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Meeting of the American Pediatric Society and the Society for Pediatric Research Pediat. Res. 2: 287-324 (1968) ABSTRACTS Meeting of The American Pediatric Society and The Society for Pediatric Research Atlantic City, New Jersey, May 4, 1968 SPECIAL SECTIONS (APS) Paper submitted to The American Pediatric Society (SPR) Paper submitted to The Society for Pediatric Research 1 The Effects on Fluid and Electrolyte Balance of Angio- FRANgois R. LAMARRE*, Dept. of Pediatrics, cardiography. AARON R. LEVIN*, HERMAN GROSS- Albert Einstein College of Medicine, Bronx, MAN*, EDWARD T. SCHUBERT* and ANGELA C. N.Y. (introduced by Henry L.Barnett). GILLADOGA*, N.Y. Hosp., Cornell Univ. Med- Abnormal hemodynamics in congenital heart dis- ical College, New York, N.Y. (introduced by ease may be responsible for growth retardation. Cel- Mary Allen Engle). lular hypoxia, metabolic alterations and dietary factors Forty-seven studies in 27 patients aged 1 month to are some important factors which have been incrimin- 18 years were performed to determine the acute effects ated in the pathogenesis of this syndrome. We recently of angiocardiography on fluid and electrolyte balance demonstrated that infants in congestive heart failure in infants and children with congenital heart disease. had significantly higher plasma glucose levels at %, 1 Studies were carried out during diagnostic cardiac cath- and 2 hours than normals following an oral glucose eterization. Twelve patients had cyanotic congenital load. Accompanying this impaired glucose tolerance heart disease. Seventy-five per cent Hypaque® (1 ml/ was a significant suppression of insulin release. In the kg body weight) was utilized, the bolus being delivered present study, we investigated glucose metabolism and within one second. Serum control values for sodium, insulin release in children with cyanotic heart disease chloride, potassium, BUN, bicarbonate, osmolality, associated with pulmonary stenosis. Oral glucose toler- pH, hemoglobin and hematocrit were obtained im- ance tests were performed on 34 infants and children mediately prior to the first angiocardiogram and then ranging from 1 month to 16 years of age. Three patient within 5 minutes and 15, 30 and 180 minutes there- groups were studied: 11 normal children, 7 with cyan- after. No fixed pattern was noted in sodium or chloride otic heart disease, and 8 with noncyanotic heart dis- values in the initial period. Osmolality showed a rise at ease. The glucose tolerance tests in the three groups 5 minutes, returning to normal by 30 minutes. BUN, were normal; however, insulin levels of the cyanotic serum potassium, pH, bicarbonate, hematocrit and children were significantly higher (p<0.01) at 1 and hemoglobin all tended to fall dramatically immediately 2 hours than normals and higher at %, 1 and 2 hours after injection; however, these parameters returned to than the noncyanotic children. near normal by 15 or 30 minutes. Patients having re- Since pancreatic secretory activities were reported peat angiocardiograms prior to return of all parameters to be directly related to blood flow, the increased in- to normal showed more pronounced and progressive sulin release in cyanotic cnildren with pulmonary sten- changes. Analysis of data suggests a marked dilutional osis may be due to hyperactivity of the Islets of Langer- and acidotic effect occurring in the first 5 minutes after hans resulting from an increase in systemic blood flow injection of 75 % Hypaque® with normality often being in these children. Abnormal insulin release in children established by 15 minutes and usually present by 30 with cyanotic heart disease may also explain the hypo- minutes after angiocardiography. Hence, repeat angio- glycemic episodes observed occasionally following com- cardiography at shorter intervals than these is to be plete surgical correction. (SPR) avoided, especially in infants in cardiac failure, on digi- talis, and in cyanotic patients, to prevent the possible 3 Relationship Between pH, PQOZ andPoz in the Pul- effects of severe acidosis, hemodilution and hypokal- monary Vascular Bed of the Cat. PETER H. VILES*, emia and to allow recovery from the acute biochemical JOHN T. SHEPHERD* and WILLIAM H. WEIDMAN, insult produced by Hypaque® on fluid and electrolyte Mayo Clinic and Mayo Foundation, Rochester, balance. (SPR) Minn. To study relationships between pH, PcO2 and P02on 2 Abnormal Insulin Release in Cyanotic Heart Disease.pulmonary vessels, isolated cat lungs were perfused GERSHON HAIT*, MARINA A. CORPUS*, and with blood at constant flow and ventilated with 20, 10, 5 and 2.5 % oxygen. Airway and left atrial pressures remained constant. Lactic acid (0.37V) or sodium bi- * By invitation carbonate (0.9M) were infused to alter pH. Pcogwas 288 Abstracts zero or 60 mm Hg (0 or 10 % CO2 in ventilating gases). The diagnosis of viral infection was based on: (1) In six lung preparations with PcO2 °f 0 and pHof7.6, positive cultures for adenovirus in 7 patients (type 3-6, pressor responses to hypoxia were attenuated or absent. type 5-1); (2) positive culture plus significant com- Lowering