To elucidate the incidence and natural history of mitral valve prolapse (MVP) during childhood, we investigated a total of 4,238 children (aged from 1 day to 15 years) classified by age into 4 groups: Group 1 : 1 to 28-day-old full-term normal newborns (n = 108), Group 2: 6 to 18-month-old infants (n = 391), Group 3: 6 to 7-year-old children (n = 2,801), and Group 4: 12 to 15-year-old children (n = 938). The incidence of MVP was determined by videorecorded two-dimensional echocardiography in a double-blind method twice-over. There were 109 cases diagnosed as having MVP. The incidence rates of MVP were as follows: Group 1: O%, Group 2: 0.25%, Group 3: 2.1% and Group 4: 5.1%. Arrhythmias were detected in 49% (27/55) by Holter ECG, and by exercise stress test in 4.7% (2/43). Eighty-three (77%) of 108 cases in Groups 3 and 4, excluding the 1 case in Group 2, showed no symptoms. Ventricular premature contraction (VPC) was the most common arrhythmia, and was benign in all cases. A mid-systolic click (MSC), late systolic murmur (LSM), MSC -t LSM, and a pansystolic murmur were detected in 23.1%, 3.7%, 4.6% and 5.6%, respectively. Symptoms caused by MVP increased and appeared more apparently with age. Further prospective long-term follow-up studies to adulthood are necessary. population. However, there are few studies reporting the incidence and clinical presentations of MVP in children. The incidence of MVP in adults is still uncertain and published figures vary in a wide range from 1% [2] to nearly 20% [ 11. To elucidate the incidence and natural history of childhood MVP, we have investigated 4,238 healthy infants and children by two-dimensional echocardiography and have studied their clinical presentations, symptoms and incidence of arrhythmias.

Recent advances in echocardiography have allowed the anatomical structure of the fetal heart to be successfully and safely seen in details. It has since enabled not only the prenatal diagnosis of congenital heart disease but the diagnosis and treatment of fetal arrhythmias. New advances of Doppler echocardiography have provided exciting informations on the fetal physiology of normal or abnormal fetal circulation. We have performed the fetal echocardiography from 1980 on 564 fetuses which comprised 254 normal and 310 high risk pregnacies. From our experiences we discuss the prenatal diagnosis of congenital heart disease and its method and accuracy, the recognition and intrauterine treatment of fetal arrhythmias, the diagnosis of fetal heart failure, the assessment or research of fetal circulation by Doppler echocardiography, and finally the management for the fetus with cardiac problems and the ethical issue in fetal cardiology.

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Balloon pulmonary valvuloplasty (BPV) was attempted in 38 cases of congenital pulmonary valve stenosis. It was effective and was done without complication in 36 cases, however it was not effective in two cases of pulmonary valve dysplasia. The balloon used was 20-50% larger in diameter than the pulmonary valve annulus. In the seven cases in which the transvalvular