Measures of cardiac repolarization and body position in infants.

Sudden Infant Death Syndrome (SIDS) is the most common cause of death in children between 1 and 6 months of age. Recent data suggest that a prolonged QTc interval on the 12-lead electrocardiogram (ECG) is associated with SIDS. Prone body position during sleep is also known to be a risk factor for SIDS; this has prompted the American Academy of Pediatrics to promote the "Back to Sleep" campaign.

Chest pain in the adolescent and young adult.

Pediatric cardiologists and cardiologists who examine adults frequently receive referrals of adolescents and young adults with chest pain. Chest pain in this age group is most likely noncardiac in origin, which often creates a diagnostic dilemma for the consultant in terms of the etiology and extent of evaluation. This review presents the noncardiac and cardiac etiologies of chest pain in adolescents and young adults, as well as the key features of a patient's history and physical examination that help delineate cardiac from noncardiac chest pain.

Clinical auscultation skills in pediatric residents.

Objective: The aim of this study is to determine the level of clinical auscultation skills in pediatric residents at Duke University Medical Center.

Methods: Forty-seven residents from pediatrics and joint medicine/pediatrics training programs at Duke University Medical Center were enrolled in this study. They were asked to examine the cardiovascular patient simulator, Harvey, and report their findings.

The heart in sickle cell anemia. The Cooperative Study of Sickle Cell Disease (CSSCD).

The objective of this study was to obtain representative echocardiographic measurements of cardiac size and function in stable patients with sickle cell disease. This prospective, multicenter study utilized central reading of echocardiograms by an investigator blinded to other patient data. Stable outpatients from a balance of inner city and rural settings with SS phenotype and a broad age range were selected, because conflicting results from earlier studies were believed to be due to these patient selection criteria.

Neonatal correction of transposition of the great arteries: the Connecticut experience.

The treatment of transposition of the great arteries, a common congenital cardiac defect, has undergone significant development. Prior to 1989 a surgical approach which repaired the transposition at the atrial level (Senning's operation), but did not restore normal anatomy, was the procedure of choice. Since 1989 a surgical approach that restores normal anatomy (Jatene's arterial switch) has been followed.

Anomalous left coronary artery from the main pulmonary trunk: physiologic and clinical importance of its association with persistent ductus arteriosus.

Anomalous left coronary artery (ALCA) from the pulmonary trunk presents in early infancy with a clinical picture of failure to thrive, congestive heart failure (CHF), angina-like episodes, and mitral insufficiency. These manifestations which are due to myocardial ischemia may change in the presence of an associated lesion. We present a case and review two previous reports of a patent ductus arteriosus (PDA) associated with this anomaly.

Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts.

The first superior vena cava-pulmonary artery shunt (Glenn shunt) in our series was performed in February 1958. From then through September 1988, 91 patients have undergone this procedure for a wide variety of congenital defects. We here report follow-up data available on all patients.

Perioperative care of the infant with congenital heart disease.

The current approach to the perioperative management of the infant and child with congenital heart disease has been discussed. The major focus has been on potential problems of oxygen transport as they relate to vital organ system function. Management strategies for specific defects or perioperative problems have also been considered as well as the newer on-line monitoring techniques, while stressing the importance of careful clinical evaluation.

Persistent left superior vena cava causing subdivided left atrium: diagnosis, embryological implications, and surgical management.

A 3-month-old infant is described in whom a persistent left superior vena cava impinged on the posterior wall of the left atrium, producing a subdivided left atrium with left-to-right shunting and congestive heart failure. To our knowledge, this anomaly has not previously been reported. The preoperative diagnosis, surgical management, and embryological implications are discussed.

Discrete subaortic obstruction in a patient with corrected transposition of the great arteries.

This report describes a case of corrected transposition of the great arteries (TGA) in which a classic subaortic membrane resulted in significant obstruction to outflow from the morphologically right ventricle. To our knowledge, discrete subaortic obstruction has not been previously reported with corrected TGA.

Accessory mitral valve tissue causing left ventricular outflow obstruction (two-dimensional echocardiographic diagnosis and surgical approach).

Accessory mitral valve tissue, a rare cause of left ventricular outflow tract obstruction, can be difficult to diagnose preoperatively and confusing even at surgery. The reported case illustrates how preoperative evaluation can be made using two-dimensional echocardiography combined with Doppler flow analysis. The intraoperative technique for removing the accessory tissue without causing damage to the native mitral valve is discussed.

Repair of aortic coarctation in the first three months of life: immediate and long-term results.

The optimum surgical procedure for treatment of coarctation of the aorta in the neonatal period remains controversial. To assess immediate and long-term results of using primarily the subclavian flap angioplasty procedure (SFA), we reviewed our initial 5-year experience. The average follow-up was 6 years.

Fetal echocardiography--applications and limitations.

