Interrupted right aortic arch and origin of the left pulmonary artery from the aorta in DiGeorge syndrome.

We describe a neonate with DiGeorge syndrome undergoing diagnosis and successful repair of interrupted right aortic arch and origin of the left pulmonary artery from the aorta. We discuss a link between this lesion and persistence of a left fifth arch.

Fluoroscopic landmark for SVC-RA junction for central venous catheter placement in children.

BACKGROUND: Vascular access devices are commonly placed under image guidance. The usual aim is to place the tip at the superior vena cava-right atrial junction (SVC-RA). OBJECTIVE: To identify a radiographic landmark for the SVC-RA junction that would be useful for accurate central venous catheter tip placement in children. MATERIALS AND METHODS: Images from 56 children undergoing contrast studies of their upper limb venous systems were examined for location of the SVC-RA in relation to a radiographic landmark. RESULTS: Most patients (92.5%) showed the SVC-RA junction to lie at the sixth thoracic vertebral level or the interspace above or below. The SVC-RA junction lay lower than the right main bronchus and the notch on the right cardiomediastinal contour. CONCLUSION: The vertebral body provides a useful and radiographically visible landmark for accurate central catheter tip placement.

Right aortic arch with retroesophageal left aberrant innominate artery.

Right aortic arch with a left retroesophageal innominate artery (type D double aortic arch) is rare. The diagnosis is made by aortography. The present case is the first known patient to undergo a magnetic resonance imaging study that outlined the anomaly clearly.

Left innominate vein compression by a brachiocephalic artery anomaly.

An unique case of left innominate vein compression by a leftward origin of a brachiocephalic artery in conjunction with an aberrant right subclavian artery anomaly occurred in a young patient. Aortography and magnetic resonance imaging were invaluable in arriving at a diagnosis.

Transcatheter closure of patent ductus arteriosus in children and adults.

AIM: To describe the initial New Zealand experience of transcatheter patent ductus arteriosus closure in adults and children. METHODS: Twenty-three children beyond infancy and four adults with isolated patent ductus arteriosus were selected for transcatheter umbrella closure. Rashkind umbrellas were placed across the patent ductus arteriosus through a percutaneously inserted long venous sheath using the Mullins technique. RESULTS: In 25 of the 27 patients a Rashkind umbrella was placed accurately. In two patients the umbrella could not be placed accurately: in one the procedure was abandoned uneventfully and in one the umbrella embolised to the right pulmonary artery necessitating surgical removal of the device and patent ductus arteriosus closure. There were no other significant complications. A second umbrella insertion is planned in two children for a significant residual leak at 1-year follow up. CONCLUSIONS: Transcatheter patent ductus arteriosus closure is a low risk and usually effective alternative to surgical closure for the majority of patients beyond infancy.

Sarcoidosis: correlation of extent of disease at CT with clinical, functional, and radiographic findings.

Computed tomography (CT) was compared with chest radiography in the assessment of disease severity in 27 patients with sarcoidosis. The CT scans and radiographs were each read twice by two independent observers. Disease extent was assessed on CT scans by visual scoring (0%-100% involvement of the lung parenchyma) and on radiographs by using an adaptation of the International Labour Office classification. The severity of parenchymal changes on the CT scan and on the radiograph was significantly correlated with the severity of dyspnea (r = .61 and .58, respectively; P less than .001), diffusing capacity (r = -.62 and -.52, P less than .01), and vital capacity (r = -.49 and -.51, P less than .01). Patients with predominantly irregular opacities had more severe dyspnea and lower lung volumes than patients with predominantly nodular opacities (P less than .05). The authors conclude that in patients with sarcoidosis, the radiographic and CT assessments of disease severity show similar correlation with clinical and functional impairment.

A comparison of the effects of ischemia and of selective occlusion of capillaries, pre-capillaries and terminal arterioles on coronary reperfusion.

To study the 'no-reflow' phenomenon is ischemic myocardium, the effects of ischemia and selective embolic blockade of capillaries, precapillaries and terminal arterioles were compared in isolated rat hearts. Hearts received oxygenated Krebs-Henseleit buffer for 10 min via an aortic cannula, and then coronary perfusion was stopped. The pattern and extent of reperfusion after 15-90 min of global ischemia and after the injection of 9, 15 or 55 mu diameter microspheres were determined from the distribution of injected 6.7% fluorescein isothiocyanate-dextran in frozen transverse sections of the ventricles. Following ischemia, progressively larger subendocardial regions surrounding the left ventricle could not be reperfused. In contrast, embolic occlusion of capillaries, precapillaries or terminal arterioles caused a transmural reduction in perfusion and a fine linear or herringbone pattern of fluorescence. Sixty min of ischemia followed by microsphere injection had no effect on the subendocardial zone of no-reflow but much reduced the intensity of fluorescence elsewhere. Thus thrombosis, erythrocyte plugging and occlusion of capillaries, precapillaries or terminal arterioles are unlikely to be primary causes of the reperfusion defect which develops in ischemic myocardium.

A method for the gross and microscopic investigation of vascular reperfusion in ischemic myocardium.

Fluorescein-isothiocyanate dextran (FITC-dextran; MW approximately 70,000) was used in isolated rat hearts to compare normal vascular perfusion of ventricular myocardium with the pattern and extent of reperfusion following 60 minutes of global ischemia. Its gross distribution in frozen transverse sections through the ventricles was similar to that of sodium fluorescein. However, unlike 0.1% sodium fluorescein, 6.7% FITC-dextran has a viscosity similar to that of blood, and its much higher molecular weight prevents its diffusion beyond the ischemically injured vessels. Furthermore, staining by the alcoholic periodic acid-Schiff technique enabled tracer distribution to be confirmed microscopically and distinguished competent from incompetent vessels in paraffin embedded material.