean left ventricular systolic pressure fell from 151 to 135 mmHg, the mean peak systolic pressure gradient across the aortic valve fell from 54 to 42 mraHg, and the mean calculated aortic valve area index increased from 0.20 to 0.39 cm2/meter2. One of the patients was operated on for symptoms which appeared at 14 months of age. The patient followed longest is now 5 years old, is growing well, has a normal electrocardiogram and an echo-predicted left ventricular systolic pressure of 128 mmHg. This experience suggests that not all asymptomatic neonates with severe valvar aortic stenosis require surgical intervention early in life. In some, the aortic valve orifice may increase in size with somatic growth and obviate the need for surgery in early childhood.

537 AEROBIC EXERCISE AND ATHEROSCLEROTIC RISK FACTORS IN ADOLESCENTS

The effect of a 7 week aerobic exercise program on atherosclerotic risk factors was assessed in 65 adolescent white males (mean age 15.8 yrs). Each subject was evaluated before and after the program for body weight, body mass index (BMI) (wgt/ ht2), % fat, systolic and diastolic blood pressure, maximum oxygen consumption (MVO2), exercise duration (ED) and fasting plasma lipids (cholesterol (CHL), triglyceride (TGL), high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C)). Mean weight (± SD) was 70.7 ± 16.5 kg before and 71 ± 16.5 after training (p NS). BMI was 23.2 ± 4.6 and 23.2 ± 4.7 (p NS). % fat decreased by 7.9% from 20.3 ± 6.9 to 18.7 ± 6.3% (p <0.001). Systolic and diastolic blood pressure remained unchanged, MVO2 increased by 10.8% from 45 ± 6.5 to 49.9 ± 7.8 ml/kg-min−1 (p < 0.0001) and ED increased from 20.5 ± 2.6 to 21.1 ± 2.5 min (p < 0.01). Plasma lipids (mg/dl) were similar pre and post exercise-CHL 154 ± 32 and 152 ± 31, TGL 87 ± 46 and 92 ± 40, HDL-C 46 ± 12 and 45 ± 9 and LDL-C 90 ± 21 and 88 ± 27. These results demonstrate that with the exception of obesity, atherosclerotic risk factors are not modified by an effective aerobic training program in adolescent males. This is at variance from that reported in adults undergoing aerobic training.