[Immunosuppressive treatment of chronic myocarditis]. / Immunsuppressive Behandlung der chronischen Myocarditis.

6 children aged 9 months to 13 8/12 years developed reduced physical capacity, failure to thrive, dyspnoea on effort and heart failure after viral infection. Bed rest and anticongestive therapy did not reduce the severe heart failure. Immunosuppressive therapy with prednisolone 2 mg/kg/d and azathioprine 2 mg/kg/d was added on the assumption of chronic myocarditis (n = 4) or endocardial fibrosis (n = 2). 3 of the 6 children showed a considerable improvement in heart size, ECG and systolic heart function. Interruption of immunosuppressive therapy due to side effects in one child led to cardiac deterioration, which was reversed by renewed prednisolone therapy. Two patients died of progressive congestive heart failure. Heart transplantation was successfully performed in the now 14 year-old girl who was suffering from terminal dilated cardiomyopathy. Since there is no specific test for selecting patients who are likely to benefit from immunosuppressive therapy we feel this regimen would be justified in hopeless cases of congestive cardiomyopathy who have not responded to conventional therapy with anti-congestive drugs.

[Comparison of surgical techniques and various suture materials for correction of aortic isthmus stenosis]. / Vergleich von Operationstechniken und verschiedenem Nahtmaterial zur Korrektur der Aortenisthmusstenose.

UNLABELLED: Clinical examination and Doppler ultrasound were performed in 31 children after repair of coarctation of the aorta. Median postoperative follow-up period was 4.5 years. The aim of our study was a comparison of different operation techniques and suture materials. In 16 infants subclavian flap repair had been performed using polydioxanone absorbable sutures (PDS) in 8 cases and polypropylene (Prolene) sutures in the other 8 cases. Resection and end-to-end repair had been carried out in 8 infants using PDS and in 7 using Prolene sutures. Doppler-echocardiographically derived gradients across the reconstructed aorta were significantly lower in infants operated with the subclavian flap technique (p < 0.05). The length of the arm on the side of the subclavian flap operation was shorter (median 1.2 cm), but there were no signs of ischaemic complications. Using PDS sutures the aortic arch and the aortic isthmus were each morphologically significantly wider in both operation techniques. Noninvasive two-dimensional echocardiography demonstrated good anatomical repair and no anastomotic aneurysm formation after aortic repair using polydioxanone. CONCLUSION: Regarding the doppler-echocardiographically derived gradients in the anastomotic region this intermediate follow-up study reveals better results using the subclavian flap technique; absorbable polydioxanone sutures favour normal growth of the anastomotic site without vascular complications.

[Doppler echocardiographic evaluation of pressure in the pulmonary artery in children with congenital heart defects]. / Dopplerechokardiographische Beurteilung des Drucks in der Arteria pulmonalis bei Kindern mit angeborenen Herzfehlern.

In children with congenital heart disease serial noninvasive assessment of the pulmonary vascular bed is desirable in order to determine the appropriate timing of cardiac catheterization and corrective surgery. To assess the value of pulmonary Doppler echocardiography for the estimation of pulmonary arterial pressure we correlated the rightsided systolic time intervals (preejection period, acceleration period, ejection period) derived from pulmonary artery Doppler traces with catheterization data (systolic, mean and diastolic pulmonary arterial pressure, total and vascular pulmonary resistances). 62 children aged from 1 month to 15 years suffering from congenital heart disease (n = 52), from rheumatic heart disease (n = 4), from cardiomyopathy (n = 5) or from primary pulmonary hypertension (n = 1) were investigated. The major finding was a highly significant correlation between the acceleration period and the systolic pulmonary arterial pressure (r = 0.79; p less than or equal to 0.0001). However the acceleration period could not be used for prediction of pulmonary arterial pressure in children with poor myocardial contractility.

[L-carnitine therapy and myocardial function in children treated with chronic hemodialysis]. / L-Carnitintherapie und Myokardfunktion bei chronisch hämodialysierten Kindern.

