Sixty-two infants and children with the Wolff-Parkinson-White syndrome (WPW) were under long-term follow-up at The New York Hospital over a 20-year period. Twenty had associated congenital heart disease. In 29 infants and 6 children in hospitalfor paroxysmal supraventricular tachycardia, digitalis relieved the episodes in all but one instance and prevented further recurrences in all but 4. One infant and 3 older children continued to experience briefepisodes ofparoxysmal tachycardia. Though three-quarters of the 42 babies were symptomatic, only 4 of the 46 followed as children and adolescents had tachyrhythmias. The prognosis into adult lifefor infants and children with WPW with or without episodes of tachycardia is good.New developments in electrophysiology, anatomy, and cardiac therapy have brought new understanding and excitement to the fascinating syndrome that Wolff, Parkinson, and White first described in I930 as an electrocardiographic combination of short PR interval and prolonged QRS duration in frequent association with attacks of paroxysmal tachycardia (Wolff, Parkinson, and White, 1930). Since that time, many case reports and several reviews of the syndrome occurring in infants and children have appeared (Engle, I952; Schiebler, Adams, and Anderson, I959; Swiderski, Lees, and Nadas, I962), but there is little reported concerning long-term followup of these patients (Wolff and White, I948; Malinow and Langendorf, I950; FlenstedJensen, I969). It is the purpose of this paper to add to the knowledge of the natural history of the infant and child with Wolff-ParkinsonWhite syndrome based on our experience over the past 20 years.

In patients undergoing carotid stenting, a strategy using both a 600-mg clopidogrel load and a short-term reload with high-dose atorvastatin protects against early ischemic cerebral events. These results, obtained along with routine mechanical neuroprotection, provide new evidence of the optimization of drug therapy before percutaneous carotid intervention. (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting [ARMYDA-9 CAROTID]; NCT01572623).

A section of the Upper Enoree River in South Carolina, USA, was contaminated with chemical waste in 1985, and high concentrations of zinc persist decades later. In this study, we examined the zinc concentrations in the water, the accumulation of zinc in a variety of fish tissues, the effects of the contaminated water on fish sperm motility in vitro, and the mortality rates of introduced fish. Zinc concentrations in the water samples collected from six sites decreased as distance from the spill site increased, ranging from 7.3 to 0.34 mg/L (p< 0.001). The zinc concentrations of tissues from native fish were highest in liver (mean across sites of 110 ppm/g tissue) and gills (77.4 ppm/g tissue), followed by gonads (30.7 ppm/g tissue) and muscle (6.9 ppm/g tissue) (p < 0.001). The duration of fast motility of Salmo trutta sperm was significantly diminished in sperm activated in samples from the contaminated stream compared with the control stream (p < 0.05). To further evaluate the ability of fish to survive at the sites with different zinc concentrations, groups of Gambusia holbrooki were placed in traps at a reference site (uncontaminated local tributary), and three sites along the contaminated stream. Rapid mortality was observed in the two sites closest to the spill, including one site in which native fish had been found. The introduced G. holbrooki expressed higher zinc concentration in gills than gonads or muscle (p < 0.001), and water zinc concentration significantly affected fish mortality (p < 0.001). The results from these experiments indicate that zinc contamination of streams can have sublethal effects on populations and physiology of fish that are able to survive in the contaminated water.

Our study demonstrates that live 3DE, easily performed at the bedside, provides incremental information on patients with a variety of congenital heart lesions. In the clinical scenario, it clarifies the pathology in all its dimensions, particularly in complex lesions with the incremental information having impact on therapeutic decision making.

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