Rodney S. Fowler

Prediction of Preschool Behavioral Problems in Healthy and Pediatric Samples

In a prospective study of 137 children (47 with cystic fibrosis, 48 with congenital heart disease, 42 with no chronic illness), four domains were examined as predictors of parent-reported behavioral problems, particularly internalizing problems, at 4 years of age: child health, child temperament, parent-child relationships, and family environment. Family environment, as measured by the Parenting Stress Index at 1, 2, and 3 years, was the most powerful predictor. This suggests that this index is useful as an early screen for children at risk for behavioral problems and that a reduction of parenting stress is an appropriate target of preventive interventions. J Dev Behav Pediatr 18:304-313, 1997.

Accidental Digitalis Intoxication in Children

Forty-eight children were seen with a history of accidental ingestion of digitalis preparations. Thirty-one patients were admitted to the hospital and two of these died. One death was caused by severe toxic effects of digitalis upon the central nervous system. Vomiting, slow irregular pulse, and drowsiness were prominent symptoms in survivors. Electrocardiograms showed exaggerated sinus arrhythmia and first and second degree atrioventricular block. The electrocardiogram should be monitored continuously. Potassium should be given intravenously and other resuscitative measures as indicated.

Left ventricular myocardial fibroma: A case report and review of cardiac tumors in children

Abstract A 30-mo-old boy had a successful excision of an intramyocardial fibroma. Fibromas constitute about one quarter of the reported primary cardiac tumors in children and offer the best chance of excision. Rhabdomyomas account for over half of childhood cardiac tumors but usually are not diagnosed until they are terminal and nonresectable. Myxomas, which account for 50% of adult tumors, are almost unknown in children.

Management of coronary artery disease in Hutchinson-Gilford syndrome

17. Diaz FV, Pelous AN, Vald6s FG, et al. Peetus excavatum: hemodynamic and electrocardiographic considerations. Am J Cardiol 1962;10:272. 18. Beveggtrd S. Postural circulatory changes at rest and during exercise in Patients with funnel chest, with special reference to factors affecting the stroke volume. Acta Med Scand 1962; 171:695. 19. Beiser GD, Epstein SE, Stampfer M, et al. Impairment of cardiac function in patients with pectus excavatum, with improvement after operative correction. N Engl J Med 1972;287:267.

Preoperative and postoperative electrocardiogram in complete transposition of the great vessels

Abstract The electrocardiograms of 30 patients with complete transposition of the great vessels were analyzed before and after surgical creation of an atrial septal defect and after total repair with the Mustard procedure. The effect of surgery was manifest in changes in the P and T waves and, to a lesser extent, in the ventricular hypertrophy pattern. Arrhythmia was commonly noted in the immediate postoperative period.

Tricuspid atresia: Results of treatment in 160 children

Experience in managing 160 patients with tricuspid atresia is reviewed. The majority of these children require operative treatment in the 1st year of life. Clinical management of this rather complex anomaly is simplified by classifying each child according to total pulmonary blood flow. An overall plan of management for patients with decreased pulmonary flow is suggested. This consists of a Potts shunt as an initial procedure, limiting its anastomotic growth so that pulmonary flow becomes inadequate at age 10 to 12 years. A Glenn anastomosis is then constructed as the second procedue. The Fontan procedure should be considered carefully as an alternative to the Glenn anastomosis in these older children. Children with increased pulmonary blood flow and transposition of the great arteries are likely to require pulmonary arterial banding in infancy. Otherwise, patients in this smaller group are managed with the same overall plan. Results of long-term palliation have been good.

