All children with dilated cardiomyopathy and fractional shortening below 20% should be treated with prophylactic anticoagulative agents.

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or many years, paediatric cardiologists and paediatric cardiac surgeons have felt the need for a common diagnostic and therapeutic coding system with which to classify patients of all ages with congenital and acquired heart disease. This desire has been highlighted by the recent, and ongoing, enquiry into the outcome of paediatric cardiac surgery at the unit in Bristol, in the United Kingdom, 1 and the resulting obligation to provide national and international comparisons of surgical results between centres caring for these patients. In order to incorporate effective clinical governance and best practice into our speciality, a method is required to gather accurate and validated data on the diagnosis, therapy and outcome of patients with heart disease from prenatal life through to adulthood. This would facilitate comparisons between individual units which fully-take into account the mix of cases involved, and thus attempt to focus on the relevant and genuine factors underlying the differing outcomes in terms of both mortality and morbidity. For this to be achieved, it is essential to have a comprehensive system of coding and classification, using mutually exclusive and unambivalent terms. The system must be both easy to use, and fulfil the needs and expectations of widely different cultures of practice. Although many centres have developed their own system of internal audit, with their own coding system, and some cooperation has taken place between centres nationally 2 and across international boundaries within Europe by the European

Echocardiographic images can be transmitted over increasing distances with less cost and better quality thanks to advances in the field of telecommunications. This technological support can be used to detect heart defects in newborns and children in remote situations. The intent of this study was to confirm the feasibility and usefulness of telemedical communication for echocardiographic evaluation of paediatric cardiovascular disease. A total of 214 echocardiographs were performed in 194 children at a remote hospital by an experienced sonographer in paediatric echocardiography. These echocardiograms were transmitted to a distant tertiary care paediatric cardiology centre using a telemedicine link across three ISDN lines. There an experienced paediatric cardiologist interpreted the tele-echocardiograms. Tele-distant diagnoses were prospectively documented and compared with the diagnoses made subsequently on direct consultation and echocardiography. The quality of transmitted echocardiographic images was sufficient for evaluation except for one case. In 191 children (98%), the remote echocardiographic diagnosis was correct as confirmed by follow-up face to face consultations. Three cases were diagnosed incor-rectly. Conclusion: our results confirm that accurate and rapid diagnosis can be provided by tele-echocardiography in neonates and children. This facilitates the appropriate care of these patients as expensive and potentially dangerous long-distance transfers can be avoided. Keywords Paediatric echocardiography AE TelemedicineAbbreviation ISDN integrated services digital network distant tertiary care paediatric cardiology centre using a Eur

IN 1999 AND EARLY 2000, THE ASSOCIATION FOR European Paediatric Cardiology published the European Paediatric Cardiac Code as independent but linked Short and Long Lists, containing 650 and 3876 primary terms respectively. The historical background and rationale for development of this coding system has been previously detailed, but essentially it followed a series of meeting of the coding committee of the Association between 1997–1999, during which a pre-existing Long List was adopted and then used to create the condensed Short List. The system was published as the recommended standard coding system for use across Europe, covering the diagnosis and therapy of children with congenital and acquired cardiac disease. The scope of the lists was to encompass the needs of all those involved with such patients, from the fetal cardiologist through to the specialist in adult congenital heart disease; and from the general paediatric cardiologist and cardiac surgeon, to those specialising in transcatheter interventions, paediatric electrophysiology, and paediatric echocardiographers. In addition, the code was crossmapped to the 9th and 10th revisions of the International Classification of Diseases (“ICD-9” and “ICD-10”) provided by the World Health Organisation in order to facilitate returns to central government, a requirement in most countries. In so doing, it was hoped to address the concerns of many centres that such information submitted by professional coding staff was often inaccurate due to the complex nature of congenital cardiac disease, together with the limited scope and vague terminology of the International listings.

