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Congenital systemic arteriovenous fistula between the descending aorta, azygos vein, and superior vena cana
318
INTERNATIONAL ABSTRACTS
failure. In the absence of any pulmonary arterial flow to the segment, excision is the treatment of choice.--Randall IV. Powell Primary Lung Abscess in Childhood. M. I. Asher, S. Spier, M. Be~and, et al. Am J Dis Child 136:491-494, (June),
1982. Fourteen cases of primary lung abscess in childhood were treated with antibiotics alone. The only organism recovered was Staphylococcus aureus. All the children recovered. Roentgenographic abnormalities took from 6 weeks to 5 years to resolve. Eleven of the 14 children were followed for an average of 9 years after treatment of the abscess. In all children, the clinical status, lung volumes, and expiratory flow rates were normal except in two with asthma. A conservative approach to the management of lung abscess in children is recommended.--J. J. Tepas I11, M.D. Pulmonary Candidiasis in Infants: Clinical, Radiologic, and Pathologic Features. E. G. Kassner, S. L. Kauffman, J. J. Yoon, et al. Am J. Roentgenol 137:707-716, (October),
1981. A retrospective review of autopsy records yielded 15 infants with systemic candidiasis, .14 having pulmonary forms of the disease. Three patients had the bronchopulmonary form with the upper-respiratory tract, tongue, or pharynx colonized and invaded while one infant had the congenital aspiration form. The remaining infants exhibited hematogenous forms: seven embolic and four of the capillaryinvasive form. Initial radiographs revealed small patchy densities which progressed to diffuse consolidation in several days. The consolidation probably resulted from diffuse pulmonary.hemorrhage which occurred in all patients. All of the embolic forms had infected venous catheters or cutdown sites as the portal of entry.--Randall W. Powell
HEART A N D GREAT VESSELS Surgical Repair of Ebstein's Anomaly. G. K. Danielson and V. Fuster. Ann Surg 139:499-504, (October), 1982.
Ebstein's anomaly is a complex malformation with a wide range of pathologic anatomy. It has been treated by various surgical techniques. In 1972, the authors developed a technique for a plastic reconstruction that is based on constructing a monocusp valve of the anterior tricuspid leaflet combined with plication of the atrialized portion of the free wall of the right ventricle, posterior tricuspid anuloplasty, and right atrial reduction. Repair is preferred to valve replacement whenever feasible since it avoids the problems of prosthetic valve dysfunction, anticoagulation, and, in children, the need for replacement of the prosthesis because of growth. Forty-two consecutive patients underwent surgical repair with indications including functional class III or IV, progressive cyanosis, paradoxic emboli, and tachyarrhythmias secondary to accessory conduction pathways. Plastic reconstructive repair was accomplished in 34 of the 42 consecutive patients (81%). Three hospital deaths and two late deaths are reported. Surgical repair of Ebstein's anomaly is recommended in those patients who are functional class I11 or IV, and the authors feel that the quality of life is improved
and longevity is increased. Significant abnormalities of the anterior leaflet, such as inadequate size or attachment of the free edge of the leaflet to the ventricular wall, may preclude successful completion of their procedure.--Richard J. Andrassy Congenital Systemic Arteriovenous Fistula Between the Descending Aorta, Azygos Vein, and Superior Vena Cava. P. Solar, A. 1I. Mehta, O.L. Garcia, et al. Chest 80:647-649,
(November), 1981. A 14-month-old female presented with an asymptomatic murmur. Pulses were increased, and a continuous murmur was heard over the anterior chest with radiation to the neck, left axilla, and maximally over the left infrascapular area. Chest radiographs and EKG were normal. Cardiac catheterization revealed no PDA but a large tortuous vessel arising posteriorly from the descending aorta giving off three vessels which emptied in the right SVC, azygos vein, and innominate veins. After ligation of these AV fistulae the murmur resolved. The differential of a continuous PDA-like murmur includes a mammary souffle, venous hum, aneurysm of the sinus of Valsalva, coronary AV fistula, pulmonary AV fistula, pseudotruncus, VSD with aortic insufficiency, absent pulmonary valve, aortopulmonary window, pulmonary artery coarctation, and traumatic or congenital AV fistula. Ligation of the fistula avoids complications which include increasing hemodynamic significance with growth, bacterial infection, and aneurysm formation. Embolization or occlusion with balloon catheters are alternatives to surgical ligation.-Randall W. Powell Artery. P. H. Nath, W. CastonedaZuniga, C. Zollikofer, et al. Am J Roentgenol 137:683-688, (October), 1981. Isolation of a Subclavian
Eight patients with isolation of the subclavian artery form the basis for this report. The authors define subclavian isolation as when the subclavian artery does not connect with the aorta but arises from the ipsilateral pulmonary artery via a ductus arteriosus. The isolation occurs contralateral to the side of the aortic arch. The left isolation occurs more often, as in this series (5 of 8), and the lesion often occurs in conjunction with intracardiac anomalies, most commonly tetralogy of Fallot. in this series, bilateral ductus arteriosus occurred in six patients. Only one patient presented with symptoms of the isolation (arm cyanosis); in seven patients the pulses were equal. The main clinical significance occurs in the tetralogy patient when a Blalock shunt is contemplated, since the shunt is usually done on the side opposite the aortic arch.--Randall IV. Powell Congenital Interruption of the Inferior Vena Cava. J. L, van der Horst and A. R. Hastreiter. Chest 80:638-640, (Novem-
ber), 1981. A 20-day-old female presented with respiratory distress and lower-body cyanosis. A chest radiograph revealed opacity of the lower right lung. During cardiac catheterization the catheter could not be passed from the leg into the heart. Angiography revealed interruption of the IVC just above the right renal vein. Collaterals via the ascending lumbar veins
