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Abstract
An anatomic study has been made of the autopsy specimens of the heart and great blood
vessels of 95 patients who had pulmonic stenosis or atresia accompanied by an interventricular
defect. Cases of “pure” valvular stenosis with an intact ventricular septum were not
included. An operation had been performed on 79 of the 95 patients in an attempt to
relieve the disability and cyanosis. It is not claimed that these cases are representative
of the condition of all of the approximately 1,100 patients upon whom such an operation
was attempted, for it is apparent that the mortality rate is highest among those with
the serious malformations.
The specimens were classified according to the anatomy of the pulmonary conus region.
It became apparent that there is extreme variability in the bulbus cordis in the tetralogy
of Fallot. The specimens may be divided into the following groups: (1) 23 per cent
showed pulmonary atresia, (2) 10 per cent valvular pulmonary stenosis, (3) 15 per
cent both infundibular stenosis and valvular stenosis, and (4) 52 per cent showed
infundibular stenosis. This last group was subdivided as follows: (1) 37 per cent
showed a low, well-developed infundibular chamber, (2) 37 per cent a high, small infundibular
chamber, and (3) the chamber was intermediate in size and position in the remaining
26 per cent.
The type of operative procedure that should be employed in the treatment of these
defects has been discussed in regard to choice between a direct attack and a shunting
procedure. It is obvious that with the possible exception of adults a direct attack
with division of the valve should be used in the treatment of stenosis of the valve
and that an artificial ductus should be made in the treatment of pulmonary atresia.
There is probably a justifiable difference of opinion regarding the choice of procedure
in the treatment of infundibular stenosis. When resection techniques are further developed,
it appears likely that low infundibular stenosis with a large chamber will be treated
by a direct approach with infundibular resection, and that shunting procedures will
continue to be used in most cases of high infundibular stenosis with a small chamber.
The advantages and disadvantages of a direct attack and of a shunting procedure are
discussed.
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Article info
Footnotes
☆Aided by a grant from the United States Public Health Service, National Heart Institute.
☆☆Presidential Address, sixth annual meeting of the Society for Vascular Surgery, Chicago, Ill., June 8, 1952.
Identification
Copyright
© 1953 Published by Elsevier Inc.
