Systolic and diastolic diameters of the right and left pulmonary arteries (RPAD, LPAD), descending thoracic aorta (DTAD), right ventricular infundibulum (RVID), and pulmonary and aortic valve roots at the proximal, commissural and distal levels were estimated from angiocardiograms in 24 infants, children, and adolescents without heart disease, and correlated with body surface area (BSA), stroke volume (SV), cardiac output (CO), and ventricular volumes. The relationships between cardiovascular diameters and BSA were better expressed by a power function than by the other functions tried. We obtained different exponents for pulmonary and aortic valve annuli and the more distally measured great arteries (RPAD, LPAD, and DTAD), suggesting different growth patterns. The right ventricular infundibular shortening fraction (RVISF) was weakly correlated with BSA (r = -0.328), and the values obtained indicated constancy during normal growth. There was a direct proportional relationship between the pulmonary valve annulus diameter and the cube root of the right ventricular volume (r = 0.952), as well as between SV and cross-sections of the right pulmonary artery (RPAC; r = 0.916), left pulmonary artery (LPAC; r = 0.878) and descending thoracic aorta (r = 0.962). RPAC and LPAC were strongly correlated (r = 0.940), the RPAC being significantly larger than the LPAC.

The purpose of this work was to develop a device which allows slow progressive banding of a great artery in infants within 4 to 5 weeks. Employed was the hygroscopic casein ameroid. When brought in contact with fluids, an ameroid cylinder expands characteristically. An early phase of fast expansion proceeds gradually to a phase of slow growth. Size, shape, and encasement of ameroid as well as temperature and type of surrounding fluid modify but do not alter the typical pattern of expansion. The developed constrictor (weight: 5.8 kg, length: 18 mm, diameter: 12 mm) includes a stainless steel socket containing an ameroid cylinder (length: 8.5 mm, diameter: 8 mm). The expanding ameroid pushes a piston with a concave extension (makrolon) a maximum of 2 mm against the artery, which is fixed to the metal housing by a teflon band (width: 4 mm, thickness: 0.5 mm). The band runs in 2 fitting grooves on the metal housing to which it is fixed by a metal ring with a precisely manufactured internal thread allowing exact tightening and loosening of the band around the artery. Utilization of inert materials like teflon, makrolon, and stainless steel warrants experimental and possibly clinical application of the developed small constrictor.

To evaluate the results of the two-stage anatomic correction of simple transposition of the great arteries the size, distensibility, and histologic characteristics of the anatomic pulmonary root, which arises from the anatomic left ventricle and which we termed the functional aortic root after anatomic correction, were determined in seven patients before and twice after anatomic correction (mean 43 and 671 days) and the results were compared with those in normal control subjects. The diameter of the systolic sinus of the anatomic pulmonary root increased after banding on the average to 140% of normal, whereas the diameter of the diastolic sinus of the functional aortic root increased after anatomic correction on the average to 150% of normal. Diameters of both the systolic and diastolic sinuses of the functional aortic root remained 30% to 55% larger than normal after anatomic correction. Growth potential of the functional aortic root after anatomic correction was normal, whereas its distensibility, as assessed by determination of the percent change in radius and pressure-strain elastic modulus (stiffness index), was decreased after anatomic correction. This pressure-strain elastic modulus was directly related to the corresponding body surface area and age at banding. In four of five specimens of the anatomic pulmonary arterial wall that were obtained at the time of anatomic correction, fragmentation and shortening of elastic fibers were observed. The histoligic characteristics of the pulmonary root in the patient with the smallest body surface area at banding and normal distensibility of the anatomic pulmonary/functional aortic root before and after anatomic correction revealed normal aortic configuration of the elastic tissue. The results of this study support the policy of an earlier pressure loading of the anatomic pulmonary root in patients with simple transposition of the great arteries by banding and/or anatomic correction. Circulation 70, No. 2, 202-208, 1984

No abstract

Volume parameters of 63 left (LV) and 50 right ventricles (RV) were calculated from bi-plane angiocardiograms of infants, children and adolescents. Seventeen of the LV were from patients who were normal or had only minor abnormalities, 26 were from patients with atrial septal defect and left-to-right shunt less than 170% and 20 were from patients with pulmonary stenosis and pressure gradients less than 50 mmHg. Sixteen of the RV were from patients who were normal, 6 from patients with slight aortic regurgitation, 17 from patients with aortic stenosis or coarctation and pressure gradients less than 30 mmHg and 11 from patients with patent ductus arteriosus and left-to-right shunt less than 60%. The ejection fraction (EF) of RV [0.626 +/- 0.050 (SD)] was smaller than that of LV (0.711 +/- 0.064). There was no significant correlation (p greater than 0.05) with body surface area (BSA) (LV: r = -0.055; RV: r = -0.063) or heart rate (HR) at rest (LV: r = 0.197; RV: r = 0.179). However, EF correlated significantly with the endsystolic volume (ESV) (normalized for BSA1.22) (LV: r = -0.82; RV: r = -0.72), but not with the normalized enddiastolic volume (EDV) (LV: r = -0.05; RV: r = -0.22). For LV as well as RV, EDV and ESV, stroke volume and LV mass were proportional to BSA1.22. In contrast, the cardiac output, being the same for RV and LV, increased in proportion to BSA. There was, however, a significant correlation (r = 0.465; p less than 0.001) between cardiac index (CI) and HR at rest. At 100 beats/min CI was 4.57 +/- 0.88 litre/min/m2. The evaluation of the spatial position of LV and RV yielded a significant descent (about 18 degrees) of both ventricular apices relative to their respective semilunar valves during the period of growth. In patients with atrial septal defect (mean shunt 86%), the apex of the normal LV was shifted posteriorly by 20 degrees. These data may contribute to our understanding of the physiology of normal circulation and heart function during the period of growth.