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[Arteries of the thalamus in man. Choroidal arteries. III. Absence of the constituted thalamic territory of the anterior choroidal artery. IV. Arteries and thalamic territories of the choroidal and postero-median thalamic arterial system. V. Arteries and thalamic territories of the choroidal and postero-lateral thalamic arterial system].

The anterior chor oideal artery cannot be considered as an arterial source for thalamic vascularization. Its territory is primarily pallidocapsular and reaches the thalamus only irregularly and superfically. 2. The posteromedian choroideal and thalamic system, in its infrathalamic portion, gives off lateral mesencephalosubthalamic, inferocentral (for the tips of the arcuate nucleus and the inferolateral part of the centre median nucleus), brachiopulvinarian and posterocentral arteries. In its suprathalamic portion it gives off medial pulvinarian and superomedian thalamic arteries. These arteries irriguate the major part of nucleus medialis and the nucleus anterior. 3. The posterolateral choroideal and thalamic system gives off lateral genicular arteries (for the lateral geniculate body), inferolateral pulvinarian and superolateral thalamic arteries. These arteries irriguate the dorsal part of the interal region of the thalamus.

Arteries

Anomalous left coronary artery from pulmonary artery. Unusual case complicated by coronary arterial disease and fistula from coronary artery to left ventricle.

A 42-year-old woman with an anomalous left coronary artery originating from the pulmonary artery and a fistula from the left coronary artery to the left ventricle was treated by aortocoronary bypass grafting of an autologous saphenous vein. The presence of an abundant collateral circulation and of fistulous communications between the left coronary artery and the left ventricle, in our opinion, was the reason that this patient remained asymptomatic until the age of 40 years. We believe that this is the first report of the findings in an adult patient who had these two rare congenital anomalies complicated occlusive coronary arterial disease.

Adult

Surgical correction of congenital left coronary artery-main pulmonary artery fistula in association with anomalous right coronary artery.

The association of a left coronary artery-main pulmonary artery fistula and an anomalous right coronary artery originating from the main pulmonary artery is the subject of this report. This unique combination of congenital cardiac anomalies establishes a double coronary steal from the left coronary artery, which hemodynamically represents the sole source of myocardial perfusion. The left coronary artery-main pulmonary artery fistula was closed and the coexisting anomalous right coronary artery reimplanted into the anterior aspect of the ascencing aorta. A dual coronary supply was therefore established and thus eliminated the potential threat of total myocardial ischemia should the left coronary artery become critically compromised. Patency of both the left coronary artery and the transplanted right coronary artery was documented 1 year postoperatively by aortic root angiography.

Angiocardiography

Anomalous origin of the left coronary artery from the pulmonary artery with coronary artery steal in adults. Report of two cases and review of the literature.

Patients with anomalous left coronary artery arising from the pulmonary artery rarely survive to adult life. Those who attain adulthood may present with angina indistinguishable from coronary artery disease and are liable to sudden death. Myocardial infarction, though rare in young adults, may occur and may be due to coronary artery steal. Accurate diagnosis requires coronary arteriography. Two further cases of coronary artery steal in adults with anomalous origin of the left coronary artery from the pulmonary artery are presented. In both patients aortocoronary bypass grafting using a reversed autogenous saphenous vein with closure of the origin of the anomalous left coronary artery was successfully performed. This operation provided complete symptomatic relief and may protect patients against the risk of sudden death.

Adolescent

Persistent proatlantal intersegmental artery and occipital artery originating from internal carotid artery.

A case of a combined anomaly of persistent hypoglossal and proatlantal intersegmental arteries, proved on arteriogram obtained by the insertion of a needle into the common trunk of both arteries, is presented. In addition, a case of anomalous occipital artery arising from the internal carotid artery associated with an intracranial aneurysm and arteriovenous malformation is presented. Based upon analysis of the persistent proatlantal intersegmental artery and the anomalous occipital artery, we conclude that both arteries have an identical embryological origin.

Arteries

Cerebral arterial spasm. Part 7: In vitro effects of alpha adrenergic agents on canine arteries from six anatomical sites and six blocking agents on serotonin-induced contractions of the canine basilar artery.

