Primary mitral valve sarcoma in infancy.

Primary cardiac sarcoma is a rare tumor, found especially in children, particularly in the left side of the heart. This report describes a rare case of primary mitral valve sarcoma in a 7-month-old male infant with hemiparesis and heart murmur who underwent mitral valve replacement because of excessive invasion of the mitral valve by the tumor. The patient remains well, free of recurrence and cerebral metastasis, and without adjuvant therapy 18 months after the operation.

Newborn with congenital arteriovenous fistulas of the abdominal wall complicated by a ductus arteriosus aneurysm.

A case of congestive heart failure in a neonate resulting from a congenital abdominal arteriovenous fistula is described; an aneurysm of the ductus arteriosus was also found in the patient. Abdominal aortography was performed and demonstrated dilated feeding arteries, including the hypogastric arteries, which communicated with a dilated umbilical vein. Ligation of the feeding arteries and the umbilical vein led to resolution of the heart failure. Transient liver dysfunction occurred, however. Symptoms improved dramatically upon removal of the ligature from the umbilical vein. Although there is one previous report of an arteriovenous fistula involving the umbilical vein, we know of no prior report of a congenital arteriovenous fistula in association with a ductus arteriosus aneurysm.

[A case report of cor triatriatum benefit of MRI for preoperative diagnosis and surgical method].

Cor triatriatum is uncommon in all congenital heart diseases. It is a malformation resulting in a separation of the left atrium or right atrium into two chambers due to a congenitally abnormal diaphragm. We wish to present a case of cor triatriatum in which MRI was found most useful for preoperative diagnosis and surgical procedure. A 2-year-old girl was transferred to us for severe pulmonary congestion as shown on chest X-ray. Echocardiography showed abnormal diaphragm in the left atrium. MRI demonstrated clearly the relationship between left pulmonary vein and the abnormal diaphragm. Therefore we should preoperatively determine type I A according to the Lucas and Schmidt's classification. Cardiac catheterization showed moderate pulmonary hypertension and confirmed cor triatriatum. The resection of the abnormal diaphragm was performed under extracorporeal circulation with moderate hypothermia. The postoperative course was uneventful. MRI is a very useful non-invasive technique in making a diagnosis and in choosing the appropriate surgical procedure for cor triatriatum.

[A case of the successful treatment of pulmonary artery pseudoaneurysm after PA banding].

Pulmonary artery pseudoaneurysm after PA banding is a rare complication and its mortality is very high. The authors successfully operated on this sort of lesion. To our knowledge, this is the first successful case in Japanese literature. The second of twins was found to be suffering asplenia, dextro cardia, TAPVC, atrioventricular septal defect, corrected TGA and PDA. On the 19th day of life, increasingly pulmonary congestion forced us to operate. We performed PDA ligation, correction of TAPVC, together with extrathoracically adjustable PA banding. 5 months following this operation, spike fever and swelling of anterior thorax were noted. PA angiography was performed, and it showed that the pulmonary artery had been cut through by the band and a pseudoaneurysm had developed. The PA banding was removed and an end-to-end anastomosis of the PA was performed using cardiopulmonary bypass and deep hypothermia with surface cooling. The diameter of the PA anastomosis was designed to be one half that of her aorta. Staphylococcus aureus was cultured from the specimen of the PA band. It was thought to have contributed to the development of this aneurysm. The post operative course was uneventful.

An experimental study on gastroschisis using fetal surgery.

Gastroschisis models were successfully created in three groups of fetal rabbits by means of fetal surgery. Anatomical and pathologic assessments were carried out on the neonates that had experimental gastroschisis. In group I surgery was performed on the fetuses of 21 days gestational age; in group II on the fetuses of 23 days; and in group III on the fetuses of 26 days, respectively. Five cases of experimental gastroschisis were made in each group. The body weights of those with gastroschisis were low as compared with those of normal neonates. Intestinal length decreased and wall thickness increased as the result of 5--10 days evisceration. Abdominal cavity decreased in volume in all cases and could not accommodate the eviscerated organs. The number and density of distal mesenteric vessels (vasa recta) was high in the shortened intestine in gastroschisis models. Therefore it can be reasonably assumed that the intestine is only contracted and the possibility of return to normal length remains.

Changes in amplitude of the EEG induced by a photic stimulus.

Occipital EEG responses to a single photic flash were studied by using a complex demodulation technique. Individual EEGs were first digitally filtered by making use of the Ormsby band-pass filter. Envelopes of the alpha (8-12 c/sec) and of the low frequency (3-7 c/sec) activities were obtained in terms of the demodulation calculation. Both individual and averaged data of raw, filtered, and demodulated EEGs were utilized for the present study. Two typical kinds of EEG responses were observed. One showed clearly the blocking as well as the enhancement of the alpha activity. The alpha activity first exhibited a reduction in amplitude in the range 50-200 msec after the stimulus (the minimum amplitude at about 150 msec). Then an evocation, rather than merely a recovery, of the alpha was observed in the range 500-800 msec (maximum amplitude at about 650 msec). The other typical example showed the low frequency evoked potential prominently. This response appeared almost locked to the stimulus and showed roughly a bi-phasic pattern in the time range where the alpha blocking took place (30-200 msec). Phases of the evoked low frequency component were almost locked to the stimulus but no distinct phase coherence was observed for the enhanced alpha wavetrains. Detection by demodulation of the phase change of the alpha was critical for a single EEG. It is pointed out that changes of the alpha must be studied on individual EEGs.