The genetic testing and genetic screening of children are commonplace. Decisions about whether to offer genetic testing and screening should be driven by the best interest of the child. The growing literature on the psychosocial and clinical effects of such testing and screening can help inform best practices. This technical report provides ethical justification and empirical data in support of the proposed policy recommendations regarding such practices in a myriad of settings.

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Eight cases of termination of the left superior vena cava in the left atrium are reviewed pathologically and clinically. In three of the five patients who died, pathologic examination revealed three anomalies which, together, are considered to form a developmental complex. The anomalies are (1) termination of the left superior vena cava in the left atrium, (2) absence of the coronary sinus, and (3) an atrial septal defect lying in the postero-inferior angle of the atrial septum. In the two remaining fatal cases, the aforementioned anomalies were associated with persistent common atrioventricular canal. In this situation, the atrial septal defect of the latter malformation was confluent with the atrial septal defect of the anomalous complex described. The coexistence of three anomalies-the left superior vena cava terminating in the left atrium, absent coronary sinus, and atrial septal defect-is considered to result from a single developmental abnormality. This takes the form of failure of complete formation of the left atriovenous fold, that fold which normally develops along the left side of the junction of the sinus venosus and the atrial portion of the heart. Clinically, features of increased pulmonary blood flow, coupled with duskiness of the skin, were the significant abnormalities. When cardiac catheterization was attempted through a right-sided vein, the data revealed a left-to-right shunt at atrial level, while levels of arterial oxygen desaturation were present. Except in cases with coexistent ventricular septal defect, pulmonary hypertension was absent. In each of the four patients in whom cardiac catheterization was performed through a left antecubital vein, the catheter was advanced into the left superior vena cava, left atrium, and left ventricle. This was substantiated by angiocardiography in three of the four patients. In our experience, angiocardiography was the most reliable procedure to substantiate the termination of the left superior vena cava in the left atrium. The present study suggests that, in the absence of pulmonary hypertension, a left-to-right transatrial shunt associated with systemic arterial oxygen desaturation may indicate the presence of a persistent left superior vena cava terminating in the left atrium. Moreover, an atrial septal defect identified surgically as lying in the postero-inferior angle of the atrial septum should suggest that an additional anomaly may be present in the form of termination of the left superior vena cava in the left atrium.

To be distinguished from aneurysm of an aortic sinus (Valsalva) is the rare condition in which an abnormal channel begins in the ascending aorta (above the right coronary artery), bypasses the aortic valve, and leads through the ventricular septum into the left ventricular cavity. This entity, which has not previously been diagnosed during life, to our knowledge, is herein named aortico-left ventricular tunnel. The cases of three patients (aged 3, 5, and 10 years) with this rare condition are described. The clinical, electrocardiographic, and radiological features were similar in each case and resembled those in aortic valvular insufficiency. The diagnosis may be established clinically through selective aortography. This reveals that the origin of the abnormal communication lies in the anterior wall of the ascending aorta above the levels of the coronary arterial origins. The abnormal communication leads to the left ventricle. The condition is distinguished from aortic sinus aneurysm by its origin above the level of the aortic sinuses. Identical anatomical findings and the presence of abnormal physical findings since infancy in each of the three patients suggest that this peculiar condition is a congenital malformation.

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