Palmaz-Schatz stent implantation after successful balloon PTCA of chronic total occlusions improves the midterm angiographic and clinical outcome and could be the preferred treatment option in selected patients with occluded vessels.

SUMMARY Ninety-six patients with an atrioventricular septal defect were assessed by two dimensional echocardiography. Forty-eight patients were judged as having two discrete valve orifices. In this group, 37 had an intact ventricular septum and 11 a ventricular septal defect. Two patterns of attachment of the valve leaflets to the interventricular septum were noted. Forty-eight patients had a common valve orifice. In 29 patients there was absence of tethering of the anterior bridging leaflet to the interventricular septum. A further 19 had varying degrees of tethering of the anterior bridging leaflet. A ventricular septal defect was identified under the anterior bridging leaflet in all cases. In 58 cases where the posterior bridging leaflet was identified, a ventricular septal defect was visualised in eight and missed in two.Seventy-eight patients had an ostium primum defect, 12 a common atrium, and a further six an intact interatrial septum. Two dimensional echocardiography provides in depth morphological information about the type of atnoventricular defect and can correctly identify the presence of a ventricular septal defect beneath the anterior or posterior bridging leaflet, unless it exists between short crowded chordae.The assessment of the atrioventricular junction is readily achieved by two dimensional echocardiography. Since atrioventncular septal defects are primarily an abnormality of this region, reliable delineation of their detailed morphology should be possible by this technique. Indeed, Hagler et al.' showed that, using echocardiography, it was possible to identify with reasonable accuracy "partial" atrioventricular septal defects, together with the three varieties of "complete" defect described by Rastelli et al. 2 The Rastelli classification has the great merit of simplicity, and has for many years been used for reporting surgical results. More recently its value in this respect has been questioned.3 Furthermore, it describes only one aspect of atrioventricular septal defects, being based on the morphology of the anterior bridging leaflet, and does not allow for description of the so-called "transitional forms" which undoubtedly exist in addition to the "partial" and "complete" varieties.4 Full description of an atrioventricular septal defect depends on identifying

This new technique can be easily implemented on conventional angiographic equipment at no additional cost. It provides complete, operator-independent exploitation of the angiographic information, resulting in enhanced diagnostic accuracy.

Twenty-three patients with total anomalous pulmonary venous connection were studied by two-dimensional echocardiography. In all cases the diagnosis was made before invasive procedures, with surgical or angiocardiographic confirmation. Eleven patients had supracardiac drainage (three to the coronary sinus, two to the right atrium,) and seven had infracardiac drainage. In the majority of cases the precise pattern of drainage could be identified by combining suprasternal, praecordial, and subcostal views. In 12 cases where the suprasternal cut was used a pulmonary venous confluence could be identified, having a cross-like structure in nine, with three others appearing as a dilated channel behind and separate from the left atrium. Thus, two-dimensional echocardiography reliably makes the diagnosis of total anomalous pulmonary venous connection and in the majority the precise pattern of drainage can be determined.