Ten patients with patent urethral duplication are presented. Nine patients had two independent patient channels originating from the bladder or the posterior urethra. Both voiding cystourethro and retrograde urethrography are necessary to completely evaluate this anomaly. In each instance the ventral channel, regardless of the position of its meatus, proved to be the more functional urethra. In those patients whose dorsal channel was in an epispadiac position, the symphysis pubis was abnormally wide. A functionally and anatomically accurate classification is proposed, and the embryology of these anomalies is discussed.

Patch (Ph) mice, whose platelet-derived growth factor receptor alpha subunit (alpha PDGFR) gene has been deleted, have been used to elucidate requirements for alpha PDGFR for normal murine development. In this report we evaluate the role of alpha PDGFR in cardiovascular development by using in situ hybridization to follow the changing pattern of alpha PDGFR expression in cardiovascular tissues after embryonic day 13, and comparing this pattern with the pattern of cardiovascular defects observed in homozygous Ph mutants. Both mesodermally derived and neural crest-derived components of the cardiovascular system are severely dysmorphic in Ph/Ph embryos and those structures most severely affected are those that normally express alpha PDGFR mRNA at the highest levels and for the longest duration. Ph/Ph vessels appear to be lined with a normal endothelium, but contain a reduced number of smooth muscle cells and are fragile during processing for histology. The myocardium is thin, the heart is small and dysmorphic, the valves are malformed, and the interventricular and interatrial septa of the heart are defective. In the outflow tract, the spectrum of defects includes both persistent truncus arteriosus and double outlet right ventricle. This pattern of abnormalities is consistent with the hypothesis that deletion of alpha PDGFR results in a functional ablation of cranial neural crest cells, and that mesodermally derived components of the vascular system also require alpha PDGFR.

Origin of the right pulmonary artery from the aorta is a congenital malformation usually associated with serious symptoms in the first year of life and characterized by a poor prognosis. Sixty-five patients with this disorder have been reviewed in the literature, and 95% presented during the first year with signs of congestive heart failure. All had cardiomegaly by radiographic and electrocardiographic examination. An accurate diagnosis was established by cineangiography, and associated cardiovascular anomalies were present in 85%. Origin of the right pulmonary artery from the ascending aorta is much more common than origin of the left pulmonary artery from this vessel (8 to 1). Twenty-three patients were managed without operation with a 30% 1-year survival rate. Among those patients managed surgically, the survival rate was 84% at 1 year. It is now clear that operation should be done as early as possible to prevent irreversible changes occurring in the pulmonary arterial vasculature since microscopic features of pulmonary hypertension have been seen during the first month of life. One patient was operated on at 5 months with correction of the deformity. The pulmonary arterial pressure decreased to normal after operation. This child is now asymptomatic and his 10-year postoperative follow-up is the longest found in the literature.