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Persistent patency of ductus arteriosus in premature newborn infants
ABSTRACTS
TOTAL ANOMALOUS PULMONARY VENOUS RETURN (TAPVR) WITH OBSTRUCTION AT THE ATRIAL SEPTUM (PALLIATION WITH BALLOON SEPTOSTOMY AND OPEN ATRIAL SEPTECTOMY) Michael A. Berman, MD;Norman S. Talner, MD, FACC; MD, Yale University School of H. C. Stansel, Jr.. Medicine, New Haven, Conn. When obstruction to pulmonary venous return occurs with TAPVR, these infants may become severely symptomatic. Obstruction, always present when the veins return below the diaphragm, also takes place with an atretic or compressed left ascending vein but is unusual when the site of return is the right atrium, coronary vena cava. Two infants are resinus, or left superior ported with TAPVR in which an inadequate atria1 communication was the site of obstruction. Symptoms in one with TAPVR to the coronary sinus was dramatically improved with balloon septostomy. In the other, the trunk entered the left innominate vein. Relief was achieved by atria1 septectomy utilizing cardiopulmonary bypass, since the conventional Blalock-Hanlon operation would be technically difficult due to the malposition of the While primary repair should be the anomalous vessel. goal of all centers caring for infants with TAPVR, it appears that a select group may benefit from initial palliation (especially if this can be performed at catheterization) and then followed by definitive repair.
PERSISTENTPATENCYOF DUCTUSARTERIOSUSIN PREMATURE NEWBORN INFANTS Carlos E. Blanco, MD; Bijan Siassi, MD, FACC; and Luis A. Cabal, MD, Department of Pediatrics, University of Southern California School of Medicine, Los Angeles, California. The incidence of patent ductus arteriosus (PDA) beyond 3 days of age was studied in 100 consecutive admissions of premature neonates with birth weights of Initial screening of the 100 infants 760 to 2000 grams. was done by auscultation, and a clinical diagnosis of Diagnosis was confirmed by thoracic PDA was made in 36. angiography in the 6 mst severely involved infants. Dye dilution ear-oximetry was performed in 20 of the remaining 30 infants and 30 to 80% left-to-right shunt The incidences of PDA were 77%, 44% was demonstrated. and 23% in babies with gestational ages of 28-30, 31-33 Chest radiographs showed and 34-36 weeks respectively. increased pulmonary vascular msrkings in 56% of babies with PDA, whereas only 11% had abnormal EKG (right ventricular hypertrophy). A clinical diagnosis of respiratory distress syndrome (RDS) was made in 81% of babies with PDA and in only 26% of babies without PDA. Because of unresponsiveness to conservative treatment, Of 16 surgical ligation was required in 4 babies. infants followed for periods up to 5 months, 9 showed spontaneous closure. From this study, it is concluded that persistent patency of the ductus arteriosus is a conrnon occurrence in small premature infants and is clearly related to When correction is made for gestational gestational age. age, there is still a higher incidence of PDA in babies recovering from RDS.
