Wood, Earl H.

This study was undertaken to ascertain whether coarctation of the aorta produces permanent hemodynamic abnormalities that may persist despite resection and end-to-end anastomosis. The results of studies in 10 patients 4 to 7 years after operation are compared to those obtained before and immediately after operation. The most significant finding was continued decrease in residual coarctation, in addition to dramatic immediate postoperative improvement in the degree of circulatory impairment.

Arterial dilution curves of T-1824 have been recorded by oximeters after injection of T-1824 into both the right and left pulmonary arteries in patients with anomalous connections of the pulmonary veins, with atrial septal defects or with persistent common atrioventricular canals. The most extreme differences were found between the pairs of curves in the patients with the anomalous connection. These differences were less pronounced but clearly recognizable in the other conditions, and suggested a more general use of the term "anomalous pulmonary venous drainage. "The findings indicate that, in the usual case of atrial septal defect, a greater proportion of the blood from the right lung passes to the right atrium than does blood from the left lung.

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.

An experience with surgical treatment for atrial septal defects in 59 patients has given evidence as to the safety and efficacy of the procedure utilizing the atrial-well technic. Data from the first 33 cases of this series are presented in detail, to allow analysis by others of the basis for these conclusions.

Evidence is presented which indicates that shunting of small amounts of blood from right to left occurs frequently through interatrial communications. Such right-to-left shunts are of small magnitude in the usual case of atrial septal defect, but it appears that of the fractions of blood shunted, a greater proportion has originated from the inferior vena cava than from the superior vena cava.

A method based on the initial portion of indicator-dilution curves has been used to determine the proportion of blood from each lung which drains anomalously. The results obtained appear to substantiate the derivation and permit the expression, in numerical values, of the greater proportion of anomalous drainage of blood from the right lung in the usual case of atrial septal defect. The principal assumptions pertaining to the method are discussed in some detail.