Echocardiographic detection of aneurysms of the interventricular septum associated with ventricular septal defect. A method of noninvasive diagnosis and follow-up.

Spontaneous closure of a ventricular septal defect is frequently accompanied by the formation of an aneurysm of the membranous septum. The exact anatomic basis for such an aneurysm varies. Some arise from redundant tissue from the endocardial cushions or from adherence of the tricuspid septal leaflet to the defect; the origin of others cannot be determined. Echocardiographic studies in 17 patients with the diagnosis of ventricular septal defect revealed in 7 an aneurysm of the membranous septum that was later confirmed by angiography. In no patient was an aneurysm missed or erroneously diagnosed in the echocardiographic study. Echocardiography can be a useful diagnostic and prognostic tool in the long-term management of patients with ventricular septal defect

Prolonged atrioventricular conduction in young children and adolescents. The role of increased vagal tone.

Prolonged atrioventricular (A-V) conduction is often an apparently normal finding in children with or without congenital heart disease. The mechanism is probably vagally mediated and appears to be benign in the majority of cases. Eleven children with first-degree and/or second-degree Mobitz type 1 A-V block were studied by intracardiac His bundle electrocardiography with atrial pacing. Six children had congenital heart disease with left-to-right shunts and 5 had normal cardiac anatomy. In all the patients studied, the A-H intervals were longer than normal. Wenckebach periodicity appeared at relatively long cycle lengths, and in 5 of the 6 patients in whom values could be determined, atrioventriculonodal effective and functional refractory periods were prolonged. With atropine and isoproterenol conduction intervals returned to normal. There was no tendency to develop echo beats with atrial extrastimuli, even when A-H intervals became markedly prolonged. The results of this study suggest that vagal tone plays a significant role in the prolongation of A-V conduction, even in congenital heart lesions that are known to be associated with a long PR interval

Vasovagal syncope in children requiring pacemaker implantation.

Four children presented with episodic loss of consciousness. Two of the children were siblings. Neurologic causes were initially suspected in all but extensive evaluations and EEGs excluded seizures. ECGs in one patient demonstrated first- and second-degree AV block and first-degree AV block in another. The QT and QTc intervals were normal in all. Eyeball pressure in all patients produced profound bradycardia. All patients became asymptomatic after the implantation of pacemakers, although one died 15 months afterward from another cause

Looking for a pattern: Error analysis as a diagnostic assessment for making instructional decisions to promote academic success

We examined the type of errors on multiplication and division computation problems of 326 rising fifth graders enrolled in four elementary schools in Northern Portugal. We further examined whether there was a difference in the number of errors across age and whether there was an association between students' performance on number knowledge and multiplication and division computation problems. Error analysis of students' responses indicated that miscalculation and no attempt to solve the problem were the two most frequent error types. We found that older students made more errors compared to younger students. We argue that knowledge of individual student error types is critical to making sound instructional decisions. Based on the results of the present study, we discuss implications for future research and classroom practice.This research was sponsored by a research award to the second author from the Fulbright U.S. Scholar Program