Utilizing the atrioventricular and semilunar valves as ultrasonic landmarks, a simple reproducible technic is described for the ultrasonic evaluation of the heart and its great vessels in the normal neonate. The importance of the clinical application of this method is discussed. Echocardiographic studies were performed on 240 normal newborns. Qualitative assessment was made of the interrelationships of the pulmonary, aortic, tricuspid, and mitral valves, and of interventricular septal motion. Quantitative norms were obtained for the following parameters: amplitude of motion of anterior leaflets of tricuspid and mitral valves, anteroposterior diameter of the ventricular and left atrial cavities, thickness of ventricular walls and interventricular septum, outside diameter of aortic and pulmonary roots, and interaortic and interpulmonary cusp distances.

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We report the successful transcatheter closure of a large persistent left superior vena cava draining into the pulmonary venous circulation causing cyanosis in two patients who had previously undergone the Fontan operation utilizing the Gianturco Grifka vascular occlusion device. Cathet Cardiovasc Intervent 2001;53:398-404.

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Kawasaki disease is a systemic vasculitis in which secondary development of coronary artery aneurysms can occur. Because Factor VIII related antigen has been found increased in other vasculiditides, VIII R:Ag was measured serially in patients with Kawasaki disease. Factor VIII related antigen was prospectively evaluated in the acute phase of ten patients with Kawasaki disease, all of whom showed increased values at this stage (p greater than 0001). In six children a second sample was drawn at the convalescent phase, and all were normal. Of the original ten patients, two developed coronary artery aneurysms. Acute Factor VIII related antigen levels were not higher nor did Factor VIII related antigen fail to return to baseline in these two patients. Based on our findings, Factor VIII related antigen is elevated in the acute phase of Kawasaki disease and returns to normal levels in the convalescent phase.

We report the use of a new biliary stent (IntraStent Double Strut LD) adapted for use in a 16-year-old young man with moderate-severe transverse arch hypoplasia/coarctation of the aorta following two surgical attempts at correction/relief of the coarctation. The stent implantation procedure resulted in complete relief of the coarctation.

SUMMARYA step-by-step approach to cardiac diagnosis utilizing a chest X-ray and echocardiography is described and used to study a normal infant and six infant patients with angiocardiographically-proven complex congenital heart malformations.The heart is divided into three major anatomical segments in order to localize the atrial and ventricular chambers and determine the relationship of the great arteries. The atrial chambers are localized by noting the position of the liver on the X-ray. The right atrium is on the same side as the liver with few exceptions. The ventricular chambers are localized by echocardiographically identifying the tricuspid and mitral valves. They are a part of the morphologically right and left ventricles, respectively. As a general rule, the atrioventricular valve whose anterior leaflet is continuous with the posterior margin of a semilunar valve is the mitral valve. The atrioventricular valve whose anterior leaflet is not continuous with a posterior semilunar valve margin is the tricuspid valve. When the tricuspid valve is to the right of the mitral valve, the ventricles are in their normal positions (ventricular d-loop); when it is to the left, the ventricles are inverted (ventricular 1-loop). The relationship of the great arteries is determined by echocardiographically identifying the semilunar valves and noting their positions relative to each other, the interventricular septum and the ventricular chambers. In a ventricular d-loop, the aortic valve is usually to the right of the pulmonary valve. In a ventricular l-loop, the opposite is true. As much as a 17% error may exist when transposition of the great arteries is a component of the malformation. Therefore, as additional aids in semilunar valve identification the R-C intervals of the valves (interval between R wave of electrocardiogram and valve closure on echogram) and outside diameters of the valve roots are measured. Usually the R-C interval is longer and, in the absence of pulmonary stenosis, the outside diameter greater for the pulmonary valve. The segmental diagnoses are then combined to obtain the "'type" of heart, and a careful search is made for associated defects.Using this approach, the positions of the atrial and ventricular chambers and the relationship of the great arteries were accurately determined in the six complex cardiac malformations studied. Additional Indexing Words:Cardiac segmental diagnosis Ultrasound cardiography Noninvasive techniquesTransposition of the great arteries IN AN EARLIER REPORT the atrioventricular and semilunar valves were used as ultrasonic landmarks to obtain an echocardiographic profile of the heart and its great arteries in the normal neonate.' Since that study, additional uses of the atrioventricular and semilunar valves have resulted in our being able to predict the character of the internal cardiac From the Cardiology Section, Norton-Children's Hospital, and