Partial Anomalous Pulmonary Venous Drainage Research Articles

CARDIAC COMPLICATIONS OF CEREBRAL ARTERIOVENOUS FISTULA IN INFANCY

Four infants with congenital arteriovenous malformation of the vein of Galen are discussed, in each of whom there was clinical or roentgenographic evidence of cardiac involvement secondary to the arteriovenous shunt. Infant 1 was a neonate who presented solely with signs of severe circulatory congestion. The infant died at 48 hours of age despite therapy directed at relief of congestion and improvement of cardiac function. Infant 2 presented during infancy with roentgenographic evidence of cardiomegaly secondary to cerebral arteriovenous fistula. Chest roentgenograms showed decrease in size of the cardiac image after reduction of the fistula. Partial anomalous pulmonary venous drainage was an associated finding at autopsy. Infant 3 underwent operation for complete removal of a cerebral arteriovenous aneurysm, and died 7 hours postoperatively with clinical evidence of circulatory overloaded. In Case 4 cardiovascular studies were done prior to successful reduction of cerebral arteriovenous fistula, and were repeated 4 weeks postoperatively. The shunt was demonstrated by a marked elevation of oxygen saturation of internal jugular venous blood as compared with iliac venous blood; this discrepancy was markedly diminished after operation. Cardiac output was measured by the dye-dilution technique and postoperatively showed a 50% decrease as compared with the abnormally high preoperative determination. The hemodynamic effects of arteriovenous fistula are discussed. The precise mechanisms responsible for the compensatory increase in blood volume are incompletely understood. The increased cardiac output is accomplished by means of augmented stroke volume in accordance with the Starling law of the heart. While phlebotomy may appear to be indicated in an attempt to reduce the circulatory load resulting from a large arteriovenous shunt, it also deprives the patient of a homeostatic response useful in maintaining adequate perfusion distal to the shunt. Digitalis should be administered when myocardial failure contributes to circulatory congestion.

Partial Anomalous Pulmonary Venous Drainage into the Inferior Vena Cava

Partial Anomalous Pulmonary Venous Drainage into the Inferior Vena Cava

The clinical diagnosis of atrial septal defect in children

The clinical features, including electrocardiographic and fluoroscopic examination, have been reviewed in 186 patients with atrial septal defect proved at surgery or necropsy to determine whether or not the site of the defect and the presence of complicating lesions can be recognised by clinical assessment. The electrocardiogram proved to be a satisfactory method of differentiating secundum from primum defects in all but a few patients in whom the mean axis of the QRS complex was indeterminate and the frontal vector formed a flat loop or figure-of-eight pattern about the horizontal plane. The clinical features of ostium secundum defects followed a uniform pattern. Variation from this pattern suggested pulmonary hypertension or a complicating lesion such as pulmonary stenosis, mitral stenosis or ventricular septal defect. The presence of partial anomalous pulmonary venous drainage could not be identified prior to cardiac catheterization. The characteristic feature of persistent ostium primum defects, with or without abnormality of the atrioventricular valves, was the counterclockwise frontal vector with left axis deviation in the electrocardiogram. When the mitral valve was cleft, clinical evidence of mitral incompetence was noted in two-thirds of the patients. Additional signs of tricuspid incompetence were lacking when both atrioventricular valves were cleft. Common atrium was recognised by the presence of cyanosis at rest and left axis deviation of the P wave with a relatively short P-R interval. Patients with common atrioventricular canal had the same type of counterclockwise vector loop at the ostium primum group of defects but the remainder of the clinical features more closely resembled ventricular than atrial septal defect.

