30 patients with severe aortic valve stenosis presented in severe congestive heart failure within the first 2 months of life. In 25 of them, left ventricular volume and contractility were assessed; five of them had a left ventricle of normal size, in 11 left ventricular size was diminished, and in nine patients it was enlarged. Eleven of the infants had extensive endocardial fibroelastosis (EFE) evidenced angiographically by myocardial sinusoids in ten of them and established at autopsy in six. The presence of EFE correlated with the size of the left ventricle; eight of 11 with a small left ventricle, two of five with a normal-sized left ventricle, and one of nine with an enlarged left ventricle displayed EFE. The severe depression of left ventricular function associated with EFE was documented by left ventricular volume determinations on exclusion of the myocardial sinusoids. Of 30 patients, 12 (including eight of 26 who underwent surgery) did not survive. Mortality, severity, and early onset of symptoms were associated mainly with small size of the left ventricle and with the severe left ventricular dysfunction associated with EFE.

Aortic Valve Stenosis↗

PubMedDate not supplied

[Clonidine therapy of "paradoxical hypertension" following surgery of isolated stenosis of the aortic isthmus in childhood].

In the period from 1974 to 1983, altogether 234 children underwent surgery of isolated coarctation of the aorta at the Heart Center Munich. In 146 of these patients, a reactive increase of blood pressure has been noted following surgery, and in about half of them the blood pressure was considerably elevated above the 95-percentile. Since the success of surgery may be endangered by a critical increase of blood pressure, in 66 patients an antihypertensive therapy with clonidine has been started immediately after operation. By this treatment the intended decrease of blood pressure has been effected within the first two days after surgery, and in 91% of the patients the therapy could be stopped within the first two postoperative weeks. In 6 out of these 66 patients, the "paradoxical hypertension" persisted so that the clonidine therapy had to be continued after discharge from hospital. The empirically determined dosage and the duration of treatment have been modified by the clinical requirements, i.e. by the actual level of the blood pressure. The average duration of drug administration has been lengthened according to the advanced age at time of surgery, while the required clonidine dosage simultaneously showed a tendency to decrease. Since no side-effects have been registered in the course of this procedure, the use of clonidine suggests a promising therapeutical approach to "paradoxical hypertension".

Age Factors↗

PubMedDate not supplied

[Experience using transcutaneous pO2 measurement (tcpO2 measurement) during the transport of premature and newborn infants with artificial respiration].

In 55 high-risk neonates of different birth-weight and gestational age, transcutaneous pO2 (tcpO2) was continuously monitored during transports from the Obstetric Units to the Neonatal Intensive Care Units. We were able to demonstrate that the need for oxygen was overestimated in most of the children and thus FiO2 could be reduced in nearly all cases. In this way, FiO2 can be adapted to the real need of the children and hypoxemias can be avoided as far as possible frequency and duration of hyperoxemias can be reduced. Moreover, valuable knowledge about further management of mechanical ventilation may be obtained. Complications, as e.g. obstruction of endotracheal tube, are more rapidly recognized than by ECG-monitoring alone.

Blood Gas Monitoring, Transcutaneous↗