A radiographic study of congenital pulmonary atresia with ventricular septal defect

Abstract

A radiographic analysis of 66 patients with congenital pulmonary atresia and ventricular septal defect was made to determine the frequency and variability of the (1) atrioventricular and ventriculoarterial relation, (2) source of pulmonary blood flow, and (3) pulmonary arterial anatomy. Of the 66 patients, 63 had situs solitus and 62 had atrioventricular concordance; the aorta arose from the right ventricle In six, left ventricle in six, and biventricularly in 54. Pulmonary arteries were present and confluent in 41 patIents, nonconfluent in five, absent in 15, and In five patients a mixed distribution to selected areas of each lung existed. In almost half of those in whom pulmonary arteries were present, the source of pulmonary blood flow was from systemic arteries (bronchials) originating from the upper descending thoracic aorta. In some, these collaterals obscured detection of pulmonary arteries when conventional anteroposterior views of the aortogram were made. The use of semiaxial craniocaudal projections and/or selective angiography were required for proper definition. Chest radlographs were correlated with angiographic details and did not permit differentiation of the various subsets of congenital pulmonary atresia from each other nor from classical tetralogy of Fallot. Abnormal central vessels were identifled in 31 patients suggesting this diagnosis. The right or left pulmonary artery identified by angiography was not detected on the plain chest film in about half of the group. Angiograms of the intraand extracardiac details of this group of malformations are presented, correlated with plain chest films, and their surgical implications discussed.