Florencio A. Hipona

CONGENITAL TRICUSPID INSUFFICIENCY; A CAUSE OF MASSIVE CARDIOMEGALY AND HEART FAILURE IN THE NEONATE.

Congenital tricuspid insufficiency resulting from a normally inserted but widely dilated tricuspid valve with shortened chordae tendinae is a relatively rare lesion which may produce signs and symptoms of congestive heart failure at birth. This occurrence reflects compromise of fetal circulatory function manifested by volume overloading of the right ventricle and right atrium in the presence of hypertension in the pulmonary circuit. Other congenital defects which may produce marked cardiomegaly and congestive failure at birth have in common severe overloading of the right ventricle. This overloading occurs as a result of tricuspid or pulmonary valve incompetence, underdevelopment of the left side of the heart, or the high output state accompanying a systemic arteriovenous fistula.

Observations on the Natural History of Varicosity of Pulmonary Veins

Pulmonary vein varix was diagnosed by roentgen studies in three patients. One showed enlargement of the lesion in 7 years with progression of heart disease and regression of the varix after correction of the mitral insufficiency. The other two patients without associated heart disease demonstrated no change in the varicosity of the pulmonary vein after 4 and 15 years.

CONGENITAL PERICARDIAL DEFECT ASSOCIATED WITH TETRALOGY OF FALLOT. HERNIATION OF NORMAL LUNG INTO THE PERICARDIAL CAVITY.

Congenital pericardial defect is a rare anomaly with a total of 115 cases in the literature. The two cases discussed are the first reported to be associated with tetralogy of Fallot. The only known case of herniation of normal lung through a pericardial defect into the pericardial cavity is described.

Anomalous origin of the left coronary artery from the pulmonary artery: A clinical spectrum

Abstract Five cases of an anomalous left coronary artery originating from the pulmonary artery have been presented. These illustrate different phases in the clinical spectrum of this anomaly. Two patients who presented with congestive failure and classic signs of myocardial infarction in early infancy underwent surgical ligation of the anomalous vessel. One survived and one died postoperatively, possibly with secondary residual mitral insufficiency as a contributory factor. Congestive failure and a clinical picture of mitral insufficiency developed in one other child at 1 year of age, and she died 10 months later with unremitting failure. Two children who were in failure in infancy, 1 with evidence of myocardial ischemia, have had a benign clinical course since that time. The clinical course and appropriate management of a patient would appear to depend upon the degree of development of the coronary collateral circulation. Some of the factors influencing the adequacy of these collateral vessels are postulated, including the presence of collateral channels at birth and the stimulation of new vessels by ischemia as the pulmonary arterial pressure falls. In those patients in whom the collateral circulation is adequate enough to allow survival, the clinical picture may be dominated by mitral regurgitation resulting from endocardial fibrosis with dilatation of the mitral valve ring.

Early Venous Filling in Cranial Angiography

Early venous filling in cerebral angiography is usually indicative of a primary or secondary neoplasm of the brain. Arteriovenous malformations, accounting for 4 per cent of all brain lesions (1) are a less common cause. With the advent of routine serial angiography, unusual causes of rapid venous filling have been seen. During the past several years we have observed 47 cases of arteriovenous shunting (early venous filling) not due to a primary or secondary intracerebral neoplasm or an arteriovenous malformation (Table I). Our experience with these disease processes is the subject of this report. Early venous filling is said to be present when there is progression from the arterial filling phase to the venous phase without an obvious or apparent intervening arterial emptying or capillary phase. Local or diffuse decrease in circulation time with an orderly progression of the arterial-venous phase also represents early venous filling. Only in this latter situation have we not used the term arteriovenous shu...

Portal Venous System as a Major Collateral in Iliac and Inferior Vena Caval Obstruction

Inferior vena cavography is frequently performed in conjunction with excretory urography and lymphangiography for the evaluation of intra-abdominal or retroperitoneal masses. Collateral circulation occurs in intrinsic obstruction with thrombosis or extrinsic compression of the inferior vena cava. Although frequently mentioned, the portal venous system as a major collateral in lower inferior vena caval obstruction is not commonly visualized at cavography. The purpose of this communication is to report two cases in which the portal venous system was visualized as a principal collateral route. Case I (T. S.): This patient was a 60-year-old white female, gravida V, Para 2, who had Stage IV epidermoid carcinoma of the cervix with urinary bladder involvement in December 1959. She was treated with intracavitary radium (3,000 mg hr.) followed by external radiation of 3,994 R/t/4 wk. The patient returned in February 1961 with recurrent tumor which was treated by an anterior pelvic exenteration and bilateral ureter...

