The great arteries in normal and some congenitally malformed hearts their internal calibres and tunica media in relation to blood flow

The road from fertilized egg to newborn baby is a fascinating and complicated one. What happens to eggs that actually come in contact with spenns has been stuclied by many authors and has been summarized by Witschi in 1969. About 16% of the eggs do not cleave, either because they are not penetrated by sperms or because the mitotic mechanism does not function. Another 15% are lost during the first week, at various preimplantation stages ( cleavage and blastocyst stages ). The stage of early implantation and development during the second week brings a further lossof 27%. In the third to sixth week there is a loss of 8% and the late abortion loss is about 3%. Live births will then amount to only 31%. It has been shown that 1-12% of all these newborn children carry some major congenital malformation recognizable at or shortly after birth ( Yerushalmy, 1969; Lilienfeld, 1969 ), Reports of congenital malformations show congenital heart malformations in about 0.8% of total births ( Kerrebijn, 1964; Hoffman and Christianson, 1978 ). In the Netherlands with 177.090 newborns in 1976 this will be about 1400 per year of which 123 were surgically corrected and 416 died in the first year of life ( Centraal Bureau voor Statistiek, 1976, 1978 ). The majority of congenital he'art malfonnations are of rmknown etiology and are believed to be the result of the interaction of environmental and genetic influences ( Nora, 1968 ). The risk for recurrence of the same lesion in cases with an affected parent or sibling is small but exceeds the expectation risk for the same lesion in the general population. Vertical transmission of atrial septal defects through four generations has been described (Lynch et al., 1978 ) . These children bom with congenital heart malfonnations are of special interest to the paediatric cardiologist and cardiovascular surgeon

Congenital arteriovenous fistula between the internal mammary artery and the pulmonary artery

This is the fourth reported case of congenital arteriovenous fistula between the internal mammary artery and pulmonary artery. Precise and complete diagnostic evaluation is required to localize, delineate and appreciate the haemodynamic significance of this type of arteriovenous shunt. A brief review of the literature is given with suggestions for diagnosis

Left ventricular apex-dimension loops in acute myocardial infarction.

Apex-dimension loops may provide useful information in patients with acute myocardial infarction because incoordinate contraction and relaxation can be demonstrated. The method could allow assessment of the effects of therapeutic interventions. Fifty consecutive patients with AMI in the coronary care unit within 48 hours after the onset of their symptoms were studied. Simultaneous recordings of the echocardiogram and apexcardiogram, which were of an adequate quality for analysis, were obtained in only 7 patients (success rate 14%). In all these patients, incoordinate relaxation was demonstrated. A major practical drawback of the method is the time needed for recording the basic data requiring 2 investigators. Therefore, because of the low success rate and difficulties in obtaining simultaneous recordings, apex-dimension loops are not practical in most patients with acute myocardial infarction