Five cases representing four different venous anomalies involving the portal system are described. The clinical importance of these anomalies, especially in patients with portal hypertension, is stressed.
Five cases representing four different venous anomalies involving the portal system are described. The clinical importance of these anomalies, especially in patients with portal hypertension, is stressed.
The mechanisms leading to traumatic injuries of the heart and coronary arteries and the typical lesions found are analyzed in light of experience with a total of 21 cases from several centers. The indications for angiography are discussed. Early angiography may be used for the emergency verification of a valvular, coronary, or myocardial rupture after intensive treatment has stabilized the patient's condition; in such situations the relative indications for angiography versus immediate surgery must be determined. Delayed angiography may be used in the more usual situations in which clear, persistent anomalies of a clinical, electric, or radiologic nature are observed.
The technique of selective renal occlusion phlebography using Swan-Ganz or Dotter-Lucas balloon catheters is described. The Swan-Ganz catheter is introduced into the femoral vein with the aid of a Cordis introducer system. The Dotter-Lucas balloon catheter is inserted via the same route using a combination of either a Desilets-Hoffman or Edslab introducer, along with a Gebauer introducer. Occlusion of the renal vein is achieved by insufflation of the balloon with air or injection of saline or dilute contrast media into the balloon. Selective renal occlusion phlebography was performed in 116 patients in order to exclude renal vein thrombosis, to delineate poorly vascularized renal masses, to determine the venous involvement of a renal tumor, and to assess the patency of splenorenal shunts. Renal occlusion phlebography optimizes the retrograde opacification of the renal veins. It has value in the delineation of poorly vascularized renal masses and in the determination of the venous involvement of renal and retroperitoneal tumors, and it would seem to be the method of choice for demonstrating the patency of surgical splenorenal shunts. Further enhancement of venous opacification by the combination of temporary arterial vasoconstriction with angiotensin (pharmaco-occlusion phlebography) and venous balloon occlusion is useful in some cases.
Calcific constrictive pericarditis (CCP) in a three-year-old child with symptoms of cardiac compression was confirmed by cardiac catheterization and angiography. Histologic examination of the pericardial tissue removed at operation revealed a tuberculous etiology. Though unusual in the pediatric age group, constrictive pericarditis (CP) may occur in children, most often as a complication of tuberculosis. Pericardial calcification may also develop in children with CP, though this too is rare. The diagnosis of CCP can be established by cardiac catheterization and angiography. Pericardiectomy is the definitive treatment.
A retrospective study was carried out to determine whether aortic arch size can be regarded as a reliable criterion for differentiating between congenital left-to-right shunt defects. The PA and AP plain chest films of children of all age groups with ductus arteriosus persistens (DAP) (n = 91), atrial septal defect (ASD) (n = 86), ventricular septal defect (VSD) (n = 87) and a normal control group (n = 387) were used to measure the size of the aortic arch, and an aortic index (AI) was calculated from aortic arch size and the height of the eighth thoracic vertebral body. Three age classes were defined from the AI values of the control group, and the diagnostic groups in each age class were compared with each other. Enlargement of the aortic arch, as reflected in an elevated AI value, was found most frequently in DAP cases. The size of the aortic arch is, however, of varying differential diagnostic value, depending on the age group. No correlation was found between aortic arch size and the size of the left-to-right shunt in cases of DAP.
Postoperative chest radiographs of 70 adults who had undergone cardiopulmonary bypass surgery were evaluated. The distribution of pulmonary collapse/consolidation and pleural effusions, and the pattern of radiopacities related to drainage tubes were considered. Radiologic manifestations related to sternotomy were noted. Cases with a recorded postoperative blood loss of more than 280 ml/hour and/or an increase in mediastinal width of more than 70% had massive mediastinal hemorrhage that required reoperation. Changes in mediastinal contour were inconsistent, although total loss of mediastinal definition suggested hemorrhage or drainage tube blockage. A left apical extrapleural cap indicated massive mediastinal hemorrhage.
Patients with major hematologic disorders who have hypersplenism and alterations in their immune mechanism are subject to a higher incidence of bacteremia after embolization procedures. In certain instances, these infectious complications can be fatal. Medical splenectomy for hematologic disorders is sometimes complicated by massive splenic infarction and spontaneous rupture; spontaneous rupture appears to be a function of both infarct size and underlying infectious complications. Prophylactic measures can be employed to avoid these complications after interventional splenic embolization.
In order to assess the functioning of the pivoting disc of the Lillehei-Kaster prosthetic valve, a cinefluoroscopic technique using multiple angulations was developed. The disc was detected in 240 (99%) of the 242 valves studied (126 aortic, 107 mitral, and nine tricuspid valves). The maximal-opening angle of the disc was measured in 75% of the aortic but only 20% of the mitral valve prostheses in the 182 valve studies in which this was attempted. Prosthetic dysfunctions were suspected clinically in three aortic and three tricuspid valves and confirmed with the cinefluoroscopic technique. This cinefluoroscopic approach constitutes a rapid, noninvasive, and sensitive evaluation of the function of the Lillehei-Kaster prosthetic valve in the aortic position.
Impedance plethysmography (IPG) was used to study 132 legs: 100 in normal volunteers not subjected to radiocontrast phlebography, seven in patients whose limbs were phlebographically normal, and 25 proven by phlebography to have deep venous thrombosis (DVT). There were no false positive IPG results when a maximum venous outflow of 0.2% was the discriminant. However, in the 25 legs with thrombosis in calf, popliteal, femoral, and iliac veins, clots were not detected by IPG in 44--51% of legs, depending upon the discriminant. These results, which are in agreement with data reported elsewhere, indicate that it is reasonable to use the IPG method as the sole diagnostic maneuver when the test result is clearly abnormal, but that if the result is not abnormal, a radiocontrast phlebogram is necessary.