Balloon valvuloplasty for critical pulmonary valve stenosis in a premature infant.

Successful balloon valvuloplasty for critical pulmonary valve stenosis is described in an 800-g infant. A modified catheter was required to cross the valve in the smallest child known to undergo this procedure.

Resolution of hypoxemia in a liver transplant recipient after ligation of a portosystemic shunt.

This report describes the unique development of pulmonary vascular dilatation and hypoxemia associated with a portosystemic shunt in a pediatric liver transplant recipient. Ligation of the shunt resulted in resolution of hypoxemia. The outcome suggests that hepatic venous return to the pulmonary circulation is important in maintaining normal pulmonary vascular caliber.

Transcatheter closure of modified Blalock-Taussig shunt with Gianturco-Grifka Vascular Occlusion Device.

A 15-year-old girl with previous repair of a complex cyanotic congenital heart defect had persistence of a modified left Blalock-Taussig shunt that could not be ligated at surgery. Six years later, antegrade delivery of a Gianturco-Grifka Vascular Occlusion Device resulted in complete closure of the shunt. Cathet. Cardiovasc. Intervent. 48:365-367, 1999.

Novel technique for coil embolization of intercostal branch of internal mammary artery graft.

Coronary artery steal resulting from a large unligated intercostal or pericardial side branch of the internal mammary artery graft causing postoperative angina has been previously described. Transcatheter coil occlusion of internal mammary artery side branch has successfully been performed to treat coronary steal syndrome. Unsuccessful deployment of the microcoils can be due to inadequate guiding support in the LIMA or prolapse of the delivery catheter in the side branch. We report a new approach for the precise deployment of coils in the side branch of a LIMA graft, when inadequate guiding support is present.

Transcatheter retrieval of an embolized Palmaz stent from the right ventricle of a child.

A young girl in whom a Palmaz stent embolized from the pulmonary artery to the right ventricle during a prior cardiac catheterization underwent successful retrieval and repositioning by a transcatheter technique 8 d later. This technique provides an alternative to surgery when intracardiac embolization of a stent occurs.

New forceps delivery technique for coil occlusion of patent ductus arteriosus.

We remain very enthusiastic about transcatheter coil occlusion of the PDA. However, surgical ligation has been performed successfully and with relatively low risk of complications. Therefore, an alternative nonsurgical technique must demonstrate comparable success and safety. We believe that this new forceps delivery technique has significant advantages over previously reported PDA coil occlusion techniques and should warrant further clinical investigation.

Local bacillus Calmette-Guérin therapy for bovine vulval papilloma and carcinoma.

Thirty cows from a pedigree Friesian dairy herd with bovine vulva papilloma and carcinoma were treated by intralesional injections of live bacillus Calmette-Guérin (BCG). This treatment induced total regression of all of six carcinomas. Whilst, after treatment, limited regression was also observed in advanced papillomas, BCG has little or no effect on the early stages of papillomas. This is the first study of BCG therapy in this type of cancer.

Transatrial lead placement for endocardial pacing in children.

Transvenous placement of endocardial leads in children may be difficult due to restrictions and complications of vascular access. We have placed endocardial leads from a transatrial approach in 5 children with various cardiac malformations. The usual surgical approach involved an anterolateral thoracotomy and, under fluoroscopic guidance, passage of the lead tip directly through the right atrial wall and across the tricuspid valve to the apex of the right ventricle. At a mean follow-up time of 23.2 months (range, 12.0 to 27.9 months), all patients have low thresholds for myocardial capture, and there have been no complications. We conclude that placement of endocardial leads by a transatrial approach provides an excellent alternative to an epicardial system in children destined for lifelong pacing.

Morphology of ventricular septal defects in complete transposition. Surgical implications.

Postmortem examination of 62 hearts with complete transposition (concordant atrioventricular and discordant ventriculoarterial connections) and an accompanying ventricular septal defect was performed to determine the morphologic variability of ventricular septal defects and to explore the surgical implications of these defects. Particular attention was directed toward assessing alignment of the outlet septum relative to the muscular septum. Coronary arterial distributions were also evaluated, but specific patterns of distribution did not correlate with morphology of the defect. Of 49 hearts with a normally aligned outlet septum, there were 24 perimembranous, 21 muscular, and 2 doubly committed and juxtaarterial defects. Two hearts had both perimembranous and muscular defects. Twelve of the 21 muscular defects were "central," being surrounded entirely by muscle and located just below the leaflets of the pulmonary valve, and 9 were located in the inlet or apical trabecular septum. There were 13 hearts with malalignment of the outlet septum, anteriorly in 11 and posteriorly in 2. All with anterior malalignment had a subpulmonary defect that was perimembranous in 7 and muscular in 4. Both defects with posterior malalignment had a subaortic perimembranous defect. Because variations in morphology of a ventricular septal defect have a direct impact on selection of the most suitable surgical repair, specific operative approaches are discussed.

Acute myocarditis simulating myocardial infarction in a child.

Pediatric chest pain usually occurs in benign conditions. However, this case portrays the dramatic electrocardiographic appearance of acute myocardial ischemia in a boy with biopsy-proven myocarditis who had only mild chest pain. This underscores the need for eliciting a detailed history when evaluating a patient with chest pain. If the pain cannot be clearly attributed to chest wall phenomena, or if there are historical or physical findings suggestive of an arrhythmia or angina, then further investigation with a chest radiograph and a 12-lead electrocardiogram is recommended. Myocarditis must be considered in the differential diagnosis of any child whose electrocardiogram is indistinguishable from an acute myocardial infarction. Finally, endomyocardial biopsy allows early diagnosis and institution of therapy, which may have beneficial effect on decreasing morbidity and mortality. Further follow-up and research is still needed to evaluate the effect of early treatment of myocarditis on long-term myocardial function and the development of chronic cardiomyopathy.