CORONARY ARTERYREPERFUSION: EARLY EFFECTSON CORONARY HEMODYNAMICS Colin M. Bloor, MD, FACC, and Francis C. White, BS, Dept. of Pathology, UCSD School of Medicine, La Jolla, Calif. Coronary artery reperfusion (CAR) studies assume that coronary hemodynamics are unaltered in the reperfused bed. To test this, we monitored reactive hyperemia (RR) responses and coronary blood flow (CBF) responses to nitroglycerine (NG), 0.3 mg i.v. before and after coronary occlusion (CO) in 20 conscious dogs, chronically instrumented with pressure tubes, and electromagnetic flow probes and occlusive cuffs on the left circumflex coronary artery. After control runs, in which we established control values for RR responses and CBF responses to NG, we occluded the left circumflex coronary artery for 2, 6, 24 or 72 hrs. On release of CO and start of CAR, we monitored RB responses and CBF responses to NG over the next 4 days. In 5 dogs occluded for 2 hrs, RH and CBF responses to NG during CAR were unchanged from controls. In 4 dogs occluded for 6 hrs, RH and CBF responses to NG were significantly reduced (P
EARLY DETECTIONOF CARDIOMYOPATHY IN MUSCULAR DYSTROPHIES Joseph A. Bonanno, M.D., FACC, James Lies, M.D., Robert G. Taylor, M.D., Jess F. Kraus, Ph.D., Ezra A. Amsterdam, M.D., FACC, Dean T. Mason, M.D., FACC, Sch. of Med., Univ. of Calif., Davis. Although cardiomyopathy (CM) is a common cause of death in the muscular dystrophies (MD), its diagnosis is often obscured until the terminal stages of these diseases. Cardiac symptoms (CSx) are late findings and physical signs are difficult to interpret because of the frequent presence of thoracic deformity and/or respiraConsequently, ECG abnormalities (Ab) have tory disease. constituted the principle means of CM identification In systolic time interval MD. In this study, non-invasive measurements (STI) were used to evaluate cardiac function in 20 patients (PTS) age 5-15 yrs with mild disease of whom 15 had progressive muscular dystrophy (Duchenne), 3 myotonic dystrophy and 2 limb girdle dystrophy. Cardiac physical and roentgen examinations were all normal and The QRS duration was normal CSx were completely absent. in all and the ECG pattern suggested CM in only 3. Total electromechanical systole (Q-Sl), Q-S,, left ventricular ejection time (LVET), pre-ejection period (PEP), isovolumic contraction time (ICT) and LVET/PEP were determined, and compared with age-corrected normal values. The STI’s were then subjected to discriminant function analysis and were found to readily discriminate PTS from normals (pc.005). PEP prolongation was the principle Ab and resulted primarily from increased Q-S1 (pc.005) although ICT was also prolonged (pc.05). LVET was not significantSince ORS duration was normal, an Ab of exly altered. citation-contraction coupling is thereby suggested. Thus, ST1 provide a sensitive means of detecting cardiac involvement in MO.
January 1973
The American Journal of CARDIOLOGY
Volume 31
121
TOTAL ANOMALOUS PULMONARY VENOUS RETURN (TAPVR) WITH OBSTRUCTION AT THE ATRIAL SEPTUM (PALLIATION WITH BALLOON SEPTOSTOMY AND OPEN ATRIAL SEPTECTOMY) Michael A. Berman, MD;Norman S. Talner, MD, FACC; MD, Yale University School of H. C. Stansel, Jr.. Medicine, New Haven, Conn. When obstruction to pulmonary venous return occurs with TAPVR, these infants may become severely symptomatic. Obstruction, always present when the veins return below the diaphragm, also takes place with an atretic or compressed left ascending vein but is unusual when the site of return is the right atrium, coronary vena cava. Two infants are resinus, or left superior ported with TAPVR in which an inadequate atria1 communication was the site of obstruction. Symptoms in one with TAPVR to the coronary sinus was dramatically improved with balloon septostomy. In the other, the trunk entered the left innominate vein. Relief was achieved by atria1 septectomy utilizing cardiopulmonary bypass, since the conventional Blalock-Hanlon operation would be technically difficult due to the malposition of the While primary repair should be the anomalous vessel. goal of all centers caring for infants with TAPVR, it appears that a select group may benefit from initial palliation (especially if this can be performed at catheterization) and then followed by definitive repair.
