Nonstructural heart disease in the newborn. Observations during one year in a perinatal service.

Abstract

SUMMARY One-third of 327 newborn infants referred to the perinatal service of the Hospital for Sick Children during 1975 with suspected cardiopulmonary disorders proved to have nonstructural heart disease. Most of these were term infants with transient tachypnoea or cyanosis who recovered. A history of fetal distress or difficult delivery was commonly associated. The haemodynamic disorder for most was a delay in the normal progress of the transitional circulation. Evidence of myocardial ischaemia was present in 40%, and about half of these developed congestive heart failure. Aids to diagnosis of the ischaemic complication included echocardiography and myocardial perfusion scanning. For a small proportion specific metabolic disturbances, myocarditis, or dysrhythmia seemed the primary cause but even for these there were reasonable grounds to suspect a prenatal origin. Current general supportive measures were of value in treatment.

Cerebral arteriovenous malformation in neonates

“…The occurrence of myocardial ischemia and infarction in newborns without "structural" heart disease and with normal coronary arteries has received renewed attention in the literature in recent years [2,25,26] . Pathologists have shown that widespread myocardial necrosis occurs in infants subjected to birth asphyxia and a variety of hypoxic stresses [2,7,10,15] .…”

“…It has been postulated that this is because the volume overload on the heart is obligatory ; that is, the volume load continues despite increase in pulmonary artery resistance [29] . Myocardial ischemia and infarction sometimes complicate congenital heart anomalies Pediatric Cardiology [12,19] and may also occur in the otherwise structurally normal heart [2,15,[25][26][27] in response to neonatal stress . We investigated the possibility that myocardial ischemia and infarction may be partly responsible for the severe failure in the infant with CAVM .…”

Coronary arterial lesions and myocardial necrosis in stillbirths and infants.

“…If the cardiovascular system is damaged the fetus is compromised. In recent years interest in the myocardial function and reserve in perinatal hypoxia or asphyxia has been growing, and there is abundant evidence that in many instances the myocardium is affected in states of severe hypoxia (Burnard and James, 1961;Rowe and Hoffman, 1972;Rowe et al, 1978). While this may reflect direct myocardial damage in hypoxia (de Sa, 1977), the possibility that damage to the coronary arterial tree may be an important factor does-not appear to have been considered, and the earlier observations of Gruenwald (1949) have passed unnoticed.…”

Structural heart disease in the newborn. Changing profile: comparison of 1975 with 1965.

“…A second group of neonates with nonstructural heart disease are reported separately (Rowe et al, 1978). Table 1 summarises the final diagnoses in the neonates with structural congenital heart disease.…”