The Vectorcardiogram in Complete Transposition of the Great Vessels Analysis of Fifty Cases

The Frank vectorcardiograms of 50 patients with complete transposition of the great vessels were analyzed, and the findings were correlated with the electrocardiogram and hemodynamics. The patients were divided into four groups according to the presence or absence of ventricular septal defect and left ventricular outflow tract obstruction. In group I, consisting of 20 patients with ventricular septal defect, the vector cardiograms showed evidence of combined ventricular hypertrophy in 80% of the cases, the scalar electrocardiogram, in 40%.In group II, 13 patients with ventricular septal defect and left ventricular outflow tract obstruction, the vectorcardiogram was consistent with either right, combined, or left ventricular hypertrophy.In groups III and IV, patients with intact ventricular septum with or without left ventricular outflow tract obstruction, the vectorcardiogram was consistent with right ventricular hypertrophy in the majority of cases.

Prediction of left ventricular pressure from the vectorcardiogram in transposition of the great arteries

Abstract Eighty-two cardiac catheterizations were performed in 72 children with complete transposition of the great arteries; vectorcardiograms (Frank lead) and orthogonal electrocardiograms were obtained in all cases within 24 hours. Fifty-six of these studies were performed in children with an additional ventricular septal defect, and 26 in children with an intact ventricular septum. There was a significant correlation between the ratio of the right and left maximal spatial vectors and the S R ratio in lead X of the orthogonal lead electrocardiogram. A clockwise loop in the horizontal vector or an S R ratio of more than 2:1 suggested decreased left ventricular pressure, whereas a counterclockwise or figure-of-8 loop in the horizontal plane or an S R ratio of less than 2:1 in lead X of the orthogonal electrocardiogram suggested increased left ventricular pressure. Nineteen additional patients with transposition of the great arteries were studied in the same way. With use of the direction of rotation of the horizontal loop and the S R ratio in lead X, left ventricular pressure was correctly predicted in 84 percent of cases. After cardiac catheterization has established the diagnosis of transposition of great arteries, repeat vectorcardiograms should be obtained to determine left ventricular pressure. In a patient with initially decreased left ventricular pressure, change to a figure-of-8 or counterclockwise loop or the presence of an S R ratio in lead X of less than 2.0 suggests the development of a systemic level of left ventricular pressure. This finding is an indication for repeat catheterization.

Terminal QRS conduction delay in pulmonary stenosis in children

Abstract Sixty-five children from 1 to 15 years of age with isolated pulmonary stenosis were studied by cardiac catheterization, Frank lead vectorcardiogram and scalar electrocardiogram. Twenty-seven patients had a definite terminal delay of the QRS complex consisting of crowded time dots in the last 15 milliseconds of the vector loops in all three planes; in these children the total duration of the QRS complex was 0.0777 ± 0.0081 sec. (S.D.) This was significantly longer than conduction time in the 38 cases with no terminal delay in which it was 0.0683 ± 0.0108 sec. The group with conduction delay had a significantly lower peak systolic right ventricular pressure (54 ± 30 mm. Hg) than the group with no conduction disturbance (89 ± 37 mm. Hg). This conduction disturbance is characteristic of the milder degrees of pressure loading on the right ventricle in isolated pulmonary stenosis of childhood. The presence of this terminal conduction delay did not correlate well with an RSR′ pattern in lead V 1 or V 3 R of the scalar electrocardiogram.

Ventricular repolarization in congenital aortic stenosis

Abstract The scalar electrocardiograms in 65 cases of isolated congenital aortic stenosis in children from 11 months to 15 years of age were studied to determine criteria for assessing the severity of the stenosis. The depth of the S wave in Leads V 1 and V 2 and the height of the R wave in Leads V 5 and V 6 were not helpful, and were sometimes misleading. Measurements of disturbed ventricular repolarization (ST-T wave changes) were very useful in predicting severity in cases in which the frontal axis of QRS was +45 degrees or greater. The following features indicated severe stenosis: (1) a frontal axis of the T wave superior to +15 degrees; (2) the sum of the frontal and horizontal QRS-T angles greater than 100 degrees (the mean direction of QRS or T taken to be at right angles to the lead with a zero or equiphasic deflection in an appropriate reference frame); (3) an RT ratio in Leads V 5 or V 6 greater than 10.