Intravascular ultrasound image subtraction: a contrast enhancing technique to facilitate automatic three-dimensional visualization of the arterial lumen.

At 30 MHz, the intravascular ultrasound backscatter of blood confounds the discrimination of the lumen from the arterial wall. This study validates a subtraction method which creates a still-frame image with a sharp demarcation of the lumen. The method involves subtraction of consecutive images and 2D ensemble averaging of the absolute pixel values.

Complete right bundle branch block after surgical closure of perimembranous ventricular septal defect. Relation to type of ventriculotomy.

The ECGs of a 100 consecutive children who had surgical repair of their ventricular septal defects (VSDs) were analyzed for postoperative right bundle branch block (RBBB). Seventy of them had an atriotomy and the other 23 also a ventriculotomy. The ventriculotomy always consisted of a transverse incision a short distance below the pulmonary annulus.

Intra-uterine tachycardia associated with multicystic encephalomalacia (MCE).

Multiple cystic brain lesions in neonates have been described as a result of a variety of causes. All events described thus far in association with multicystic encephalomalacia (MCE) seem to point to hypoxic-ischaemic injury as the common factor for this particular form of central nervous system damage. We describe a neonate in whom repeated, prolonged episodes of intrauterine tachycardia had been documented.

Actinobacillus actinomycetem-comitans endocarditis in a child with a prosthetic heart valve.

The first case of Actinobacillus actinomycetem-comitans endocarditis in a child with a prosthetic cardiac valve is reported. Endocarditis was possibly caused by dental work done without antibiotic prophylaxis four weeks prior to admission.

Subcostal two-dimensional echocardiographic recognition of a criss-cross heart with discordant ventriculo-arterial connection.

Two-dimensional echocardiography was performed on a patient with criss-cross atrioventricular (AV) relationship and ventriculo-arterial discordance. A systematic approach from the subcostal area revealed the complex cardiac pathology including the criss-cross AV relationship of right and left heart, indicating that this very abnormal relationship can be identified echocardiographically. The echocardiographic findings were confirmed by angiocardiography.

The concurrence of dimensional aortic arch anomalies and abnormal left ventricular muscle bundles.

This anatomical study was designed to evaluate the concept that reduced blood flow through the embryonic preductal aorta contributes to the pathogenesis of dimensional aortic arch anomalies. For that purpose the intracardiac anatomy of 151 specimens was examined, of which 22 had an interruption, five atresia, 76 tubular hypoplasia, and 48 local coarctation of the aortic arch. Associated malformations were found in 148 specimens (98%); the remaining three (2%) had isolated local coarctation.

Histology of the persistent ductus arteriosus in cases of congenital rubella.

Histologic study of the persistent ductus arteriosus in case of a congenital rubella syndrome revealed that this persistency is probably due to an arrest in the development of the ductus. Histologically, it resembles a very immature ductus and not the most common type of persistent ductus arteriosus. The earlier finding, that in the human ductus arteriosus, the presence of an extensive subendothelial elastic lamina is incompatible with anatomic sealing, still holds.

Classification of ventricular septal defects.

A classification with clinical significance is proposed for ventricular septal defect based on the study of 220 hearts with defects of the ventricular septum. All had atrioventricular and ventriculoarterial concordance with normal relations of cardiac structure. For the purpose of classification, the ventricular septum was considered as possessing muscular and membranous portions, the muscular septum itself being divided into inlet, trabecular, and outlet (or infundibular) components.

The ductus arteriosus in the preterm infant: histologic and clinical observations.

In order to elucidate some of the unexplained phenomena in prolonged patency of the ductus arteriosus in preterm infants, the histology of the ductus was studied in 27 cases. Some of the infants had been treated with indomethacin. Four morphologic maturation stages are distinguished.

Muscular ventricular septal defects: a reappraisal of the anatomy.

Among 79 autopsy specimens of heart with an isolated ventricular septal defect, there were 29 cases of muscular defect. Among 60 hearts with complete transposition of the great arteries and a ventricular septal defect, there were 13 cases with a muscular defect. All muscular defects could be classified in three different types, based on the specific pathologic anatomy of the ventricular septum.

[Effects of prostaglandin in heart abnormalities with needed patency of the arterial canal (clinical and histological study)].

Eight infants with cardiac malformations that were dependent on the patency of the ductus, were treated with Prostaglandin E 1 to reverse the closure of the duct. There was clinical improvement in 7 out of the 8 infants, confirmed by improvement in oxygen saturation and/or blood gases. In four cases the opening of the duct was visualised by angiography immediately after the prostaglandin infusion.

Transposition of the great arteries with ventricular septal defect and pulmonary stenosis.

A postmortem investigation was carried out of 19 heart specimens with transposition of the great arteries, ventricular septal defect, and congenital subvalvular pulmonary stenosis. Certain types of obstruction appeared to be closely related to other features of the hearts. In cases with malalignment of the infundibular septum, the obstruction was caused by this septum and the anterolateral muscle bundle of the left ventricle.

Ventricular septal defect associated with left ventricular outlfow tract obstruction below the defect.

Muscular subaortic stenosis associated with ventricular septal defect (VSD) is a rare but important anomaly. Two types of left ventricular outflow tract (LVOT) obstruction should be distinguished on the basis of morphologic as well as hemodynamic differences, depending on whether the stenosis is localized above (Type I) or below (Type II) the defect. The five cases presented are all in the latter category.

Histopathology of the ductus arteriosus after prostaglandin E1 administration in ductus dependent cardiac anomalies.

The histology of the ductus arteriosus was studied after prostaglandin E1 (PGE1) administration in 4 infants with ductus dependent cardiac malformations. Pronounced pathological changes were found in each instance. The changes consisted of oedema of the media with separation of medial components by clear spaces, pathological interruptions of the internal elastic lamina, and intimal lacerations, some of which extended into the media.

Effect of E1 type prostaglandin on hypoxemia in a cyanotic congenital cardiac malformation.

Prostaglandin type E1 has been administered on 4 different occasions in a newborn with a ductus-dependent complex congenital cyanotic heart disease. Dramatic improvement of the arterial oxygen concentration followed each prostaglandin infusion. Increased pulmonary circulation and widening of the ductus arteriosus were seen on angiographic examination.

Anomalies of the aortic arch and ventricular septal defects.

This investigation presents additional evidence for the hemodynamic influence of intracardiac anomalies on the development of the aortic arch, based on measurements of different parts of the great vessels. Criteria are given to define the normal aortic arch and the different anomalies of the aortic arch, such as interruption, atresia, tubular hypoplasia, hypoplasia, abnormal long segment and juxtaductal coarctation. Two types of of malignment venentricular septal defects are described to illustrate how prenatal intracardiac flow disturbances can account for various aortic arch patterns.

The postvalvulotomy propranolol test to determine reversibility of the residual gradient in pulmonary stenosis.

We advocate the use of propranolol in very low dosage at the end of operation to determine a prognosis of the long-term results to be expected after valvulotomy in diverse types of pulmonary stenosis.

Anterolateral muscle bundle of the left ventricle, bulboventricular flange and subaortic stenosis.

A hitherto unrecognized muscle bundle in the left ventricular outflow tract is described. Found between the left coronary aortic semilunar cusp and the anterior leaflet of the mitral valve, this anterolateral muscle bundle of the left ventricle is present in approximately 40 percent of normal hearts. On embryologic grounds it is suggested that this bundle is a muscular remnant of the left extremity of the bulboatrioventircular flange.