PERSISTENTPATENCYOF DUCTUSARTERIOSUSIN PREMATURE NEWBORN INFANTS Carlos E. Blanco, MD; Bijan Siassi, MD, FACC; and Luis A. Cabal, MD, Department of Pediatrics, University of Southern California School of Medicine, Los Angeles, California. The incidence of patent ductus arteriosus (PDA) beyond 3 days of age was studied in 100 consecutive admissions of premature neonates with birth weights of Initial screening of the 100 infants 760 to 2000 grams. was done by auscultation, and a clinical diagnosis of Diagnosis was confirmed by thoracic PDA was made in 36. angiography in the 6 mst severely involved infants. Dye dilution ear-oximetry was performed in 20 of the remaining 30 infants and 30 to 80% left-to-right shunt The incidences of PDA were 77%, 44% was demonstrated. and 23% in babies with gestational ages of 28-30, 31-33 Chest radiographs showed and 34-36 weeks respectively. increased pulmonary vascular msrkings in 56% of babies with PDA, whereas only 11% had abnormal EKG (right ventricular hypertrophy). A clinical diagnosis of respiratory distress syndrome (RDS) was made in 81% of babies with PDA and in only 26% of babies without PDA. Because of unresponsiveness to conservative treatment, Of 16 surgical ligation was required in 4 babies. infants followed for periods up to 5 months, 9 showed spontaneous closure. From this study, it is concluded that persistent patency of the ductus arteriosus is a conrnon occurrence in small premature infants and is clearly related to When correction is made for gestational gestational age. age, there is still a higher incidence of PDA in babies recovering from RDS.
CORONARY ARTERYREPERFUSION: EARLY EFFECTSON CORONARY HEMODYNAMICS Colin M. Bloor, MD, FACC, and Francis C. White, BS, Dept. of Pathology, UCSD School of Medicine, La Jolla, Calif. Coronary artery reperfusion (CAR) studies assume that coronary hemodynamics are unaltered in the reperfused bed. To test this, we monitored reactive hyperemia (RR) responses and coronary blood flow (CBF) responses to nitroglycerine (NG), 0.3 mg i.v. before and after coronary occlusion (CO) in 20 conscious dogs, chronically instrumented with pressure tubes, and electromagnetic flow probes and occlusive cuffs on the left circumflex coronary artery. After control runs, in which we established control values for RR responses and CBF responses to NG, we occluded the left circumflex coronary artery for 2, 6, 24 or 72 hrs. On release of CO and start of CAR, we monitored RB responses and CBF responses to NG over the next 4 days. In 5 dogs occluded for 2 hrs, RH and CBF responses to NG during CAR were unchanged from controls. In 4 dogs occluded for 6 hrs, RH and CBF responses to NG were significantly reduced (P
EARLY DETECTIONOF CARDIOMYOPATHY IN MUSCULAR DYSTROPHIES Joseph A. Bonanno, M.D., FACC, James Lies, M.D., Robert G. Taylor, M.D., Jess F. Kraus, Ph.D., Ezra A. Amsterdam, M.D., FACC, Dean T. Mason, M.D., FACC, Sch. of Med., Univ. of Calif., Davis. Although cardiomyopathy (CM) is a common cause of death in the muscular dystrophies (MD), its diagnosis is often obscured until the terminal stages of these diseases. Cardiac symptoms (CSx) are late findings and physical signs are difficult to interpret because of the frequent presence of thoracic deformity and/or respiraConsequently, ECG abnormalities (Ab) have tory disease. constituted the principle means of CM identification In systolic time interval MD. In this study, non-invasive measurements (STI) were used to evaluate cardiac function in 20 patients (PTS) age 5-15 yrs with mild disease of whom 15 had progressive muscular dystrophy (Duchenne), 3 myotonic dystrophy and 2 limb girdle dystrophy. Cardiac physical and roentgen examinations were all normal and The QRS duration was normal CSx were completely absent. in all and the ECG pattern suggested CM in only 3. Total electromechanical systole (Q-Sl), Q-S,, left ventricular ejection time (LVET), pre-ejection period (PEP), isovolumic contraction time (ICT) and LVET/PEP were determined, and compared with age-corrected normal values. The STI’s were then subjected to discriminant function analysis and were found to readily discriminate PTS from normals (pc.005). PEP prolongation was the principle Ab and resulted primarily from increased Q-S1 (pc.005) although ICT was also prolonged (pc.05). LVET was not significantSince ORS duration was normal, an Ab of exly altered. citation-contraction coupling is thereby suggested. Thus, ST1 provide a sensitive means of detecting cardiac involvement in MO.
January 1973
The American Journal of CARDIOLOGY
Volume 31
121