Six out of 14 chronically hemodialysed children with significantly decreased serum carnitine levels were substituted with L-carnitine (15-30 mg/kg/day-Biocarn) up to normal and above normal carnitine levels. None of these patients were digitalised. During the time of investigation plasma carnitine levels were investigated monthly and, simultaneously, three echocardiographic parameters in M-mode were quantitatively und qualitatively determined: shortening fraction (SF-%), ratio of left ventricular pre-ejection/ejection time (LVPT/LVET) and velocity of circumferential fibre shortening (Vcf). Carnitine substitution produced measurable changes in echocardiographic parameters, and a significant quantitative improvement in left ventricular function and performance: after 6 months of carnitine substitution a 24% improvement was seen, after 18 months a 44% mean improvement. No side effects of carnitine were observed; the compatibility was good. Beside these positive effects all patients reported decreased dialysis-associated spasms and polyneuropathic symptoms and increased somatic ability.

Differentiation of celosia mosaic virus and asparagus virus 1 based on biological properties.

An attempt was made to distinguish between celosia mosaic virus (CIMV) and asparagus virus 1 (AV-1) based on biological properties, which hitherto was obscured from serological data from previous work. The host range of AV-1 was found to be a subset of that of CIMV and AV-1 was transmitted by the aphid Myzus persicae which, on the other hand, did not transmit CIMV. No evidence of cross-protection was obtained between these two viruses.

A mosaic disease of Senna hirsuta induced by a potyvirus in Nigeria.

A virus inducing mosaic and severe leaf malformation, isolated from Senna hirsuta in Nigeria, was studied. The virus had a rather narrow host range, infecting a few species in Caesalpinaceae, Chenopodiaceae and Fabaceae families. The virus was widespread in southern Nigeria with prevalence ranging from 74% to 86.4% in some locations. It was transmitted mechanically and in a non-persistent manner by Myzuspersicae, Aphis craccivora and A. spiraecola. There was no evidence of transmission by seeds. Electron microscopy of leaf dip preparations revealed flexuous rod-shaped particles. The viral coat protein had Mr of 32.5 K. The virus reacted positively with a monoclonal antibody (MAb) to peanut stripe virus specific for potyviruses (members of the Potvvirus genus) and with antisera to turnip mosaic virus (TuMV), potato virus Y (PVY), TuMV, potato virus A (PVA), potato virus V (PVV) and bean yellow mosaic virus (BYMV), but it failed to react with antisera to celery mosaic virrus (CeMV), bean common mosaic virus (BCMV), soybean mosaic virus (SMV), and clover yellow mosaic virus (ClYMV) in plate-trapped ELISA (PTA-ELISA). No positive reaction was obtained when the virus was tested against any of the antisera in double-antibody sandwich ELISA (DAS-ELISA). This is the first report of natural infection of Senna species in Nigeria. The virus, tentatively designated as Senna mosaic virus (SeMV), seems to differ from other viruses previously described from Senna species in the literature and indeed other legume potyviruses in Nigeria.

Serological relationships between Robinia mosiac, clover blotch and peanut stunt viruses.

Based on the results of agar gel double immunodiffusion tests with broad spectrum rabbit antisera and narrow spectrum mouse immune ascitic fluids and formalin-fixed purified viruses, a close relationship was established between 3 members of the Cucumovirus group namely Robinia mosaic virus (RoMV), clover blotch virus (CBV) and peanut stunt virus (PSV). The relationship of these 3 viruses to cucumber mosiac virus proved to be more distant. The results also suggested that RoMV and CBV could represent distinct strains of PSV.

Properties of a virus causing mosaic and leaf curl disease of Celosia argentea L. in Nigeria.

