The lungs of 68 children with malformations of the heart or the great vessels which could cause pulmonary hypertension were obtained at autopsy. We analysed the media of muscular pulmonary arteries morphometrically and calculated the area ratio (area media/total area of the vessel). As hemodynamic parameter we used the systolic blood pressure ratio (pulmonary/systemic). Additionally we employed the mean pressure of the pulmonary artery in 38 cases. We analysed the correlation between hemodynamic and morphometric parameters and obtained a product moment correlation of 0.7. There was a linear correlation between the area and pressure ratios. Younger children showed a higher relative thickness of the media than older children with comparable pressure ratios. After dividing the children into three age groups, we obtained an even higher correlation (r = 0.90 in the oldest group). We found these correlations not only in cases with left-to-right shunt but also in children with other heart defects. There was also a good correlation between the quantitatively measured data and the qualitative Heath and Edwards classification.

Adolescent↗

PubMedDate not supplied

Left ventricular thrombi in three children with dilated cardiomyopathy: diagnostic procedure and clinical course.

In three of nine children with dilated cardiomyopathy (aged 1-9 years), left ventricular thrombi were diagnosed and followed by echocardiography. Thrombi recurred in two patients, in one of them, embolized to the cerebral arteries. Resolution of the thrombi was observed under therapy directed against platelet aggregation. However, this did not prevent thrombus formation.

Cardiomyopathy, Dilated↗

PubMedDate not supplied

Increased turnover of serotonin in children with pulmonary hypertension secondary to congenital heart disease.

Serotonin (5HT) is a potent vasoconstrictor of the pulmonary vascular bed and may be involved in the pathophysiology of secondary pulmonary hypertension in children with a left-to-right shunt due to a congenital heart defect. To test this hypothesis we measured the total and free 5HT concentration in blood as well as the urinary excretion of its main metabolite 5-hydroxyindoleacetic acid (HIAA) in children showing a left-to-right shunt with (n = 10) and without (n = 18) pulmonary hypertension. 5HT and HIAA were also measured in children after corrective cardiac surgery using cardiopulmonary bypass (n = 14) and in controls without congenital heart disease (n = 18). The concentrations of total and free 5HT were not significantly different between controls and patients with a left-to-right shunt. After cardiac surgery total 5HT concentration was significantly reduced by about 65% owing to a postoperatively reduced platelet count. In patients with a left-to-right shunt the total 5HT content was similar in the right atrium (204.0 +/- 17.3 ng/ml), pulmonary artery (189.0 +/- 19.1 ng/ml), and aorta (195.0 +/- 19.3 ng/ml), as was the free 5HT concentration. Therefore no net release of 5HT from platelets occurred between these sampling sites. In patients with pulmonary hypertension, the urinary excretion of HIAA was significantly increased when compared with controls and patients without pulmonary hypertension. It is concluded that turbulent blood flow in children with a left-to-right shunt does not lead to a significant release of 5HT from platelets. However, the increased urinary excretion of HIAA in patients with pulmonary hypertension indicates an increased turnover of 5HT, probably due to an increased number of intrapulmonary neuroepithelial cells or a higher metabolic rate of 5HT within those cells.

Cardiopulmonary Bypass↗

PubMedDate not supplied

[Interventional cardiology in children].

Interventional heart catheterizations are catheterizations for a therapeutic purpose. The widest spread example is the balloon atrioseptostomy (BAS) according to Rashkind, which is performed in patients with transposition of the great arteries preceding interatrial corrective surgery, in patients with right-sided valve atresias and interatrial obstruction and in patients with complex mitral atresia. In 248 BAS, performed within 20 years we observed 26 (= 10.5%) minor and 3 (= 1.2%) lethal complications. When the BAS is ineffective or the atrial septum very muscular, the Park-blade-septostomy may be performed, provided corrective surgery is out of question. intravasal foreign bodies, e.g. catheter fragments can be extracted without harm and risk by the Dotter retriever. This prevents grave complications. Arteriovenous aneurysms, coronary fistulas or aortopulmonary collaterals can be embolized by steel coils, detachable balloons or Ivalon particles. With increasing frequency patent ducts, seldom also atrial or ventricular septal defects are closed by means of the Rashkind occluder. Balloonvalvuloplasty (BVP) of pulmonary or aortic stenosis became generally accepted. In cooperative studies of the German Society of Pediatric Cardiology in 305 BVP's of pulmonary stenosis 4% complications with one late death have been observed. In aortic stenosis of children early mortality was 1.6%, complication rate 20%, in the critical aortis stenosis of infants early mortality was 19%, complication rate 50%. So BVP of pulmonary and non-critical aortic stenosis may be considered as the treatment of choice, while BVP of critical aortic stenosis and other stenosis of valves or vessels has to be further evaluated.

Cardiac Catheterization↗