Neonatal asymmetric crying facies, described 75 years ago, is a clinical phenotype resembling unilateral partial peripheral facial nerve paralysis, with an incidence of approximately 1 per 160 live births. The cause is either facial nerve compression or faulty facial muscle and/or nerve development. Spontaneous resolution is expected with the former, but not necessarily with the latter etiology. Approximately 10% of the developmental cases have associated major malformations. Mandibular asymmetry and maxillary-mandibular asynclitism (non-parallelism of the gums) are frequently overlooked visual clues to nerve compression. Ultrasound imaging of facial muscles and electrodiagnostic testing may be useful for differential diagnosis and management.

At operation the hemodynamics of the left side of the heart were studied in six patients without mitral stenosis, and in eight patients with mitral stenosis, by means of simultaneous needle puncture of the left atrium, left ventricle, and aorta. This technic permits analysis of the various phases of the cardiac cycale in normal subjects and in patients with mitral stenosis. The fundamental hemo-(lynamic expression of mitral stenosis is the presence of an elevated left atrioventricular filling pressure gradient, which ranged from 4 to 20 mm.Hg, and after valvulotomy fell in relation to the adequacy of the procedure.O UR knowledge of the human cardiac cycle has been retarded by the inability to study completely the hemodynamics of the left side of the heart. The technique of venous catheterization, which has contributed so much to an analysis of events in the right side of the heart of man1-3 does not permit the direct study of the left heart chambers except in isolated instances of congenital communications between the right and left cavities.Previous investigation of the left side of the circulation has been carried out primarily through animal experimentation.

A rare and striking echocardiographic finding with color-flow Doppler--visualization of intercoronary collaterals within the ventricular septum--in an asymptomatic 5-year-old girl is reported. It strongly suggests anomalous origin of the left coronary artery from the pulmonary artery. Several additional echocardiographic features can secure the diagnosis and allow one to proceed with surgical correction without confirmatory cardiac catheterization and angiocardiography. The ages of our patient and of the seven cases reported previously suggest that these collaterals will more likely be identified beyond infancy and in relatively asymptomatic patients with this congenital anomaly.

No abstract

Cardiac catheterization and angiocardiography through the umbilical artery and vein were performed in the first 10 days of life on 50 infants with serious congenital heart lesions. This procedure has been diagnostically effective and presents minimal risk to the critically ill newborn. The methods, effectiveness, advantages, limitations, and complications of this procedure are discussed.