Personality, clinical performance and knowledge in paediatric residents.

This study examines the relationship between personality, knowledge and teachers' evaluations of paediatric residents at a large, urban teaching hospital. All residents (n = 30) were graduates of foreign medical schools. Each resident completed the Myers-Briggs Type Indicator (MBTI) as a measure of personality and was rated (on a scale of 1-7) by teachers on each of 35 items representing 14 different aspects of clinical performance. These data were correlated with performance on the American Board of Pediatrics In-training Examination (ABPITE), and with demographic data. Ratings of knowledge were directly associated with scores on the ABPITE (r = 0.51, P < 0.01) and with the MBTI continuous score for extraversion (r = 0.51, P < 0.01), but inversely associated with age (r = -0.41, P < 0.01). ABPITE scores were also associated directly with MBTI Extraversion (r = 0.44, P < 0.01) and inversely with age (r = -0.56, P < 0.001). Age and MBTI Extraversion were independently significant predictors of ABPITE (Multiple R = 0.64, P < 0.01) and ratings of knowledge (Multiple R = 0.59, P < 0.01). Results suggest that teachers' evaluations of knowledge have validity, and that age and introversion/extroversion play a significant role in both subjective and objective evaluations of paediatric knowledge. Demographic and personality variables may be predictive of knowledge acquisition, but are unrelated to many dimensions of clinical performance.

EKG screening program for school athletes.

Hypertrophic cardiomyopathy is the most common cardiovascular cause of sudden death in adolescent athletes. The electrocardiogram is abnormal in more than 90% of these individuals. An EKG screening program was developed in order to ascertain the role of the electrocardiogram in identifying athletes at risk for sudden death. A training program was created to instruct school nurses on how to perform electrocardiograms. A questionnaire/consent form was sent to the parents of the athletes. This form asked basic questions concerning the child's past medical history and family history. The electrocardiograms were interpreted by staff pediatric cardiologists. A total of 1,424 students, ages 13 to 18, had 12-lead electrocardiograms performed. In 88.8% the electrocardiogram was normal and the health screening questionnaire revealed no abnormalities in family or personal medical history. In 6.5% of the students, the family history or screening blood pressure recording justified further evaluation. In 72 students abnormalities on the electrocardiogram were noted (5.1%). There were 87 abnormalities noted in the 72 students. Conduction disturbances and arrhythmias were the most common abnormalities noted. In 12 students evidence of ventricular hypertrophy was found. Echocardiograms and stress tests were normal in these individuals. No student was found to have hypertrophic myopathy and no student was restricted from participating in competitive athletic activities. Despite the apparent negative results of this program there were benefits of the screening project. The program resulted in a closer working relationship between school health officials and a major health care facility.(ABSTRACT TRUNCATED AT 250 WORDS)

Noninvasive diagnosis of congenital left coronary artery to right ventricle fistula by nuclear magnetic resonance imaging.

In two children with left coronary artery to right ventricle fistula, nuclear magnetic resonance imaging provided high-quality images of the course of the dilated coronary artery and its termination in the right ventricular apex. The advantages of this noninvasive multiplanar imaging technique for visualization of coronary fistulae and dilated coronary arteries are described. This report represents the first description of coronary artery fistula by nuclear magnetic resonance imaging.

Noninvasive pulse oximetry in children with cyanotic congenital heart disease.

Arterial oxygen saturation, determined noninvasively by pulse oximetry in 32 pediatric patients with cyanotic congenital heart disease (CHD), was compared with oxygen saturation measured by a cooximeter in simultaneously obtained arterial blood samples. The patients were studied in the cardiac catheterization laboratory, operating room, and ICU. Excellent correlation by linear regression (n = 108, r = .95) was observed between the two methods at oxygen saturations ranging from 35% to 95%. These observations show that in infants and children with cyanotic CHD, arterial oxygen saturations can be determined accurately and reliably by pulse oximetry at rest and during changing circulatory states.

Congenital intracardiac rhabdomyoma: prenatal detection by echocardiography, perinatal management, and surgical treatment.

A case of a newborn infant with an intracardiac tumor, detected in utero by fetal echocardiography at 30 weeks gestation, is presented. The prenatal evaluation by serial fetal echocardiograms and nonstress tests is described. In the perinatal period, ventricular tachycardia occurred and was successfully managed with antiarrhythmic medications. At 20 months of age, a right ventricular rhabdomyoma was removed at open heart surgery. The patient represents the earliest in utero detection of a fetal intracardiac tumor with successful postnatal outcome.

Cardiac MR imaging in Pompe disease.

The magnetic resonance (MR) imaging findings in a 5-month-old infant with glycogen storage disease of the heart revealed hypertrophy of the right and left ventricles and the interventricular septum with an irregular inhomogeneous appearance of the myocardium. The descriptive features of the MR study are correlated with cardiac angiography and echocardiography in Pompe disease.

