Klaus Ranniger

Congestive heart failure from suspected ductal closure in utero

This is the 1st case report of a ductal closure occurring during fetal growth. The case was a spontaneous delivery in cephalic presentation from a 31-year-old gravida 3, para 3 Black woman who had been treated with isoniazid and spreptomycin up to 2 months before her delivery. Gestational age was 37 weeks when the fetus was delivered weighing 3.15 kgm. The cord had been wrapped around the fetuss neck, and breathing was delayed 2 minutes. In the nursery, the babys general condition was poor, and congestive heart failure was diagnosed. The newborn had trieuspid insufficiency, severe heart failure, and acidosis at birth. These disappeared the next day. Hemodynamic studies when the baby was 4 hours old showed a large cone-shaped ductus arteriousus extending from the pulmonary artery but ending blindly at the aortic end.

Angiographic Diagnosis of an Anomalous Right Coronary Artery Arising from the Pulmonary Artery

Abnormal origin of the coronary arteries from the pulmonary artery can occur in four different ways. Either the left or the right coronary artery, both coronary arteries, or an accessory coronary artery may arise from the pulmonary artery. The most frequent of these malformations is the abnormal origin of the left coronary artery. Many publications have dealt with the clinical, physiological, and anatomical picture of this malformation (7). The majority of patients are symptomatic in early life because of marked anoxia of the anterolateral and apical portions of the left ventricle, the result of insufficient intercoronary anastomoses. Some patients, however, may become symptomatic later in life, and in these abundant anastomoses are found between both coronary arteries. From catheterization and angiographic investigations, there is conclusive evidence that the blood flow is directed from the right coronary artery through intercoronary anastomoses into the distal branches of the left coronary artery and fr...

Cor triatriatum in the adult: Complicated by mitral insufficiency and aortic dissection☆

Abstract A case of cor triatriatum, complicated by acquired mitral insufficiency and aortic dissection with survival to the fifth decade is presented. A diastolic pressure gradient was recorded between the left ventricle and the proximal left atrial chamber which was entered by the transseptal catheter, but no transmitral gradient was present at surgery. Indicator, injected in the left ventricle, was not detected during sampling from the transseptal catheter, despite the demonstration of considerable mitral regurgitation by left ventricular angiocardiography. Cor triatriatum should be suspected, even in the adult patient, when such apparently anomalous hemodynamic observations as those present in this patient are encountered.

Control of thoracic dissecting hematoma: Case report with serial aortograms∗

Abstract The medical treatment of the acute phase of dissecting hematoma using the therapeutic regimen of Wheat et al. has been described. The apparent resolution of most of the extensive dissection process with this therapy is emphasized and demonstrated angiographically.

Staging of Lymphoma: Clinical, Radiographic, Scintigraphic, and Histologic Correlations.

Excerpt The usefulness of staging laparotomy has gained acceptance in the evaluation of Hodgkins disease. We report our results in the staging of other lymphomas. Fifty-seven patients (26 males, 3...

Abnormal initial QRS vectors in atrial septal defect

Abstract Vectorcardiograms were obtained with the Frank orthogonal system in 31 cases of secundum atrial septal defect. The previously reported findings of frontal QRS clockwise inscription, terminal slowing and increase of the rightward and anterior QRS forces were observed. In addition, abnormal inscription of the initial QRS vectors was observed. The 5 and 10 msec. horizontal QRS vectors were directed to less than 90 ° in 15 and 21 cases, respectively. These were observed in vectorcardiograms showing marked as well as mild to moderate right ventricular hypertrophy. Analysis of biplane cineangiocardiograms in 16 cases revealed varying degrees of posterior and leftward rotation of the interventricular septum. Positive correlation was observed between this and the direction of the 5 and 10 msec. horizontal QRS vectors ( r = +0.68 and +0.67, respectively). No correlation was found between the initial horizontal QRS vectors and the pulmonary/systemic flow ratio, right ventricular systolic pressure, and pulmonary/aortic systolic diameter ratio.

Pulmonary atresia with aneurysmal systemic-pulmonary arterial anastomosis: an angiographic study.

Abstract A description is given of a 5-year-old girl with a pseudotruncus whose pulmonary blood flow is derived from a single large anomalous systemic artery that feeds into the pulmonary artery via an aneurysmatic connection representing an arterioarterial fistula. The clinical findings related to this vascular fistula were a high-pitched continuous murmur located over the right hemithorax and a circumscribed radiologic density in the right hilar area. The probable origin of this fistula from embryonic vascular connections between the bronchial arteries and pulmonary arteries is discussed.