pH to 7.0 with oxygen tension normal caused plement fixing (C.F.) antibodies in 4 patients (type a mean increase in perfusion pressure (Pp) from 17 to 3-2; type 1 and 5-1); (3) significant change in titre of 25 mm Hg and augmented pressor responses to hypoxia. C.F. antibody in acute and convalescent sera in 16; In six lung preparations with PcO2 of 60 mmHgand pH (4) significant change in C.F. antibody for both adeno- of 7.6, Pp increased from 14 to 26 mm Hg with severe virus and respiratory syncytial virus (RSV) in 2; (5) hypoxia (P02 = 20 mm Hg); lowering pH to 7.0 with significant change in C.F. antibody for RSV in 5. Thus, oxygen tension normal caused Pp to increase from 14 29 had adenoviral disease while 5 had RSV infection. to 16 mm Hg, and near maximal increases in Pp (11 The acute stage was a typical picture of bronchiolitis mm Hg) occurred with Po2 of 40 mm Hg. Assuming with radiological changes in lungs. that an element of pulmonary vasoconstriction, which Nineteen out of 26 survivors of acute bronchiolitis may be caused in part by acidosis and hypoxia, exists in have recurrent episodes of coughing and wheezing re- infants with respiratory distress syndrome, this study quiring 94 hospital admissions and 437 out-patient supports the rationale of treatment directed toward visits. Seven have been placed in foster homes and one repair of acidosis, hypercapnia and hypoxia. is in hospital 12 months after admission because of (Supported in part by USPHS Grants HE-5883 and chronic respiratory failure. Nearly all have barrel- HE-5515.) (SPR) shaped chests and abnormal physical findings in the lungs. Only one has clubbing. Chest x-rays have shown 4 Abnormal Cardiac Rhythms Associated with Con- hyperinflation in 14 and stable, but chronic changes genital Anomalies of the Venae Cavae. KAZUO MOM-in all 19. Three have partial atelectasis of lobe and 4 MA* and LEONARD M. LINDE, UCLA School of have proven bronchiactesis. Medicine, Department of Pediatrics, Division of It is suggested that severe bronchiolitis caused by Cardiology, Los Angeles, Cal. either adenovirus or RSV can lead to chronic disease Electrocardiograms of 43 patients with congenital of the lung. (APS) heart diseases (CHD) and anomalies of the venae cavae were studied. In 26 patients with persistent left superior 6 Hypoxic Constriction of Pulmonary Artery and Vein vena cava draining into the coronary sinus, left axis of in Intact Dogs. BEVERLY C. MORGAN and WARREN frontal P waves between +15 and —30 degrees was G. GUNTHEROTH, Univ. of Washington School found in 35 %. Isorhythmic A-V dissociation with inter- of Medicine, Seattle, Wash. ference was observed in two patients. In nine patients There is general agreement that hypoxia produces with persistent left superior vena cava draining into the pulmonary vasoconstriction. From pressure-flow data, left atrium, there were eight instances of abnormal it is not clear whether the vasoconstriction is pre- or atrial activation. These included a vertical P wave axis postcapillary. The purpose of this study was to estab- between +75 and + 90 degrees in three, extreme left P lish, by direct measurement of pulmonary vein dia- wave axis between —40 and —80 degrees in three, meter, whether pulmonary venous constriction occurs and left atrial rhythm in two patients. In electro- in intact dogs breathing an hypoxic gas mixture. cardiograms of patients with absence of the inferior Eighteen animals were studied following recovery from vena cava and azygos continuation, eight of eleven implantation of dimension transducers (miniature showed left axis of the P wave (between —10 and —80 mutual inductance coils) on a pulmonary artery and degrees). Wandering or shifting atrial pacemaker was pulmonary vein, ultrasonic flowmeters on aorta and observed in six cases. In five control groups of cardiac pulmonary vein, and pressure cannulae in pulmonary patients with presumably normal caval drainage, fron- artery, pulmonary vein, pleural space and femoral tal P wave axis usually fell between +20 and +70 de- artery. Breathing hypoxic mixtures for 10 minutes pro- grees. Therefore, abnormal left or vertical axis of the duced an increase in depth and rate of respiration, frontal P wave, left atrial rhythm, wandering or shift- respiratory alkalosis, a rise in cardiac output, and a rise ing pacemaker and A-V dissociation in patients with in pulmonary and systemic arterial pressure. Pulmon- CHD suggests the presence of either persistent left ary vein pressure and mean intrapleural pressure de- superior vena cava or absence of the inferior vena cava. creased, but distending pressure (intraluminal minus (SPR) intrapleural) in the pulmonary vein rose during hy- poxia due to a greater fall in intrapleural pressure. Vein 5 Chronic Obstructive Lung Disease Following Viraldiameter either decreased or was unchanged in the Bronchopneumonia. P.K.ADHIKARI*, N.V.RAO*, presence of increased distending pressure; thus pul- C.A.FERGUSON*, Department of Paediatrics, monary venous constriction was demonstrated in 15 of University of Manitoba and Children's Hos- 18 experiments.
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