A METHOD FOR DOUBLE-CONTRAST STEREOSCOPIC STUDY OF THE INTERNAL ANATOMY OF THE HEART

Post mortem radiology in children with congenital heart disease

Contrast radiology has valuable applications in routine necropsy practice. Contrast radiology was used to study the vascular anatomy in four normal fetuses, in five children with cardiovascular malformations, and in two hearts prepared by the perfusion fixation method. A contrast radiograph provides permanent documentation of anatomical associations before they are disrupted by dissection and permits a planned approach to the necropsy. While these injection studies are seldom undertaken by pathologists because they are felt to be too difficult and time-consuming, contrast studies should form part of the post mortem investigation of children with congenital heart disease, even when angiography has been performed in life.

Postmortem angiocardiography in newborn infants with congenital malformation of the heart and great vessels

In congenital malformations of the heart and great vessels with a fatal outcome a postmortem angiocardiography may contribute to diagnosis. In this technique the heart is not dissected and the topographical relationships remain unchanged. A postmorten angiocardiography is of particular interest if no autopsy is to be performed. Some patho-anatomical details are demonstrated in three selected cases: newborn infants with 1. hypoplastic left heart syndrome, 2. truncus arteriosus communis with interruption of the aortic arch, and 3. aortic-left ventricular tunnel.

An analysis of 35 cases of the complete form of persistent common atrioventricular canal

Thirty-five hearts with the complete form of persistent common atrioventricular canal were classified according to the morphology of the common anterior leaflet. The ratio of specimens with a free-floating undivided common anterior leaflet (Type I) to those with a divided common anterior leaflet attached to the septum (Type II) was 1:2. Type I cases had a high incidence of other cardiac (90 percent) and noncardiac (80 percent) malformations. These were primarily conotruncal anomalies (80 percent), left ventricular outflow obstructions (66 percent), aortic arch hypoplasia (30 percent), and abnormalities of organ position or symmetry including the polysplenia and asplenia syndromes. In contrast, Type II canals exhibited a high incidence of Down's syndrome (40 percent), other cardiac and noncardiac anomalies being less common. The associated anomalies suggest that Type I lesions reflect an earlier interference during embryogenesis than Type II lesions.

A clockwise QRS loop and a normal or right axis on the electrocardiogram in four cases were associated with a left ventricular inflow tract of normal length, suggesting that conduction system displacement and a deficient base of the heart may be interrelated.

Postmortem double contrast radiography confirmed the angiographic differences between Type I and II lesions, and in Type I lesions clarified the alterations in the angiographic profile occurring with variations in the fullness of the common anterior leaflet.

Sudden death in idiopathic (congenital) right atrial enlargement. Postmortem findings and review of cases

A case of idiopathic enlargement of the right atrium is presented and 13 other cases are reviewed. The patient whose case is reported died suddenly at home 6 months after onset of atrial flutter. This represents the first case in which postmortem findings are available. The patient demonstrates that the anomaly cannot be considered entirely benign as has been suggested in previous reports. Other complications that may occur particularly in cases of massive atrial enlargement are atrial arrhythmias, syncope, and right ventricular compression. The importance of recognizing this condition as a clinical entity is stressed because surgical excision of a portion of the enlarged atrium appears to be both easy and curative and because these cases may be mistakenly diagnosed as mediastinal tumor or pericardial effusion. The possible relationship of this apparently congenital abnormality to Uhl's anomaly is discussed.