Cross-sectional echocardiographic studies were used to measure and compare the internal diameter of both aortic root and pulmonary artery in 104 patients with normally related great arteries. Six groups of patients were assessed: normal, with an intracardiac shunt, with tetralogy of Fallot, with pulmonary stenosis, with aortic stenosis, and with atresia of the right atrioventricular valve orifice. In addition, a postmortem study was carried out in normal heart specimens and in specimens with an atrioventricular septal defect. It appeared that the echocardiographically studied ratio between the aortic and pulmonary artery diameter varied considerably. In normal subjects the pulmonary artery diameter tends to be slightly larger than the aortic root diameter: this observation was confirmed by the postmortem data. In other instances the pulmonary artery diameter appeared to be smaller than the aortic root diameter, for example patients with tetralogy of Fallot and those with tricuspid atresia, whereas the reverse was noted in patients with an intracardiac shunt. This two dimensional study has shown that functional adaptations of the calibre of the great arteries can be measured and identified in patients with congenital heart disease.

In order to obtain reference data, useful in paediatric cardiology and paediatric cardiovascular surgery, internal diameters of the ostia of the great arteries, of the aortic isthmus, and of the descending aorta were determined with the aid of calibrated probes in 46 necropsy specimens of normal hearts with great vessels. Age range wasfrom 25 weeks ofgestational age up to 9 years post partum. The method used proved to be as accurate as echocardiography in vivo. The data revealed linear correlations between body length and calibres of aortic and pulmonary ostia. The correlation between the calibres of the pulmonary and the aortic ostia was also a linear one with the pulmonary ostium being slightly larger than the aortic ostium. From the crosssectional areas of the aortic isthmus and of the descending aorta an isthmus index was calculated which indicates the presence (and degree) or absence of a narrowing (tubular hypoplasia) of the aortic isthmus. Results show that narrowing of the aortic isthmus is inconstantly present in infants younger than 10 weeks, whereas it is always absent in infants and children older than 10 weeks. No dependence of narrowing of the aortic isthmus on developmental age attained at birth has been found.

The extent to which a conventional cardiac rehabilitation programme can influence plasma lipoproteins was investigated in a prospective study. The relationship between changes in plasma lipoproteins and baseline characteristics, as well as variables related to the physical training and to dietary habits were assessed in 77 cardiac patients. All patients participated in a physical training programme, including general dietary advice. Patients who received lipid-lowering drugs were excluded from this study. Total plasma cholesterol decreased from 7.1 +/- 1.6 to 6.8 +/- 1.2 mmol l-1 (P less than 0.05), but it remained high in many patients, 61% having a level above 6.5 mmol l-1. The high- and low-density lipoprotein fractions (HDL- and LDL-cholesterol), and the ratio of total cholesterol to HDL-cholesterol, did not change significantly. The change in total plasma cholesterol was greatest (P less than 0.05) in patients who changed their diet in the recommended direction, and was poorly related to the change in maximal workload. It is concluded that a combination of general dietary advice and moderate physical exercise training is followed by a small reduction in total plasma cholesterol levels without changing HDL-cholesterol, and that cardiac rehabilitation should include strict programmes for the reduction of elevated plasma cholesterol.

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