We report the case of a 14-year-old boy who developed Kawasaki disease at 5 months of age. The patient developed severe aneurysmal disease of both the left and right coronary arteries. He eventually developed total calcified occlusion of the right coronary artery despite long-term treatment with aspirin. Catheterisation showed no antegrade flow into the right coronary artery, with retrograde flow from the left coronary system into the right coronary. At the most recent follow-up he was asymptomatic, with normal exercise tolerance and a negative exercise stress test. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging was carried out during stress and at rest using intravenous persantine (dipyridamole) and technetium-99m tetrofosmin. During stress, there were prominent left ventricular apical and anteroseptal defects, which normalised at rest. SPECT during stress and at rest may detect subclinical ischaemia and influence further management options in such patients.

P e d l a t r t c Cardlology. Chlcaso. (Spon: R o b e r t A. M i l l e r )When the heart stops, a r t e r i a l pressure decays asymptotlcally t o a value d l f f e r e n t from the venous pressure.0ur study was performed t o t e s t the hypothesls t h a t t h l s decay Is influenced by vasomotor tone and contalns Information t h a t could lead t o the development of an Index of vasomotor tone.Twelve anesthetlted dogs were subJected t o brlef periods of cardlac a r r e s t by stlmul a t l n g the d l s t a l ends of the cut vagl.Th1s was done approxlm t e l y 9 times In each dog a t varylng levels of vasomotor tone produced by I V nltroprusslde and methoxamlne and decay of c e n t r a l a o r t l c pressure was rec0rded.A fncthematlcal motel of the lumped a r t e r i a l bed was evolved In whlch each term had recognizable physlologlc meanlng.Uslng multlple nonlinear regression analysis, the pressure-time data were f l t t e d t o t h l s model and, In most cases, f i t ed and observed decays were hardly dlstlngulshable t o 4 the eye ( r values were g r e a t e r than . ? ) . l t was predlcttd t h a t asymptotic pressure. calculated ualng the m d e l . would r l s e o r f a l l a s vasomotor tone rose o r fell.The average asymptotlc pressures under the lnfluence of methoxamlne were s l g n l f l c a n t l y g r e a t e r (F<.05) than control values and average asymptotlc press u r e s under the Influence. of nltroprusslde were s l g n l f l c a n t l y l e s s (P<.05) than average control values. l t Is suggested t h a t these asymptotes may form the basls f o r developing an Index of vasomotor tone Independent of flow measurement. HEMODYNAMIC EFFECTS OF E. COLI ENWTOXIN I N PUPPIES.YL Pipie. Chiemmongkoltip, Masakatsu Goto. Bruce Bernheim, Zenshiro Onouchi. John B. Paton. P r i t z k e r School of Medicine. University of Chicago. Michael Reese Hospital and Medical Center. Department o f -~e d i a t r i c s , Chicago -S e r i a l hemodynamic changes following intravenous E. c o l i OlllB4 endotoxin were evaluated i n 28 puppies. 1-18 days and 270-1800 grams. S e r i a l cardiac outputs were measured by a modified reinfusion dye d i l u t i o n technique. Heart r a t e and systemic arter i a l pressures a l s o were measured. Changes were recorded a t 5 min. 10 rnin and st 10 min i n t e r v a l s t h e r e a f t e r f o r 1 hour following endotoxin. Heart r a t e dropped from 2lO/min t o 14l/mln a t 5 mln and s t a b i l i z e d a t a s l i g h t l y higher l e v e l t h e r e a f t e r (p < 0.01). Mean systemic pressure decreased gradually from 70 mm Hg t o 42 mm Hg a t 1 hour (p < 0.01).Cardiac index decreased from 266 ml/mln/kg t o 131 ml/min/kg a t 5 rnin and continued t o decline t o 115 ml/mtn/kg a t 1 hour (p < 0.01). Systemic vascular resistance rose from 0.467 u n i t t o 0.846 u n i t a t 5 rnin and remained elevated a t s l i g h t l y lower l e v e l a t 1 hour (p < 0.01).Minute work decreased a t 5 rnin from 0.301 Kg-m/kg t o 0.134 Kg-m/kg and t o 0.066 Kg-m/kg a t 1 hour (p < 0.01).Mean e j e c t i ...