A sap transmissible virus, causing mosaic and leaf curl disease of Celosia argentea, was isolated at vegetable farms in Amuwo Odofin, Tejuoso, and Abule Ado, Lagos, Nigeria. The virus had a restricted host range confined to a few species of the Amaranthaceae, Chenopodiaceae and Solanaceae families. It failed to infect several other species of the Aizoaceae, Brassicaceae, Cucurbitaceae, Fabaceae, Lamiaceae, Malvaceae, Poaceae and Tiliaceae families. The virus was transmitted in a non-persistent manner by Aphis spiraecola and Toxoptera citricidus but not by eight other aphid species tested. There was no evidence of transmission by seeds of C. argentae varieties. The viral coat protein had a relative molecular mass (M(r)) of about 30.2 K. Electron microscopy of purified virus preparations revealed flexuous rod shaped particles of about 750 nm in length. Serological studies were performed using the enzyme-linked immunosorbent assay (ELISA), immunosorbent electron microscopy (ISEM) and Western blot analysis. The virus reacted positively with an universal potyvirus group monoclonal antibody (MoAb) and MoAb P-3-3H8 raised against peanut stripe potyvirus. It also reacted with polyclonal antibodies raised against several potyviruses including asparagus virus-1 (AV-1), turnip mosaic virus (TuMV), maize dwarf mosaic virus (MDMV), watermelon mosaic virus (WMV-2), plum pox virus (PPV), soybean mosaic virus (SoyMV), lettuce mosaic virus (LMV), bean common mosaic virus (BCMV) and beet mosaic virus (BMV) in at least one of the serological assays used. On the basis of host range, mode of transmission, and available literature data, the celosia virus seems to be different from potyviruses previously reported to infect vegetables in Nigeria. The name celosia mosaic virus (CIMV) has been proposed for this virus.

Characterisation of epitopes on barley mild mosaic virus coat protein recognised by a panel of novel monoclonal antibodies.

Barley mild mosaic virus (BaMMV), a member of the family Potyviridae, genus Bymovirus, is involved in the economically important yellow mosaic disease of winter barley in East Asia and Europe. We investigated serological properties of bacterially expressed BaMMV coat protein (CP) of a German isolate. Ten mouse monoclonal antibodies were produced using purified E. coli expressed BaMMV-CP as immunogen. The reactivity of MAbs with different strains of BaMMV was analysed by several immunological methods that are frequently used in diagnostic virology: enzyme-linked immunosorbent assay (ELISA), dot-blot, Western-blotting (WB), direct tissue blotting immunoassay (DTBIA) and immunoelectron microscopy (IEM). The amino acids involved in the formation of epitopes recognised by several MAbs were mapped by using synthetic pin-bound peptides and the localisation of epitopes in assembled virus particles was determined by electron microscope studies. MAbs V29 and M1 decorated the whole virion indicating that their epitopes 6PDPI9 and 96ITDDEK101, respectively, are exposed on the surface. The MAbs V6 and V14 both interacted with 44LPEPKM49, which seems to be accessible at only one end of the virus particle. The MAbs V6, V14, V29 and M1 detected epitopes common to a wide range of BaMMV isolates and can therefore be used effectively in routine diagnostic tests for BaMMV from barley leaves. We suggest that MAbs M1, V6, V14 and V29 are most suitable for use in TAS-ELISA, V6, V14 and V29 for Western blotting and V29 and M1 for electron microscope serology.

Intercoronary collateral flow detected by Doppler colour flow mapping is an additional diagnostic sign in children with anomalous origin of the left coronary artery from the pulmonary artery.

Intercoronary collateral flow within septal collaterals was detected by colour-coded Doppler echocardiography in three children with anomalous origin of the left coronary artery from the pulmonary artery. In each of the three patients angiography confirmed the presence of septal collaterals.

Doppler flow profiles in the right and left pulmonary artery in children with congenital heart disease and a bidirectional cavopulmonary shunt.

The systolic and diastolic Doppler tracings in the right and left pulmonary artery were analyzed in 10 patients with complex cyanotic congenital heart disease, aged 6 months to 12 years (median 3 years), after employment of a bidirectional cavopulmonary shunt. The postoperative interval ranged from 2 weeks to 1.7 years (median 1.3 years). In children with pulmonary atresia or severe pulmonary stenosis with minimal antegrade pulsatile pulmonary blood flow Doppler echocardiography confirmed a systolic and diastolic bidirectional shunt from the vena cava superior to both pulmonary arteries. In children with pulmonary stenosis, Doppler echocardiography confirmed a systolic shunt only to the right pulmonary artery and a diastolic bidirectional shunt into both pulmonary arteries. As the left pulmonary artery was perfused by the pulsatile transvalvular flow it was difficult to detect a concomitant systolic Glenn-related flow in those patients. Quantitative analysis of the diastolic Doppler tracings revealed a significant difference in the velocity time integral in the right and left pulmonary artery indicating a dominant right lung perfusion in diastole.

