There is a high incidence of intimal tears and dissections immediately after balloon angioplasty for native and recurrent CoAs. Intravascular ultrasound is more sensitive than angiography in detecting the vascular wall changes. Even significant intimal tears are not necessarily associated with aneurysm formation, and many decrease in size or disappear at short-term follow-up.

Two-dimensional echocardiography has provided information to aid in the diagnosis and management of infants with ventricular septal defect, but its inability to resolve very small ventricular septal defects and problems with defining ventricular septal defect orifice size (because of overlying muscle or tricuspid tissue) have made it unsuitable as a standard for defining the natural history of ventricular septal defect. In this study, 114 serial two-dimensional Doppler color flow mapping studies were performed to define ventricular septal defect anatomy, location and color flow diameter as an indicator of shunt size in 66 patients (over a 40 month period). Twenty-five patients first studied at 6 months of age (mean age at most recent study 15.9 months) had congestive heart failure and 41 (mean age 45 months) did not. In the congestive heart failure group, there were 24 perimembranous and 1 muscular ventricular septal defect and aneurysm formation was present in 17. Mean (+/- SD) color flow diameter was 8.2 +/- 1.9 mm and color flow diameter/aortic root diameter ratio was 0.63. In the 30 patients who underwent cardiac catheterization, color flow diameter bore a close relation to angiographic diameter (r = 0.96) and pulmonary/systemic flow ratio (Qp/Qs) (r = 0.88). In the patients with congestive heart failure, 4 of the 25 ventricular septal defects, all with aneurysm present or positioned adjacent to the tricuspid valve, became smaller but none closed. Of the 41 patients without congestive heart failure, 21 had a perimembranous defect (15 with aneurysm), 18 had a muscular ventricular septal defect and 2 had a supracristal ventricular septal defect.(ABSTRACT TRUNCATED AT 250 WORDS)

In this study, ultrasound Doppler color flow mapping systems were utilized to examine flow in the pulmonary artery in 31 premature and term infants (aged 4 hours to 9 months) with patent ductus arteriosus accompanying respiratory distress syndrome, as an isolated lesion, or with patent ductus in association with other cyanotic or acyanotic congenital heart disorders. The flow mapping patterns were compared with those of a control population of 15 infants who did not have patent ductus arteriosus. In unconstricted ductus arteriosus, the flow from the aorta into the pulmonary artery was detected in late systole and early diastole and was distributed along the superior leftward lateral wall of the main pulmonary artery from the origin of the left pulmonary artery back in a proximal direction toward the pulmonary valve. In constricted patent ductus arteriosus, or especially in a ductus in association with cyanotic heart disease, the position of the ductal shunt in the pulmonary artery was more variable, often directed centrally or medially. Waveform spectral Doppler sampling could be performed in specific positions guided by the Doppler flow map to verify the phasic characteristics of the ductal shunt on spectral and audio outputs. Shunts through a very small patent ductus arteriosus were routinely detected in this group of infants, and right to left ductal shunts could also be verified by the Doppler flow mapping technique. This study suggests substantial promise for real-time two-dimensional Doppler echocardiographic flow mapping for evaluation of patent ductus arteriosus in infants.

We performed color Doppler flow mapping in 15 patients, 1 week to 17 years old (mean 42 months), with coarctation of the aorta that was confirmed subsequently by angiography and/or surgery. Twelve patients had native coarctation and three had mild recoarctation after surgical repair. Color Doppler flow maps were analyzed with a digital analysis package and a Sony computer system. The diameter in the region of coarctation from the color Doppler flow map (mean = 2.0 0.8 mm [SD]) correlated well with the coarctation diameter measured at angiography (mean = 1.8 0.8 mm; r=.83, SEE 0.43 mm) in the 10 patients with native coarctation undergoing angiography, but the coarctation diameter measured by two-dimensional echocardiography (3.9 ± 1.5 mm) was poorly predictive of the angiographic severity (r=.23). Additionally, spatial acceleration was seen in all patients proximal to the coarctation site, with an aliased and accelerating stream narrowing progressively as it proceeded toward the coarctation site, a pattern that is not seen in healthy subjects. Computer analysis of the color Doppler images provided pseudo three-dimensional and digital velocity maps for blue, red, and green (turbulent) flow velocities to allow an enhanced appreciation of the accelerating stream, easily separating this from normal desending aortic aliasing patterns. The narrowing of the acceleration area in the proximal descending aorta (distal/proximal acceleration zone ratio) was also predictive of the angiographic severity of coarctation (r = .83). The distribution of low-level turbulence seen proximally paralleled the distribution of the proximal accelerating stream. Highly turbulent flow distal to the coarctation was identified in all patients, continuing into diastole in the seven patients with increased diastolic flow velocities on continuous-wave Doppler images. Color Doppler flow mapping allows new observations of coarctation flow diameter, spatial aortic acceleration, and turbulence in the proximal descending aorta that enhance the noninvasive assessment of patients with coarctation of the aorta. Circulation 77, No. 4, 736-744, 1988. TWO-DIMENSIONAL echocardiography has been quite useful for the noninvasive assessment of patients with coarctation of the aorta1'2 and when high-resolution images are obtained many patients can safely undergo surgery without the need for a confirmatory invasive study. In normal newborn infants, however, mild isthmic narrowing is a common finding and confusion may arise in attempts to diagnose coarctation From the Divison

Twenty-four children and young adults with electrocardiographic evidence of sinus node dysfunction (SND) are described. The patients, whose ages ranged from three days to 25 years, were divided into three groups based on the type of SND. Ten patients had persistent and inappropriate sinus bradycardia (group I): twelve patients had episodes of prolonged sinus arrest (group II); and seven patients had repeated episodes of Mobitz type I or II sinoatrial exit block (group III). Eighteeen patients had significant heart disease and in 11 of these the SND followed corrective cardiac surgery. Seven were operations for atrial septal defect and transposition repair. Seven patients with SND were symptomatic, having either syncopal (3) or near syncopal episodes (4). All three with syncope have received permanent demand pacemakers. These data show that sinotrial exit block occurs in many young patients with SND (29% in this series). Its recognition, however, requires careful electrocardiographic analysis in order to differentiate sinus bradycardia and sinus arrhythmia. Although SND most commonly occurs in children with congenital or acquired heart disease, particularly following corrective cardiac surgery, it may occur in the absence of other cardiac abnormalities.