We studied the morphology of the ductus arteriosus in 14 infants, ages 2--90 days. Eight (group 1) had pulmonary atresia (structural and functional) with an intact interventricular septum; six (group 2) had pulmonary atresia with a ventricular septal defect. The inferior angle of the ductus arteriosus at the aortic junction was measured in each patient. In group 1, this angle was obtuse in all but one patient. In group 2, the angle was acute in all. Further study of intracardiac anatomy suggested that in group 1, the obtuse inferior angle of the ductus arteriosus was the result of a late and progressive obstructive phenomenon that allowed normal right-to-left flow through the ductus arteriosus during much of fetal life. In group 2, the direction of ductus arteriosus flow (normally from the pulmonary trunk to the aorta) was reversed, and flowed from the aorta to the pulmonary trunk. This reversal of flow was probably of early onset in the fetus, the aorta receiving the total combined ventricular output, and produced a small ductus arteriosus with an acute inferior angle. It is extremely important not to rule out pulmonary atresia with an intact interventricular septum when aortography in the newborn shows a normal-sized ductus arteriosus with an obtuse inferior angle. Despite existing pulmonary atresia, these patients have neither a hypoplastic right ventricle nor discontinuity of the right ventricle with the pulmonary artery.
SUMMARY Increased filling of aortopulmonary collateral arteries occurs when the descending aorta is obstructed distal to their origin. We used this fact to develop a simple, safe technique for improving angiographic visualization of these arteries. The abdominal aorta is manually compressed against the spine during injection of contrast medium. A slight reflex bradycardia resulted, which probably also enhanced filling of the collateral arteries. In eight infants and children with either pulmonary atresia and a ventricular septal defect or truncus arteriosus communis, excellent visualization was consistently achieved without complication.SURGICAL TECHNIQUES for correction of congenital heart malformations with a single arterial outlet from the heart (pulmonary atresia with ventricular septal defect or truncus arteriosus communis) have been significantly improved. 1-It is important, therefore, to accurately identify all collateral pulmonary arteries as they arise from the aorta and carefully define their course, size and distribution, and the presence and site of stenotic areas.4-9 Previously, this has been possible only by selective catheterization using special techniques or by selective angiography.10 We devised a simple, safe technique that improves visualization of aortopulmonary collateral arteries at any level of the thoracic aorta. Clear anatomic definition of the arteries and their origins from the aorta is possible. MethodsWe studied eight patients with a single arterial outlet overriding a ventricular septal defect and with absent direct connection between the right ventricle and pulmonary trunk.11 1' Six were less than 6 months old and two were 1-2 years old. All underwent routine diagnostic cardiac catheterization under light halothane anesthesia.The procedure consisted of manual compression of the abdominal aorta against the spine. Aortic pulsation was palpated through the abdominal wall and we then observed the amount of compression necessary to raise the proximal aortic systolic pressure by 50-100% ( fig. 1). A similar amount of compression was then used during cineangiography. Compression was started immediately before injection of the contrast medium and was released as soon as possible. The duration of compression did not exceed 8 seconds in any patient. Adequate compression was more difficult in the older children. Formerly, we used 1.5 ml/kg of contrast material; with this technique, visualization is excellent with 0.75-1.0 ml/kg. Results Aortic compression was most useful during aortic root and particularly aortic arch injections, but visualization of aortic collaterals was also enhanced with ventricular injections. In many instances, an initial ventricular injection was performed with the patient in the anteroposterior position to define the origin and course of the major collateral arteries ( fig. 2A). For subsequent angiograms performed by injecting contrast medium into the aorta ( fig. 2B), the patients were repositioned.In all patients, anatomic detail was clearly obtained. The origin a...
Purpose -To evaluate retrospectively stent implantation (SI) in patients with coronary artery disease (CAD) performed in 7 hospitals in Rio de
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.