Experience with long-term nifedipine therapy in paediatric cardiological patients.

Clinical experience with long-term nifedipine treatment in 23 patients aged between 1 1/12 and 14 8/12 years is reported. The cardiopulmonary diseases comprised primary pulmonary diseases with pulmonary hypertension (n = 4), congenital heart defects with intracardiac shunts and pulmonary hypertension which either were inoperable as a result of an Eisenmenger reaction (n = 7) or presented a high surgical risk (n = 5), or defects in which pulmonary hypertension did not regress despite corrective (n = 1) or palliative surgery (n = 3), and congenital defects without pulmonary hypertension (n = 3). Subjective improvement with an increase in physical performance was clearly observed in 15 cases. Echocardiography and cardiac catheter examinations showed no progression of the pulmonary arterial diseases, except in 1 patient with severe primary pulmonary hypertension and an 11-year observation period with nifedipine treatment during the last 4 years. No complications occurred during the 4 corrective operations. A patient aged 14 8/12 years with the Down syndrome and atrioventricular septal defect developed easily controllable heart failure during 7-day administration of nifedipine without additional cardiotherapy. 4 children initially suffered from flushed face and scalp, in one case with headache; 2 children reported fatigue. Long-term treatment with nifedipine should begin with strict 7-day supervision in hospital and possibly additional digitalization. Success of the treatment was determined by an improved quality of life in patients with primary pulmonary hypertension and inoperable defects, and by a reduced perioperative risk and postoperative regression of pulmonary hypertension in patients with operable defects.

Two-dimensional and Doppler echocardiographic follow-up after the arterial switch operation for transposition of the great arteries.

An echocardiographic follow-up examination was performed in 20 children who underwent an arterial switch operation from November 1984 to October 1990. The age at the time of operation ranged from 1 to 54 days, the weight ranged from 2.5 to 4.5 kg body weight. The time interval from the day of operation and the examination ranged from 3 to 74 months. M-mode echocardiography showed hypokinetic left ventricular function in 6 patients (30%). Abnormal segmental left ventricular wall motions were found in 6/16 patients (37.5%). Doppler echocardiographic examination at the site of the pulmonary anastomosis revealed an instantaneous gradient less than 20 mmHg in 9 patients (45%), a gradient between 20 and 60 mmHg in 9 patients (45) and a gradient greater than 60 mmHg in two patients (10%). The location of the stenosis was just below the bifurcation in 17 patients (85%) and seemed to be related to stretching of the pulmonary trunk during the Lecompte maneuver. One patient (5%) had a supravalvular aortic stenosis with a gradient of 43 mmHg. Color-flow mapping revealed mild aortic regurgitation in 8 patients (40%) but moderate regurgitation in one patient (5%). Three patients (15%) showed mild mitral regurgitation, all of them also had hypokinetic left ventricular function.

Echocardiographic evidence of aortopulmonary collaterals in premature infants after closure of ductus arteriosus.

Aortopulmonary collaterals occur in a variety of congenital heart diseases, in chronic pulmonary infection and abscesses, in association with lung tumors, and after multiple pulmonary emboli. In patients with congenital cyanotic heart disease aortopulmonary collaterals mainly occur in conditions with reduced pulmonary blood flow. We investigated 12 preterm low-birth-weight infants, gestational age 29.3+/-3.3 weeks, with respiratory failure who suffered from moderate to severe chronic lung disease after a period of mechanical ventilation. All patients developed aortopulmonary collaterals after closure of a patent ductus arteriosus. Aortopulmonary collaterals could be displayed clearly by color Doppler echocardiography and originated mainly from the descending aorta or the aortic arch. Hypoxic and hypercapnic episodes favored the development of aortopulmonary collaterals, which disappeared after pulmonary hemodynamics and respiratory function had improved. In only one patient coiling of a large col lateral vessel had to be performed. Systemic-to-pulmonary collateral vessels potentially aggravate chronic lung disease by increasing collateral pulmonary blood flow and reducing lung compliance. We conclude that aortopulmonary collaterals occur in bronchopulmonary dysplasia and can cause major problems in ventilated premature infants. Echocardiographic evaluation is important to prevent aggravation of chronic lung disease of infants at risk.