[Translumbar coronary angiography and aortography in a patient with Takayasu's arteritis]. / Arteriografía coronaria y aortografía por vía translumbar en una paciente con arteritis de takayasu.

Since its introduction by Dos Santos in 1929, arterial angiography by translumbar percutaneous approach has suffered some transformations. Nowadays it has been replaced by other percutaneous approaches and it is indicated only when these routes of access have failed due to aortoiliac or subclavian arteries obstruction. This report presents a patient with Takayasu's Arteritis with severe peripheral arterial obstruction and unstable angina, who underwent coronary arteriography and aortography by translumbar approach. A review of this technique is made.

[The importance of radiology in the localization of pheochromocytoma]. / Importancia de la radiologia en el estudio de localizacion del feocromocitoma.

The usefulness of different radiologic studies in localizing the tumor was evaluated in 26 patients with a firmly established diagnosis of pheochromocytoma. The site of the lesion was correctly identified in 8% of the cases by the plain abdominal x-ray films: in 11% by the plain thoracic films; in 34% by uronephrotomography; in 88% by angiography and in 6 patients (100%) in whom computed tomography scans (CT) were performed. The tumors were intra-adrenal in 19 patients and extra-adrenal in the remaining 7 cases. Of the latter, two were found in the organ of Zuckerkandl, two were abdominal para-aortic, two others in the para-aortic region of thorax, and one with intra an extra-adrenal tumors. It is concluded that CT scans are quite successful in preoperative localization of pheochromocytoma. The non-invasive nature of the technique makes it the method of choice in the anatomical localization of this type of tumors.

[Coronary arteriovenous fistula. Study of 14 cases]. / Fístula arteriovenosa coronaria. Estudio de 14 casos.

Fourteen cases of coronary arteriovenous fistulae observed at the Instituto Nacional de Cardiología Ignacio Chávez were analyzed. The fistula originated from the right coronary artery in 57.1% of the cases, from the left coronary artery in 35.7% and from both coronary arteries in 7.2%. Drainage occurred into the right ventricle in 71.4% of the cases, into the right atrium in 7.2% and into the main pulmonary artery in 21.4%. The physical, roentgenological and electrocardiographic findings are undistinguishable from those usually obtained in malformations with a shunt between the aorta and the right heart or the pulmonary artery. Definite diagnosis is made at angiography. 2D and Doppler echocardiography may also be very useful. Natural history depends on the age of the patient, the size of the arteriovenous shunt, the presence of pulmonary hypertension and the development of complications. Even though malformations with small shunts may be well tolerated, serious complications are frequent and, thus, 14.3% of the patients developed infective endocarditis, 42.9% were in heart failure, 14.3% complained of angina pectoris and 54.5% had pulmonary hypertension. Mortality in this series was 28.6%. Early elective ligation seems to be the optimal treatment of coronary arteriovenous fistulae. The surgical procedure, however, is not devoid of risk. Thus, two of the three patients in this series who were operated upon after 1967 developed perioperative myocardial infarctions. Improvement in surgical technique should prevent this complication.

[Unilateral agenesis of the main branch of the pulmonary artery]. / Agenesia unilateral de rama principal de la arteria pulmonar.

We studied ten patients with unilateral absence of main branch of pulmonary artery (UAMBPA). Six patients with absent right pulmonary artery (ARPA) and four with the left pulmonary artery (ALPA). The presence of either atrial septal defect, ventricular septal defect and patent ductus arteriosus alone or combinated were associated with pulmonary hypertension (mean pressure of the pulmonary artery greater than 48 mm Hg). The patients without associated cardiac defects were asymptomatic and with little elevation of the pulmonary arterial pressure (mean pressure of the pulmonary artery less than 26 mmHg).