Fetal echocardiography has been a useful technique for demonstrating the anatomy of the developing human heart. M-mode echocardiography may be used to provide rhythm diagnosis in the absence of high-fidelity transabdominal fetal electrocardiograms. The information so generated may be applied to plan the management of pregnancy and delivery in a population at "high risk" for structural or functional heart disease and may provide the impetus for developing in utero treatment programs.

Effects of alterations of oxygen transport on the neonate.

In the foregoing discussion we have attempted to provide an overview of much of the information available on the effects of changes in systemic oxygen transport on the neonatal and young subject. Using data synthesized from both human and animal studies, we have described the normal developmental changes and the findings of studies in which oxygen transport has been acutely altered by experimental means. This was intended to highlight the potentially delicate balance that can occur between oxygen supply and utilization during the critical period of rapid growth after birth.

Evaluation of the preterm infant for patent ductus arteriosus.

As a first step in a multicenter, collaborative project to study the role of indomethacin in the management of patent ductus arteriosus in premature infants, a diagnostic scheme was developed, on an a priori basis, by a consensus of the participating neonatologists and pediatric cardiologists. The scheme, which utilizes clinical and noninvasive findings, was designed to detect infants with a "hemodynamically significant" patent ductus arteriosus (PDA). Among 1,689 infants with birth weight less than 1,750 g who were monitored during the first year of the study, 342 (20.

Fetal echocardiography. A tool for evaluation of in utero cardiac arrhythmias and monitoring of in utero therapy: analysis of 71 patients.

Fetal echocardiographic studies were performed in 71 patients referred for evaluation of cardiac rhythm disturbances at 24 to 40 weeks' gestation. After 2-dimensional echocardiographic study of cardiac structure was performed, M-mode echocardiograms were analyzed for measurement of cardiac rate, atrioventricular contraction sequence, atrioventricular valve motion, and duration of postectopic pauses. Arrhythmias were diagnosed in 59 patients.

Fetal echocardiography for evaluation of in utero congestive heart failure.

Thirteen fetuses with nonimmune hydrops (22 to 39 weeks of gestation) were evaluated with two-dimensional and M-mode echocardiography. Ten fetuses had cardiovascular abnormalities resulting in heart failure, and three had noncardiac causes of hydrops. In three cases, hydrops was caused by supraventricular tachycardia.

Physiologic effects of increasing hemoglobin concentration in left-to-right shunting in infants with ventricular septal defects.

We studied the acute effects of increasing hemoglobin concentration and hematocrit on the pulmonary and systemic circulations of nine infants with large left-to-right shunts. After isovolemic exchange transfusion, which was designed to raise hemoglobin but keep blood volume constant, a consistent rise in systemic and pulmonary vascular resistances occurred. This rise was comparable to those previously found in isolated circulations showing a linear relation between hematocrit and loge of the vascular resistance.

Reversible changes in norepinephrine extraction by the lungs in children with pulmonary hypertension.

Extraction of circulating vasoactive hormones by the lung may influence systemic vasomotor tone. Since this process occurs in the pulmonary microcirculation, we evaluated the effects of pulmonary artery hypertension (PAH) secondary to congenital heart disease (CHD) on this metabolic function of lung. Eleven patients with varying congenital cardiac lesions were studied preoperatively and postoperatively.

Myocardial damage following transthoracic direct current countershock in newborn piglets.

The effect of transthoracic direct current countershock on the myocardium of 21 newborn piglets was studied. Myocardial damage was quantified by measuring the myocardial uptake of technetium-99m pyrophosphate injected 24 hours after countershock. Substantial myocardial damage occurred in animals given greater than 150 joules/kg but not at lower energy doses.

Effect of physical training on exercise performance of children following surgical repair of congenital heart disease.

The effect of physical training on the exercise performance of 26 patients following surgical repair of tetralogy of Fallot (16 patients) and ventricular septal defect (ten patients) was evaluated. Base line exercise testing was performed on a bicycle ergometer using the technique of Godfrey. Patients were placed on a six-week alternate day submaximal interval home exercise program of varying duration and intensity.

Patch reconstruction of the right ventricular outflow tract with pulmonary valve insertion.

Although pulmonary regurgitation is generally well tolerated, reconstruction of the right ventricular outflow tract and insertion of a pulmonary valve are indicated in some patients. This procedure was performed in 12 patients, ages 1 1/2-17 years (mean 10 years). Seven had tetralogy of Fallot; of these, one underwent primary repair with Glenn shunt takedown and six underwent repeat operations after previous repairs.

The pathophysiology of disorders of oxygen transport in the infant.

The major attempt in this monograph has been to provide a systematic approach to OT in the infant under normal and abnormal conditions based on an appreciation of pathophysiologic mechanisms. This has included a consideration of oxygen uptake, gas transfer from the lungs to the circulation, oxygen delivery to the tissues, and various adaptive responses. We have discussed disorders involving the control of respiration, the upper and lower airways, lung parenchyma, pulmonary circulation, heart, and the oxygen carrier, hemoglobin, that may impair OT to tissues, and how compensation for these conditions can be achieved.