In vitro experiments were performed using a small volume chamber to determine the contractile activity of several adrenergic agents on arteries from six locations of the canine vascular bed. Cumulative log-dose response curves were obtained for epinephrine, norepinephrine, phenylephrine and dopamine. It was found that the basilar and internal carotid arteries responded much less to these agents than did the mesenteric, renal and femoral arteries. Six blocking agents including nitroprusside were tested to determine their effect on the response of the canine basilar artery to log-dose additions of serotonin, prostaglandin F2alpha and KC1. Another chamber was developed to study the differential effect of nitroprusside and papaverine when placed on the luminal side versus the adventitial (cerebrospinal fluid) side of the basilar artery during a sustained contraction with serotonin. A theoretical treatment of cerebral arterial spasm following a subarachnoid hemorrhage is presented.

Adrenergic alpha-Agonists

Management of pulmonary artery sling (anomalous left pulmonary artery arising from right pulmonary artery): a conservative approach.

An anomalous left pulmonary artery arising from a right pulmonary artery and passing between the trachea and oesophagus was seen in seven patients over a period of 20 years. All of them had main airway obstruction. Surgical division and re-anastomosis of the anomalous artery in front of the trachea produced an unsatisfactory result in the first two patients. The only surgical procedure undertaken in the subsequent five patients was division of a ligamentum arteriosum; this formed part of a compressing ring in one patient. Three patients, one of whom had associated tracheobronchial stenosis, became completely asymptomatic. Two others, both with tracheobronchial stenosis, still have symptoms; the older has shown considerable improvement, while the younger is only 7 months old. It is suggested that a more conservative approach to the management of this anomaly is justified. In patients with associated tracheobronchial stenosis, symptoms are most probably the result of that anomaly. Surgical division of the anomalous artery is unlikely to be beneficial, and death from postoperative complications frequently occurs. Surgical division of the anomalous artery in patients with extrinsic tracheal compression should be considered only if life is threatened, as spontaneous improvement can be anticipated. Recent advances in respiratory care should assist in the conservative management of distressed infants.

Adult

The underfilled coronary artery: some pre- and post-operative observations on recipient arterial quality and left ventricular function after coronary artery surgery.

In a series of 141 saphenous vein aortocoronary bypass grafts in 59 patients undergoing routine restudy of the coronary arteries within four weeks of operation, an overall graft occlusion rate of 12% was found. A trend towards a higher occlusion rate was seen in arteries that were small (19%), that had a limited run-off (15%), significant distal disease (24%) or severe atheroma at the graft site (22%). Statistically, these occlusion rates are not significantly different from the overall failure rate and do not give absolute contra-indications to grafting. A particular group of arteries which seemed underfilled in the pre-operative angiogram (1.5 mm or less in diameter but apparently healthy with smooth walls and supplying a larger area of myocardium than would be expected from their apparent size) was identified. These arteries showed a significant increase in diameter in the post-operative angiograms and had a low occlusion rate (1 of 15 grafts; 7%). When all grafts were patent, the mean post-operative left ventricular ejection fraction showed a significant increase over the pre-operative valve, but when one or more grafts were occluded there was no significant change.

Arterial Occlusive Diseases

Surgical possibilities in the third portion of the vertebral artery (above C2). Anatomical study and report of a case of anastomosis between subclavian artery and vertebral artery at C1-C2 level.

A reappraisal of surgical possibilities in the third portion of the vertebral artery (VA) above C2, has been done from an anatomical study on twenty autopsy specimens. A route passing between the internal jugular vein and the Sterno-cleido-mastoid muscle allows a simple approach to the transverse process of C1. After division of two muscles attached to this process, 1.5 cm of the VA can be exposed. For larger exposure of the artery, the foramen transversarium of C1 must be unroofed and the artery dissected in the guttering of the posterior arch of the atlas. This surgical route was used in a case of aneurysmal dysplasia at the C3 level. An anastomosis between the subclavian artery and VA at the C1-C2 level was performed with an autologous saphenous vein graft. The key points are the highest possible freeing of the XI nerve and the head position. Rotation and extension move the transverse process and the posterior arch of the atlas superficially and anteriorly.

Cerebral Revascularization

Anomalous origin of the right coronary artery from the pulmonary artery with large left-to-right shunt (anomalous right coronary artery).

