Citations

In complete transposition of the great vessels, survival is possible only when a route of access exists by means of which venous blood may enter the lungs. This report concerns 2 patients in relatively good health in whom a high degree of mixing of venous and arterial blood occurred through an atrial septal defect. The diagnosis was established in both patients by cardiac catheterization.

Congenital insufficiency of the pulmonary valve may result if the valvular cusps develop faultily or fail to develop. It is commonly associated with ventricular septal defect, with or without pulmonary stenosis. Under these conditions a continuous precordial murmur may be present. Less commonly, congenital pulmonary valvular insufficiency may appear as an isolated cardiac malformation.

The relative importance of organic changes and vasoconstrictive influences in the production of increased pulmonary vascular resistance in congenital heart disease is problematic. With use of a grading system previously described, a study was made of the relation between each of the grades of hypertensive pulmonary vascular disease associated with ventricular or atrial septal defects and the change of pulmonary artery blood pressure immediately following closure of the abnormal communications. The immediate reversibility of the pulmonary hypertension varies inversely with the severity of the structural changes.

With use of a previously described system of grading, a study was made of the relation between each of the grades of hypertensive pulmonary vascular disease and the hemodynamic findings in the lesser circulation in 15 cases of atrial septal defect, 19 cases of ventricular septal defect, and 6 cases of patent ductus arteriosus.

In a necropsy study of 50 cases of ventricular septal defects, the anatomic position and relations of ventricular septal defects, the causes of and ages at death, and association of ventricular septal defects with other cardiovascular malformations were determined. The present availability of surgical closure of ventricular septal defects makes this information of practical significance.

The combination of patent ductus arteriosus and coarctation of the aorta poses special anatomic, physiologic and surgical problems. An experience with 14 such cases is presented, which suggests that pulmonary hypertension occurs frequently in these cases. Physiologic data in cases having coarctation of the aorta, patent ductus arteriosus and pulmonary hypertension that underwent cardiac catheterization are presented. Clinical, anatomic, physiologic and surgical implications of this combination are discussed.

Scalar electrocardiograms of 31 patients with double-outlet right ventricle (19 with and 12 without pulmonary stenosis) were correlated with the hemodynamic and anatomic findings. Atrioventricular conduction defects, intraventricular conduction delay, and counterclockwise frontal-plane loops were found less often than formerly reported. Counterclockwise frontal-plane loops were found with, as well as without, pulmonary stenosis. The presence or absence of left ventricular hypertrophy did not correlate with the severity of pulmonary vascular obstructive disease. Electrocardiographic evidence of left atrial enlargement was difficult to interpret. Additional intracardiac malformations could not be appreciated from the electrocardiographic findings. The predictive value of the electrocardiogram for the diagnosis of double-outlet right ventricle was considered to be low. In patients with double-outlet right ventricle without pulmonary stenosis, the electrocardiogram was not helpful in predicting the severity of pulmonary vascular obstructive disease.