Cardiac rhythm after Mustard repair and after arterial switch operation for complete transposition.

We compared the prevalence of arrhythmias among the first consecutive 45 patients with complete transposition (concordant atrioventricular and discordant ventriculo-arterial connexions) after arterial switch operation and the last 47 patients after Mustard repair in infancy. Both groups had 24-hour Holter electrocardiographic studies at similar periods of follow up (24 +/- 14 and 25 +/- 18 months). A second group of patients undergoing the Mustard procedure had been repaired at an older age before 1981. They were studied to determine the frequency of disturbances of rhythm during later postoperative follow-up (85 +/- 24 months). Symptomatic brady-/tachyarrhythmia syndrome never occurred after the arterial switch and only once in the group of patients repaired by the Mustard procedure in infancy, but developed at a late stage (69 +/- 28 months); five times in the group of patients having Mustard's repair at an older age. In addition, Holter monitoring did not detect bradyarrhythmias indicating sinus node dysfunction in a single patient after the arterial switch, but did so to a similar extent in both groups having the Mustard procedure (recent: n = 14; older: n = 18). Three cases of the group of older patients undergoing a Mustard operation developed complete atrioventricular block during follow-up. Normal findings were present in 93% of the cases after arterial switch, but in only 51% of the cases with a similar follow-up repaired by the Mustard procedure, and in 29% of the group having the Mustard repair at an older age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Present aspects of bacterial endocarditis in infants and children. Observation during the years 1969-1976 (author's transl)]. / Gegenwärtige Merkmale der bakteriellen Endokarditis im Kindesalter. Erfahrungsbericht aus den Jahren 1969 bis 1976.

21 infants and children with proven bacterial endocarditis were observed at the Unviersity Children Hospital of Düsseldorf from January 1969 to December 1976. There was high incidence of cases in the infant group and again among the 6 to 8 years old children. Some important aspects of the disease were characteristic for the infant group (N=5): No congenital cardiac abnormality was present, but a surgical cerebro-atrial connection in two cases of hydrocephalus and a prolonged artifical respiration in a third patient could have been predisposing factors. Staphylococci were the pathologic organisms in three infants. The course of the disease consistently resembled that of septicemia and the outcome was always lethal. The diagnosis of bacterial endocarditis was disclosed only by the post mortem examination. The mitral and the tricuspid valves were affected twice respectively, the pulmonary cusps only once. In the children group (N=16) fifteen patients had a congenital malformation of the heart confirmed by previous catheterization. 8 were cyanotic and 5 of them had a tetralogy of Fallot with previous aorto-pulmonary shunting procedure (Waterston). Unlike the spectrum of micro-organisms presently found in adults, the streptococcus viridans prevailed as before, it was isolated in 11 of the 13 blood cultures which yielded positive results. The disease displayed a subacute course and mortality remained with 3 deaths relatively low. In 3 other cases a valve lesion subsisted, in two instances severe enough to necessitate surgery (aortic valve prosthesis, mitral annular narrowing). No relapse was observed during the mean follow up period of 2;8 years.

[The diagnostic value of M-mode-, two-dimensional echocardiography, and computed tomography in comparison to the results of cardiac catheterization in the diagnosis of tumors of the heart (author's transl)]. / Die diagnostische Wertigkeit von M-Mode-, zweidimensionaler Echokardiographie und Computertomographie im Vergleich zur Herzkatheteruntersuchung bei der Erkennung kardialer Tumoren.

12 patients with cardiac tumors (7 myxomas of the left, 2 of the right atrium, 2 ventricular, 2 intramural tumors and 1 epicardial cyst) were examined by M-Mode-(ME) and two-dimensional (2DE) echocardiography, computertomography (CT) and heart catheterization (HK) with angiography (A). The results were compared with intraoperative findings. There were no false negative results with 2DE and CT, but in 1 case the size of an intramural tumor was underestimated by 2DE. With ME all atrial myxomas were diagnosed, but 2 ventricular and 2 intramural tumors as well as the epicardial cyst were overlooked. Also with HK and A, the 2 intramural tumors and the epicardial cyst were not recognized well. The results indicate that the diagnosis of cardiac tumors can be made with great accuracy by noninvasive methods. The sensitivity of the single methods depends on the location of the tumors.