Vascular origin of Poland syndrome? A comparative rheographic study of the vascularisation of the arms in eight patients.

Vascularization of the arms has been studied by impedance plethysmography (rheography) in eight children with Poland syndrome, a common malformation characterized by unilateral hand anomaly and ipsilateral aplasia of the inferior head of the pectoralis major muscle. A marked decrease of the velocity of the systolic increase in the arterial volume (Velm) was shown in the affected arms, and the difference between the two arms was significantly higher in the patients than in a control group (P less than 0.02). These results, which are also observed in stenotic atherosclerosis, support the hypothesis of hypoplasia of the ipsilateral subclavian artery as the origin of the malformation, although a local anomaly in arterial-wall viscosity cannot be ruled out. The opacification of the aortic arch in another patient confirmed this hypothesis. Aortography in further patients will be necessary to substantiate our results. However, this technique is not without danger and should only be used during the first months of life when a vascular operation can be envisaged.

[The plateau of the apex cardiogram]. / Le plateau du cardiogramme de pointe

The apex cardiogram should normally include a flat part, but when one looks carefully, one may note that this flat part normally includes a flat wave between the descending part from the first summit and the part rising towards the second summit. This is therefore something which occurs in the middle of systole. Now, quite different curves, such as those of ventricular volume collected by rheography or cineangiography, also show a mesodiastolic occurence. As far as clinical medicine is concerned, it is expressed more frequently during proto or telesystole, rather than during mesosystole, which may be totally free of abnormal waves. What thus occurs in mesosystole? This is the question which is raised by these findings]