Inadvertent transvenous left ventricular pacing through an unsuspected atrial septal defect.

A 65-year-old male patient with a long standing history of chronic obstructive lung disease had permanent pacemaker implantation for symptomatic atrioventricular nodal blocks. Preoperative echocardiography showed dilated right heart chambers and moderate pulmonary arterial hypertension without any demonstrable intracardiac shunt. Postoperative twelve-lead ECG showed right bundle branch block configuration of paced complexes. This suggested left ventricular pacing which was confirmed by transthoracic echocardiography. Later, transoesophageal echocardiography showed the lead entering into left atrium from right atrium through a sinus venosus type of atrial septal defect. The patient refused any further intervention and continues to remain asymptomatic with stable pacing on aspirin-anticoagulant therapy at end of four years.

Lipid profile of Indian children and adolescents.

Dyslipidaemia when diagnosed in childhood predicts the development of clinical atherosclerotic disease in adulthood. Ever since we became aware of the abnormally high incidence of coronary artery disease amongst Indians, there always has been an ever-growing need for study of lipid values amongst Indian children and adolescents. Five hundred and eighty-six children (352 boys and 234 girls) from a public school aged between 8 and 18 years (mean age: 12.86 for boys and 12.15 for girls) were included in the study for assessment of lipid profile during the period from April, 1999 to March, 2000. Fasting venous blood was drawn from each child and total cholesterol and triglyceride levels were measured by enzymatic method, high-density lipoportein (HDL)-cholesterol was measured using specific precipitation method and lipoprotein (a) [Lp (a)] was measured by immunoturbidimetric method. After biochemical estimation was completed reference values and percentiles were calculated for each lipid component. Mean cholesterol and triglyceride values were higher amongst girls compared to boys. HDL-cholesterol values were lower amongst Indian boys compared to girls. Mean Lp (a) values were higher amongst both Indian boys and girls and more so amongst girls compared to boys. Since Lp(a) values remain unchanged through ages, these values should represent corresponding values in adult Indian males and females. It is being expected that data presented in this study should form guidelines with regard to dietary and pharmacological intervention for dyslipidaemia amongst children and adolescents.