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Ventricular aneurysms in children are unusual. Three patients with cardiomyopathy associated with angiographically proved left ventricular aneurysms in this age group are reported. Two of them were girls. The ages were 20 months, 7 years, and 14 years. Heart failure was present in all patients. There was radiological evidence of cardiomegaly in all three, and the electrocardiogram showed signs of necrosis in two of them. Selective left ventricular angiography disclosed generalized hypokinesis in all patients. One child had an aneurysm of the diaphragmatic wall. In another the aneurysm was localized in the muscular ventricular septum, causing severe subpulmonary stenosis by encroaching in the right ventricular outflow tract during systole. The third patient had an aneurysm of the left ventricular free wall partly encircling the left ventricle. The coronary arteries appeared normal in all cases. The clinical features of the underlying disease were not altered by the presence of the aneurysm except in the patient with the septal aneurysm and subpulmonary stenosis. In this patient the aneurysm was successfully resected.

SUMMARY A patient is described in whom diagnosis of isolated pulmonary valve endocarditis was made by M-mode and two dimensional echocardiography. Angiography confirmed the presence of vegetations on the pulmonary valve. At cardiac surgery a quadricuspid, non-stenotic valve with ruptured medial leaflet covered by necrotic vegetations and a small ventricular septal defect were found.Echocardiography is known to be useful in diagnosing valvular endocarditisl 2 of the mitral and aortic valves but only two cases of pulmonary valve endocarditis have been previously diagnosed in this way. We report another. Case reportA 46-year-old man, known to have an undiagnosed asymptomatic congenital heart defect, had a high temperature in November 1979. He was treated with antibiotics which were at first effective but pyrexia reappeared two weeks later. Cephalosporin was given intravenously for 10 days, but the patient became very weak, and haemorrhagic purpura appeared on the legs; evening pyrexia persisted. Finally, in May 1980, he was admitted to this hospital; bacterial endocarditis was suspected and penicillin started.At physical examination the patient appeared very ill and febrile, with gross hepatosplenomegaly. A grade 4/6 harsh pansystolic murmur was heard in the second and the third left intercostal space followed by a grade 1/6 diastolic murmur. The second heart sound was almost inaudible on the pulmonary area.The electrocardiogram and chest x-ray film appeared to be within normal limits. The M-mode echocardiogram ( Fig. 1) Treatment with cefuroxime led to a brief remission of fever with apparent clinical improvement but high fever reappeared after 10 days despite continuous treatment and finally the patient developed a left lower lobe infarction with pleural effusion. As he was so ill, cardiac catheterisation and angiocardiography, previously planned, were abandoned and cardiac surgery was performed on the evidence of the echocardiographic diagnosis on 5 June. The pulmonary artery was incised transversely above the level of the valve. A quadricuspid non-stenotic valve was seen; the medial leaflet was ruptured and covered by an overgrowth of necrotic tissue (Fig. 3); a small ventricular septal defect was found just below the pulmonary valve which was excised. A biological prosthesis was inserted, and the ventricular septal defect sutured with four stitches on Teflon pledgets.Culture of the valve grew Staphylococcus cutis.

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A case report of a patient with peritonitis due to Candida albicans will be described. The infection occurred following the unrecognized perforation of an atypic gastric ulcer and the abdominal syndrome with severe ascites was at first attributed to a liver cirrhosis. The patient was treated with Amphotericin B with a very good result.

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