248 i.IFEHA:URt RE’dr’v-,:

normothermic ischemia. IIearts were divided unto three groups on

reperfusion; controls. dobutamine treated. or pyruvate treated.

Postischcmic function was 779 of prei\chemicvaluea in the control group and Ireturncd to preischemic level\ in hoth dobutaminc and

pyruvate groups. Cellular magnesium was elevated significantly in the control postischcmic hearts compared with prrischemic, posti-

schemic dobutamine. and pyruvate hearts. Impaired contractile function in the postischemic “stunned” heart is associated with

increased intracellular magnesium levels. which decline with inotro- pit agent-improved contractile function.

Horner SM: Efficacy of intravenous magnesium in acute myocardial infarction in reducing arrhythmias and mortality. Meta-analysis of magnesium in acute myocardial infarction. Circulation 86:774-779,1992

A me&analysis of eight randomized controlled trials of intrave-

nous magnesium in acute myocardial infarction involving 930 patients was performed. Admmistration of magnesium was associ-

ated with an approximately 50% reduction in the incidence of ventricular tachycardia and fibrillation. cardiac arrest, and mortal- ity. The odds ratio for development of ventricular arrhythmia or

mortality after magnesium administration was reduced in the majority. hut not all. of the studies. The mechanism of magnesium’s effect is unknown.

Schranz D, Zepp F, Iversen S, et al: Effects of tolazoline and prostacyclin on pulmonary hyperten- sion in infants after cardiac surgery. Crit Care Med 20:1243-1249,1992

Fourteen of 42 infants who underwent cardiac surgery for congenital heart disease and pulmonary hypertension, monitored

with pulmonary artery pressure catheters postoperatively. required treatment of persistent pulmonary hypertension or acute hyperten- sive crises. Tolazoline (0.5 mg/kg bolus followed by 0.5 mg/kg/h

infusion) decreased pulmonary vascular resistance hy 45% in 7 infants. In the 7 nonresponders to tolazoline, prostacyclin (5 to 10

ngikglmin infusion) reduced pulmonary vascular resistance by 43qi.

Peters NS, Somerville J: Arrhythmias after the Fontan procedure. Br Heart J 68:199-204,1992

The determinants and outcome of arrhythmias after the Fontan-

type operation were studied in 60 patients. Nineteen patients had arrhythmias within 7 days after operation and of these 11 (58%) died. Atria1 fibrillation and His bundle tachycardia were always fatal. Previous atrial fibrillation is now regarded as a relative

contraindication to this procedure. The incidence of early arrhyth- mias was higher and they were less well tolerated in patients with

double-inlet singleventricle. Late arrhythmias developed in 37% of the hospital survivors, and were associated with higher RA pres-

Niemelti MJ, Airaksinen KEJ, Tahvanainen KUO: Effect of coronary artery bypass grafting on cardiac parasympathetic nervous function. Eur Heart J 13: 932-935,1992

In patients with corcmap artery disease. and alter myocard~ai

infarction. a reduction m heart rate variability (HRV) is a predictor

of mortality. HRV was studied in 35 patients before and I week after (‘ABC; surgery. Significant reductions in all spectral camp”-

nents of HRV and in the heart rate response to deep breathing. a

standard test of cardiac parasympathetic control. were found after

surgery. In the 26 patients who were reexamined at 6 week\ after

surgery. there wah no recovery of the medium or high-frequency powers in IlRV. The prognostic significance of this derangement ot

autonomic heart-rate control after CABG remains to he deter- mined. hul It mav contribute to the phenomenon of unfavorable

sinus tachycardia.after (‘ABC;.

REVIEW ARTICLES

Weintraub R, Shiota T, Elkadi T, et al: Transesoph- ageal echocardiography in infants and children with congenital heart disease. Circulation 86:711-722,1992

Miniaturization of probes and recognition of its diagnostic value

have led to the widespread use of transesophageal echocardiogra-

phy (TEE) in pediatric cardiac patients. This review focuses on the common indications for TEE in the pediatric population. Authors

categorize indications for pediatric TEE as diagnostic (both preoperative and postoperative). intraoperative. and as an adjunct to interventional catheterization procedures. The role of intraoper-

ative TEE monitoring is described for septal defects, atrioventricu- lar valve repairs, repair of tetralogy of Fallot, atrial and arterial

repair of transposition. and cavopulmonary shunt and Fontan procedures. Elegant photographs include color Doppler images of

many examples.

ACKNOWLEDGMENT

Papers reviewed in this issue were selected from those published

in the following journals: Armulr of Thoruc~c Surges, British Heart Journal, Circulation, Critical Cure Medicirle. European Heart Journul, Journul oj’ifnesthesia (Japan), Journal qf Thoracic and Cardiovascu- lar Surgery, Journal of Vuscular Surgen’, New England Journal of Medicine, Surges, Thrombosrs trml ffmvuxta.si.s. und Va,scular S/u- gety.

Contributions to the Literature Review in the issue were made

by Dr. J.G. Bovill. Leiden, The Netherlands and Masao Fujita. MD, Tokyo. Japan.