A coronary arteriovenous fistula was diagnosed in a 20-year-old white male because of a continuous murmur atypically located along the left sternal border. Cardiac catheterization revealed a large left-to-right shunt, and selective coronary arteriography established the precise anatomic diagnosis. The patient was treated successfully by surgical reimplantation of the anomalous coronary artery into the aorta and ligation of its origin at the pulmonary artery. The embryological and clinical features of this anomaly are discussed, and mechanisms for its production are suggested. Attention is called to our observation of an apparent male sex predilection of this anomaly from review of the literature, in addition to the present patient. This is apparently the fourth patient with this anomaly whose condition was diagnosed antemortem by selective coronary arteriography and the fourth to have been treated by aortocoronary anastomosis providing an additive supply for both the present and the future. This is also the second case in the literature to have the transplanted right anomalous coronary artery demonstrated by selective coronary arteriography. It is likely that, with increasing use of selective coronary arteriography inthe diagnostic work-up of cardiac patients, more cases will be discovered and treated surgically.

Adult

[Arterial and renal parenchymal histological data in the areas on polar and truncal arteries in arterial hypertension of adult patients].

The Cardiac Clinic reports its experience of 16 cases having unilateral curative renal surgery for hypertension in the adult, and has found a particularly high incidence (8 per cent of all cases). A study has been made of the lesions in the malformed and dysplastic renal arteries on the one hand, and of the correspondingly ischaemic and atrophic renal parenchyma on the other. Attention is drawn to the cases of unilateral renal atrophy (50 per cent of cases), the commonest involving gross lymphoplasia of congenital arterial origin. The other cases are of stenotic dysplasias, and special points to notice are the spread of the dysplasia towards the parenchyma, the presence of multiple aneurysms which militate towards nephrectomy, and the relative frequency of dysplasia of the intima (2 cases out of 8).

Adult

Effect of unilateral pulmonary artery occlusion on the arterial oxygen pressure of children undergoing pulmonary systemic artery shunt procedures.

Of 20 children undergoing thoracotomy who had blood-gas analysis at various intervals during their operative procedure, 18 had congenital heart disease causing cyanosis. The venous admixture was apparent on compressing the lung to expose the mediastinal structures and was diminished upon clamping the pulmonary artery to the exposed lung. This observation may be of clinical value in raising the arterial oxygen pressure when sudden deterioration occurs during performance of a systemic pulmonary shunt in cyanotic children.

Blood Gas Analysis

[The tentorial meningioma fed by "marginal tentorial artery" arising from the external carotid artery--a case report and review of literature (author's transl)].

It is well known that a Bernasconi-Cassinari artery is an important finding at diagnosis of the abnormality in tentorium. Since Bernasconi and Cassinari reported the artery in 1956, many reports have been presented and showed that the artery arose from the intracavernous portion of the internal carotid artery. We presented a 54-year-old female with tentorial meningioma. In selective external carotid angiography, the artery feeding the tumor was revealed arising from the accessory meningeal artery, which came off the internal maxillary artery and passed into the carnium through the foramen ovale, and took the same course of "Bernasconi-Cassinari artery". This angiographic finding suggests that it is possible for marginal tentorial artery to arise from an external carotid arterial system. It is said in the anatomical studies, when the trunk of primitive maxillary artery which is one of maxillo-carotid anastomotic arteries in fetus regresses, "marginal tentorial artery" usually remains linked to the internal carotid artery. But, if this transition of "the artery" from the external to the internal carotid artery failed, it is easily conceived the artery results in the origin of accessory meningeal artery, a branch of the external carotid artery.

Brain Neoplasms

[A case of multiple anomalies of cerebral vessels--fenestration of the middle cerebral artery aneurysm of the anterior communicating artery and arteriovenous malformation on the frontopolar region (author's transl)].

