In patients with Fallot's tetralogy and variants, right ventricular angiocardiography is routinely used to demonstrate the basic anatomy. This investigation may fail to demonstrate clearly the aortic branches and the anatomy of the systemic arteries supplying the lungs. The contribution of aortography in the pre-operative investigation of these patients has been examined in detail.
SUBJECTS AND METHODSForty-one aortograms obtained in 40 patients were available for study. One patient had an aortogram before and after a shunt operation. The diagnosis was Fallot's tetralogy in 28, pulmonary atresia in 10, corrected transposition with pulmonary stenosis and ventricular septal defect in 1, and transposition with pulmonary atresia in 1. In 36 investigations the catheter was passed from the saphenous vein through the right ventricle into the aorta, and in 5 retrograde arterial catheterization was used. 0 75 to 1-5 ml./kg. body weight of Conray 420 was injected under pressure into the ascending aorta at a rate of approximately 33 ml. per second. The dose of contrast medium was higher in patients with pulmonary atresia and in those who were thought to have a large aortopulmonary communication. Full-size films were exposed in antero-posterior and lateral projections at 6 or 12 frames per second. After the aortogram, the catheter tip was withdrawn to the right ventricle and a right ventricular angiocardiogram obtained in the usual way. The following structures were studied on the aortogram: surgical anastomoses, systemic to pulmonary collateral arteries, persistent ductus, the anatomy of the aortic root, the aortic branches including the coronary arteries, and the pulmonary arteries in pulmonary atresia. In addition, the presence or absence of an audible continuous murmur was correlated with the findings on aortography in an attempt to determine the clinical indications for this investigation.
RESULTSAortography added no morbidity to the investigation. One patient who developed a hemiplegia