No abstract

Fetal aspiration of meconium in amniotic fluid is a well-known cause of respiratory distress in newborn infants. It causes an irregular, coarse, nodular pattern on chest radiographs. Less known is that aspiration of vernix caseosa causes a similar syndrome. We present a post-mature infant in whom aspiration of vernix caseosa caused respiratory distress, ventilatory difficulty, and radiographic changes essentially the same as in aspiration of meconium.

The purpose of this paper is to present our experience with percutaneous balloon angioplasty (PBA) for coarctation of the aorta (COA). The children between the ages of one month and 11 years (mean age 18 months) underwent PBA during an eight-month period ending September 1985. Number 5 to 9 French catheters with 5-to 15-mm balloons were used, depending upon the size of the angiographically measured coarcted segment and the aorta proximal to COA. The peak inflation pressure used in the balloons varied from 4 to 8 atmospheres of pressure and the duration of inflation was 8 to 15 seconds. At least four balloon dilatations were performed in every case. Following PBA for COA, descending aortic systolic pressure rose from 86.4 ± 17.7 to 107.8 ± 20 (p <0.02) and the peak systolic pressure gradient across the COA fell from 44.1 ± 19.1 to 8.5 ± 8.5 (p <0.001). Increase in the angiographically measured coarcted segment, decrease in Doppler estimate of coarctation gradient, and improvement in the femoral pulses also occurred. No significant complications were encountered. PBA for COA is a safe and effective alternative to surgical coarctectomy. It may become the procedure of choice for treatment of coarctation of the aorta once favorable long-term results are documented.

We studied three families in which patients with the Holt-Oram syndrome (HOS) had various skeletal abnormalities and congenital heart defects. Two patients had absent thumbs and first metacarpals, hypoplastic radii, and atrial and ventricular septal defects. Patient 2 had pulmonary stenosis, an atrial septal defect, and triphalangeal thumbs. A sister had atrial septal defect and abnormalities of the thumbs; two brothers had abnormalities of the thumbs. The mother had unilateral defect of the thumb with a normal heart. The third patient had tetralogy of Fallot and hypoplastic pulmonary artery. In two families the HOS appeared to be the result of new mutations; in one it was transmitted as an autosomal dominant trait.