Decreased HDL cholesterol in prepubertal and pubertal children of CHD patients.

Prepubertal boys and pubertal girls and boys selected because of the occurrence of acute myocardial infarction in their father or mother were characterized by a low HDL cholesterol when compared to healthy controls. This observation extends our previous observations of low HDL cholesterol in adult relatives of CHD patients to the children of the same patients. The occurrence of an HDL abnormality in young children demonstrates that the low HDL cholesterol precedes the occurrence of cardiovascular disease. Low HDL cholesterol was associated with increased VLDL cholesterol in prepubertal children and pubertal boys without significant increase in VLDL triglycerides. Smoking and drinking habits, and physical activity which are environmental factors known to affect HDL did not differ between these children and the controls and cannot account for the observed differences. The results show that the low HDL cholesterol is detectable early in life in close relatives of CHD patients, persists throughout the lifespan and is possibly genetically determined.

Atrial natriuretic factor after heart operations in children. Relation to hemodynamic and renal parameters.

The purpose of this study was to measure changes in serum atrial natriuretic factor concentrations immediately after heart operations in children under baseline conditions and in response to continuous infusion of dopamine (2.5 and 5.0 micrograms/kg/min). During control periods, levels of atrial natriuretic factor were elevated at 190 +/- 24 and 199 +/- 36 pg/ml. The cardiac index was 2.6 L/min/m2 and the renal plasma flow was decreased to 269 +/- 41 ml/min/1.73 m2, indicating a state of renal vasoconstriction (mean renal fraction of cardiac index of 10.0% +/- 1.0%). The mean sodium fractional reabsorption was 99.0% +/- 0.2%. During dopamine infusion, atrial natriuretic factor concentrations increased to 259 +/- 57 pg/ml and to 280 +/- 56 pg/ml, with dopamine 2.5 and 5.0 micrograms/kg/min, respectively (p = not significant), whereas left atrial pressure decreased from 11.7 +/- 0.9 mm Hg during the control period to 10.1 +/- 0.9 and to 9.9 +/- 1.0 mm Hg (p less than 0.05). No correlation was found between changes in left atrial pressure and atrial natriuretic factor levels. Dopamine at 5 micrograms/kg/min increased the cardiac index to 3.0 +/- 0.2 L/min/m2 (p less than 0.001) and the renal plasma flow to 406 +/- 61 ml/min 1.73 m2 (p less than 0.001), alleviating the renal vasoconstriction. The mean urinary sodium excretion increased to 0.33 +/- 0.08 mmol/kg/hr (p less than 0.01). The atrial natriuretic factor plasma concentrations were not related to the urinary sodium excretion, renal plasma flow, or glomerular filtration rate during the control period or during dopamine treatment. These data indicate that after heart operations in children, low urinary sodium excretion occurs despite high circulating atrial natriuretic factor levels. Atrial natriuretic factor concentrations were related neither to left atrial pressures nor to the renal changes induced by dopamine.

Endomyocardial fibrosis in the child.

Endomyocardial fibrosis is a rare disease in children and has been mainly observed in tropical Africa, seldom in Europe. Its precise aetiology remains unknown. New surgical procedures have recently led to better survival. Four children, a 5 year old Swiss boy and 3 African girls, aged 12 to 14 years, were submitted with global heart failure class III to IV of the NYHA classification. Two patients had eosinophilia on admission. A third had a history of transient eosinophilia. The echocardiographic examination showed a very typical picture. In 3 patients (2 f and 1 m) both ventricles were involved; in one girl only the left ventricle. Decreased ventricular distensibility with impaired filling of the left and/or right ventricle was present in all. Diastolic pressures ranged between 24 and 35 mmHg; the systolic function was satisfactory in 3 children (ejection fraction [EF] of 44 to 61%) and severely decreased in the fourth (EF 10%). Three patients underwent endocardectomy: both ventricles in 1 case, only the left in 2 cases. Mitral valve repair by means of the Carpentier ring was done once, valve replacement once (Starr-Edwards prothesis). One child died; the 2 surviving patients showed a distinct improvement in their clinical state and are now in class II of the NYHA classification. Echocardiographic and catheter investigations show, however, persistence of the restrictive cardiomyopathy. Thus, surgical intervention must be considered a palliative procedure in these cases. The diagnosis can clearly be made nowadays with bidimensional and Doppler echocardiography.

[Dietary lipids and serum lipids in adolescents, based on the Geneva study of the precursors of atherosclerosis]. / Lipides alimentaires et lipides sanguins chez les adolescents, d'après l'étude genevoise des précurseurs de l'athérosclérose.

The relationship between serum lipids and nutrition, physical activity and body mass index were studies with a multifactorial analysis of variance in a group of 160 adolescents of both sexes (Table I). These relationships are complex and difficult to demonstrate; they give rise, however, to certain considerations of presumptive characteristics possibly linked with adolescence.

Ultrasound screening for congenital cardiac malformations in the fetus. Its importance for peri- and postnatal care.

