Victor Deutsch

Corrected transposition of the great arteries: A modified approach to the clinical diagnosis in 30 cases

Abstract A simplified approach to the diagnosis of corrected transposition of the great arteries is proposed. Patients are divided into 3 groups —those without obstruction to pulmonary blood flow, those with obstruction to pulmonary blood flow and those without associated defects—each presenting a uniform clinical, electrocardiographic and roentgenographic picture. Patients without obstruction to pulmonary blood flow had the clinical findings of a large ventricular septal defect with pulmonary hypertension and a large, predominant left to right shunt. Observations in patients with corrected transposition of the great arteries and with obstruction to pulmonary blood flow clinically resembled those of patients who had a large ventricular septal defect with pulmonic stenosis and a predominant right to left shunt. A case of corrected transposition of the great arteries without associated defects is reported. A review of reports of similar cases revealed that the majority had insufficiency of the left atrioventricular valve or atrioventricular block, or both; very few cases without these latter anomalies were reported. We believe that this group of patients also has distinctive clinical, electrocardiographic and roentgenographic findings.

Subaortic Stenosis (Discrete Form)' Classification and Angiocardiographic Features

The angiocardiographic features of 18 cases of discrete form subaortic stenosis (DSAS) are analyzed and four classifications defined: Type I, a thin membranous diaphragmatic stenosis; Type II, a fibrotic ring stenosis; Type III, a fibromuscular additional tissue stenosis; and Type IV, a tunnel-like stricture of the left ventricular outflow tract. This classification allows the distinction of DSAS from muscular hypertrophic stenosis with which it is often confused. Due to the concomitant finding of aortic insufficiency, the types of DSAS are better recognized if selective thoracic aortography as well as selective left ventriculography are performed.

Bilateral renal cortical necrosis with survival through the acute phase with a note on the value of selective nephroangiography

Abstract A case of bilateral cortical necrosis after an obstetric complication (possibly premature separation of placenta) with survival through the acute phase of the disease, after an almost complete anuric period of forty-one days, is presented. The diagnosis was secured by open renal biopsy. Selective nephroangiography was found to be useful as a diagnostic procedure. Characteristic features seen in the arterial phase were incomplete filling of interlobular cortical arteries and marked filling of the capsular arteries. In the nephrographic phase the renal cortex had a mottled appearance. Early filling of the veins completed the picture. The importance of prolonged treatment with dialysis in cases of bilateral renal cortical necrosis is stressed.

Compression of the coeliac trunk and the angiographic evaluation of its hemodynamic significance

Cases of the recently recognised syndrome of external compression of the coeliac trunk, causing visceral ischaemia in young adults, are reported. A method for the assessment of the functional significance of visceral artery narrowing is described, based on its opacification via collaterals following selective arteriography of a neighbouring artery. The possibility of a varied symptomatology resulting from coeliac insufficiency, and the mechanisms responsible for visceral ischaemia are discussed.

Congenital pericardial defect

Congenital pericardial defect was first described over 400 years ago by Columbus (quoted from Ellis, Leeds and Himmelstein, 1959). Chang and Amory, in 1965, referring to previous publications from 1961 (Chang and Leigh) compiled 112 cases from the medical literature, including their own recent one. The present case report, together with three other recent ones (Baker, Schlang and Ballenger, 1965; Rogge, Mischkin and Genovese, 1966; Varriable, Rossi and Grace, 1967), brings the total number of published cases to 116. Up to the last decade the majority of instances described were observed incidentally at autopsy or during various surgical procedures. In the last decade, however, with the increasing awareness of the lesion, radiological investigations have been the means of detecting such cases. Recognition of this anomaly is of importance because the resulting radiologic appearance may simulate different serious pathological conditions. Two types of congenital pericardial defects have been described in the ...

Renal venography in the diagnosis of agenesis and small contracted kidney

Selective renal venography was found to be the most reliable method in the differentiation between unilateral renal agenesis and non-functioning contracted kidney. Examples are given that demonstrate that all the other diagnostic methods, including abdominal aortography, cystoscopy and retrograde pyelography, may be misleading in the diagnosis of renal agenesis or a non-functioning small kidney. In renal agenesis the lobar veins of the kidney are absent and only the non-renal tributaries of the renal vein, i.e. adrenal and sex veins, are visualized. In a non-functioning small contracted kidney a normal or a diminished-sized main renal vein with its corresponding lobar veins is demonstrated.

Deformed anterior mitral valve leaflet without mitral insufficiency in persistent common atrioventricular canal: Anatomic and angiocardiographic correlations

Abstract The basic anatomic features of persistent common atrioventricular canal are reviewed and correlated with the angiocardiographic features of this anomaly. It is emphasized that selective left ventriculography is the method of choice for diagnosing and assessing the severity of the malformations, and that the left anterior oblique position best delineates the characteristic abnormal attachment of the anterior mitral valve leaflet to the septum. The importance of the preoperative assessment of the mitral insufficiency is stressed, and the difficulties encountered in the diagnosis of it are outlined. Four cases are presented in which selective left ventriculography revealed no evidence of mitral incompetence, despite the presence of a markedly deformed and distorted anterior mitral valve leaflet. Left ventriculography by the transseptal approach may interfere with the mobility of the mitral valve leaflet and may produce an artifactual mitral insufficiency. This may be avoided by using the aortic retrograde approach. It is suggested that, in the absence of mitral incompetence, repair of the mitral cleft should be avoided, since it may hamper the operative results.

The pulmonary vasculature in tetralogy of Fallot (roentgenographic and cardioangiographic analysis in 50 consecutive cases).

In 50 cases of tetralogy of Fallot, the following different patterns in the pulmonary arterial tree were found: (1) Hypoplastic pulmonary arterial tree—44 per cent; (2) Definite evidence of narrowing at the origin of one or both pulmonary arteries—18 per cent; (3) Kinking, simulating obstruction, with post-stenotic dilatation of the left pulmonary artery—16 per cent; (4) Mild stenosis of questionable importance of one of the peripheral pulmonary arterial branches—12 per cent; (5) Mild central narrowing at the bifurcation of the main pulmonary trunk causing apparent dilatation of the main branches—10 per cent. The importance of differentiating between these above findings is pointed out.

Right aortic arch diagnosis in the radiogram of the neonate

Difficulty may be experienced in diagnosing a Right Aortic Arch (R.A.A.) in the neonate owing to the aortic arch being obscured on a plain film and by inability in adequately filling the oesophagus in oesophagograms. The author emphasizes a useful sign viz. the oesophagus is displaced bodily to the left in cases of R.A.A. when the aorta descends on the right side.

Multiple Anomalous Venous Systemic Connections in a Case of Atrial Septal Defect Associated with Right Aortic Arch and Spine Deformities

Multiple anomalies of persistent left superior vena cava and left hepatic vein emptying into the left atrium associated with atrial septal defect, right aortic arch and multiple skeletal malformations are presented. The anatomy and the embryology of these anomalous venous connections are briefly reviewed. Clinical, hemodynamic and surgical implications of these anomalies are discussed.