Partial liquid ventilation leads to clinical improvement and survival in some infants with severe respiratory distress syndrome who are not predicted to survive.

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Both lung protective strategies were associated with improved oxygenation, attenuated inflammation, and decreased lung damage. However, in this small-animal model of acute lung injury, an open lung strategy with deliberate hypercapnia was associated with significant hemodynamic instability.

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SUMMARY Balloon dilation angioplasty (BDA) was attempted in seven children with either stenosis or hypoplasia (a narrowing greater than 1 cm long extending past the lung hilum) of both right and left pulmonary arteries (PAs). In two of these seven, the procedure could not be performed because of technical difficulties. In each of the remaining five children (11/216 years THE advent of a safe and effective method for dilating atherosclerotic lesions in peripheral arteries' 2 promptly led to the extension of this approach to coronary arteries,3 renal artery stenosis,4 and other lesions throughout the body. The results of balloon dilation angioplasty in these acquired arteriopathies have, in general, been gratifying. However, the extension of balloon dilation angioplasty to children with congenital vascular and cardiac narrowings has been slow. There are good reasons for caution. Congenital stenoses have no soft intimal plaque that may be "squeezed" by the balloon; the goal of therapy is not to restore a vessel lumen, but to enlarge an abnormally small structure; congenital lesions require treatment during growth; and if dilation produces vessel scarring, vascular growth may be impaired. Also, since most important congenital stenoses involve cardiac valves or large vessels near the heart, the ability of an already compromised circulation to tolerate prolonged occlusion of such a vessel is not established. As a result, the current clinical literature on dilating congenital lesions consists of isolated case reports5 -7 or small series8 of cases, with variable results. Postmortem,9 excised specimen10 and animal studies'4 indicate that balloon dilatation of congenital cardiac defects may, under certain circumstances, be safe and effective. Armed with guidelines and experience derived from such studies, we instituted a clinical trial of balloon dilation angioplasty in congenital cardiac lesions in January 1981. Initially, we chose to dilate a lesion for which traditional surgical approaches have been particularly unrewarding: the hypoplastic or stenotic pulmonary artery. Materials and Methods PatientsBefore considering a child for balloon dilation, several hemodynamic and angiographic findings were sought: congenital stenosis or hypoplasia of one or more branch pulmonary arteries; a diameter of the narrowed segment of 6 mm or less; right ventricular pressure greater than 2/3 of left ventricular pressure without associated left-to-right shunt; main pulmonary artery (MPA) pressure of 60 mm Hg or greater; and previous operative attempt at relief of right ventricular outflow obstruction. Children who met all of the above requirements were presented at the combined Pediatric Cardiology/Surgery/Radiology conference at the University of Minnesota. If the conference consensus was that further attempts at gradient relief were warranted, the parents of those children were offered either an attempt at experimental dilation of the pulmonary artery or traditional surgical management. If the pulmonary arterial narrowing was greater...

Exposure of alveolar macrophages to perfluorooctylbromide in vitro decreases the responsiveness of macrophages to potent stimuli. This finding may partially explain the decrease in pulmonary inflammation seen in animals treated with partial liquid ventilation during experimentally induced lung injury.