Treatment of paroxysmal supraventricular tachycardia in infancy with digitalis, adenosine-5'-triphosphate, and verapamil: a comparative study.

The treatment of paroxysmal supraventricular tachycardia (PSVT) in infancy with digitalis, adenosine triphosphate (ATP) and verapamil is reported. Treatment was successful in about 90% of the patients treated with ATP and verapamil and in 61--71% of the patients treated with digitalis (Lanatoside C). Verapamil terminated the tachycardia within 2 minutes of administration in most instances and ATP in less than 1 minute. Digitalis, however, took as long as 2 hours; it was therefore excluded as the drug of first choice in emergencies, and is better suited for treating patients with poor hemodynamics. Side effects with ATP are common but short-lived. With verapamil, side effects are rare, but may be serious if certain contraindications are not taken into account. Digitalis in the dose used in this trial rarely produced side effects. We conclude that ATP or verapamil is the drug of first choice for quick termination of PSVT in infancy.

[Straddling and overriding atrio-ventricular valves: echocardiographic and angiographic findings]. / Valvole atrio-ventricolari cavalcanti. Rilievi ecoangiocardiografici.

Recent advances in surgical technique for correction of positional abnormalities of atrio-ventricular (A-V) valve require accurate preoperative diagnosis of this malformation which can be distinguished into a complete (overriding + straddling) and a partial form (overriding or straddling). In this study, echocardiography and angiocardiography are shown to be complementary to each other for definition of the anatomic details of this pathology. Six cases of positional abnormalities of the A-V valves are reported. Group I includes three patients with tricuspid valve abnormalities: two are complete forms (overriding + straddling) one of which is associated with DORV and the other is associated with d-TGA. The third patient is a partial form: straddling tricuspid valve with only a large ventricular septal defect involving the inlet septum. Group II includes three patients with mitral valve abnormalities: one complete form and two partial ones (straddling), all associated with DORV. We illustrate the best echocardiographic and angiocardiographic projection for the recognition of A-V valve malposition and demonstrate that both techniques greatly add to the diagnostic accuracy. Echocardiography defines better the abnormal attachments of the leaflet apparatus, whereas angiocardiography identifies better the displacement of the A-V valve annulus.

[The contrast echocardiography for the diagnosis of the venous system anomalies. Echo-angiographic correlations (author's transl)]. / L'ecocontrastografia nelle anomalie delle connessioni veno-atriali sistemiche. Correlazione eco-angiografica.

Contrast echocardiography is described as an important technique for the diagnosis of the anomalies of the venous system. Six patients with intrahepatic interruption of the inferior vena cava (IVC), ten patients with persistent left superior vena cava (PLSVC) connecting to coronary sinus (CS), one patient with PLSVC connecting to left atrium (LA) and ten patients, control group, with normal venous connections were studied by two-dimensional echocardiography; the injections of dextrose were made into the left hand, right hand, leg; the locations of the transducer were: subcostal position, parasternal and suprasternal. All patients underwent cardiac catheterization and cineangiography. When the injection was made into a leg vein, in the patients with infrahepatic interruption of the IVC we observed the contrast medium descending from the superior vena cava into the right atrium (RA). In the cases with PLSVC connecting to CS, contrast medium injected into the left hand, the sequential clouding of CS, RA and right ventricle was seen. The pattern of opacification in the case of PLSVC connecting to LA is discussed. In conclusion, contrast echocardiographic study of the connections of the venous system may be useful in planning the way for cardiac catheterization and also for the diagnosis of some anomalies which might be mistaken even at the time of the hemodynamic study.

[Enlarged coronary sinus. Mono and bidimensional echocardiographic aspects (author's transl)]. / Dilatazione del seno coronarico. Rilievi ecocardiografici mono e bidimensionali.

One case of enlarged coronary sinus with a total anomalous pulmonary venous connection (TAPVC) is described. The echocardiographic findings are compared to those seen in cases with persistence of the left superior vena cava (PLSVC). The diagnosis has been established by single crystal and two-dimensional echocardiography, by cardiac catheterization and angiography and was confirmed at surgery; post-operative echocardiographic control was performed. The differential diagnosis between TAPVC or PLSVC and other anomalies which may simulate a dilated coronary sinus is discussed. The differences between TAPVC and PLSVC by contrast echocardiography are reported.