Aortic valve injury 10 years after tetralogy of Fallot repair.

Although recognized by pediatric cardiac surgeons, aortic insufficiency as a technical complication after tetralogy of Fallot repair is poorly documented, especially if it occurs late. The case of a boy with aortic insufficiency 10 years after complete tetralogy repair is described. No documentation in the literature other than summary statements in textbooks of this occurrence was found.

Side effects of methylphenidate and desipramine alone and in combination in children.

OBJECTIVE: To investigate side effects of methylphenidate and desipramine alone and in combination in hospitalized children with symptoms of attention-deficit hyperactivity disorder and depression. METHOD: A double-blind placebo controlled crossover design was used to investigate each medication alone and in combination. Side effect ratings and EKGs were done weekly. Pulse and blood pressure were monitored daily. RESULTS: Nausea, dry mouth, and tremor were present in at least twice as many children on combined methylphenidate and desipramine compared with any other condition. Nausea/vomiting, headaches, other aches, refusal of food, and feeling "tired" were significantly more frequent during the combined methylphenidate plus desipramine condition when compared with either methylphenidate alone or with baseline. Significantly higher ventricular heart rate was found on combined methylphenidate plus desipramine compared with desipramine alone, methylphenidate alone, and baseline. Prolonged PR interval and significantly higher heart rate occurred during desipramine alone compared with baseline. CONCLUSIONS: During the several-month duration of the study, there were more frequent side effects during combined methylphenidate plus desipramine treatment than with either medication alone. Clinically, side effects present during combined medication appeared to be similar to and no more serious than those associated with desipramine alone.

Purulent meningococcal pericarditis: chronic percutaneous drainage with a modified catheter aided by echocardiography.

A 7-month-old infant presented with suspected sepsis. On the third day of illness signs of cardiac tamponade developed. Tamponade was relieved by pericardiocentesis, and countercurrent immunoelectrophoresis (CIE) analysis of the fluid was positive for meningococcus group B. Antibiotic treatment was changed to penicillin G. After echocardiography demonstrated reaccumulation of fluid, a modified #16 gauge angiocatheter was placed percutaneously in the pericardial space. When drainage slowed it was repositioned using two-dimensional echocardiography. After 24 h the catheter was removed and no further accumulation occurred. The antibiotics were continued an additional 10 days and the infant recovered uneventfully. Modification of the catheter and echographic repositioning may decrease the need for surgical drainage in such patients.

Treatment of critical neonatal edema with hemo-ultrafiltration.

Three neonates with extreme edema associated with cardiovascular and renal insufficiency were treated with hemo-ultrafiltration for removal of critical edema fluid. In each patient peritoneal dialysis had not been effective in expedient fluid removal. Ultrafiltration was accomplished by occlusion of the proximal dialysate portal of a Travenol EX12-11, 0.8 m2 dialyzer and the application of vacuum suction to the distal portal. Blood flow ranged from 10-25 ml/min. The rate of ultrafiltration averaged 0.57 ml/kg/min resulting in losses of 4-16% of body weight. Episodes of hypotension were associated with too rapid ultrafiltration rate and not total volume removed. All patients tolerated the procedure. Two of the three patients demonstrated improvement in blood pressure, oxygenation and urine flow following the ultrafiltration. Ultrafiltration in the newborn may be a useful therapeutic procedure when conventional treatment fails.

Primary benign intramural ventricular tumors in children: pre- and postoperative electrocardiographic, echocardiographic, and angiocardiographic evaluation.

The clinical, ECG, echocardiographic, and angiographic data, as well as the operative findings and postoperative courses of three children with intramural ventricular tumors are presented. In all three children, the specific diagnosis of intramural tumor was unsuspected. The ECGs showed a superior axis in all patients. M-mode echocardiography missed the mass in one patient and was nonspecific in the other two; however, two-dimensional echo (2DE) was able to accurately delineate the tumors preoperatively in all three. Angiographic findings were nonspecific, only demonstrating the presence of space-occupying lesions. All three patients underwent surgery and the tumors were removed successfully. This investigation emphasizes the clinical picture that led to the diagnostic evaluations, and demonstrates the usefulness of 2DE in accurately diagnosing the intramural ventricular tumors. In addition, the sequential ECGs and 2DEs after removal of the tumors are delineated as well as showing the resolution of the tumor craters by 2DE examinations.

Left atrial size in childhood.

To determine the accuracy of the diagnosis of left atrial enlargement (LAE) by vectorcardiogram (VCG) and electrocardiogram (ECG), we analyzed the magnitude of the P loop on VCG and the P wave duration, amplitude, and deflection on the ECG and compared them with echographic and angiographic data. Twenty-eight children with LAE were selected who had congenital or acquired heart disease. The control population consisted of 24 children with normal left atrial (LA) dimensions. No significant difference in P wave amplitude or duration was found in the two groups on ECG. Negative terminal deflection greater than orequal to - 1 mm in V1 predicted LAE in only 25% of the patients with LAE. P loop magnitudes in all vector planes showed considerable overlap in both groups. When magnitude and direction were considered on VCG, only 29% of the patients with LAE would have been diagnosed as LAE by VCG criteria. Patients with large LA volumes, determined from biplane angiography,were compared with echocardiography, VCG and ECG. All had echocardiographic LAE, 50% had LAE by ECG criteria and only 33% by VCG criteria. It is concluded that more sensitive ECG and VCG criteria for diagnosing LAE by ECG and VCG need to be developed. It must also be determined which of these changes correlate with conduction delay, atrial hypertrophy and/or enlargement.