Abraham Brand’s research while affiliated with Hebrew University of Jerusalem and other places

To determine the prevalence of valvular regurgitation in children (from birth to 14 years old) with structurally normal hearts, the records of 1360 consecutive patients referred for echocardiographic and Doppler examination were analyzed. A total of 461 (33.9%) patients were found to have structurally normal hearts. Flow patterns across the four valves were examined by pulsed, continuous-wave, and color Doppler imaging techniques. Regurgitation was detected in 124 (26.9%). Pulmonic regurgitation was most commonly found and was detected in 101 (21.9%) patients, tricuspid regurgitation in 29 (6.3%), and mitral regurgitation in 11 (2.4%). Aortic regurgitation was not found. Regurgitation of one valve occurred in 106 (23.0%) patients and of two valves in 18 (3.9%) patients. No patient had regurgitation of more than two valves. The prevalence of pulmonic regurgitation increased significantly with age (p less than 0.0001), whereas the prevalence of mitral, tricuspid, and bivalvular regurgitation did not change with age. Valvular regurgitation was trivial or mild in 87% of patients. Thus mild valvular regurgitation is commonly found in children with structurally normal hearts.

Atrial septum aneurysm (ASA), usually involving the region of the fossa ovalis, has rarely been described in children. In this study, the incidence and natural course of this anomaly were prospectively evaluated in 3,500 children referred for echocardiographic examination. ASA was found in 35 patients, 19 female and 16 male (1.0%). Patients were 6 years of age or younger at the time of diagnosis and 18 were neonates. None of the 750 children with normal echocardiograms had ASA. The most common associated lesion was atrial septal defect (ASD), which occurred in 24 of the 35 patients (69%). Other associated cardiac lesions were ventricular septal defect in 10, pulmonary stenosis in 5, patient ductus arteriosus in 4 and coarctation or interruption of the aorta with subaortic membrane in 2. No clinical complications were associated with ASA. Six patients with complex heart disease died. When associated with ASD, the direction of the ASA motion and that of the shunt found by Doppler echocardiography were similar. Fourteen patients with ASD were followed for 0.5 to 4 years. In 8 the ASD closed and in 6 the ASA disappeared. In 6 patients the ASD and ASA persisted until the end of the follow-up (p less than 0.01). Thus, the incidence of ASA in children in this series was higher than previously presumed and usually was associated with other cardiac anomalies, mainly ASD. In children, ASA tends to disappear with age and may have a role in spontaneous closure of associated ASD.

Williams syndrome is a relatively rare, usually nonfamilial disorder, characterized by typical facial features, growth deficiency, mental retardation, microcephaly, variable cardiovascular abnormalities and occasionally hypercalcemia.1–8 The characteristic cardiovascular defects include stenosis, hypoplasia or atresia of major vessels, mainly of the supravalvular aortic segment1–8 and the pulmonary arteries.4 Most cases reported have had a precordial murmur that was related to major defects defined by cardiac catheterization or autopsy.1–8 However, in other cases the clinical condition of the patients did not warrant invasive investigation and the etiology of the murmurs remained speculative.2 The M-mode echocardiographic features of supraaortic stenosis have been described by Bolen et al.5 When 2-dimensional echocardiography was first developed, supraaortic stenosis was reported in a few cases.6,7 In a recent report, severe mitral regurgitation was described in 2 cases with Williams syndrome and myxomotous degeneration of the mitral valve.8 This report presents 6 consecutive patients with Williams syndrome and precordial murmurs in whom echocardiographic and Doppler evaluations were useful for differentiating innocent murmurs from structural abnormalities.

A seven-year-old girl, stung by a scorpion, was hospitalized in a confused state with signs of myocarditis and pulmonary edema. In spite of clinical improvement within 24 h, 14 serial echocardiograms and electrocardiograms performed during a four-month period showed severe changes. There have been no previously published reports of echocardiographic studies showing myocardial changes after a scorpion sting.

Without Abstract

Buckling of the brachiocephalic arteries is a relatively common anomaly.1–4 Until now, this anomaly has been diagnosed during life only by angiography or as a postmortem finding.1–4 To the best of our knowledge, involvement of the innominate artery in pediatric patients has not yet been reported. We present 14 patients with buckling of the innominate artery who were diagnosed by 2-dimensional (2-D) echocardiography and nuclear angiography. In 4 patients angiography was also performed and the diagnosis was confirmed in all.