Left-sided Obstruction Research Articles

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A 26-year-old woman developed a mass in the midline of her neck anteriorly, approximately nine months prior to admission. The mass appeared suddenly after mild blunt trauma to the area and had displayed moderate swelling and inflammation on one subsequent occasion. The patient is a heroin addict with a history of many local injection-site abscesses. On examination, the mass was 1.5 × 1 cm, was located at the level of the cricothyroid membrane, and was mobile, doughy, and smooth. Thyroid scan revealed a normal-sized gland with a 24-hour uptake of 8%. The uptake of the right lobe was slightly greater than that of the left. Results of thyroid function studies were within normal limits. The mass was excised, and pathologic sections were taken (Fig 1 and 2). What is your diagnosis? A 38-year-old woman had a sevenyear history of left-sided nasal obstruction and recurrent left epistaxis. Multiple polypectomies were performed,

Alternate pathways to pulmonary venous flow in left-sided obstructive anomalies.

In cardiac anomalies causing severe obstruction in the left side of the heart, such as aortic atresia, mitral atresia, or occasionally severe aortic stenosis, maintenance of circulation depends upon shunting of pulmonary venous blood into the right atrium. The usual pathway by which the shunt is achieved is across the atrial septum through the foramen ovale. When this route is closed or severely narrowed, alternate but less common pathways may exist. These involve either anomalous connections of pulmonary veins to systemic veins or communications with the coronary venous system. In the latter, as commonly occurs in aortic atresia, left ventricular myocardial sinusoids carry pulmonary venous blood from the left ventricular cavity and into the cardiac veins. In other instances of severe left-sided obstruction, a direct communication may exist between the left atrium and the coronary sinus.

Clinicopathologic correlations. Atrial septal defect in infancy: common association with other anomalies.

The atrial septum was evaluated in necropsy specimens from subjects who died under the age of one year. Observations indicated that when an atrial septal defect (ASD) was present, there was commonly an associated condition. In the vast majority, the ASD was at the fossa ovalis and took the form of valvular incompetent foramen ovale. The findings strongly support the concept that an ASD at the fossa ovalis found in symptomatic infants is acquired secondary to the effects of an underlying anomaly. Overloading of the left or right atrium appears to be the mechanism resulting in the formation of an acquired ASD. In infants with various anomalies that cause overloading of the left atrium, such as left-to-right shunts from ventricular septal defect and left-sided inflow obstruction, the incidence of a defect at the fossa ovalis was 18% and 29%, respectively. A similar type of ASD was found in 31% of the cases with right-sided inflow or outflow obstruction.