Pulmonary stenosis and ventricular septal defect with arteriovenous shunts; a clinical and hemodynamic study of eleven patients

Patients who have pulmonary stenosis and ventricular septal defect usually have a right-to-left intracardiac shunt. This paper presents hemodynamic and clinical data on 11 patients who have pulmonary stenosis, ventricular septal defect and left-to-right shunts. Four of these patients also have defects in the atrial septum, and three have demonstrable bidirectional shunts. The level and direction of shunts were determined by blood oxygen-saturation data and indicator-dilution studies. Choice of the form of treatment to be used in patients such as these should be based largely on hemodynamic considerations. Many resemble patients with tetralogy of Fallot who have had a successful pulmonary valvotomy.

Cardioaortic fistula; a case diagnosed in life and treated surgically

A case of cardioaortic fistula, due to rupture of an aneurysm of a sinus of Valsalva into the right ventricle, is described. This case was diagnosed in life and treated surgically one year later when the patient was admitted to hospital with bacterial endocarditis. The clinical features are discussed and the role of special methods of investigation in the diagnosis of the condition is defined. The importance of cardiac catheterization is stressed. The operative technique is described briefly. Following the patient's death from the uncontrolled infection an autopsy examination was carried out and the findings in the heart and small pulmonary vessels are given.

Syndrome of left ventricular-right atrial shunt resulting from high interventricular septal defect associated with defective septal leaflet of the tricuspid valve

Two similar cases of unusual congenital anomalies of the heart are presented, in which there existed a direct communication between the left ventricle and the right auricle through a defect involving the membranous portion of the interventricular septum with defective formation of the medial leaflet of the tricuspid valve. Data obtained at catheterization, operative and postmortem findings are presented in each case. The differential diagnosis of this type of lesion is discussed.

Repair of the partial form of persistent common atrioventricular canal; so-called ostium primum type of atrial septal defect with interventricular communication

Images