Gerbode defect, left ventricular to right atrial communicationLeft ventricular to right atrial (LV-RA) communications were first described in the 19th century by Thurman. 1 It was not until 1958, however, that interest in this lesion was renewed following the publication by Gerbode et al. 2 of a series of five patients who underwent successful surgical repair. We present herein a case of an acquired Gerbode defect discovered in a young female during pregnancy.A 30-year-old asymptomatic female was referred to our hospital's cardiology clinic for evaluation of a murmur discovered by her obstetrician in her 18th week of an otherwise uncomplicated pregnancy. At the age of 17, the patient underwent operative repair of a perimembranous ventricular septal defect (VSD). She remained asymptomatic postoperatively and did not seek medical attention until she became pregnant. On examination, there was wide splitting of the second heart sound and a grade 3/6 systolic murmur which was best heard along the left sternal border. A 12-lead electrocardiogram demonstrated normal sinus rhythm at 75 beats per minute with an incomplete right bundle branch block.

Hydrocephalic women with cerebrospinal fluid shunts are now surviving to reproductive age. Twenty-one pregnancies in 18 patients with shunts, including 11 from the present series and 10 from previous series, were analyzed for neurological, obstetrical, and perinatal outcome. Fourteen women had preexisting shunts, and 4 had the onset of symptomatic hydrocephalus and the placement of shunts during pregnancy. Neurological complications occurred in 13 of 17 (76%) pregnancies in patients with preexisting shunts, including symptoms of increased intracranial pressure (ICP) in 10 of 17 (59%) pregnancies, exacerbation of seizure disorder in 2 of 17 (12%) pregnancies, and severe headaches without increased ICD in 1 patient. In 7 of 11 (66%) of the symptomatic patients, symptoms spontaneously resolved postpartum. Four of 17 (23%) of these pregnancies were associated with shunt obstruction requiring antepartum or postpartum surgery. Four patients had a primary shunt placement, and one had a shunt revision during pregnancy without complications. There were no unusual obstetrical or perinatal complications in the series. The clinical management of pregnant patients with hydrocephalus should include preconception counseling and magnetic resonance imaging, as well as the use of serial antenatal magnetic resonance images, ICP monitoring, or the judicious use of radioisotope studies of shunt patency if signs of increased ICP appear. A cesarean section is recommended for the delivery of the neurologically unstable patient. For asymptomatic mothers, a vaginal delivery with a shortened second stage and prophylactic antibiotics are advised.

SUMMARY The cerebral function monitor (CFM) is a monitoring device which records integrated encephalograms (EEGs) on slow‐running paper, allowing continuous observations of cerebral activity for prolonged periods. The CFM was assessed in 49 normal neonates of different gestational ages and was found to reflect EEG activity accurately. Gestatibnal age and sleep‐wake states could be differentiated and normal patterns were defined. The establishment of normal patterns will allow further assessment of the CFM as a screening tool for the neonate at risk for cerebral hypoxic ischemic injury. RÉSUMÉ Moniteur des fonctions cérébrales chez les nouveau‐nés. I: Schémas normaux Le moniteur des fonctions cérébrales (CFM) est un appareil de monitoring qui enregistre des encéphalogrammes (EEG) intégrés, sur papier à déroulement lent, permettant des observations continues de l'activité cérébrale pour des périodes prolongées. Le CFM a été apprécié chez 49 nouveau‐nés normaux d'âge de gestation différent et s'est révélé traduire l'activité EEG avec précision. L'âge de gestation et les états sommeil‐veille ont pu être différenciés et des schémas normaux ont pu être définis. L'établissement des schémas normaux devrait permettre une utilisation ultérieure du CFM comme outil de dépistage chez le nouveau‐néà risque en raison de lesions cérébrales avec hypoxie ischémique. ZUSAMMENFASSUNG Monitor für Cerebralfunktionen bei Neubeborenen. I: Normale Muster Der Monitor für Cerebralfunktionen (MCF) registriert integrierte Encephalogramme (EEG) auf langsam laufendem Papier, wodurch eine kontinuierliche Überwachung der cerebralen Aktivität über lange Zeiträume möglich ist. Der MCF wurde bei 49 gesunden Neugeborenen unterschiedlichen Gestationsalters eingesetzt und registrierte die EEG‐Aktivität sehr genau. Das Gestationalter und die Schlaf‐Wach‐Stadien konnten bestimmt werden und es wurden Normalmuster definiert. Die Definition von Normalmustern wird eine weitere Anwendung des MCF als Screening Gerät bei Neugeborenen mit dem Risiko einer cerebralen hypoxisch ischämischen Schädigung ermöglichen. RESUMEN Monitor de la funcion cerebral en el recién nacido. I: Esquemas normales El monitor de la función cerebral (MFC) es un sistema de monitorización que registra encefalogramas integrados (EEG) sobre un papel de velocidad lenta, lo que permite observaciones continuas de la actividad cerebral durante periodos prolongados. El MFC fue evaluado en 49 recih nacidos normales de diferentes edades gestacionales y se halló que reflejaba con precisión la actividad EEG. La edad gestacional y los estados de sueño‐vigilia podian ser diferenciados y se definieron esquemas normales. El establecimiento de esquemas normales permitira la evaluación futura del MFC como una herramienta de screening para el neonato con riesgo a consecuencia de una agresión cerebral hipóxica isquémica.