A limited experience with an initial series of nine patients operated upon for tricuspid atresia using a modified superior vena cava to right pulmonary artery anastomosis is presented. The modified technique is described and illustrated. It avoids permanent disruption of pulmonary artery continuity and the high incidence of superior vena cava syndrome. In short, the right pulmonary artery is not severed, the azygos vein is always ligated, the superior vena cava is not mass ligated and is subjected to delayed interruption.Analysis of the results shows an operative and overall mortality of 33 %. The advantages of this modified surgical approach are outlined.

The peripheral blood vessels of infants and children are difficult to cannulate and to repair. The lumen will accommodate only small bore catheters and these are harder to manoeuvre, and impair the quality of angiograms. Lengthening of the procedure and an increase in the amount of contrast medium which is needed both contribute to the morbidity. To our knowledge, cannulation of the internaljugular vein and/or carotid artery for purpose of heart catheterization in humans has never been reported. The technique of this approach is described in detail and illustrated. A brief outline of the advantages and disadvantages of the procedure is given. The fact that the technique requires an operator experienced in handling major vessels is stressed. In all, 705 approaches to the great vessels of the neck have now been performed, and both the potential complications and those encountered are listed. With strict adherence to andfamiliarity with the technique the procedure is safe and offers, we believe, decided advantages.Cannulation of arteries and veins for cardiac catheterization in the adult is usually easy. In the newborn and infants, however, it may be very difficult and time consuming. In the first two months of life mortality rates are very high, of the order of 6 per cent (Burchell and Ongley, I968). The duration of the procedure is directly related to the mortality and morbidity in this category of patient (Banyai and Gordon, i966), and the investigation should, in general, seek only those data essential to an accurate diagnosis. Because of the patient's size, difficulties are posed by the length-gauge ratio of the catheter and the amount of dye in relation to body weight to be delivered in unit of time (Banyai and Gordon, I966).The technique we describe was developed between I965 and I966 by one of us (G.A.) and it has proved to be useful in the newborn, in infants, and in children up to the age of 3 to 4 years. We have often used it in children between 4 and 7 years of age, and occasionally in young adults. The approach is strongly indicated when previous catheterizations or other procedures have been carried out at or in the vicinity of the usual areas of venous or arterial cannulation. This is often the case in our patient population.To our knowledge open cannulation of the internal jugular vein and/or the common carotid artery

suMMARY In order to assess the performance of pulsed Doppler echocardiography and to examine the factors affecting its reliability for the diagnosis of ventricular septal defects, 51 patients, in whom angiographic studies had recently been performed, were investigated before and after operation by this technique. The In this paper the data on preoperative angiocardiographic and echocardiographic examinations are compared with the description of the actual malformation, as observed at the time of cardiac surgery, and with the postoperative echocardiographic controls.

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