Partial Anomalous Pulmonary Venous Drainage and its Surgical Correction

Partial Anomalous Pulmonary Venous Drainage and its Surgical Correction

Surgical Treatment of Atrial Septal Defect and Partial Anomalous Pulmonary Venous Drainage

Surgical Treatment of Atrial Septal Defect and Partial Anomalous Pulmonary Venous Drainage

Situs inversus totalis associated with complex cardiovascular anomalies

Two cases of situs inversus totalis complicated by complex cardiovascular anomalies are presented. In Case 1 the associated cardiovascular abnormalities consisted of an anteriorly located aorta and systemic ventricle, ventricular septal defect, pulmonic stenosis, and partial anomalous pulmonary venous drainage, while in Case 2 a ventricular septal defect and an absent inferior vena cava with functional replacement by the azygous vein were diagnosed. Cardiac catheterization and angiocardiography were utilized in order to obtain accurate preoperative anatomic and functional data. Embryologic aspects and the various cardiac anomalies associated with situs inversus totalis are discussed.

Localization of left-to-right cardiac shunts by dye-dilution curves following injection into the left side of the heart and into the aorta

A technic for the detection and precise localization of left-to-right cardiac shunts is described. It consists of the rapid injection of an indicator dye into the catheterized left side of the heart or into the central aorta and the recording of an indicator dilution curve from a systemic artery or from the heat-flushed ear. In patients without left-to-right shunts the curves consisted of a steep ascent and smooth, rapid descent. When the dye was injected proximal to the origin of a left-to-right shunt the descent of the primary curve was interrupted by the appearance of dye which had been shunted through the pulmonary circulation. Injections distal to the origin of the shunt resulted in normal curves. The technic has been applied in a total of eighty patients. It has proved of particular value in distinguishing: (1) uncomplicated atrial septal defect from atrioventricularis communis or interventricular septal defect; (2) atrial septal defect from partial anomalous pulmonary venous drainage and patent foramen ovale; and (3) patent ductus arteriosus from shunts originating at the root of the aorta.

Partial anomalous pulmonary venous drainage associated with mitral stenosis: Report of a case with surgical correction of both lesions

1. 1. A case of partial anomalous pulmonary venous drainage into the left innominate vein associated with mitral stenosis is reported. 2. 2. Mitral commissurotomy and transplantation of the anomalous vein into the left atrial appendage were successfully performed at one operation. 3. 3. A follow-up of one year is presented.

Anomalous drainage of pulmonary veins: Clinical, physiologic and angiocardiographic features

Three cases of partial and three of total anomalous pulmonary venous drainage into the right atrium or its tributaries are reported and the main clinical, physiologic and angiocardiographic features are discussed. Among the group with partial anomalous pulmonary venous drainage one case was uncomplicated and asymptomatic. The two with symptoms had associated defects; pulmonic stenosis in one and rheumatic mitral stenosis in the other. In the latter patient the demonstration of an elevated pulmonary “capillary” pressure in the normally draining lung as compared to a normal venous pressure in the anomalously draining lung led to a definite diagnosis of mitral stenosis and successful surgical correction of this valvular lesion. All patients with total anomalous drainage of the pulmonary veins had symptoms and two were cyanotic. One forty-two year old patient, the oldest in the literature, was treated previously for a mediastinal lymphoma mistakenly diagnosed because of the roentgenographic appearance of the anomalous veins. Similarity of blood oxygen contents in the right ventricle, pulmonary and systemic arteries is a diagnostic feature of this anomaly. In one patient an attempt to anastomose the anomalous veins to the left atrial appendage had to be abandoned because of the small size of the left atrium. A filling defect produced by turbulence of the contrast material at the site of insertion of the anomalous vein was observed in the angiocardiogram of five of the cases. This previously unrecognized sign was of great value in establishing the diagnosis and permitting differentiation from an uncomplicated interatrial septal defect.

The clinical diagnosis of anomalous pulmonary venous drainage.

Clinical studies are presented in: ( a ) One case of partial anomalous pulmonary venous drainage (right common pulmonary vein into inferior vena cava), and ( b ) four cases of total abnormal pulmonary venous drainage (via "left vena cava" and left innominate vein into the superior vena cava on the right side). One of the latter four cases was verified on exploratory thoracotomy. The diagnosis was based on angiocardiography and heart catheterization, but the conventional chest roentgenogram proved to be quite characteristic of both conditions. The relatively slight impairment of health is stressed in the cases reported here.