Objective: Fetal echocardiography, physical examination and pulse oximetry detect only half of coarctation of aorta (CoA) cases. We aimed to quantify delayed arrival and diminished amplitude of lower extremity photoplethysmographic (PPG) pulses relative to the right hand in affected patients. Study design: We studied 8 CoA infants and 32 healthy controls. The pulse arrival time difference between foot and hand (f-hTD) and pulse amplitude ratio (F/H) were measured on PPG signal waveforms by digitally-determining maxima and minima of systolic decrease of light transmission. Mann–Whitney test was used for group comparisons. Results: In comparison to healthy newborns, CoA infants’ PPG waveforms demonstrated prolonged f-hTD (mean±s.d. of 73.2±26.6 versus 35.2±8.3 ms, P <0.001) and lower F/H (0.57±0.26 versus 0.99±0.58, P =0.014). Conclusions: F-hTD and F/H are quantifiable from hand- and foot-derived PPG waveforms and are significantly different in CoA versus healthy newborns. Larger studies are needed to validate PPG for improved critical congenital heart disease screening.

Background and hypothesis: Although results of surgical ligation of the patent ductus arteriosus (PDA) in the pediatric age group are excellent, surgical management of the adult with a PDA may be more problematic. The PDA that presents in adulthood may be calcified and friable, rendering simple ligation via a thoracotomy difficult, inadequate, and hazardous. Patch closure of the ductus arteriosus from either the aortic or pulmonary artery orifice using cardiopulmonary bypass or transient aortic cross-clamping is necessary but increases surgical risks. Furthermore, older patients with diseases unrelated to their PDA and patients with Down's syndrome may have higher risks with intubation, general anesthesia, and surgery. Early results of percutaneous transcatheter occlusion of the PDA with Gianturco coils performed under sedation and local anesthesia are promising.Methods: Six adults with mean age of 39.1 years (range 23.1-62.0 years) were found to have an isolated PDA with mean minimum diameter of 2.7 mm (range 1.0-5.0 mm) at cardiac catheterization. All underwent percutaneous transcatheter occulsion of the PDA using Gianturco coils.Results: Coil implantation was successful in all patients. There were no complications and all were discharged home within 24 hours. Complete ductal occlusion was seen immediately in 4 of 6 patients (67%) while 2 of 6 (33%) had small residual leaks. However, complete occlusion was achieved in all patients by 6 months following the procedure.Conclusion: Transcatheter occlusion of the PDA using coils is safe and efficacious in adults.

Previous data has suggested a deleterious action of Amrinone (Am) on newborn (NB) myocardium. An investigation of the relationship between dose, age, and contractility has been undertaken using isolated right ventricular papillary muscles from NB (0-5 days), juvenile (J) (18-29 days), and adult (A) New Zealand white rabbits. At least six rabbits were studied in each age group using four sequential concentrations of Am (30, 100, 200, 500 mcg/ml). Peak tension (PT), maximum rate of tension development (+dP/dt) and maximum rate of relaxation (-dP/dT) were measured after a fifteen minute equilibration period at each concentration. Repeated measures analysis was used to compare dose response data between age groups. T-tests were used to compare normalized data from the various age groups at a given concentration. Adult heart demonstrated an increase in PT, +dP/dt and -dP/dT with each increase in Am concentration. NB and J heart demonstrated a significant (P<0.05) decrease in PT and +dP/dt for only the lowest dose of An. In contrast to NB the lowest dose did not depress -dP/dT In J. Above 200 mcg/ml, NB and J hearts demonstrated a significant (P<0.05) increase in PT, +dP/dt, and -dP/dt. These results suggest that higher concentrations of Am enhance contractility in NB and J myocardium. While the dose dependence of A heart is monotonic, the NB and J response is biphasic, suggesting multiple and age dependent mechanisms of action. The differential effect of Am on -dP/dT In NB and J hearts implies a developmentally determined action of Am on Ca sequestration in addition to its positive inotropic effect.

Two infants with Pompe's disease (type II glycogenosis) showing echocardiographic evidence of obstructive cardiomyopathy are described. On M-mode and two-dimensional (2-D) echocardiography there was a severe hypertrophy of the interventricular septum, free, and posterior left ventricular wall with midsystolic closure of the aortic valve. The combined echocardiographic and electrocardiographic findings are helpful in the clinical diagnosis of this severe disease.

Verapamil is a useful drug for treating supraventricular tachycardia; however, severe side effects occasionally have been reported in infants. We describe here our experience with the use of a 10 percent solution of intravenous calcium gluconate prior to the use of verapamil in infants with paroxysmal supraventricular tachycardia. In all the attacks verapamil converted the supraventricular tachycardia to sinus rhythm. We feel that calcium gluconate injected previous to verapamil can avoid the negative inotropic effects without interfering with the antiarrhythmic properties of verapamil.

A 6-day-old baby with a single arterial trunk arising from the aortic arch is reported. The baby had coarctation of aorta with patent ductus arteriosus and ostium primum atrial septal defect. A review of the literature in English reveals no other case reported of an infant with this association of anomlies.

Duodenal obstruction occurred in a 7-year-old girl who suffered from encephalitis. She was of asthenic build, had recently lost much weight and had been lying supine for several days. A diagnosis of superior mesenteric artery syndrome (SMAS) was entertained and subsequently confirmed by roentgenologic studies and by the clinical course. Unnecessary surgery was thus avoided. Because of its varied expression and the alleged infrequent occurrence in children, there is special need for awareness and recognition of SMAS in the pediatric patient.