Four cases ofjuxtaposition of the atrial appendages diagnosed during cardiac catheterization and angiocardiocopyright.

No abstract

A notch in the inferior border of the left atrium has been observed in patients with a persistent left superior vena cava draining via the coronary sinus into the right atrium. It is suggested that the notch is due to the dilated coronary sinus.

A validatory study of quantitative single plane left ventricular cineangiography is presented, using human left ventricular casts ranging in sizefrom I.6 to 135 ml. Good correlation wasfound between actual and calculated volumes (r= o.967 (Fig. i) With the casts in a position approximating to the right anterior oblique projection 35-mm cine x-rays were taken. For calibration purposes a grid of centimetre squares was x-rayed at the position the cast occupied and these films were used to correct for x-ray magnification and distortion (Dodge, I97I).The cast volumes were calculated from these x-ray films using the area-length method of Dodge et al. (I960), assuming the left ventricle to be an ellipsoid of revolution. Regression analysis was performed comparing calculated volumes with true volumes using a logarithmic linearizing transformation. The graph thus derived (Fig. 2) was employed to correct the left ventricular volumes calculated from cineangiography in the clinical series.2) Patient studies A total of 62 patients was studied. The volume estimations were made from left ventricular angiocardiograms recorded during the course of clinically indicated cardiac catheterization. The right anterior oblique projection was chosen as it gave the maximum amount of clinical information about mitral valve movement, atrial and ventricular shunting, and mitral-aortic relations. The film speeds were either 44 or 64 frames/second. When the left heart was not entered, a pulmonary artery injection was performed. Left ventricular end-systolic and on 10 May 2018 by guest. Protected by copyright.

SUMMARY The complications of ventriculo‐atrial shunts in 143 cases of hydrocephalus associated with spina bifida are enumerated and described. Prophylactic lengthening of the atrial cathétér has not been undertaken, and in over half of the cases has not yet proved necessary. The difficulty of the early diagnosis of pulmonary thromboembolism is stressed, and the similarity of its clinical features to those of congenital heart disease is mentioned. The argument in favour of elective lengthening cf atrial catheters is re‐examined and the absence of any account of a controlled trial of prophylactic versus therapeutic revision is regretted. RÉSUMÉ Complications de thrombose et d'embolie dans les shunts atrio‐ventriculaires Les complications du shunt atrio‐ventriculaire dans 143 cas d'hydrocéphalie associée à un spina bifida sont précisées et détaillées. L'allongement prophylactique du cathétér auriculaire n'a pas été entrepris et dans plus de la moitie des cas ne s'est pas avéré nécessaire. Les difficultés du diagnostic précoce de thrombo‐embolie pulmonaire sont précisées et l'identité de leur manifestation clinique avec celles des maladies cardiaques congénitales est mentionnee. Les arguments en faveur d'un allongement électif des cathétérs sont réexamines; l'absence de tout essai controle d'une correction prophylactique plutôt que thérapeutique est regréttée. ZUSAMMENFASSUNG Thrombotische und Embolische Komplikationen bei Ventriculo‐atrialen Shunts Bei 143 Fällen mit Hydrocephalus in Verbindung mit Spina bifida werden die Komplikationen von ventriculo‐atrialen Shunts aufgezählt und beschrieben. Eine prophylaktische Verlängerung des atrialen Katheters wurde nicht vorgenommen, und in über der Hälfte der Fälle ist es auch noch nicht gesichert, daß sie notwendig war. Die Schwierigkeit der Friiherkennung thrombo‐embolischer Komplikationen in der Lunge wird betont und die Ähnlichkeit ihrer klinischen Erscheinungen mit denen eines congenitalen Herzfehlers wird erwahnt. Das Argument für die elektive Verlängerung der atrialen Kathétér wird nochmals überprüft und das Fehlen jeglichen Berichtes über eine kontrollierte Studie der prophylak‐tischen gegenüber der therapeutischen Revision wird bedauert. RESUMEN Complicaciones trombdticas y embdlicas en las derivaciones ventriculo‐atriales Se enumeran y describen las complicaciones de las derivaciones ventriculo‐atriales en 143 casos de hidrocefalia asociada a espina bifida. No se ha realizado el alargamiento pro‐filactico del catétér atrial y en mas de la mitad de los casos no se ha probado que fuese necesario. Se insiste en la dificultad del diagn6stico precoz del trombo‐embolismo pulmonar y se menciona la semejanza de sus caracteres clinicos con los de una malformaci6n cardiaca congenita. Se reexamina el argumento a favor de un alargamiento selectivo de los catétéres atriales y se lamenta la falta de una revisi6n profilactica y una terapeutica.