Cardiac magnetic resonance imaging in children with congenital heart disease.

Electrocardiogram-gated magnetic resonance imaging (MRI) was used to evaluate 36 children, ages 2 to 17 years, with congenital heart disease. With the use of multiple imaging planes, including transverse, sagittal, coronal, and 60-degree left anterior oblique views, high contrast images with excellent spatial resolution were produced. In 34 of the 36 patients the anatomic detail provided by MRI was sufficient to make the cardiac diagnosis. Electrocardiogram-gated MRI is an important new imaging technique for use in children with cardiovascular disease.

Nuclear magnetic resonance imaging in evaluation and follow-up of children treated for coarctation of the aorta.

Electrocardiographic-gated nuclear magnetic resonance imaging was used to evaluate 10 patients, aged 2.5 to 18 years, with coarctation of the aorta. Six patients had balloon dilation angioplasty, one had surgical repair and three are awaiting treatment. Imaging studies were performed before and after therapy in three patients. In all pretreatment studies, the sagittal and 60 degrees left anterior oblique imaging planes adequately revealed the anatomy of the coarctation. Post-treatment imaging studies demonstrated effective relief of the coarctation in all cases. In three of the six patients who had balloon angioplasty, there was a variable degree of dilation of the aorta at the site of the previous coarctation. Nuclear magnetic resonance imaging is an effective noninvasive imaging method for visualizing coarctation of the aorta and for follow-up after treatment.

Atrioventricular canal ventricular septal defect with cleft mitral valve. Angiographic and echocardiographic features.

A rare form of endocardial cushion defect is an atrioventricular (AV) canal-type ventricular septal defect with cleft mitral valve in the absence of a primum atrial septal defect. In two infants with Down's syndrome, preoperative delineation of this entity was accomplished. M-mode echocardiographic features included presence of two distinct AV valves, attachment of the anterior portion of the anterior leaflet of the mitral valve to the interventricular septum, and normal septal motion. Two-dimensional echocardiography demonstrated the intact atrial septum, ventricular septal defect, presence of two distinct AV valves, and the cleft mitral valve. Angled (axial) cineangiography was employed to delineate the AV valve morphological characteristics, position of ventricular septal defect, and absence of a primum atrial septal defect. Since the surgical approach to this lesion is different from other forms of endocardial cushion defects and specific problems related to AV valve morphology may be encountered, the preoperative diagnosis of this entity is important.

Accessory mitral valve tissue causing left ventricular outflow tract obstruction in D-transposition of the great arteries.

Two patients with D-transposition of the great arteries (D-TGA) were found to have an unusual form of left ventricular outflow tract obstruction. Both had ball-like accessory mitral valve tissue that partially occluded the outflow tract. In one patient there was an intact septum, while in the other there were ventricular septal defects. The appearances have been described previously, although not in D-TGA. Recognition of accessory mitral valve tissue may allow resection of the tissue at the time of repair of the transposition complex.

Echocardiographic evaluation of valvar and shunt lesions in children.

An evaluation of valvar and shunt lesions in children is directed toward appraising the need for, and timing of, surgical repair or palliation as well as demonstrating the cardiac anatomy which will, in turn, direct the type of surgery to be chosen. Static dimension measurements as well as dynamic measurements of wall velocity and time intervals are atraumatic and easily obtained values that increase our sensitivity to early cardiac decompensation. Contrast studies add both functional and anatomic information. Although one-dimensional time-motion scanning remains an invaluable source of anatomic detail, two-dimensional imaging has made positional information clearer and more reliable. The combined use of these three techniques offers the most complete evaluation of children with volume and pressure overload lesions.

Overriding tricuspid valve: echocardiographic and angiocardiographic features.

Eight cases are presented in which the diagnosis of overriding of the tricuspid valve was made during life and the electrocardiographic, echocardiographic and angiographic features of the defect are presented. Four of the patients had dextrotransposition of the great arteries, three had normally related great arteries and one had corrected transposition. In each case there was hypoplasia of the right ventricle and a ventricular septal defect of the atrioventricular (A-V) canal type. The electrocardiogram in the cases with d-transposition was characterized by diminished right ventricular forces, left ventricular forces, left ventricular hypertrophy and a superior leftward frontal plane axis. The echocardiogram in seven cases demonstrated a septal leaflet of the tricuspid valve opening posterior to the septum into the left ventricle. In four cases the anterior leaflet of the tricuspid valve was shown crossing the plane of the interventricular septum as it opened in diastole. The diagnosis in five cases was made angiographically by a left ventricular injection in the left anterior oblique projection. In this view the septum was viewed tangentially and in diastole the negative silhouette of the tricuspid valve was seen straddling the interventricular septum. The presence of an overriding tricuspid valve can greatly complicate repair of intracardiac defects. The diagnosis of this A-V valve anomaly can be accurately made with the use of echocardiography and selective left ventricular angiography.