Conduction disturbances have been documented after correction of ventricular septal defects by the ventricular route. Recently, repair of the ventricular septal defect has been through the right atrium to overcome damage to the conduction system and a right ventriculotomy. Thirty-nine children with ventricular septal defects under the age of 5 years were operated upon by the atrial route (group 1). The incidence of conduction disturbances in this group was compared with that occurring in 19 children of comparable age with a ventricular septal defect repaired via a right ventriculotomy (group 2). Complete right bundle-branch block developed in 13 of 39 children (33.3%) in group 1, compared with 15 of 19 children (78.9%) in group 2. This was a statistically significant reduction in complete right bundle-branch block in group 1. The incidence of left axis deviation occurring with complete right bundle-branch block was similarly statistically reduced. Transient complete heart block and arrhythmias were not statistically different in the two groups. The atrial approach to the repair of the ventricular septal defect significantly reduced the incidence of complete right bundle-branch block alone and occurring with left axis deviation.

SUMMARY The efficacy of treatment with spironolactone for congestive heart failure secondary to congenital heart disease was studied in 21 infants under 1 year of age. All received digoxin and chlorothiazide. In addition, group A (n = 10) was given supplements of potassium and group B (n = 11) received spironolactone. Daily clinical observations of vital signs, weight, hepatomegaly, and vomiting were recorded. Paired t test analysis showed significant reduction in liver size and weight (P< 01) and respiratory rate (P< 0 05) in group B, and less significant decreases in group A. The incidence of vomiting was slightly lower in group B. We conclude that the addition of spironolactone hastens and enhances the response to standard treatment with digoxin and chlorothiazide in infants with congestive heart failure.Spironolactone, a pharmacological antagonist of the adrenal mineralocorticoid,l has been used for some years in the treatment of congestive heart failure (CHF). By competitively binding to specific nuclear macromolecules in the distal convoluted renal tubular cells, this agent inhibits aldosterone's regulatory effects on electrolytes, increasing sodium excretion and decreasing potassium excretion.2 Spironolactone is particularly effective in the treatment of patients with CHF who are taking diuretics, because it neutralises the kaliuretic effect of the thiazides and enhances natriuresis.We have used spironolactone in the treatment of CHF for about 10 years at this hospital. However, its use in infants has been poorly documented. We therefore wished to compare the efficacy of spironolactone with that of a conventional potassium supplement, given in conjunction with digoxin and diuretic, in infants who had CHF secondary to congenital heart disease. Patients and methods

IntroductionChronic obstructive pulmonary disease (COPD) is an inflammatory disease associated with comorbidities including periodontitis.1–2 Periodontitis is characterised by plaque build-up, anaerobic bacterial overgrowth and gingival inflammation which promotes recruitment and activation of neutrophils leading to alveolar bone destruction and tooth loss. However, the characterisation of periodontitis varies between studies causing some uncertainty of any association.AimTo determine whether clinical indices of periodontitis affects its prevalence in COPD patients with and without Alpha-1-antitrypsin deficiency (AATD) and any association with lung function.Methods108 COPD and 63 PiZ AATD patients underwent dental examinations and lung function testing as part of an EU FP7 cross sectional study.Varying definitions of periodontitis used in previous publications were applied; including criteria from the Centres for Disease Control and Prevention in collaboration with the American Academy of Periodontology CDC-AAP (CDC-AAP) and 5th European Workshop in Periodontology.Periodontal indices of probing depth (PD – depth from gingival margin to the base of periodontal pocket) and clinical attachment level (CAL – distance from the cemento-enamel junction to the gingival margin plus probing depth) were then compared to lung function parameters.ResultsThe prevalence of periodontitis varied depending on the definition used.Prevalence ranged from 0.7–98.6% for the whole cohort, with the lowest prevalence for average probing depth >4 mm, but CDC-AAP criteria gave a prevalence of 84.2% and 98.6% with the 5th European workshop criteria.Lung function was significantly correlated with indices of periodontitis for AATD patients; see Table.ConclusionsThe prevalence of periodontitis depends on the definition used. PD is a marker of current status, whilst CAL represents cumulative disease activity, rather like current lung function parameters.Periodontal indices are correlated with lung function parameters in AATD patients which could reflect the inflammatory and predominantly neutrophilic pathophysiology leading to excessive tissue destruction in both diseases.ReferencesShen TC, et al. Risk of Periodontal Diseases in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Population-based Cohort Study. Medicine (Baltimore) 2015;94(46):e2047.Chung JH, et al. J Periodontol2016:1–11.Abstract P52 Table 1Relationships between clinical indices of periodontitis and lung function in COPD and AATDSpearman’s Rho and p-valueAverage Probing Depth (PD)Average Clinical Attachment Level (CAL)COPDAATDCOPDAATD% predicted FEV10.085p = NS−0.42p < 0.01−0.03p = NS−0.52p < 0.001% predicted TLCO−0.06p = NS−0.34p < 0.010.01p = NS−0.51p < 0.001% predicted KCO−0.10p = NS−0.30p < 0.05−0.04p = NS−0.42p < 0.01

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