Robert F. Ziegler

The importance of patent ductus arteriosus in infants

Abstract A correlative analysis of clinical and laboratory data has been made in a group of twenty-two infants from the age of 6 weeks to 3 years with uncomplicated patent ductus arteriosus. Observations are cited which are believed to support a number of important conclusions among which are the following: 1.1. The diagnosis of uncomplicated patent ductus arteriosus can be made clinically at any age. 2.2. Diagnostic findings, such as the type of murmur, systemic blood pressure, and heart size, are analyzed and explained in terms of physiological data. 3.3. Some of the most important factors in differential diagnosis of congenital cardiovascular defects in infants are outlined. 4.4. Reasons are given for believing that an uncomplicated patent ductus arteriosus may be and frequently is a serious defect in infancy. 5.5. Surgical results in this group of infants support the belief that operation can be done safely and successfully in the age group under consideration.

The genesis and importance of the electrocardiogram in coarctation of the aorta.

The electrocardiogram in uncomplicated coarctation of the aorta in infants reflects the pattern of the fetal circulation and serves as a useful prognostic guide. When the fetal ductus inserts proximally to the region of coarctation and closes at birth, right ventricular enlargement is present at birth but is retrogressive. Furthermore, in this situation collateral circulation has begun to develop before birth so that the left ventricle can compensate on assumption of the postnatal circulation, and the prognosis is good. When the insertion of the fetal ductus is distal to the coarctation, progressive, and frequently fatal, left ventricular enlargement and failure develop shortly after birth. Modifications of these electrocardiographic patterns in the production of right bundle branch block are also discussed and illustrated.

Circulation Time Determinations from the Right Ventricle

The determination of the circulation time from the ventricle to the face using fluorescein and ultraviolet light eliminates all of the variable factors from the venous side of the circulation and gives evidence specifically of the presence or absence of an intraventricular right to left shunt. The most important clinical application is the differentiation of tetralogy of Fallot from pulmonary valvular stenosis with an intact ventricular septum, the first requiring a shunting type of operation and the second a pulmonary valvulotomy.

Combined mitral and pulmonary atresia.

Abstract A cyanotic infant of three months died following a Potts operation (anastomosis between the aorta and the left pulmonary artery). Autopsy showed a hitherto undescribed anomalous structure of the heart. There was atresia of both the mitral and pulmonary valves, together with a questionably patent ductus arteriosus, intact interatrial septum, and an interventricular septal defect.

Characteristics of the unipolar precordial electrocardiogram in normal infants.

The electrocardiogram should have as much clinical value in infants and children as in adults. Such value, as in adults, must depend upon an accurate knowledge of normal standards which change progressively during infancy and early childhood. Some of the more important measurements in the precordial leads of normal infants are presented and discussed. These measurements, the amplitude and the time of inscription of the intrinsic deflection, are believed to indicate the changing relationship between the mass of the right and left ventricles, and on the basis of these data it is also believed that an earlier and more accurate diagnosis of ventricular hypertrophy can be made at any age.

Surgical treatment of anomalies of the coronary arteries

Abstract Many anomalies of the coronary arteries may be corrected by surgical procedures. Those with fistulas into the right side of the heart, atrium, ventricle and pulmonary artery, are most favorable for treatment. Most of these have loud continuous murmurs. 42 cases from the literature are reviewed, and we have added 6 cases. There has been no mortality in any of these operations. In some cases of single coronary artery with fistula, it is feasible to establish a dual coronary circulation with a graft to the aorta. Attempts at the surgical treatment of patients with single coronary arteries which do not have the correct distribution or size to nourish the myocardium have not been palliated by operative procedures. The same can be said of cases with anomalous origin of the left coronary artery from the pulmonary artery, where no collateral connections with the right coronary artery have developed. Cardiac transplantation must be considered for these cases.

Indications for the surgical correction of coarctation of the aorta in infancy

Abstract Evidence is presented to establish the fact that operation for correction of coarctation of the aorta is feasible in infancy, and in certain cases is urgently indicated as an emergency measure. Using criteria described in this communication, one third of infants with uncomplicated coarctation seen during the first year of life were subjected to operation without mortality. The presence of the additional anomaly of ventricular septal defect makes the operation even more urgent. Patent ductus arteriosus, either proximal or distal to the coarctation, makes the prognosis much poorer, but operation gives the infant his only chance.

The cure of subacute bacterial endarteritis by surgical ligation in a patient with patent ductus arteriosus complicated by the presence of multiple congentital cardiac defects

Abstract A case of subacute bacterial endarteritis with patent ductus arteriosus, patent interventricular septal defect, and anomalous left vena cava, in which cure was effected by surgical ligation of the patent ductus, is reported. Surgical treatment, when otherwise contraindicated by atypical physical signs, should be considered when the infecting organism is resistant to chemotherapy and when a complicating congenital defect, requiring a patent ductus as a compensatory mechanism, is not present.