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Balloon dilation angioplasty was attempted in 10 infants and children with severe congenital or operative "venous" obstructions. In five children the obstructions were "vena caval" and followed repair for transposition of the great vessels (four patients) or orthotopic liver transplantation (one patient). In the four patients with fixed vena caval or baffle obstructions, balloon angioplasty was successful in relieving the obstruction, decreasing the average gradient (16.0 to 4.5 mm Hg), and increasing the average diameter (3.0 to 8.9 mm) of the obstructed site. One child died 1 week later from an unrelated cerebral hemorrhage; the three survivors have had persistent clinical and angiographic improvement. The fifth child had severe systolic narrowing of the superior baffle limb caused by marked tricuspid regurgitation, which ballooned the superior limb of the baffle against the atrial roof. Angioplasty was unsuccessful in relieving this type of obstruction, which resolved with tricuspid valve replacement. Of the five infants with obstructed pulmonary veins, three had congenitally narrowed vessels associated with total anomalous pulmonary venous connection, one had acquired stenosis, and one had postoperative obstruction after repair of a mixed type of total anomalous pulmonary venous connection. Dilation was unsuccessful in all five patients, but for different reasons: in the congenitally narrowed veins, the waist in the balloon could not be eliminated, even with high dilating pressures; in the infant with acquired stenosis, the vein stretched but did not tear at low dilating pressures; and in the postoperative obstruction, angioplasty increased the diameter of the obstruction but did not increase flow to the affected lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Infants born to mothers with disseminated lupus erythematosus occasionally have transient manifestations of the maternal disease. In six infants with congenital heart block born to mothers with systemic lupus erythematosus we postulated a causative relation. In one of the infants a post-mortem study of the conduction system suggested faulty embryonic development of the atrioventricular node with an abnormally thick annulus fibrosus and the effects of early inflammatory changes. Two of the infants had a cardiomyopathy and three, associated congenital heart disease.

SUMMARY . 1 . A technique has been presented for transcatheter closure of a patent ductus arteriosus . 2 . A 3 .5-kg infant has been treated successfully in this manner . 3 . The method should be considered in high-risk patients . 4 . Further miniaturization of the system should make it suitable for use in premature infants critically ill as a result of ductal patency . 5 . Increased experience will likely indicate that the technique is applicable to most patients who require ductus closure . KEY WORDS : Patent ductus arteriosus -Transcatheter closure deviceIn 1907, Munro proposed an operation for closing a ductus arteriosus and described the procedure in detail [3] . It was nearly 30 years before a bona fide attempt was made at surgical closure . Graybiel et at [1] intended to ligate the ductus in a 22-year-old girl with infectious endocarditis, but were able only to apply plicating sutures and did not achieve a lasting success . In 1938, the modern era of surgery for congenital heart disease was inaugurated when Gross et al [3] performed the first successful ductus ligation, Within a few years, many surgeons were duplicating this feat . ; and ductus surgery became commonplace, safe, and effective . Porstmann et al [4] first proved the clinical applicability of trans-