Aberrant left subclavian artery in tetralogy of Fallot.

The anatomy of the aberrant left subclavian artery in a right-sided aortic arch is different in patients with tetralogy of Fallot than in persons with a normal heart. In all eight patients with tetralogy of Fallot and aberrant left subclavian artery in this series, the left subclavian artery arose directly from the distal aortic arch. In contrast, normal persons with right aortic arch and aberrant left subclavian artery invariably have an aortic diverticulum from which the left subclavian artery and the left ductus arteriosus originate. The possible different embryologic events responsible for these two forms of aberrant left subclavian artery are discussed.

Computer-assisted assessment of the kinetic function of disk-type artificial heart valves.

A simple and accurate computer simulation method was developed to evaluate the geometrical parameters of disk-type artificial heart valves from cinefluorographic recordings. In vitro valve models with preset occluder angles were used to test the accuracy of the method. Linear regression analysis produced slope 1.00055 and intercept 0.0402, with r = 0.999. In vivo reproducibility was tested through repeated measurements, taken several weeks apart, of OMS valves in situ. Regression with slope 1.02 and intercept -0.95, r = 0.95 were found.

Transvenous embolization of internal spermatic veins: nonoperative approach to treatment of varicocele.

Eleven men, shown on routine spermatic venography to have bilateral varicocele, underwent transjugular bilateral embolization of the internal spermatic veins with stainless steel coils or Ivalon plugs. Embolization of the left spermatic vein was successful in 9; in the other 2 it was not attempted because of aberrant drainage of the vein. Embolization of right spermatic vein was successful in 8 patients. There were three complications, none of which was serious. These preliminary results suggest that both internal spermatic veins can be occluded consistently by the transjugular approach. However, it has not yet been established that fertility is improved by detecting and correcting varicocele on the right side.

Persistent truncus arteriosis associated with interruption of the aortic arch.

Five patients with a combination of truncus arteriosus and interruption of the aortic arch are reported. The combination of those defects significantly increases the surgical risk. This rare cardiac malformation can only be diagnosed radiographically. An aberrant right subclavian artery is present in 25% of patients. It is helpful in suspecting the diagnosis from plain films of the chest. The diagnosis can be made from a ventriculogram, but usually a truncogram is necessary to define the anatomy of the aortic arch.

The three types of criss-cross heart: a simple rotational anomaly.

Criss-cross heart is an angiographically confusing malformation where apparent crossing but not mixing of contrast medium is seen at atrioventricular level. The malformation can be understood by a clockwise or counter-clockwise ventricular rotation. In the normal heart or one with complete transposition ventricular rotation is clockwise. With corrected transposition rotation occurs in a counter-clockwise fashion. One case of criss-cross heart with associated corrected transposition and two criss-cross hearts occurring with complete transposition are reported.

Primary liver tumors in the pediatric age group: an angiographic challenge.

Eleven children, ranging in age from three months to fifteen years, with primary liver tumors were examined by large volume direct magnification arteriography (2.5--3 ml of contrast material per 1 kg body weight for a single selective study). The following tumors were found: hepatoblastoma (1), hepatocellular carcinoma of the adult type, hepatoma (3), infantile hemangioendothelioma (4), hemangiosarcoma (1), focal nodular hyperplasia (1) and cystic mesenchymal hamartoma (1). Some of the tumors have a quite typical angiographic appearance as infantile hemangioendothelioma, hemangiosarcoma, cystic mesenchymal hamartoma. The other highly vascular neoplasms show unspecific signs of vascular malignant tumors; subtile angiographic signs may, however, be present and help in the differential diagnosis.

Single ventricle: a new angiographic classification.

