Hu A. Blake

Anomalous Pulmonary Venous Return

One hundred and thirteen selected anomalous pulmonary venous returns have been well documented anatomically. Twenty-seven variations were seen. With the use of simplified diagrams, these have been correlated with related cases in the literature. Emphasis has been placed on transitional forms with one anomaly shading off into the next, rather than upon a series of neat, compartmentalized, classic types of anomalous pulmonary venous return. It is hoped that the broad anatomic spectrum shown will promote additional understanding and interest.

An Unusual Late Complication of Pulmonary Artery Banding

An unusual case is reported in which severe cyanosis developed many months following banding of the pulmonary artery. The obstruction resulted from a thrombus which originated beneath the band and eventually almost completely occluded the main pulmonary artery. The late onset of severe cyanosis following a banding procedure should suggest this rare complication and prompt definitive hemodynamic and angiographic studies.

Traumatic Aortic Aneurysms

Aneurysm of the thoracic aorta may follow severe, nonpenetrating injuries of the thorax unaccompanied by rib fractures. The aneurysms characteristically appear in the first portion of the descending aorta or less commonly in the proximal ascending portion. A large aneurysm, progressive enlargement, or symptoms may necessitate excision or repair. Such repair is now feasible. Traumatic aortic aneurysm should be considered in the differential diagnosis of obscure lesions in the thorax when there is a history of severe antecedent trauma.

Massive Pulmonary Arteriovenous Fistula in the Newborn A Correctable Form of "Cyanotic Heart Disease;" An Additional Cause of Cyanosis with Left Axis Deviation

A case of massive pulmonary arteriovenous fistula, diagnosed and treated in the first week of life is reported. A concept of severely altered intrauterine and neonatal pulmonary blood flow is proposed, with consequent left ventricular overload manifested electrocardiographically by left axis deviation and left ventricular preponderance. Consideration of this malformation in seriously ill cyanotic infantswith a radiographic density and these electrocardiographic changes is essential, since this is a surgically curable lesion.

Unilateral Raynaud's phenomenon caused by cervical-first rib anomalies

Abstract Two cases of a complete cervical rib and one of an anomalous first rib causing subclavian artery thrombosis and distal arm thromboemboli are reported. In each case unilateral Raynaudis phenomenon, believed to be the consequence of small digital emboli, preceded serious thromboembolism by one year or longer. The vast majority of thromboembolic complications of the thoracic outlet syndromes are related to these two rib anomalies, which are usually identifiable on routine chest roentgenograms. Thromboembolism is an unusual complication of an incomplete cervical rib and the scalenus anticus syndrome. Diagnosis is made by arteriographic study of the subclavian artery and the distal circulation. The routine thoracic outlet maneuvers often contribute little to the diagnosis. Therapy consists of surgical removal of the subclavian artery thrombus and restoration of vascular integrity, excision of the cervical or anomalous first rib, transection of the scalenus anticus muscle, thoracocervical sympathectomy and an attempt to remove as much distal thrombus in the brachial-radial-ulnar vessels as possible. Results are optimal only if such surgery is performed before subclavian artery scarring and extensive distal embolization has occurred.