A case associated with multiple cerebral vascular anomalies, which consisted of fenestration of the middle cerebral artery, arteriovenous malformation and aneurysm of the anterior communicating artery, was reported. A 48 year-old male has been suffering from the left paralysis and mental disorder after the initial attack of subarachnoid hemorrhage, and the second attack resulted in the deterioration of the symptoms. He was admitted to our clinic on October 28, 1974. On neurological examination, mental disorders, such as disorientation, emotional incontinence, amnesia and acalculia, hemiplegia on the left and meningeal irritation signs were observed in admission period. Physical examination was negative. Cerebral angiographic findings were as follows: 1) Moderate vasospasm of the right internal carotid artery at the terminal segment, mild bowing of the anterior cerebral artery and stretching of the frontparietal opercular branches of the middle cerebral artery were observed. 2) Right frontpolar arteriovenous malformation fed by the frontobasal artery and the frontopolar artery, and drained via the aberrant cortical vein into the superior sagittal sinus. 3) Aneurysm of the anterior communicating artery was opacified by left carotid angiography. 4) An abnormal vessel derived from the terminal segment of the right internal carotid artery and terminated at the portion of the sphenoidal segment of the middle cerebral artery. Complete loop was formed between genuine middle cerebral artery and this abnormal artery. He was operated with dissecting microscope on November 11, 1974. The arteriovenous malformation at right frontopolar region was totally removed and aneurysm of the anterior communicating artery was clipped. According to the operative findings, the arachnoid membrane over the right frontopolar region was turbid and adhered to the adjacent tissues. On the contrary, no abnormal findings suggestive of previous subarachnoid hemorrhage were observed around the region of the anterior communicating artery aneurysm. These findings showed that subarachnoidal bleeding was caused by rupture of the arteriovenous malformation of right frontopolar region, but not by the aneurysm on the anterior communicating artery. The postoperative course was uneventful and during the hospitalization the patient starts on rehabilitation therapy. The authors discussed the genesis of fenestration of the middle cerebral artery and relation among these combined vascular anomalies. We inferred that fenestration of the middle cerebral artery arose from the in complete fusion of procursor vascular network in embryonic stage. Additionally, we emphasized that it was necessary to make a distinction between these two terms "fenestration" and "duplication".

Cerebral Angiography

Choice of ophthalmic artery branch for Doppler cerebrovascular examination: advantages of the frontal artery.

One hundred normal young adult volunteers were assessed by directional Doppler ultrasound to determine which branch of the ophthalmic artery was most suitable for assessment of the patency of the extracranial internal carotid artery. Each frontal artery of all subjects had normal flow direction and response to compression of the temporal, facial, and common carotid arteries. One supraorbital artery of 2 subjects had reversed flow supplied by the ipsilateral temporal artery and was probably a palpebral artery in each of these individuals. The nasal artery carried reversed flow in 39% of the individuals and was undetectable unilaterally in 2 subjects. From these data we conclude that the frontal artery is the most suitable branch of the ophthalmic artery for Doppler ultrasonic examination. Evaluation of directional flow in the frontal artery and of the influence of compression of all branches of the external carotid artery as well as the common carotid artery is a highly reliable technique to identify significant obstruction of the extracranial internal carotid artery.

Adult

[Relationship between the afferent artery and the site of neck of anterior communicating artery aneurysm, and hemodynamics in the anterior part of the circle of Willis (author's transl)].

Of 346 patients with direct intracranial surgery for an aneurysm of anterior communicating artery that we have experienced from June 1961 to September 1975, 213 patients having sufficient data were selected to study a relationship between hypoplasia of the A1 of the anterior communicating artery, and sites of an afferent artery and a neck of an aneurysm. 1. Ninety seven of 182 patients who had had the bilateral angiography before surgery had hypoplasia of the right A1, 90 of which (92%) had an afferent artery of an aneurysm only in the left A1. All 29 patients with hypoplasia of the left A1 had an afferent artery of an aneurysm only in the right A1. An afferent artery was limited to the dominant A1 in about 95% of them. 2. Angiography revealed that of 204 patients in whom the neck of an aneurysm in the anterior communicating artery was confirmed, 140 patients had hypoplasia of a unilateral A1. The neck of an aneurysm was located at the bifurcation of the dominant A1 and the anterior communicating artery in 48 of the 140 patient (34.3%), at the bifurcation of the non-dominant A1 and the anterior communicating artery in 14 patients (10.0%), and in the anterior communicating artery itself in 78 patients (55.7%). Cerebral angiography revealed that the neck of an aneurysm was more than 3 times greater at the bifurcation of the dominant A1 and the anterior communicating artery than at the bifurcation of the non-dominant A1 and the anterior communicating artery. 3. The above findings suggest that hemodynamics in the anterior part of the circle of Willis may participate in the initiation, growth, and rupture of an aneurysm of the anterior communicating artery.

Adult