Congenital cardiac malformations (CCM) are the commonest congenital anomalies. Using ultrasonography (US), the incidence of CCM in a selected group of fetuses and the impact of CCM on perinatal and postnatal care was evaluated. The indication for fetal echocardiography (F-ECHO) in 152 pregnancies was a positive family history in 61, fetal arrhythmias seen by routine obstetrical controls in 53, suspected CCM during obstetrical US in 9, growth retardation in 3 and contracted maternal factors in 6. Twenty pregnancies had no special indication. F-ECHO was performed between the 18th and the 39th gestational week. Twenty-seven cardiac malformations were found (18%), 10 of which were important; 3 succumbed at birth, 2 after surgical intervention, 1 was aborted and 4 needed intensive care at birth. Of 53 cases with arrhythmias, 3 needed special care during pregnancy: Digitalis in a case of atrial flutter, sick leave and bedrest in 2 with supraventricular tachycardia, premature delivery in 1 case with complete AV block due to an intraventricular tumor. The extremely high incidence of CCM in this group proves the need for careful fetal evaluation to detect malformations. Nowadays F-ECHO can and should be performed as early as in the 18th gestational week, allowing either to interrupt a pregnancy or to plan delivery in a well-equipped center which provides the necessary measures for these newborns.

Radionuclide evaluation of right ventricular wall motion after surgery in tetralogy of Fallot.

Regional wall motion patterns in tetralogy of Fallot and its postoperative modifications by electrical and hemodynamic factors were assessed by Fourier analysis of gated radionuclide angiograms in 24 studies performed in children after surgical correction of tetralogy of Fallot. The range of right ventricular (RV) phase angles (standard deviation of the peak [SDP] of RV) as well as the difference between RV and LV (delta MPh) were used as indices of the synchronicity of wall motion and were correlated with RV apical electrical activation time determined by endocardial electrical mapping. Postoperative studies were divided into two groups according to apical activation: (a) those involving right bundle branch block (RBBB) (nine patients), and (b) those involving distal RBBB (15 patients). delta MPh was longer in proximal than in distal RBBB. Best discrimination between the two groups was obtained with SDP of RV (proximal = 24 degrees +/- 3 degrees, and distal = 17 degrees +/- 2 degrees; p less than 0.0001). These results showed that the range of ventricular phases measured by the SD of the phase distribution of the right ventricle is a good index for distinguishing between proximal and distal RBBB after cardiac surgery.

Ebstein's anomaly of the tricuspid and mitral valves in an otherwise normal heart.

A case in which there was Ebstein's anomaly of both the tricuspid and mitral valve is described: the structure of the h eart was otherwise normal.

Teratoma of the heart. A case report and review of the literature.

The clinical manifestations and pathological features of an extremely rare cardiac tumour, a mature (benign) teratoma, in a 6 year-old girl are described. These are compared with those reported in the literature.

Morphologic and functional evaluation of congenital heart disease by magnetic resonance imaging.

Magnetic resonance imaging (MRI) has evolved sufficiently to be recognized as a useful complementary noninvasive method to echocardiography in the evaluation of congenital heart disease (CHD). In some cases, MRI is superior to other imaging modalities, particularly in the evaluation of thoracic aortic anomalies and in defining the anatomy of central pulmonary arteries; it is also the procedure of choice in the postoperative follow-up of patients with CHD. Recent technological advances permit not only morphological evaluation (provided by spin-echo and MR angiographic techniques) but functional and flow information (provided by fast cine-GE and velocity-encoded sequences), causing it to be recognized by pediatric cardiologists and cardiac surgeons as an unavoidable technique for pre- and postoperative evaluation of some CHD. This review describes the various techniques used in the evaluation of CHD with emphasis on recent developments as well as recognized clinical applications. J. Magn. Reson. Imaging 1999;10:639-655.

Trefoil balloon for percutaneous valvuloplasty.

A new balloon (Trefoil balloon) was developed to avoid complete interruption of blood flow during percutaneous balloon valvuloplasty. It consists of three identical 2- to 4-cm-long angioplasty balloons mounted in a parallel fashion on a single catheter. Filled simultaneously, they assume the cross section of a rosette, allowing for continued blood flow. Trefoil balloons of various sizes were tested in five dogs (aorta and aortic valve). They created a gradient ranging from 5 to 40 mmHg where conventional, single balloons of comparable size were completely obstructive. In three consecutive patients with congenital pulmonary stenosis, Trefoil balloons were used successfully and without significant complications. Continued transvalvular blood flow during the actual dilatation process was documented in all cases. The Trefoil balloon is a promising new device for percutaneous valvuloplasty and, perhaps, coronary angioplasty.

Cine gradient-echo MR imaging in the evaluation of cardiovascular diseases.

The contributions of cine gradient-echo (GRE) magnetic resonance imaging were compared with those of spin-echo (SE) imaging for the evaluation of morphologic, functional, and flow alterations in 78 cases of congenital and acquired cardiac diseases. High temporal and spatial resolution cine GRE images (256 phase-encoding steps, 256 x 256 acquisition matrix interpolated to 512 x 512 for display, 16-64 frames per cycle) and SE images were acquired in each case. Cine GRE images provided a better diagnostic evaluation than SE images in several cases: (a) both masses and thrombi could be differentiated from flow artifacts; (b) abnormalities in cardiac function, such as infarction, abnormal wall motion, and ventricular dysfunction, could be evaluated; (c) small defects, shunts, and abnormal communications could be clearly seen; and (d) valvular regurgitations, poststenotic flow alterations, and aortic coarctation could be assessed. Cine GRE imaging was also valuable for postoperative evaluations. The authors believe that cine GRE imaging is a useful addition to SE sequences, especially for the assessment of blood flow and cardiac function.