During the 35 month period ending December 1987, 30 children, aged 14 days to 13 years, underwent balloon angioplasty of unoperated aortic coarctation with resultant reduction in coarctation gradient from 43.6 +/- 20.4 to 9.5 +/- 7.6 mm Hg (p less than 0.001). None of the patients required immediate surgical intervention. On the basis of results of 6 to 30 month follow-up catheterization data in 20 children, the patients were classified as follows: Group A, 13 patients with good results (gradient less than or equal to 20 mm Hg and no recoarctation on angiograms) and Group B, 7 patients with fair or poor results (gradient greater than 21 mm Hg with or without recoarctation on angiography). No patient developed aortic aneurysm at the site of angioplasty. Thirty variables were examined by multivariate logistic regression analysis and four factors were identified as risk factors for development of recoarctation: 1) age less than 12 months, 2) aortic isthmus less than 2/3 the size of the ascending aorta immediately proximal to the right innominate artery, 3) coarcted aortic segment less than 3.5 mm before dilation, and 4) coarcted aortic segment less than 6 mm after angioplasty. The identification of risk factors may help in selection of patients for balloon angioplasty. Avoiding or minimizing the number of risk factors may help reduce the chance of recoarctation after angioplasty. The intermediate-term follow-up results with regard to recoarctation are comparable with those after surgical repair of coarctation. Recoarctation after angioplasty was dealt with by repeat balloon angioplasty or surgical resection for those requiring treatment and clinical follow-up for the remaining children.(ABSTRACT TRUNCATED AT 250 WORDS)

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SUMMARY The prevalence and clinical importance of false tendons were studied in 488 consecutive patients referred for echocardiography. Two hundred and eighty three (58%) patients had acquired heart disease, 91 (19%) had congenital heart disease, and 114 (23%) had normal hearts. Sixty six patients with normal hearts had innocent systolic murmurs and one had recurrent ventricular tachycardia. The overall prevalence of false tendons was 25% compared with 1 6% in a retrospective analysis of 763 cross sectional echocardiograms. When patients with innocent murmurs were excluded from statistical analysis, there was no significant difference in the prevalence of these tendons between children and adults, boys and girls, men and women, or between patients with acquired or congenital heart disease and normal patients. The prevalence of false tendons in patients with dilated left ventricles (57%), however, resembled that seen in necropsy studies. The prevalence of false tendons in patients with an innocent systolic murmur was 76% in children and 40% in adults, with an overall prevalence of 52%.False tendons are a common echocardiographic finding of no clinical importance except for their possible role in the genesis of innocent murmurs and ventricular arrhythmias. The echocardiographic detection of false tendons increases considerably when these structures are specifically sought and in conditions that result in left ventricular chamber dilatation.The echocardiographic features of left ventricular false tendons have been reported,`and the reliability of cross sectional echocardiography in the recognition of false tendons has been established.4 In a recent morphological study these left ventricular bands were found in 48% of children and 52% of adults.5 The reported prevalence of false tendons in patients referred for echocardiography, however, has varied widely between 0-4% to 61% (Table 1). We have re-evaluated the prevalence, location, and clinical importance of false tendons in patients referred for echocardiography and have attempted to explain the major discrepancies between morphological studies and most echocardiographic studies.

We present two sisters with tetralogy of Fallot and pulmonary valve atresia. Both had identical anatomical findings as seen at cardiac catheterization and angiography and verified operatively, with, in particular, identical bronchial circulation and pulmonary valve structure. The parents are first cousins and there is no history of other affected relatives. We suggest that this is a specific, recessively inherited type of tetralogy of Fallot.