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The collateral circulation in coarctation of the aorta
1162
AMERICAN
HEART
JOURNAL
Edwards, J. E., Clagett, 0. T., Drake, R. L., and Christensen, N. A.: The Collateral Circulation in Coarctation of the Aorta. Proc. Staff Meet., Mayo Clin. 23:333 (July 21), 1948. The anatomy of the collateral system of arteries in coarctation of the aorta accompanied by The authors show that a closed ductus arteriosus is discussed in this portion of the symposium. the subclavian arteries, through the communications of their branches, play the paramount role in carrying blood from the part of the aorta above the coarctation to that part below the coarctation. The internal mammary, the intercostal, and the periscapular arteries bear the brunt of the anastomotic bridging. The anterior spinal artery has an important role. Contrary to usual statements, focal erosion of rib substance does not occur on the lower margin of the rib. It is observed on the inferior and anterior aspects of the main body of the rib, where it forms the wall of the costal groove. Major disproportion between the size of the collateral channels on the two sides of the body may be used as a criterion in establishing the site of an unusual type of coarctation. ARKLESS. Christensen, A Review
N. A., and Hines, E. A., Jr.: Clinical of 96 Cases. Proc. Staff Meet., Mayo
Features in Coarctation Clin. 23:339 (July 21),
of the
Aorta:
1948.
Of 119 patients with a diagnosis of coarctation of the aorta, the records of ninety-six were considered to be adequate for this study. Male patients predominated in the ratio of 3.8 to 1 (76 to 20). The age range at the time of initial diagnosis was 4 to 59 years, although one individual who is being followed is now 67 years of age. Only 26 per cent were below the age of 20 years, the maximum deemed feasible for surgery. High blood pressure in the upper extremities was the most frequent presenting symptom (43 per cent). Other complaints included dyspnea, headaches, vertigo and dizziness, tachycardia and palpitation, and nosebleeds. The abdominal aortic and peripheral arterial pulsations of the lower extremities were described as feeble or not palpable in 84 per cent. While the pusation of the large arteries is a more reliable guide to diagnosis in coarctation of the aorta than that of the smaller arteries of the legs, the converse is the more likely in occlusive arterial disease of the extremities. Pulsations of the arteries of the neck and upper extremities are frequently described as “bounding.” Eighty-nine per cent of all patients had hypertension in the upper extremities. Six individuals of forty-nine had significant differences between the blood pressures in the two upper extremities. Positive evidence of collateral circulation was found in sixty-one of seventyfour individuals investigated. It was found most frequently over the scapular and interscapular regions. Ninety-four per cent of all patients had heart murmurs. The most frequent was a systolic bruit heard best at the base of the heart but extending up to the neck and to the interscapular region of the back. When diastolic murmurs occur, associated defects should be considered. Twenty-five per cent of individuals showed roentgenographic evidence of cardiac enlargement. About one-third of the cases gave electrocardiographic evidence of left ventricular strain. Renal function was Normal ocular fundi were found in only 22 per cent of patients examined. normal in the many cases studied, unless complications were present.
ARKLESS. Borden, ing
R., and Cooper, the Peripheral
D.: The Vascular
Roentgen System
of
Appearance the Lungs.
of the Chest Radiology
in Diseases Affect51:44 (July), 1948.
‘The small pulmonary blood vessels may be affected pathologically so that there is an increased permeability of their walls, which may or may not be associated with actual anatomic defects: or the pathologic changes may result in acute or progressive obstruction of their lumina leading to a marked reduction in the pulmonary vascular bed. The present paper deals with the first of these changes. Trauma: Nonpenetrating chest injury has been followed by pulmonary complications. Roentgenographically, these patients show shadows ranging from localized dense lobar consolida-
AMERICAN
HEART
JOURNAL
Edwards, J. E., Clagett, 0. T., Drake, R. L., and Christensen, N. A.: The Collateral Circulation in Coarctation of the Aorta. Proc. Staff Meet., Mayo Clin. 23:333 (July 21), 1948. The anatomy of the collateral system of arteries in coarctation of the aorta accompanied by The authors show that a closed ductus arteriosus is discussed in this portion of the symposium. the subclavian arteries, through the communications of their branches, play the paramount role in carrying blood from the part of the aorta above the coarctation to that part below the coarctation. The internal mammary, the intercostal, and the periscapular arteries bear the brunt of the anastomotic bridging. The anterior spinal artery has an important role. Contrary to usual statements, focal erosion of rib substance does not occur on the lower margin of the rib. It is observed on the inferior and anterior aspects of the main body of the rib, where it forms the wall of the costal groove. Major disproportion between the size of the collateral channels on the two sides of the body may be used as a criterion in establishing the site of an unusual type of coarctation. ARKLESS. Christensen, A Review
N. A., and Hines, E. A., Jr.: Clinical of 96 Cases. Proc. Staff Meet., Mayo
Features in Coarctation Clin. 23:339 (July 21),
of the
Aorta:
1948.
Of 119 patients with a diagnosis of coarctation of the aorta, the records of ninety-six were considered to be adequate for this study. Male patients predominated in the ratio of 3.8 to 1 (76 to 20). The age range at the time of initial diagnosis was 4 to 59 years, although one individual who is being followed is now 67 years of age. Only 26 per cent were below the age of 20 years, the maximum deemed feasible for surgery. High blood pressure in the upper extremities was the most frequent presenting symptom (43 per cent). Other complaints included dyspnea, headaches, vertigo and dizziness, tachycardia and palpitation, and nosebleeds. The abdominal aortic and peripheral arterial pulsations of the lower extremities were described as feeble or not palpable in 84 per cent. While the pusation of the large arteries is a more reliable guide to diagnosis in coarctation of the aorta than that of the smaller arteries of the legs, the converse is the more likely in occlusive arterial disease of the extremities. Pulsations of the arteries of the neck and upper extremities are frequently described as “bounding.” Eighty-nine per cent of all patients had hypertension in the upper extremities. Six individuals of forty-nine had significant differences between the blood pressures in the two upper extremities. Positive evidence of collateral circulation was found in sixty-one of seventyfour individuals investigated. It was found most frequently over the scapular and interscapular regions. Ninety-four per cent of all patients had heart murmurs. The most frequent was a systolic bruit heard best at the base of the heart but extending up to the neck and to the interscapular region of the back. When diastolic murmurs occur, associated defects should be considered. Twenty-five per cent of individuals showed roentgenographic evidence of cardiac enlargement. About one-third of the cases gave electrocardiographic evidence of left ventricular strain. Renal function was Normal ocular fundi were found in only 22 per cent of patients examined. normal in the many cases studied, unless complications were present.
ARKLESS. Borden, ing
R., and Cooper, the Peripheral
D.: The Vascular
Roentgen System
of
Appearance the Lungs.
of the Chest Radiology
in Diseases Affect51:44 (July), 1948.
‘The small pulmonary blood vessels may be affected pathologically so that there is an increased permeability of their walls, which may or may not be associated with actual anatomic defects: or the pathologic changes may result in acute or progressive obstruction of their lumina leading to a marked reduction in the pulmonary vascular bed. The present paper deals with the first of these changes. Trauma: Nonpenetrating chest injury has been followed by pulmonary complications. Roentgenographically, these patients show shadows ranging from localized dense lobar consolida-