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In a multicentered trial, the authors investigated 280 cardiac patients to determine the level of recovery of their social life after they had completed a physical training program. Data on work and leisure activities (sports, hobbies, social contacts, and odd jobs) were obtained immediately before and after rehabilitation and again 12 months later by means of semistructured interviews and an inventory of leisure activities. For the analysis of leisure variables, they developed a classification procedure to assign patients to one of five categories indicating an unchanged good outcome, significant recovery, nonparticipation, significant deterioration, or an unchanged poor outcome. The results after rehabilitation showed that some patients had benefited more than others. In addition, improvement or deterioration in one aspect of social recovery appeared to be independent from other aspects. Further systematic research is needed to determine which factors influence the amount of benefit derived from rehabilitation.

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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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In order to obtain reference data for a better evaluation of the operability of infants and children with congenital heart malformations, investigations were made on the growth of the aortic ventriculo-arterial junction along with the aortic arch as well as of the pulmonary root and the pulmonary tree. The internal diameters of the junctions and of various sites of both great arteries were measured in fresh post mortem specimens of 126 children having an age from 21 weeks of gestation up to 10 years after birth and who died from noncardiac diseases. Linear correlations were found between the internal diameters and body length. The post mortem data were in agreement with echocardiographic observations.

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A multidisciplinary study was undertaken to determine the number of patients that recovered, deteriorated or remained unchanged during a cardiac rehabilitation programme, as assessed in medical, social and psychological terms. In addition, the relationship between the medical, social and psychological aspects of recovery were investigated. Criteria for improvement, deterioration and an unchanged condition had been developed for the different aspects of recovery. These criteria were based on the degree of change during the rehabilitation programme (expressed in an effect size index) and the outcome at completion of the programme (expressed in terms of good, moderate or poor according to external standards). Although more patients improved than deteriorated, quite a few patients remained unchanged in medical, social or psychological condition. We conclude that cardiac rehabilitation might not be necessary for some patients and is not sufficient for others. Further, the relationship between the several aspects of recovery investigated was found to be weak.

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The developmental changes in the tunica media of the pulmonary trunk and left and right pulmonary arteries were studied in 51 hearts and the great vessels of infants and children up to the age of ten years who died from non-vascular diseases. The internal diameters of the pulmonary arterial tree were measured together with the thickness of the tunica media and the packing density of its elastic fibres. In spite of the age-related (about sixfold) increase in the internal diameters of the vessels there were no parallel significant changes in the characteristics of their tunica media. Furthermore, the configuration of the elastic fibres showed no clear age-related changes in any of the vessels. In conclusion the structure of the wall of the pulmonary trunk and of the pulmonary arteries, although different in embryological origin, seems to show the same pattern of growth during bodily development, with absence of significant correlations between the internal diameters on the one hand and media thickness and packing densities of the elastic fibres on the other. This is possibly the result of the low pulmonary blood pressure.

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To provide a better understanding of the operability of the pulmonary arteries in children with tetralogy of Fallot or with pulmonary atresia, we investigated the growth of the internal diameters of the pulmonary arterial tree in fresh postmortem hearts and great arteries of infants and children of ages up to 10 years after birth, who died from non-vascular diseases. Linear correlations were found between, on the one hand, the internal diameters of the pulmonary ostium, pulmonary trunk and left and right pulmonary artery and, on the other, body length. Based on an approach used in clinical studies we also determined the ratios between the internal diameter of the pulmonary arterial tree and the ascending aorta and also the ratios of the internal diameters of the descending aorta and the sum of the size of the left and right pulmonary arteries. Comparison of the data from the postmortem material with observations on the internal diameters measured with two dimensional (sector) echocardiography echo indicates that the latter may slightly underestimate the true diameters.

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After resection of the coarctation in a 3-year-old child with end-to-end anastomosis, a second membrane was found 1.5 cm lower. After a successful reoperation with an aortoplasty using Gore-Tex weak femoral pulses persisted. At catheterization, an area of irregular narrowing of the abdominal aorta just distal to the superior mesenteric artery was found with hypoplasia of the iliac and femoral arteries. In addition, this child had a two-sided cheilo-gnatho-palatoschisis, vesicoureteral reflux and absence of gall bladder and hepato-duodenal ligament. It is worthwhile considering that a second or third aortic abnormality can be hidden by a coarctation of the aorta.

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Apex-dimension loops may provide useful information in patients with acute myocardial infarction because incoordinate contraction and relaxation can be demonstrated. The method could allow assessment of the effects of therapeutic interventions. Fifty consecutive patients with AMI in the coronary care unit within 48 hours after the onset of their symptoms were studied. Simultaneous recordings of the echocardiogram and apexcardiogram, which were of an adequate quality for analysis, were obtained in only 7 patients (success rate 14%). In all these patients, incoordinate relaxation was demonstrated. A major practical drawback of the method is the time needed for recording the basic data requiring 2 investigators. Therefore, because of the low success rate and difficulties in obtaining simultaneous recordings, apex-dimension loops are not practical in most patients with acute myocardial infarction.

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In 23 patients with Ebstein's anomaly of the tricuspid valve, the functional class of the patients has been related to the echocardiographic parameters generally used to diagnose this disorder. These are the extent of apical displacement of the tricuspid valve and the delay in tricuspid valve closure time related to that of the mitral valve. In addition, the functional class of the patients has also been evaluated in relation to the severity of tricuspid valve insufficiency and to the presence or absence of associated cardiac abnormalities. The study revealed that the echocardiographic parameters i.e. the degree of apical displacement of the tricuspid valve and the delayed closure time of the tricuspid valve have no predictive value for the patient's clinical condition. On the other hand, both tricuspid valve insufficiency and the presence of additional anomalies have a direct correlation with the well-being of the patient.

