Pulmonary endarterectomy has been successfully implemented in Denmark. The perioperative mortality was reduced over time to 9% during the past 5 years. Functional outcome and long-term survival were excellent stressing the importance of surgical treatment for chronic thromboembolic pulmonary hypertension.

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Portal hypertension is a rarely encountered late complication of umbilical vein catheterization. A survey of the 38 cases previously published is presented together with an additional case report. It is concluded that catheterization for more than 2 days carries an increased risk of thrombosis, and that umbilical artery catheterization should be preferred in the majority of cases due to a reduced risk of complications. The correct position of the catheter tip must always be controlled by fluoroscopy or X-ray. Infusion of hypertonic solutions with unphysiological pH should be restricted and umbilical vessel catheterization should only be carried out in severe cases. Pretreatment of the catheters with heparin possibly reduces the hazards.

ABSTRACT. Objectives. To evaluate the reproducibility and the accuracy of pediatric radiologists' assessments of chest radiographs with respect to the presence or absence of heart defects in children with an asymptomatic heart murmur.Design. Ninety-eight children, ages 1 month to 15 years (median, 30.1 months), referred for evaluation of a heart murmur were consecutively included. They all had a standard chest radiograph and a color Doppler echocardiograph (CDE) performed. Six specialists in pediatric radiology evaluated the chest radiographs independently on two occasions 6 months apart. The radiologists were asked to classify each set of films into one of two categories: heart disease or no heart disease. The outcome of the CDE was considered the definite diagnosis. statistics were used to analyze the reproducibility of the radiologic assessments. Sensitivity, specificity, and the predictive value of a positive and a negative test were used for evaluation of the accuracy of the radiologic assessments.Results. Mean intra-and interobserver values were all <0.6, and the majority were <0.4. Mean sensitivity was 0.3 (range: 0.17-0.52), mean predictive value of a positive test was 0.4, implying that 60% of the positive assessments were falsely positive. Mean specificity was 0.86 (range: 0.75-0.93) and the mean predictive value of a negative test was 0.80 implying that 20% of the negative assessments were falsely negative.Conclusion We found a low reproducibility, as well as a low accuracy, of the radiologic assessments of the chest radiographs of children with an asymptomatic heart murmur with respect to the presence or absence of heart disease. A false-positive radiologic assessment of the chest radiograph with respect to heart defects causes unnecessary anxiety and further examinations, whereas a false-negative assessment might result in omission of relevant investigations and proper identification of the heart defect. We cannot recommend the use of chest radiographs in the initial evaluation of the asymptomatic child with a heart murmur. If a heart defect cannot be excluded by clinical examination a CDE must be performed. Pediatrics 1999;103(2). URL: http://www. pediatrics.org/cgi/content/full/103/2/e15; child, cardiac murmur, chest radiograph, reproducibility, accuracy.ABBREVIATION. CDE, color Doppler echocardiography.