With the current trend to performing surgical valvotomy for infantile aortic stenosis without cardiac catheterization, there is a need to develop echocardiographic criteria for adequacy of left ventricular size. The echocardiograms and catheterization data of all 25 infants less than 3 months of age undergoing aortic valvotomy for isolated aortic valve stenosis from September 1980 through July 1990 were reviewed. Significant differences (p less than 0.05) between the survivors and nonsurvivors were noted for age at operation (30 +/- 28 vs. 3 +/- 1.5 days), mitral valve diameter (10.1 +/- 1.7 vs. 7.7 +/- 1.5 mm), left ventricular end-diastolic dimension (18.4 +/- 6.4 vs. 11.4 +/- 3 mm), left atrial dimensions (15.3 +/- 3.8 vs. 10 +/- 2.4 mm), left ventricular cross-sectional area on the parasternal long-axis echocardiogram (4 +/- 1.9 vs. 2 +/- 1.9 cm2) and angiographically determined left ventricular end-diastolic volume (43 +/- 23 vs. 11 +/- 5 ml/m2). There was no difference with respect to patient weight, body surface area, aortic root dimension or left ventricular ejection fraction. Left ventricular cross-sectional area less than 2 cm2 as measured on the parasternal long-axis echocardiogram was found in 5 of 7 nonsurvivors and 0 of 12 survivors, making this a risk factor for perioperative death (p less than 0.05). Left ventricular end-diastolic dimension less than 13 mm was found in 5 of 6 nonsurvivors and 2 of 17 survivors, making this another risk factor for early mortality (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

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Printedin U.S.A. METHODS Subjects.A total of seven lambs of mixed breed with documented dates of birth was studied. The lambs were surgically prepared and studied within 24 h after surgery. Two of these lambs, although in good health during the study, died after their initial study, one due to complications of an intracardiac catheter and another due to trauma. The lambs were studied multiple times over the next 2 to 3 months following surgery.Under lidocaine local analgesia, a Tygon catheter was placed either in a hindlimb or carotid artery and advanced into the aorta. A Tygon catheter or balloon flow directed catheter was passed through a jugular vein into the pulmonary artery while pressure was monitored to ensure proper placement. All newborn lambs had a second venous catheter inserted through either the 177 ABSTRACT. We studied the response of O 2 consumption, systemic O 2 transport, arterial blood lactate concentration, base deficit, and respiratory exchange ratio (C0 2 production/O, consumption) to graded alveolar hypoxia (fractional concentration of inspired oxygen 0.21, 0.16, 0.12, and 0.08) in seven intact, conscious chronically catheterized lambs at <1 wk after birth, at 25-40 days and at >40 days. To test whether there was an age related difference in the metabolic response to a decline in O 2 transport due to hypoxemia, we related the changes in blood lactate and base deficit to the systemic O2 transport and to the fractional change in O 2 consumption. Systemic O 2 transport and O 2 consumption decreased with severe hypoxemia, while lactate concentration and respiratory exchange ratio increased in all age groups. The changes in base deficit were not significant. When the hypoxemia-induced reduction in O 2 consumption was <15% of the baseline value (at fractional concentration of inspired oxygen 0.21) there was no elevation in lactate concentration; however, when O2 consumption was reduced by more than 15%, lactate concentration consistently increased by more than 1 mmol/ liter. There were no apparent differences amongst the age groups in this response. Therefore, the newborn lamb does show metabolic consequences of a fall in O2 consumption with hypoxemia which is similar to the older sheep, however, there is a "buffer zone" in which O2 consumption may decrease before evidence of tissue hypoxia can be found. The mechanism by which O 2 consumption can decrease without accumulation of lactate remains speculative. (Pediatr Res 22: 177-183, 1987 Supported by grants from the American Heart Association with funds contributed in part by the Connecticut Heart affiliate and from the National Institute of Child Health and Human Development HD-15834. M. M. and G. M. were supported by a National Heart, Lung and Blood Institute Training Grant HL-07272. G. L. is a recipient of an American Heart Established Investigatorship.In anesthetized adult subjects, the systemic O 2 consumption has been found to be independent of the systemic O 2 transport (product of arterial O 2 content and cardiac output) when the transpor...

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