A retrospective review of 149 episodes of bacterial endocarditis (BE) in 141 patients under 25 years of age, at The Children's Hospital Medical Center from 1933 through June of 1972, demonstrates increasing survival and a distinct change in the frequency of underlying congenital heart disease and rheumatic heart disease (RHD). Certain forms of congenital heart disease such as tetralogy of Fallot, small ventricular septal defect, and aortic stenosis are at particular risk for BE. Following BE, patients with ventricular septal defect and tetralogy of Fallot have less morbidity and higher survival rates than children with aortic outflow lesions. over the entire time period, alpha Streptococcus is the most common pathogen and Staphylococcus aureus, second most frequent organism. Surgical correction in patients with congenital heart disease may offer the best form of prevention.

Since deferoxamine B, when administered as a single daily intramuscular injection of 0.75 g, is unable to promote sufficient urinary iron excretion to achieve net negative iron balance in siderosis, we evaluated its administration as a constant infusion over 24 hours. We compared intravenous and subcutaneous routes in 24 siderotic patients who had excreted 420 to 630 mg (mean, 480 mg) of iron per month on intramuscular therapy. With the intravenous route urinary iron excretions increased to 570 to 3690 mg (mean, 1595 mg) per month. Constant subcutaneous delivery was 90 per cent as effective as intravenous administration on a dose-for-dose basis. Noteworthy net cumulative urinary iron excretions (urinary iron excretions minus transfused iron), often in excess of 1 g per month, have been maintained in all patients. Constant subcutaneous deferoxamine administration may prove to be an effective and practical means of eliminating large quantities of iron in siderosis.

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Thrombosis at the site of arterial puncture is a common and serious complication of percutaneous cardiac catheterization in children. A double-blind study was therefore designed to test the efficacy of heparin administered during catheterization in reducing this complication. One hundred and sixty-one unselected children over one year of age were studied. Prior to catheterization, the pulse amplitudes were measured in both legs using a Pulse Volume Recorder (a standardized oscillometer). Immediately after arterial cannulation, heparin, 1 mg/kg, or a placebo was administered. On the morning following catheterization, the pulse amplitude in both legs was remeasured and a pulse volume index calculated using the uncatheterized leg as a control. Patients in whom the catheterized leg was cold, with poor capillary filling and absent arterial pulses four hours after the completion of catheterization, were started on intravenous infusion of heparin. If no improvement occurred within 48 hours, embolectomy was performed. There was no evidence of arterial compromise to the catheterized extremity to any patient older than 10 years. Of 77 children ten years of age or younger, systemic heparinization postcatheterization was required for a pulseless extremity in 40% (15/37) of those in the placebo group and 8% (3/40) in the heparin group ( P = 0.003). Only 5% (2/40) of children in the heparinized group had a pulse volume index of less than 50%, compared to 27% (10/37) in the placebo group ( P = 0.003). Embolectomy was performed in seven of the 37 children in the placebo group and none of 40 in the heparin group ( P = 0.01). No complications related to the use of heparin were found. We conclude that heparin administered during percutaneous catheterization is effective in preventing arterial thrombosis in children ten years of age or younger and should be routinely administered unless a specific contraindication to its use exists.