INTERNATIONAL ABSTRACTS
failure. In the absence of any pulmonary arterial flow to the segment, excision is the treatment of choice.--Randall IV. Powell Primary Lung Abscess in Childhood. M. I. Asher, S. Spier, M. Be~and, et al. Am J Dis Child 136:491-494, (June),
1982. Fourteen cases of primary lung abscess in childhood were treated with antibiotics alone. The only organism recovered was Staphylococcus aureus. All the children recovered. Roentgenographic abnormalities took from 6 weeks to 5 years to resolve. Eleven of the 14 children were followed for an average of 9 years after treatment of the abscess. In all children, the clinical status, lung volumes, and expiratory flow rates were normal except in two with asthma. A conservative approach to the management of lung abscess in children is recommended.--J. J. Tepas I11, M.D. Pulmonary Candidiasis in Infants: Clinical, Radiologic, and Pathologic Features. E. G. Kassner, S. L. Kauffman, J. J. Yoon, et al. Am J. Roentgenol 137:707-716, (October),
1981. A retrospective review of autopsy records yielded 15 infants with systemic candidiasis, .14 having pulmonary forms of the disease. Three patients had the bronchopulmonary form with the upper-respiratory tract, tongue, or pharynx colonized and invaded while one infant had the congenital aspiration form. The remaining infants exhibited hematogenous forms: seven embolic and four of the capillaryinvasive form. Initial radiographs revealed small patchy densities which progressed to diffuse consolidation in several days. The consolidation probably resulted from diffuse pulmonary.hemorrhage which occurred in all patients. All of the embolic forms had infected venous catheters or cutdown sites as the portal of entry.--Randall W. Powell
HEART A N D GREAT VESSELS Surgical Repair of Ebstein's Anomaly. G. K. Danielson and V. Fuster. Ann Surg 139:499-504, (October), 1982.
Ebstein's anomaly is a complex malformation with a wide range of pathologic anatomy. It has been treated by various surgical techniques. In 1972, the authors developed a technique for a plastic reconstruction that is based on constructing a monocusp valve of the anterior tricuspid leaflet combined with plication of the atrialized portion of the free wall of the right ventricle, posterior tricuspid anuloplasty, and right atrial reduction. Repair is preferred to valve replacement whenever feasible since it avoids the problems of prosthetic valve dysfunction, anticoagulation, and, in children, the need for replacement of the prosthesis because of growth. Forty-two consecutive patients underwent surgical repair with indications including functional class III or IV, progressive cyanosis, paradoxic emboli, and tachyarrhythmias secondary to accessory conduction pathways. Plastic reconstructive repair was accomplished in 34 of the 42 consecutive patients (81%). Three hospital deaths and two late deaths are reported. Surgical repair of Ebstein's anomaly is recommended in those patients who are functional class I11 or IV, and the authors feel that the quality of life is improved
and longevity is increased. Significant abnormalities of the anterior leaflet, such as inadequate size or attachment of the free edge of the leaflet to the ventricular wall, may preclude successful completion of their procedure.--Richard J. Andrassy Congenital Systemic Arteriovenous Fistula Between the Descending Aorta, Azygos Vein, and Superior Vena Cava. P. Solar, A. 1I. Mehta, O.L. Garcia, et al. Chest 80:647-649,
(November), 1981. A 14-month-old female presented with an asymptomatic murmur. Pulses were increased, and a continuous murmur was heard over the anterior chest with radiation to the neck, left axilla, and maximally over the left infrascapular area. Chest radiographs and EKG were normal. Cardiac catheterization revealed no PDA but a large tortuous vessel arising posteriorly from the descending aorta giving off three vessels which emptied in the right SVC, azygos vein, and innominate veins. After ligation of these AV fistulae the murmur resolved. The differential of a continuous PDA-like murmur includes a mammary souffle, venous hum, aneurysm of the sinus of Valsalva, coronary AV fistula, pulmonary AV fistula, pseudotruncus, VSD with aortic insufficiency, absent pulmonary valve, aortopulmonary window, pulmonary artery coarctation, and traumatic or congenital AV fistula. Ligation of the fistula avoids complications which include increasing hemodynamic significance with growth, bacterial infection, and aneurysm formation. Embolization or occlusion with balloon catheters are alternatives to surgical ligation.-Randall W. Powell Artery. P. H. Nath, W. CastonedaZuniga, C. Zollikofer, et al. Am J Roentgenol 137:683-688, (October), 1981. Isolation of a Subclavian
Eight patients with isolation of the subclavian artery form the basis for this report. The authors define subclavian isolation as when the subclavian artery does not connect with the aorta but arises from the ipsilateral pulmonary artery via a ductus arteriosus. The isolation occurs contralateral to the side of the aortic arch. The left isolation occurs more often, as in this series (5 of 8), and the lesion often occurs in conjunction with intracardiac anomalies, most commonly tetralogy of Fallot. in this series, bilateral ductus arteriosus occurred in six patients. Only one patient presented with symptoms of the isolation (arm cyanosis); in seven patients the pulses were equal. The main clinical significance occurs in the tetralogy patient when a Blalock shunt is contemplated, since the shunt is usually done on the side opposite the aortic arch.--Randall IV. Powell Congenital Interruption of the Inferior Vena Cava. J. L, van der Horst and A. R. Hastreiter. Chest 80:638-640, (Novem-
ber), 1981. A 20-day-old female presented with respiratory distress and lower-body cyanosis. A chest radiograph revealed opacity of the lower right lung. During cardiac catheterization the catheter could not be passed from the leg into the heart. Angiography revealed interruption of the IVC just above the right renal vein. Collaterals via the ascending lumbar veins