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The case histories of two children with echinococcal cysts of the left ventricular myocardium are reported. Both patients underwent successful enucleation of the cysts, after initial local treatment with 0.5 percent silver nitrate solution. A previous review of the world literature on the surgical treatment of echinococcal cyst of the heart, published in 1971, is brought up to date by the addition of 60 new cases to the 118 cases then described. Instillation of 0.5 percent silver nitrate solution into the cyst cavity is now a routine procedure in our institution to sterilize the cyst and to kill the scolices. This substance is preferable to formalin and hypertonic sodium chloride solution, because it acts rapidly and is nontoxic and nonabsorbable. The two children in this report are the first in whom silver nitrate solution was used to sterilize the myocardial cysts.

Experience is presented of paediatric cardiology in a well-equipped and staffed centre during a six-year period in a developing country. Despite the success of the programme in offering first class medical investigation and surgical care to a large number of children, it is estimated that only about 2% of the existing cases in the country were operated upon. The main problems were the large numbers of cases, creating long waiting lists, and the lack of adequately trained paramedical personnel. Although paediatric cardiology in other developing countries is by no means a first priority, thousands of children suffering from heart disease should not be ignored. It appears that establishing similar centres for the care of children with heart disease in those countries is necessary; that they would contribute to patient care and medical education, would uncover the magnitude of the problem and would open ways to its future solution. The possibility of utilization of the facilities in the Western countries must also be considered.

Atrioventricular conduction characteristics were examined by atrial extrastimulus technique in 45 children aged 50 days to 14 years following diagnostic cardiac catheterization. None of the patients had a history of supraventricular tachycardia and none had evidence of pre-excitation on routine electrocardiogram. By plotting the A2H2 and H1H2 intervals against corresponding S1S2 intervals 2 types of conduction curve were obtained. Eight of the 45 children (17.7%) showed discontinuous conduction curves, characteristic of dual atrioventricular nodal pathways, whereas 37 patients had continuous curves. Of the 8 patients with discontinuous curves 3 showed unsustained echo beats following extrastimuli, after the effective refractory period of the fast pathway was reached. This study showed that, as in adults, the atrioventricular node was frequently functionally dissociated in children.