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After repair of coarctation of the aorta using the technique of resection and end-to-end anastomosis, the internal diameters of the aortic isthmus and descending aorta often fail to increase. Better results seem possible with aortoplasty using the left subclavian flap technique. In order to clarify this matter, we investigated the structure of the left subclavian artery comparing it with that of the descending aorta and aortic isthmus: we studied the internal diameter, the thickness of the tunica media and the packing density of its elastic fibers in these vascular elements using a postmortem material of children with a coarctation of the aorta. The ages ranged from 4 days to 13 months with one child of 8 years. All 16 cases had one or more additional cardiac lesions. Operation had been performed in 3 children: 2 end-to-end anastomoses and one subclavian bypass of the aortic arch. Data were compared with observations on autopsy cases of children without cardiovascular abnormalities. The mean findings were that the calibers of the left subclavian artery and the descending aorta were within normal limits but that the caliber of the aortic isthmus was smaller than in normal children. The measurements on the tunica media showed that although, generally, the thickness of the media of the left subclavian artery was smaller than that of the aortic isthmus and descending aorta of the same individual, it contained relatively more elastic fibers than the matching vessels. This may indicate that the structure of the left subclavian artery is well suited to grow out as a part of the aortic arch.(ABSTRACT TRUNCATED AT 250 WORDS)

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In this paper we report the sequelae of a patient with an anomalous right coronary artery (RCA) originating from the pulmonary artery (PA) in association with a normal heart, operated upon at the age of 13 years. Three years after the end-to-side reimplantation of the RCA, with a rim of the PA, into the aorta, the surgical result has been evaluated by cineangiography. Before operation both coronary arteries were tortuous and increased in size. Afterwards the left coronary artery showed a normalized calibre, although the RCA remained tortuous with no decrease of the internal diameter. The notable postoperative changes in shape and size of the LCA may be due to the disappearance of the steal phenomenon. The lack of involutive changes in the RCA could be explained by its thinner wall. Left ventricular wall motion, evaluated under resting conditions and during an atrial pacing stress test, was found to be normal.

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This is the fourth reported case of congenital arteriovenous fistula between the internal mammary artery and pulmonary artery. Precise and complete diagnostic evaluation is required to localize, delineate and appreciate the haemodynamic significance of this type of arteriovenous shunt. A brief review of the literature is given with suggestions for diagnosis.

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This study concerns the normal histological growth of the aorta in infants and children. We measured, in post mortem material consisting of 69 hearts and great vessels of infants and children who died from non-vascular diseases, the internal diameters of the ascending aorta, aortic isthmus and descending aorta together with the thickness of the tunica media and the packing density of its elastic fibres. Age range was from 27 weeks of gestational age up to 10 years after birth. The growth of the tunica media of the ascending aorta was, in part, different from that of the aortic isthmus and descending aorta. Notwithstanding an increase in the thickness of the tunica media parallelling, in all three parts of the aorta, an increase in their internal diameters, the packing density of the elastic fibres of the tunica media of the aortic isthmus and of the descending aorta showed no tendency to increase with age. However, the packing density of the elastic fibres of the ascending aorta showed a continuing increase with age parallelling the increase of the internal diameter. This can probably be better explained as a result of functional difference than as a result of different embryological origin.

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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.

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In paediatric cardiovascular surgery, knowledge of internal diameters along the first part of the aorta is essential. This paper presents reference data on the internal diameters of aortic ostium, ascending aorta, aortic isthmus and descending aorta, 1 cm distal to the ductus arteriosus. Measurements were made with the aid of calibrated probes in 126 post mortem specimens of normal hearts with great vessels. The age range was from 25 weeks of gestation up to 10 years after birth. The data revealed linear correlations between the internal diameters of the different parts of the aortic arch and body length. At variance with the literature, we found that, with few exceptions, the internal diameter of the ascending aorta was greater than that of the descending aorta.

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In 104 hearts of infants and children, who died from non-vascular diseases, and whose ages ranged up to 10 years after birth, narrowing of the aortic isthmus, i.e. an internal diameter of 80% or less of that of the descending aorta, was found in 26 cases (24%). The remaining cases showed a lesser degree or no narrowing of the aortic isthmus. Among the 38 cases who died within 2 days after birth (gestational age range 21 to 42 weeks) narrowing of the aortic isthmus, as defined above, was present in only 14 cases (37%). This is much less frequent than is suggested in the literature. No correlation was found between presence, and degree, or absence of narrowing of the aortic isthmus and the relative sizes of the aortic and pulmonary narrowing of the aortic isthmus and the relative sizes of the aortic and pulmonary ostia. Possibly, to define the limits of the normal condition of the aortic isthmus, not only its diameter, but also the characteristics of its tunica media may be of importance. Therefore, the thickness and the packing density of the elastic fibres of both the aortic isthmus and the descending aorta were measured in 69 cases, equally distributed over the material. It is reasoned that in the 3 out of a total of 26 cases, in which not only a marked narrowing of the aortic isthmus was observed but also a relative underdevelopment of its tunica media, a persistent narrowing might have developed, whereas development of such a persistent narrowing seems less likely with a tunica media of normal volume and structure.

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