Maximal exercise stress testing in evaluation of arrhythmias in children: results and reproducibility.
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Biomedical subjects
Publications and source records attributed to I Dimich.
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The indirect measurement of blood pressure in the pediatric population is often difficult or impossible to perform and when values are obtained, they are often unreliable or inaccurate. An accurate measurement of arterial systolic pressure in the upper extremity is obtainable with a properly designed and sized occluding cuff and an ultrasonic device to detect the first Korotoff sound. For the detection of the first Korotkoff sound ultrasonic Doppler devices are superior to the stethoscope. When wider occluding cuffs than usual are applied to the upper extremity, the error of measurement is minimized. A method for accurately measuring end diastolic pressure has yet to be described despite assertions to the contrary.
The systemic arterial blood pressures obtained in infants and children utilizing three indirect measuring devices--Arteriosonde 1010. Infrasonde 3000, Pedisphyg system--were compared to each other and to intra-arterial pressure measured directly. The results indicate that Arteriosonde performs considerably better than Infrasonde; nevertheless, the Arteriosonde values are often only approximations of true systole and diastole. The Pedisphyg system yields accurate, reproducible values for systole; however, the system is not designed to determine diastolic blood pressure.
Operative relief of congenital tunnel subaortic stenosis by means of local incision or excision, or both, has generally been unsatisfactory. The use of a valve-bearing conduit between the left ventricular apex and thoracic aorta offers a predictable means of bypassing the left ventricular outflow obstruction. The procedure was used in a 17 year old girl with an excellent hemodynamic result. The history of operative management with diverting plantation of valved conduits in this position have not been defined, but use of these prostheses appears advisable in severe subvalvular, valvular and supravalvular obstructions that are not readily amenable to predictable and safe surgical palliation. The operation may prove useful in selected cases of idiopathic hypertrophic obstructive cardiomyopathy.
Of 184 patients with acute rheumatic fever and associated mitral insufficiency encountered during a 15 year period, 34 manifested a mid-late systolic murmur or a nonejection click, or both, during the course of follow-up. The mid-late systolic murmur later disappeared in four patients whose condition is now considered normal. In one of the four, systolic prolapse of the mitral valve was demonstrated on an angiocardiogram obtained when the systolic murmur was present. Since disappearance of the murmur there has been no evidence of systolic prolapse on meticulous echocardiographic study of the mitral valve. In another child with angiographically demonstrated systolic prolapse of the mitral valve the systolic murmur has also disappeared, but systolic prolapse is still evident on echocardiographic study. None of the 34 patients with a mid-late systolic murmur manifested the T wave abnormalities commonly associated with the familial variety of mitral valve prolapse.
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