The Role of Pulmonary Angiography in Pulmonary Embolism: A Comprehensive Review of the Roentgen Findings

This paper was presented at the 12th Annual Meeting of the American College of Angiology, New Orleans, Louisiana April 21-23, 1966. We are indebted to James O. Hoppe, Ph.D., Section Head, Department of Pharmacology of the Stering-Winthrop Research Institute for his aid in the study of the contrast media utilized in these procedures. There is substantial evidence that pulmonary embolic disease represents a major cause of death. It has been indicated that pulmonary thromboembolism may be the sole cause of death of 47,000 persons annually in the United States and a contributing factor in three times as many more deaths (2, 5). Studies have been made of pulmonary thromboembolism employing the measurement of blood enzymes, pulmonary scanning after injection of radioactive macroalbumin, and clot detection after tagging with radioactive fibrin or plasminogen (22, 29). There has been critical appraisal of the current medical and surgical therapy now being utilized (27). Observations have also been made of the pharmacological and mechanical effects resulting in bronchoconstriction and vascular constriction associated with acute pulmonary embolism. It is acknowledged that a better understanding of pulmonary embolism in all of its aspects may lead to an early precise diagnosis with institution of proper therapy. A high suspicion and the recognition of the manifestations of the disease in chest roentgenograms are essential. Moreover, it is important to stress that an aggressive approach must be urged with utilization of pulmonary angiography as a necessity for accurate diagnosis and as a guide to proper therapy (1, 32). The papers on pulmonary embolism by Westermark (31), Hanelin (14) and Eyler, Torrance (28), and others have been mainly concerned with the evaluation of the plain chest roentgenograms (9). Fleischner (10) has described these radiologic findings utilizing the terms oligemia to designate diminished blood flow and ~leonemia to designate increased blood flow to the lung. These terms have been utilized subsequently by Chrispin (4) and other authors (20, 23, 25) to describe the roentgen findings associated with pulmonary embolism.

The experimental production of unilateral renal artery injury and hypertension. I. The arteriography of allylamine-induced renal vascular lesions in the dog.

A study of the arteriography of experimentally induced renal arterial lesions requires a reliable method of creating such lesions in a model animal. Previous attempts to produce selective injury of the arterial wall by intra-arterial catheterization technics have been limited to the coronary arteries (8). The present report represents the preliminary studies utilizing selective renal arterial injuries followed by selective severe unilateral renal arteriosclerosis and renal ischemia. The general plan of the investigation has been to observe the effects of intra-arterially injected allylamine on the basic morphologic sequences of the lesions in the renal arteries injured by the drugs administration. The progressive manifestations characterizing the allylamine vascular lesions produced by selective arterial technics have been evaluated by correlative histopathologic studies together with renal angiography, excretory urography, and radioisotopic renograms. Allylamine, CH2=CH-CH2-NH2, an unsaturated aliphatic...

CONGENITAL INSUFFICIENCY OF THE PULMONARY VALVE.

Congenital insufficiency of the pulmonary valve, whether an isolated entity or associated with other intracardiac defects, is rare. The clinical picture varies from one of total absence of symptoms to one in which signs of congestive cardiac failure occur during the neonatal period. One case is presented with 3 normal cusps and a lack of valvular tissue posteriorly through which regurgitation occurred. Such an anatomic variation has not been recorded previously. The characteristic clinical features are discussed as well as roentgenographic findings, electrocardiographic tracings, and cardiac catheterization data which may be of help in making the diagnosis.

The aortic impression in inferior venacavography

Summary A review of one hundred abdominal aortograms showed that in 20 per cent the abdominal aorta curved convexly to the right. Four inferior venacavograms showing impressions caused by a tortuous but non-dilated aorta are presented. The appearance is similar to that noted in retroperitoneal tumours. The nature of the impression may be clarified by aortography.