Severe (Stage IV) bronchopulmonary dysplasia (BPD) has been associated with pulmonary hypertension and right heart failure, with a mortality rate of 39%. Recently, M-mode echocardiography has been used to measure right-sided systolic time intervals (the ratio of right ventricular pre-ejection period to ejection time; RVPEP/RVET), with a value greater than 0.35 predicting pulmonary hypertension. This measurement has also been used to predict outcome of BPD and response to oxygen therapy. A retrospective study of six infants with Stage IV BPD who had had cardiac catheterizations and M-mode echocardiography is reported. By catheterization criteria, four of the six had pulmonary hypertension. By echocardiographic criteria, only two of the six had unequivocally prolonged RVPEP/RVET ratios, and correlations with mean or diastolic pulmonary arterial pressures were poor (0.069 and 0.255, respectively). The validity of M-mode echocardiography in the assessment of the pulmonary vascular bed in Stage IV BPD is open to debate, and its role in predicting outcome and response to therapy is unknown.

Bronchopulmonary Dysplasia↗

PubMedDate not supplied

Hypertrophic cardiomyopathy presenting before 2 years of age in 13 patients.

Thirteen patients with hypertrophic cardiomyopathy (HCM) who presented by 2 years of age were evaluated. All had been referred because of a heart murmur. Four had positive family histories for HCM and 2 had congestive heart failure. Cardiothoracic ratios ranged from 0.43 to 0.70 (mean 0.56). In 12 cases, electrocardiograms showed abnormal Q waves, ventricular hypertrophy, or aberrant rhythms. Resting peak systolic pressure differences ranged from 0 to 92 mm Hg (mean 21.1) across the right ventricular outflow tract, and from 0 to 112 mm Hg (mean 36) across the left ventricular outflow tract (LVOT). Cardiac angiography showed evidence of asymmetric septal hypertrophy (ASH) in all patients, LVOT obstruction in 3, and aortic and mitral insufficiency in 1. Six patients received no therapy, 6 were treated with propranolol, and 3 were treated with left ventricular myomectomy. During follow-up (mean 6.1 years), no patient died and 10 became or remained asymptomatic. The apparently favorable clinical course observed in these patients during this period of follow-up may be related to early treatment, made possible by the early diagnosis.

Adolescent↗

PubMedDate not supplied

Cerebral arteriovenous malformation in neonates. The role of myocardial ischemia.

Ischemic myocardial damage was identified as a complicating feature in the clinical course of 12 newborn infants who died in congestive failure with cerebral arteriovenous malformation. Electrocardiograms of 11 patients showed signs of chamber hypertrophy and T wave and ST segment features of varying degree compatible with ischemia or infarction. Histological evidence of myocardial necrosis or infarction was detected in seven of the ten infants from whom autopsy material was still available.

Cerebral Angiography↗

PubMedDate not supplied

Qualitative phase analysis in pediatric nuclear cardiology: isolation of cardiac chambers and identification of asynchronous contraction patterns.

Qualitative phase analysis of radionuclide angiocardiograms has been applied in pediatric nuclear cardiology. The technique involves the static and dynamic display of phase images. Qualitative phase analysis is valuable in two major images: (a) delineating borders of adjacent cardiac chambers such as the AV valve planes and the borders of the right ventricular outflow tract, for accurate selection of regions of interest, and (b) identifying and evaluating patterns of asynchronous contraction. Radionuclide angiography with phase analysis is a safe, noninvasive, and easily repeatable assessment of cardiac function well suited to patients with congenital heart disease.

Adolescent↗

PubMedDate not supplied

Measuring heart patients' willingness to pay for changes in angina symptoms.

Willingness-to-pay (WTP) measures of the effects of changes in health on a person's welfare are more comprehensive than traditional cost-of-illness (COI) measures, but they are sometimes difficult to obtain. The authors investigated two approaches for measuring heart patients' WTP for changes in their angina symptoms. First, actual expenditures and perceived angina episodes avoided were used to infer an averting-behavior measurement of WTP. Second, a contingent-valuation approach was used to ask direct WTP questions regarding a hypothetical medical treatment that could be purchased to avoid additional angina episodes. The results indicated that although negligible COI changes were expected with small changes in angina frequency, the subjects had significant WTP to avoid increases in angina. The average WTP to avoid additional angina episodes revealed by the averting-behavior questions was comparable to the directly-elicited WTP, providing a test of the validity of the contingent-valuation approach.

Aged↗

PubMedDate not supplied

Results from an international survey of Kawasaki disease in 1979-82.

Kawasaki disease is a febrile illness of unknown etiology affecting mainly children younger than five years, 20% of whom develop coronary artery aneurysms. The disease was first reported in Japan, but case reports have come from several countries; epidemics apparently occur every two to three years. A committee of the International Society and Federation of Cardiology (ISFC) collaborated on an international, retrospective survey in mid-1983 through 1984, asking about Kawasaki disease cases seen in 1979-82 and their outcomes. Responses were received from 53 countries; reports from 20 countries indicated that no cases were seen in the years surveyed. Kawasaki disease did not always follow the Japanese pattern. An indication of 'epidemic' increases was found in some years in some countries. Recognition of Kawasaki disease varies considerably, but further educational efforts are likely to uncover additional cases, and intensive epidemiological efforts would be possible in a number of countries.

Child, Preschool↗

PubMedDate not supplied

Peripheral arterial trauma in children. A fifteen year review.

A 15 year retrospective evaluation of peripheral vascular trauma in infants and children was undertaken. Forty-eight affected limbs in 47 patients (mean age 5.1 years) were explored for peripheral arterial injury. There were 40 iatrogenic, five penetrating and three blunt injuries. Thrombectomy alone, thrombectomy with autogenous saphenous vein patch angioplasty, direct angioplasty, segmental resection with end-to-end anastomosis and interposition-bypass grafting were the most common reparative procedures used. Circulation was normal within 24 hours of surgery in 35 of the 45 limbs (77.8%) whose patency was restored. In patients less than three years or 12.5 kg with iatrogenic injuries, patency rate was significantly lower (p 0.05). Four children died of congenital heart disease. All six children with failed vascular reconstruction suffered late sequelae.

Adolescent↗

PubMedDate not supplied

Separation and divorce in Canada: can we get closer to accurate data?

Explore the source record for details and available documents.

Age Factors↗