By Donald N. Ross B. Sc., M. B., CH. B., F. R. C. S. (auth.)
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Extra info for A Surgeons’ Guide to Cardiac Diagnosis: Part II The Clinical Picture
The characteristic x-ray picture of a "snow-man" heart may be helpful but this silhouette is not invariable. Cardiac catheterisation may suggest the diagnosis by the passage of the catheter into the anomalous veins or into the left superior vena cava and by the presence of equally unsaturated blood in the pulmonary and systemic arteries. In cases with obvious cyanosis, the presence of plethoric lung fields raises the possibility of transposition of the great vessels or the Eisenmenger syndrome.
Other causes of functional left ventricular obstruction may be familial obstructive cardiomyopathy, asymmetrical hypertrophy of the ventricular septum or a rhabdomyoma of the left ventricle. Operation aims at removing or splitting the hypertrophied muscle, but it is essential to be aware of the condition, particularly where the symptoms and signs 38 Coarctation of the Aorta of aortic stenosis are present against a past history of hypertension or with a strong family history of sudden cardiac death.
In infants with coarctation there may be additional lesions like persistent ductus arteriosus and a ventricular septal defect. In some of these cases the distal aorta is supplied with blood through the septal defect and ductus so that the~e may be a slightly reduced oxygen saturation in the lower half of the body. The femorals may have a good pulsation transmitted from the right ventricle via the ductus. The picture described above is sometimes known by the term preductal coarctation. Special Investigations A plain radiograph of the chest confirms the diagnosis by showing the characteristic notching of the lower borders of the ribs caused by the enlarged intercostal arteries.
A Surgeons’ Guide to Cardiac Diagnosis: Part II The Clinical Picture by Donald N. Ross B. Sc., M. B., CH. B., F. R. C. S. (auth.)