For many years, paediatric cardiologists and paediatric cardiac surgeons have felt the need for a common diagnostic and therapeutic coding system with which to classify patients of all ages with congenital and acquired heart disease. This desire has been highlighted by the recent, and ongoing, enquiry into the outcome of paediatric cardiac surgery at the unit in Bristol, in the United Kingdom, and the resulting obligation to provide national and international comparisons of surgical results between centres caring for these patients. In order to incorporate effective clinical governance and best practice into our speciality, a method is required to gather accurate and validated data on the diagnosis, therapy and outcome of patients with heart disease from prenatal life through to adulthood. This would facilitate comparisons between individual units which fully take into account the mix of cases involved, and thus attempt to focus on the relevant and genuine factors underlying the differing outcomes in terms of both mortality and morbidity. For this to be achieved, it is essential to have a comprehensive system of coding and classification, using mutually exclusive and unambivalent terms. The system must be both easy to use, and fulfil the needs and expectations of widely different cultures of practice. Although many centres have developed their own system of internal audit, with their own coding system, and some co-operation has taken place between centres nationally and across international boundaries within Europe by the European Congenital Heart Surgeons Federation (see below), a cohesive, and comprehensive system suitable for setting standards has yet to emerge. Historically, this has partly been due to the lack of recognition by governments of the importance of such a process, with underfunding of initiatives aimed at addressing these issues, both technologically and in terms of human resources.

Right pulmonary artery-to-left atrial communication is a rare congenital vascular malformation that results in a right-to-left shunting. This report describes the case history of a neonate with a large right pulmonary artery-to-left atrial connection resulting in cyanosis and severe heart failure who underwent successful early catheter interventional therapy. In the neonate, this lesion can be diagnosed accurately using transthoracic echocardiography. Closure of the communication can be achieved even in infants via percutaneous interventional catheterization with a low procedure-related risk and a good midterm follow-up result.Keywords Catheter interventional therapy Á Congenital heart defect Á Pulmonary artery-to-left atrium communication Á Neonate One-third of neonatal cyanosis cases are caused by congenital heart defects and it is important to differentiate them from pulmonary disease or persistent fetal circulation [5]. Right pulmonary artery (RPA)-to-left atrium (LA) communication involves a direct connection between the pulmonary artery and the pulmonary vein or LA [11] and is a very uncommon cause of right-to-left shunting. This pathologic vascular communication results in a large shunting of venous blood to the arterial side, leading to both cyanosis and volume overload. Case ReportA female term neonate with a birth weight of 3 kg and 620 g presented 14 h postnatally with central cyanosis and clinical signs of respiratory distress. An echocardiogram showed a large RPA-LA communication from the proximal RPA to the roof of the LA (Fig. 1). The LA and the left ventricle were dilated, and left ventricular function was impaired (ejection fraction, 33%).The patient's condition improved and stabilized after initiation of continuous epinephrine and milrinone administered intravenously. After 6 days, cardiac catheterization was performed with the patient under general anesthesia via a transfemoral venous approach using a 5-Fr introducer sheath. The size and anatomy of the fistula were identified and measured by a selective pulmonary angiogram (Fig. 2).Due to the shunt volume, the diameter of the proximal RPA was double that of the left pulmonary artery. The fistula itself measured 9-mm at the pulmonary end, narrowed to 2.2-mm, and widened again to 9-mm at the atrial end at the roof of the LA.The communication was entered from the pulmonary arterial side with an 0.018 in. wire. Through the 5-Fr sheath and across the wire, a flexible introducer catheter was advanced into the fistula. Successful closure then was performed with a detachable patent arterial duct (PDA) coil (7 9 6-mm, Nit-Occlud; pfm, Cologne, Germany) from the pulmonary arterial side. Three loops of the coil were placed into the LA, and the remaining loops were placed into the fistula and the RPA.After confirmation that the positioning of the device was stable and the flow of the RPA and LA was unimpaired (via a contrast injection through the introducer catheter and a transthoracic echocardiography), the coil was released. A final angiogram s...

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