Jesse E. Edwards

The disease-free wall in coronary atherosclerosis: Its relation to degree of obstruction

Coronary atherosclerotic lesions are more often located eccentrically (70%) than concentrically (30%). In this study, the configuration of eccentric coronary artery atherosclerotic lesions was assessed by means of computerized planimetry in 100 specimens of eccentric arterial lesions. Special attention was given to the relation between the disease-free wall and the severity of obstruction. The mean disease-free wall are length measured between 17 and 23% of the total vessel circumference in eccentric coronary artery lesions that obstructed 50 to 90% of the cross-sectional area. This ratio persisted irrespective of the location of the lesion within the vessel and was not significantly different with vessels of different sizes. The presence of disease-free arcs of coronary artery wall as observed in this pathologic study may relate to three factors in clinical coronary artery disease: The published observations of spasm in segments of arteries harboring structural obstructive lesions may be explained by the frequent presence of uninvolved arcs of coronary artery walls. Multiple views during coronary arteriography are necessary to accurately reflect the degree of obstruction. The results of percutaneous transluminal coronary angioplasty may be influenced by both the disease-free arc and the atheromatous obstruction.

Scimitar syndrome in neonates: Report of four cases and review of the literature

SummaryFour neonates with scimitar syndrome are presented. Three of the cases had congenital cardiovascular abnormalities not usually regarded as part of the scimitar syndrome, namely, ventricular septal defect, abnormalities of the aortic arch, and abnormal relationship of the pulmonary arteries and bronchi. Review of the literature indicates that among subjects of all ages the incidence of additional congenital heart disease is 24%; in patients within the pediatric age group the incidence is about 36% and is highest (75%) among those subjects having diagnostic studies while neonates.

Interruption of the aortic arch with aorticopulmonary septal defect - An anatomic review

SummaryInterruption of the aortic arch may occur with aorticopulmonary septal defect (APSD) as part of a developmental complex. The anatomic details of 46 cases of interruption of the aortic arch with APSD revealed the following characteristics: (1) type A interruption of the aortic arch occurred nearly six times more commonly than type B interruption; (2) the APSD was variable in size and position, conforming to the types previously described; (3) the ventricular septum was usually intact, but a ventricular septal defect was present in six cases and occurred more frequently with type B interruption of the aortic arch; (4) subaortic stenosis was not present in any of the 16 cases in which adequate details were available to make a judgment.The association of APSD with interruption of the aortic arch in infancy is not uncommon. Evaluation of infants with APSD should thus include evaluation of the aortic arch. The occurrence of interruption of the aortic arch with an intact ventricular septum is distinctly unusual. In such cases an APSD should be suspected and sought.

Aneurysm of the fossa ovalis in infants: A pathologic study

SummaryAn aneurysm of the fossa ovalis was identified at autopsy in 17 infants. In each case the aneurysm of the fossa ovalis was considered to have resulted from excessive elevation of pressure in that atrium contralateral to the side into which the aneurysm bulged. The aneurysms were divided into two types: intrinsic (three cases) and extrinsic (14 cases). The intrinsic types of aneurysms of the fossa ovalis were considered to have started in fetal life and were consequences of abnormally narrow states of interatrial ostium II. Each intrinsic aneurysm bulged toward the left. Among the extrinsic types of aneurysm of the fossa ovalis, each was considered to have resulted from the hemodynamic consequences of a congenital anomaly in one side of the heart or other. Six aneurysms of extrinsic type bulged toward the left and eight toward the right. Aneurysm of the fossa ovalis should be included in the differential diagnosis of space-occupying conditions within the atria.

Left-sided anomalies in Ebstein's malformation of the tricuspid valve

SummaryA review of 34 autopsied cases with classical Ebsteins malformation of the tricuspid valves revealed 8 cases with left-sided anomalies. Among these, appearing in 1 case each, were aortic atresia and persistent common atrioventricular canal. The latter 2 conditions were dominant clinically.In the remaining 6 cases the left-sided anomalies were not apparent clinically and probably of no functional significance. These conditions were parachute mitral valve, bicuspid aortic valve, cor triatriatum and pulmonary stenosis, cleft mitral valve, stenosis of individual pulmonary veins, and prolapse of mitral valve.

Epilogue: The pathologist

The pathologist writing an epilogue on postoperative pediatric cardiology reflects in an inverse way on the striking progress that has been made in this field. Mary Allen Engle and Joseph Perloff, who invited me to write this piece, suggested that I concentrate on personal experiences. Thus, I review some experiences of the past 35 years as a pathologist whose work involved the field of congenital heart disease. I shall concentrate on my own experiences and, in doing so, I shall not refer to the specific and significant contributions of others to our present knowledge of the pathology of congenital heart disease. Nevertheless, it would be inappropriate to omit the names of others who, during the period involved, have provided numerous additions to our understanding of the pathologic complexities of the area simply called congenital heart disease. Particular recognition should paid to Maurice Lev, whose work in the field antedates my own. Properly added to Lev’s name are those of Richard Van Praagh, Robert Van Mierop, William Roberts, Jack Titus and Saroja Bharati. In 1946, after almost 4 years of active duty as a pathologist in the Army during and after World War II, I was invited to join the Mayo Clinic staff. Here I found adequate material, a willingness of the institution to aid one in his work and, in particular, an accumulation of people from whom a team, without committee planning, naturally developed. I found those people involved in cardiovascular disease to be generous in sharing their special knowledge and skills with those in other subspecialties, recognizing that interchange of ideas is a stimulus for progress-progress to the point where the total effect is greater than the sum of its parts. Also, the time was ripe for progress.