The authors recommend that the "single ventricle" be differentiated into two types. There are single ventricles of the left ventricular type, and others of the primitive type; in other words, the chamber is typically left ventricular or cannot be differentiated into left or right. In the latter case we are dealing with a primitive chamber. In addition there may be variations of the large vessels. Of 40 patients with a single ventricle of the left ventricular type, ten showed normal topography of the major vessels, 13 had a d-transposition and 17 an 1-transposition. In the d-transposition, the outflow track of the ventricle was anterior and to the right and the aorta arises in front of the pulmonary artery; in the 1-transposition and sub-aortic portion is anterior and to the left, the aorta is ventral and to the left of the pulmonary artery. In the discussion it is pointed out that the "single ventricle" must be included in the differential diagnosis of cyanotic, congenital heart disease. Angiographic confirmation of the "single ventricle" depends on the demonstration of an absent ventricular septum and of two separate atrio-ventricular valves.

The multiple faces of fibromuscular dysplasia of the renal arteries.

For surgical treatment of patients with FMD of the renal arteries an optimal angiographic study is necessary. Preferably aortography as well as selective magnification renal angiography should be carried out. Oblique views may be necessary to demonstrate the peripheral extension into segmental branches, collateral circulation, the presence of aneurysms, and/or associated complications as AV fistulas, infarctions, intramural hematomas and pseudoaneurysms.

Noninvasive localization of the aortic arch in infants with tracheoesophageal fistula: an experimental study.

For surgical treatment of patients with tracheoesophageal fistulas the localization of the aortic arch is great practical importance. Aortography and CT scanning have been advocated as the radiographic techniques of choice. The location of the aortic arch can be diagnosed on a chest x-ray by the deviation of the trachea alone. A barium swallow is not required. The optimal radiographic technique for this purpose was investigated in phantom studies and tested in animals and newborns. It is proposed that in addition to the standard chest x-ray a high kvp film with hardened beam (1 mm copper -- 1 mm aluminum) be added in order to demonstrate the tracheal deviation. The additional x-ray exposure to the infant is negligible; and the technique is simple, reliable, and noninvasive.

Coarctation of the abdominal aorta.

Coarctation of the abdominal aorta is an uncommon process but an important cause of systemic hypertension. Angiography is the investigation of choice to establish a diagnosis and document the extent of involvement. However, angiography does not provide an etiological diagnosis; and it may not be possible to distinguish an acquired coarctation from a congenital process. Three patients with coarctation of the abdominal aorta are presented.

MR imaging in congenital heart disease: where is the leading edge?

MRI has proved to be a useful tool in the evaluation of congenital heart disease. Two types of information can be gleaned from this new imaging modality. The first has to do with the acquisition of anatomical details which are best retrieved from "static" scanning using a low field strength. We have found magnetic resonance to be superior to angiocardiography and/or echocardiography in gathering anatomical information in the following situations: congenital heart defects having giant compartments; conotruncal malformations; and assessment of surgical results. Secondly, physiological information can be obtained using "dynamic" or cine magnetic resonance imaging, utilizing a high field strength.

Thickness of the descending aortic wall: an unreliable angiographic sign for dissecting aneurysms.

A large fusiform atherosclerotic aneurysm of the aorta with a long, thick, laminated, calcified thrombus mimicked the angiographic appearance of a dissection of the descending aorta with a 20-mm wide thrombosed false channel. Therefore, an increase in the width of the aortic wall exceeding 10 mm may not be a uniformly reliable sign for dissecting aneurysms of the descending aorta.

Takayasu's arteritis. Protean manifestations.

An adolescent girl presented with fever, weight loss, and headache. Despite extensive diagnostic studies, the diagnosis of Takayasu's arteritis was made only after she developed bruits and diminished pulses. Although the initial manifestations of Takayasu's arteritis are often protean and confusing, characteristic clinical and radiographic findings develop after the onset of vascular insufficiency. The chest radiograph may provide an early clue to diagnosis, which can be confirmed by arterial digital subtraction aortography. Physicians should consider Takayasu's arteritis in the differential diagnosis of prolonged fever or weight loss in young females because treatment appears to be more effective when started early.