Type D double aortic arch in a five year old boy (with interruption of left arch proximal to left common carotid artery)--with persistent ductus arteriosus and stenosis of right and left pulmonary arteries diagnosed during life is reported. At surgery for P.D.A., the anatomy was confirmed. There was no vascular ring. Types A, B and C double aortic arches with interruption of left arch respectively distal to P.D.A., proximal to P.D.A. and proximal to left subclavian artery have already been reported. Ours happens to be the first case of type D double aortic arch diagnosed ante-mortem and confirmed at surgery.
Chest roentgenograms of 125 patients (115 with pure or predominant mitral stenosis) were studied by the pulmonary arterial angle method to estimate systolic pulmonary artery pressure without prior knowledge of catheterization data. First the angle between the line drawn along the right upper lobe artery and the tangent drawn along the point of junction of superior and lateral borders of the right pulmonary artery was determined. Next the angle between the right middle lobe artery and the descending pulmonary artery is determined. The difference between these angles equals systolic pulmonary artery pressure. Catheter and angle values were identical in 26 patients. There was a 1- to 5-mm difference in 70, a 6- to 10-mm difference in 18, an 11- to 15-mm difference in 8, and a difference greater than 15 mm in 3.
Our improvement on Turner's technique enabled more accurate plain x-ray estimation of pulmonary venous pressure (PVP) up to 60 mm and of systolic pulmonary arterial pressure (PAP) up to 150 mm in 215 patients catheterized for mitral valvular disease. Our improvement comprises (1) five main pulmonary artery (MPA) grades 0 to IV according to its area and volume; (2) modified pressure values assigned for MPA and kinetic energy of the right ventricle (required to pump blood into the pulmonary arterial bed) according to MPA grades; and (3) nine PVP grades from 0 to 8 with corresponding assigned PVP values. These modifications have enhanced the accuracy of the technique up to 85 to 95%.
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