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Prostaglandin E1(PGE1) was administered to 27 infants in whom pulmonary or systemic blood flow was entirely or significantly dependent upon the patency of the ductus arteriosus. In 12 patients with pulmonary atresia or severe pulmonary stenosis, PGE1 infusion was followed by an improvement in hypoxemia and acidemia (group I). In 2 patients with left ventricular outflow-tract obstruction, PGE1 infusion was followed by an improvement in arterial blood pressure, peripheral perfusion and urine output (group II). In 5 patients with d-transposition of the great arteries and intact ventricular septum who had persistent severe hypoxemia after creation of an interatrial communication, PGE1 infusion improved the arterial oxygenation with dilatation of the ductus arteriosus (group III). Seven patients (3 of group I, 2 of group II and 2 of group III) failed to respond to PGE1. There were no fatal side effects. It is concluded that PGE1 therapy is highly effective in stabilizing pre-operative conditions of infants with ductus-dependent congenital heaat disease. prostaglandin E1 i ductus-dependent congenital heart disease ; pre-operative management Adequate pulmonary or systemic blood flow is dependent upon the patency of the ductus arteriosus in some of the critically ill infants with congenital heart disease. Partial or complete closure of the ductus after birth results in hypoxemia or severe heart failure with the progressive development of acidemia. Although palliative or corrective surgical procedures were available, mortality in these infants was high, because of their deteriorated pre-operative conditions and of the difficulties of the surgical techniques. Elliott et al. (1975) and Olley et al. (19Th, 1976) reported that administration of prostaglandins E1 (POE1) and E2 (PGE2) to such infants improved the deteriorated conditions. Following their reports, several authors have recongn-

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In a previous paper, it was stated that open lung biopsy for determination of operative indications could be recommended if pulmonary vascular resistance (PVR) were higher than 8 units.m2 in patients with ventricular septal defect (VSD) and/or patent ductus arteriosus (PDA) with severe pulmonary hypertension. In the present study, oxygen inhalation or Tolazoline administration tests with or without occlusion of ductus arteriosus were performed during cardiac catheterization in 47 patients with VSD and/or PDA with severe pulmonary hypertension. The results obtained were compared with the operability based on our histopathological diagnostic criteria. There was no correlation between the oxygen, Tolazoline, or ductus occlusion hemodynamics and the baseline hemodynamics for better prediction of the biopsy should be performed for the determination of operative indication when patients with VSD and/or PDA have a PVR higher than 8 units.m2, and if the PVR is greater than 4 units.m2 with the oxygen inhalation test or 7 units.m2 with the Tolazoline test.

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