Antoni M. Diehl

Anomalous left coronary artery arising from the pulmonary artery; report of a case and surgical consideration.

Summary 1. The report of a 3-month-old male infant with a left coronary artery arising from the pulmonary artery is presented. The symptomatology and clinical and laboratory findings are given: Operation was attempted to increase blood flow through the anomalous artery. 2. The physiology of this type of coronary artery anomaly is briefly discussed. Attention is directed to several operative procedures that might be used in reinstating an adequate blood supply to the heart.

Lethal tricuspid and mitral regurgitation in Marfan's syndrome∗

Abstract A 4 3 4 month old white male infant with Marfans syndrome had presenting clinical signs and symptoms of progressive congestive heart failure due to severe mitral and tricuspid insufficiency which resulted in death. The classic features of Marfans syndrome that the patient exhibited included arachnodactyly, high-arched palate, floppy ears, iridodonesis and subluxated lenses. Cardiac catheterization and selective angiography documented the diagnosis of severe bilateral regurgitation from the atrioventricular valve. At autopsy, the cystic medial changes seen in Marfans syndrome were observed in the pulmonary artery and aorta. Myxomatous transformation involving the mitral and tricuspid valves, with similar changes within the annulus, and fibrosis of each valve led to the hemodynamic alterations and demise. In all infants and children with otherwise unexplained valvular regurgitation, occult or overt Marfans syndrome should be considered in the differential diagnosis. Furthermore, in infants and children with any of the clinical features of Marfans syndrome careful cardiovascular evaluations should be made to detect valvular insufficiency due to fibromyxomatous abiotrophy.

Hemodynamic complications in tetralogy of fallot after pulmonary valvectomy or infundibulectomy (brock procedure)

Abstract The ultimate goal in treatment of the tetralogy of Fallot is correction of the basic anatomic defects and establishment of normal cardiophysiologic function. The creation of an aortopulmonic communication suggested by Blalock and Taussig 1 and Potts 2 usually results in improved cardiophysiologic function. Relief of the pulmonary stenosis by valvotomy or infundibular resection as proposed and subsequently reported by Brock, Campbell and associates 3–5 corrects one of the anatomic defects. In a group of 25 patients with Fallots tetralogy operated upon at the University of Kansas Medical Center by pulmonary valvectomy or infundibulectomy, 3 individuals have had serious postoperative hemodynamic complications. The present communication reports these in detail and their physiologic explanation.

Nonsurgical correction of a “Frozen” disc valve prosthesis using a catheter technique and intracardiac streptokinase infusion

An immobile disc of a Björk-Shiley valve prosthesis positioned within a right ventricle to main pulmonary artery conduit was restored to normal function through mechanical tugging of a balloon catheter combined with selective right ventricular streptokinase infusion.

Staged Correction of Total Transposition of the Great Vessels

Proper selection of palliative operation for transposition of the great vessels must be based on a careful anatomical and physiological diagnosis. Subsequent correction, utilizing the interatrial baffle technique, is possible with low risk in selected patients.Details of the clinical course of four patients with transposition from birth to total correction are presented.

Transposition of the great vessels. Hemodynamic changes after physiologic total correction.

Abstract Hemodynamic and angiocardiographic studies in three of four patients with complete transposition of the great vessels and who underwent successful Mustard procedure at intervals of eleven and a half to twenty-three months after surgery are presented. Normal hemodynamic findings are correlated with other clinical parameters, namely, body growth, disappearance of cyanosis, and increased exercise ability. The pericardial baffle seems to have kept pace with the growth of the body as evidenced by the normal size of the surgically created new atria. Two patients had small shunts at the atrial level which, however, have not become hemodynamically significant. Longer observation may be needed before final conclusions can be drawn about the suitability of pericardial tissue as a permanent intracardiac baffle. Finally, although this operative procedure is hemodynamically corrective, long-term follow-up studies will be necessary to determine the cardiovascular prognosis.

Unruptured congenital aortic sinus aneurysm with aneurysmal dilatation of the aorta and aortic regurgitation without arachnodactyly

Abstract 1. 1. An unusual case of unruptured congenital aortic sinus aneurysm with aneurysmal dilatation of the aorta and aortic regurgitation without arachnodactyly is reported. 2. 2. Cardiac catheterization and angiocardiographic studies are presented and discussed.