The detection of a coronary artery fistula (CAF) is usually by chance and, because of the to-and-fro characters of the murmur, a misdiagnosis of a patent ductus arteriosus is frequently made. Correct diagnosis can only be reached after hemodynamic investigation completed by angiography. This lesion is often accompanied by few or no symptoms in infancy, but may become symptomatic with aging even if the shunt is small: complications such as endocarditis, rhythm disturbances, aneurysmatic dilation and rupture have been reported. Five cases of CAF have been studied in our institution: 3 of them have been operated upon in extracorporeal circulation with good results. Principles of management are controversial: many authors advocate delay of treatment until symptoms appear: in our opinion, based on the natural history of the disease and on our experience, closure of the fistula in pediatric age, even in asymptomatic patients, is the treatment of choice.

A statistically significant number of congenital heart disease patients were evaluated for urinary tract anomalies. Twelve percent (160 cases among 1340 patients) had such associated anomalies. However, no association between a specific congenital heart disease and a particular urinary tract anomaly could be found. The results were very similar to those reported in clinical series, but slightly higher than those found at autopsy. The percentage of urinary tract malformations varied over a wide range, with some congenital heart disease having a much higher association than others. However, the total average incidence of urinary tract malformation was similar to that of the general population.

Blood that drains into the right atrium through an isolated left superior vena cava (LSVC) can be a complicating condition during cardiac surgery. In cases of LSVC, a double shadow can be present on standard chest X-ray over the left mediastinum. A notch along the lower contour of left atrium has been previously reported by Owen et al. in 4 cases as an indirect sign of this LSVC anomaly. These two indirect signs were evaluated in 135 (4.5%) cases of LSVC, viewing 89 chest radiographs and 40 angiograms. Their incidence, separately (17-45%) or in combination (9-20%), was observed to be frequent enough to justify a systematic search of these signs in open-heart surgery candidates.

A case of cervical aortic arch is reported. To the best of our knowledge, it is the first to be associated with a serious intracardiac anomaly. In (Beavan and Fatti, 1947;Bender, Menges, and Shulze, 1964;Chang et al., 1971;Defrenne and Verney, 1968;De Jong and Klinkhamer, 1969;DuBrow et al., 1974;Gravier, Vialtel, and Pinet, 1959;Harley, 1959;Hastreiter, D'Cruz, and Cantez 1966;Mahoney and Manning, 1964;Massumi, Wiener, and Charif, 1963; Muflins, Gillete, and McNamara, 1973;Pitzus and Camoglio, 1974;Richie et al., 1972;Sheperd, Kerth, and Rosenthal, 1969;Shuford et al., 1972). Right-sided in the majority of instances, it has been found only as an isolated entity. The purpose of this article is to describe a case associated with pseudotruncus and which constitutes a new type of asymptomatic double aortic arch.Case report A 33-month-old undernourished male child,cyanotic since the age of 1 month, with a history of several upper respiratory infections was admitt3d for evaluation. Pertinent physical findings were a systolic thrill over the left supraclavicular region and a superficial venous network over face, neck, and upper trunk. Peripheral pulses were normal. Laboratory studies were within normal limits except for haematocrit (63%) and haemoglobin (17*3 g/100 ml). Electrocardiogram showed obvious right axis deviation, right atrial overload, pronounced right ventricular hypertrophy, and systolic overload. Phonocardiogram showed a modest systolic murmur at the second and third interspaces and an increased second heart sound. On chest x-ray film the heart was slightly enlarged; the apex was rounded and tilted upward. The pulmonary artery segment was concave and the hilar and pulmonary vascular markings were decreased. In the left anterior oblique projection the aortic knob was unusually high and prominent. Lungs were clear. At cardiac catheterization very low oxygen saturation values were found both in the venous (34-8% in right atrium) and arterial systems (38&9% in ascending aorta). The pulmonary artery could not be entered. The right ventricular pressure was 85/3-5 mmHg (11'3/04-O07 kPa). CineangiocardiogramThe right infundibulum wrs atretic. A dilated ascending aorta overrode a large ventricular septal defect. The aortic arch was right-sided. The first aortic branch crossed the midline, ascended to the left side of the neck, then turned abruptly downward and rejoined the aorta at the level of the rightsided arch. The second and third branches were, respectively, the right subclavian and right common carotid arteries. The left brachiocephalic arteries could not be properly assessed, but the left common carotid artery seemed to arise from the descending portion of the left cervical arch. A hypoplastic main pulmonary artery was supplied by a small persistent ductus arteriosus which originated from the

Four cases of congenital absence of the pulmonary valve are described. Three of them underwent successful operation. The fourth case, operated on in the first days of life, died because of severe respiratory distress. After examining the embryological aspects of this malformation, its treatment is discussed in relation to particular respiratory problems in infants and to the possibility of inserting prosthetic valves in children undergoing elective surgical treatment.