Laura Knight

Right Aortic Arch Types and Associated Cardiac Anomalies

An analysis was made of 78 pathologic specimens in which a right aortic arch was present. In four, the right arch was part of a double aortic arch. In 74 cases the right aortic arch was the only arch. The cases of right aortic arch could be subdivided into two groups as follows: (1) that with a retroesophageal aortic segment (three cases) and (2) that without a retroesophageal segment (71 cases).The latter cases could be subdivided according to the nature of the origin of the branches of the arch as follows: (1) mirror image branching (60 cases), (2) aberrant left subclavian artery (ten cases) and (3) isolation of left subelavian artery (one case).Congenital heart disease, of which the tetralogy of Fallot was the most common, was observed in each of the cases of right arch without retroesophageal aortic segment. Such an association was seen in one of three cases of right aortic arch with retroesophageal aortic segment and in three of the four cases of double aortic arch.The potential for significant tracheal and esophageal obstruction is present in double aortic arch, in right aortic arch with retroesophageal segment and in right aortic arch without retroesophageal segment but with an aberrant left subelavian artery. In the latter condition, significant esophageal and tracheal compression depends upon the presence of a left-sided ductus arteriosus. This state was observed in five of ten cases with right aortic arch and aberrant left subelavian artery.

Pulmonary artery banding: long-term results in 63 patients.

Sixty-three patients who underwent banding of the pulmonary artery between 1968 and 1975 were studied. Mortality among patients who underwent the banding procedure was 22%, and among those with ventricular septal defect it was 7%. Thirty-eight of the 49 survivors of the banding procedure were investigated for abnormalities of the pulmonary outflow tract caused by the band. Seventy-one percent of these 38 patients had an identifiable abnormality of the pulmonary valve or artery. These complications occurred more frequently in patients banded at a very young age (less than 2 months old) and in patients in whom the band was in place more than two years. Corrective operations have been performed in 24 of the 49 patients who survived banding. Seventy-six percent of the patients with ventricular septal defect survived corrective operation, while only 29% of the patients with more complex lesions survived.

Coarctation of the aorta associated with aortic valvular atresia.

The aortas in 41 specimeans of aortic atresia (ten with associated mitral atresia) were studied for the presence of coarctation of the aorta. The basic lesion, causing varying degrees of obstruction, was observed in 31 instances (75%), 24 minor, seven with major degrees of obstruction. In half, the aortic lesion lay proximal to the ductus, and in the majority of the remainder, opposite the ductus arteriosus. The location of lesion and degree of obstruction was essentially the same whether aortic atresia occurred alone or in association with mitral atresia. Angiography is a fairly reliable method of identifying coarctation associated with aortic atresia. An additional point of interest was that in aortic atresia alone there was strong dominance of the male sex, while this tendency was not observed when mitral atresia was associated with aortic atresia.

Evaluation of retroperitoneum with computerized tomography and ultrasonography in patients with testicular tumors.

Results of CT and US examinations in 24 patients with testicular tumors yielded similar sensitivity and specificity in the diagnosis of enlarged retroperitoneal lymph nodes found at laparatomy. Therefore, the choice of either imaging modality may be influenced by other factors such as presence of abundant bowel gas, post-operative wounds, surgical clips in the abdomen, cachexia or obesity.

Computer tomography, radionuclide imaging and ultrasonography in hepatic mass lesions.

The livers of 86 patients comprising this report were examined by both transmission computerized tomography (CT) and radionuclide scans (LS). Fifty-nine of them were also examined by gray-scale ultrasound (US). In a comparative study, the strengths and weaknesses of each modality were evaluated. CT demonstrated 85%. US 82%, and LS 73% of masses involving the liver. Because of better resolution and sectioning capabilities, together with stop-motion imaging, CT and US detected smaller and deeper mass lesions than did LS. However, LS was more informative in hepatocellular disorders than was US or CT. Our experience indicated that information obtained on the liver and surrounding structures by each imaging modality used here tends to be somewhat unique, and thus these procedures complement one another rather than being competitive.

The effect of valium on myocardial blood flow.

The effect of Valium on coronary blood flow was studied. In 18 patients undergoing coronary angiography, total and regional myocardial blood flow was determined by the 133Xe wash-out technique. A total of 39 pre- and 39 post-Valium injection wash-out curves were constructed. Results indicate (99% confidence) that intravenous Valium injection (0.1 mg/kg body weight) decreases myocardial blood flow 12--15%.

Peripheral Angiograph Enhancement by Long Leg Pneumatic Boots

In patients with arterial occlusive disease it is virtually impossible to predict the speed of blood flow due to the presence of stenoses, occlusions, and collaterals. Repeated exposures and injections can be avoided by the use of pneumatic boots which increase peripheral blood flow by reactive hyperemia, are well tolerated by patients, and decreases the pain associated with injection of contrast material.