[Left superior vena cava communicating with the left atrium. Apropos of 8 cases].
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Biomedical subjects
Publications and source records attributed to A M Worms.
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Fifteen cases of truncus arteriosus have been studied on frontal and lateral views of thoracic X-ray plain film in infants and children. In infants (12 radiological records), the left middle segment is concave or straight, mainly at the lower part and this pattern is typical if associated with an active pulmonary hypervasculature. Cases without marked pulmonary hypervasculature are very difficult to diagnose. On 7 lateral X-ray films we noted three patterns of empty retrosternal space which were visible at birth. In children from 2 to 6 years, a pattern of cardiomegaly with right aortic arch and pulmonary hypervasculature is very typical. In children older than 6 years, we noted a typical Eisenmenger syndrome. The pattern of empty retrosternal space was marked. In our experience, association of right aortic arch with pulmonary hypervasculature is very typical.
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The hypoplastic left heart syndrome is a malformative complex which unfortunately can not be treated surgically. This cardiopathy is the result of a serious embryogenic error and takes into consideration the different anatomic varieties described here. Borderline cases are also noted especially isthmic coarctation of the aorta or aortic stenosis in the neonatal period. Though several years ago, the diagnosis of the hypoplastic left heart syndrome was made only on pathology, it is now possible to make this diagnosis using clinical, laboratory and radiologic examinations. However, they are cases that remain difficult to label precisely, especially in minor forms and we feel that these deserve hemodynamic investigations.
Arterio-venous fistulas are rare in children but usually congenital. We report four cases which are very unusual because of their origin or their localization. We compiled a classification of congenital fistulas which is easily used and collected 582 cases of congenital arterio-venous fistulas from the literature.
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Right-sided aortic arch with a retro-oesophageal segment is much rarer than right-sided aortic arch without a retro-oesophageal segment. As opposed to the latter situation which is always associated with congenital heart disease, it is usually an isolated finding. The left subclavian artery arises from a posterior diverticulum and may be stenosed at its origin, giving rise to a systolic murmur as in one of the reported cases, or to a subclavian steal syndrome. The ligamentum arteriosum completes the aortic ring and may give rise to respiratory problems at varying ages and of variable severity, sometimes attributed to asthma. In one of the cases followed up over 15 years chronic respiratory problems and late tracheal lesions were observed. Although the possibility of a double aortic arch may be raised, early surgical treatment is desirable.
Our case of azygos continuation of the inferior vena cava is very rare because there was no associated heart disease or abdominal situs inversus. The diagnosis of this anomaly of the inferior vena cava should be suspected by observation of a dilated azygos vein on the chest roentgenogram and confirmed by venography.
Arteriovenous fistulae are rarely seen in children and are usually the result of malformations. Three cases are reported which were unusual because of their location and the manner in which they evolved. A simplified classification of these lesions is described and 582 cases from the published literature are reviewed.
The urinary tract visualized on plain abdominal film 10 min after angiocardiography revealed 49 abnormalities of the urinary tract in 680 patients with congenital heart disease (7.2%). The diagnostic value is high, as among the 49 abnormalities 40.9% had no urinary symptoms. 5 abnormalities of the urinary tract required rapid surgical treatment.
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