Abnormalities in position of left ventricular papillary muscles in congenital aortic stenosis.

Subclinical structural abnormalities may accompany some congenital cardiovascular abnormalities. Echocardiographic observations led us to hypothesize that the positions of the left ventricular papillary muscles are abnormal in hearts with aortic valvar stenosis. To test this hypothesis, we examined 6 normal heart specimens and hearts with congenital cardiovascular malformations, including 5 with pulmonary atresia and an intact ventricular septum, 6 with tetralogy of Fallot and 5 with aortic valvar stenosis. We marked the papillary muscles and the mitral commissures, X-rayed the hearts, and measured the angular positions of the papillary muscles using the midpoint of a chord drawn between the mitral commissures as a reference point. The direction from the midpoint to the lateral commissure was designated as 0 degrees. The data (mean +/- SEM) were analyzed using a computer program (ANOVA). In normal hearts, the anterolateral and posteromedial papillary muscles were positioned, respectively, at 43 +/- 19 degrees and 126 +/- 26 degrees. The positions of the papillary muscles were similar to normal in the hearts with pulmonary atresia (62 +/- 38 degrees and 128 +/- 27 degrees) and tetralogy of Fallot (40 +/- 13 degrees and 130 +/- 37 degrees). In aortic stenosis, the locations of the papillary muscles (-76 +/- 42 degrees and 71 +/- 25 degrees) were significantly different from normal (P less than 0.05). The arc between the papillary muscles was 83 +/- 16 degrees in normals and 147 +/- 45 degrees in aortic stenosis (P less than 0.05). The length of the arc was similar to normal in other heart specimens. Thus, the papillary muscles were abnormally positioned in aortic stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical therapy for the hydropic fetus with congenital complete atrioventricular block.

Early delivery, immediate ventricular pacing, and inotropic support have failed to improve the outcome of hydropic fetuses with congenital complete atrioventricular block. On detection of hydrops, two fetuses were treated with maternally administered digoxin and furosemide with prompt and sustained resolution of intrathoracic fluid accumulations. Clearance of serosal fluid collections may prevent pulmonary hypoplasia and improve cardiac function. Before proceeding with premature delivery in such patients, a brief trial of transplacental anti-congestive therapy is indicated.

Parenteral indomethacin for closure of the patent ductus arteriosus. Clinical experience with 67 preterm infants.

During a 19-month period, 23% of preterm infants had symptomatic patent ductus arteriosus (PDA). Intravenous indomethacin was administered to 67 infants with successful closure in 91% of the patients and in 83% of those with birth weights less than 1,000 g. No differences were found between the number of doses required and birth weight, gestational age, or age at initial therapy. Transient alterations in renal function were common after therapy, but mild renal failure occurred in only four infants. The incidence of intraventricular hemorrhage and necrotizing enterocolitis in treated infants was similar to that in the total preterm population. Cicatricial retrolental fibroplasia developed in one patient. Bronchopulmonary dysplasia occurred more frequently in infants with PDA, but a decreased incidence was found after early ductal closure. Intravenous indomethacin administration successfully effects ductal closure without major complications in preterm infants.

Echocardiographic definition of right pulmonary venous connection at catheterization.

Traditional methods of identifying partial anomalous pulmonary venous connection to the right atrium in the presence of an atrial defect are not always reliable. Twenty patients were studied with a new technique in which the catheter is introduced into the right superior pulmonary vein followed by echocardiographic assessment of the catheter position in relation to the left atrium and atrial septum. The insertion site of the right pulmonary veins was detected in every patient and in ten patients has been verified at operation. This approach can be performed rapidly and appears to be accurate as well as reliable.