Report
of
Three
By
Cases
L.
HERBERT
ATRESIA
and
Evaluation
M.D.,
ABRAMS,
San
ONGENITAL
absence
and
of
of
failure
of
the
tion
right
of
normal
left
of the
which
atresia.
upper
Tricuspid
border
enlargement
in
this
picture
is one
atresia
anomaly
die
It
has
procedure
The
before
is both
of
authors
present
pertinent
for
The
the
available
have
tricuspid
atresia
or
electrocardiographic
very
In
noteworthy.
Incidence.-Grayzel
the
In
and
a review
to
total
of
the
was
Age
of Death.-Age
in
at Time
which
it
to
were
excluded.
three
fourths
From
the
of
substantiat-
list
that
with
with
the
may
be
with
is generally
ad-
the
Potts-Gibson
tricuspid
atresia.
tricuspid
atresia
the
and
more
the
a review
of
recent
generally
accepted
diagnostic
in which
data
cases
congenital
and
hitherto
44
cases
unreported
of
which
the
of
roentgenologic
were
and
the
LITERATURE
15
since
which
of infants
is desirable.
one
THE
disease
cases
1933,
of
57
tricuspid
additional
atresia
cases
reported
were
prior
found,
to
bringing
72.3_26
Sex.-There
dropped
Tennant
of
three
in
OF
literature
absence
operation
prompted
been
addition,
are
recognicyanosis,
majority
associates
infants
atresia
findings
ventricle
antemortem
heart
infants
reviewed
REVIEW
1933.
young
tricuspid
presented,
is
development
and
The
his
has
are
there
right
roentgenogram,
flow.1,2
limitations
stenosis
the
be : persistent
Blalock-Taussig
anomaly
the
to the
to
congenital
young
of
analyzed.*
been
of
in very
17 years
leading
stated
blood
and
of
and
of normal
projection,
the
this
auricle
in which
deviation.
forms
of
M.D.
ALWAY,
failure
anterior-oblique
Gasul
with
past
are
by
recognition
of the
clues
axis
effective
Awareness
clinical
the
criteria
at which
relief
right
It is this
pulmonary
and
Criteria
anomaly
anterior-posterior
cyanotic
age
experience
literature
left
however,
surgical
literature.
criteria
the
the
the
feasible
possibility
the
the
of left
of
shown,
between
provide
additional
been
is a cardiac
ventricle.
in
H.
ROBERT
stenosis
diagnostic
cardiac
by providing
vised.
should
The
electrocardiographic
alleviated
or
right
AND
Diagnostic
Francisco
comn5unication
ventricle
ventricular
ing
atresia
development
tricuspid
concave
right
tricuspid
of
an equal
noted.
was
12 months
distribution
The
age
dead
the Departments
(12
one
before
age
of Radiology
of
and
from
2 years,
25
the
years
among
females
ranged
was
and
third
the
males
of death
average
if 2 patients
Approximately
were
of
at time
6 days
8 months,
old,
patients
the
although
respectively,
died
by the
reported
to 25 years
the
at time
age
cases.
in 26 cases
average
of
death)
of 6 months,
and
of 1 year.
and
Pediatrics,
Stanford
University
School
of Medicine,
San
Francisco.
(Received
Since
Edwards,
America
this
for publication
paper
was
J. E.,
33:1177,
and
Sept.
completed,
Burchell,
25,
1950.)
the
H.
B.,
following
reference
Congenital
tricuspid
has
been
atresia:
called
to the
Classification,
1949.
660
authors
M.
attention:
Clin.
North
TRICUSPID
Pathologic
Findings.-
only
tricuspid
cases
with
was
normal
in
was
intact
cation
cases
stenosis
In
all
plastic
cases
vessels
the
cases
cases.
Dyspnea
lungs
were
it
ventricle
in
stated
Murmurs
was
definitely
enlarged.
although
the
to
normal
systolic
loud,
and
in
all
in
some.
and
the
The
the
artery
ductus
was
arteriosus
at the
cases,
infundib-
the
foramen
right
thickness
In
six
one
of
of
cases,
communi-
ovale,
ventricle
the
and
was
muscle
in
hypo-
wall
transposition
level
blood
case
of
of
the
the
great
any
ranged
cell
count
Left
axis
have
whom
scattered
not
been
described.
was
was
although
was
present
the
patients.
of
rales
were
in
in
13
The
heard
patients.
pulsation
14
pre-
5 to
was
present
liver
gm./100
was
cc.,
were
fourth
palpable
murmurs
usually
interspace.
in six patients,
present.
with
million/cmm.,
12
They
to the
to be
stated
present
The
murmur.
second
The
to 29
from
the
were
mentioned.
a diastolic
from
definite
Murmurs
specifically
also
sternum
from
in some
in
in seven
ranged
persistent,
Clubbing
common.
there
the
and
period.
paroxysmally
occurrence
of
enlarged
was
or
three,
atresia
left
at birth
neonatal
rest
was
their
in one
these
hemoglobin
red
at
tricuspid
present
the
except
growth
to the
was clinically
only
either
in whom
in all,
after
patients
of
patients
generally
until
physical
maximal
heart
The
noted
diagnostic
28
were
in
the
not
ventricular
pulmonary
to be a patent
stated
; the
stenosis
10 of
had
Among
present.
case,
be
the
and
with
In
every
marked
was
Retarded
of
cases,
two.
of these
as well.
arteriosus
present
arteries,
other
was
was
was
not
was
clear
terminally.
The
left
auricle
defect
Findings.-Cyanosis
a few
but
left
septal
in the
ductus
was
Half
orifice
remaining
defect
pulmonary
valve
20 cases.
present.
was
The
hypoplastic
on
pulmonary
a patent
of the
septal
and
the
all had
In six
at the
right
was
Clinical
20
had
rudimentary
ventricle
two.
661
available
of
atresia,
but
interauricular
or
right
the
an
were
atresia
interventricular
and
between
cases
in
in all
an
Three
in one
data
complete
pulmonary
size,
closed.
six
but
associated
septum
ulum
Autopsy
atresia
ATRESIA
an
average
with
an
of
19 gm.
average
of
million.
Electrocardiographic
obtained
in
weeks
10
old,
In
one
found.2426
and
these
Findings.-Among
39.
were
old
the
thought
Roentgenologic
reproduced
months
of
and
three
to show
23
of
axis
hypertrophy
cases,
and
reviewed,
in
36
old,
without
cases
the
of
cases.
respectively,
In
no
were
three
axis
unipolar
patients,
deviation
leads
was
were
utilized
ventricles.
reviewed,
findings
electrocardiograms
these
deviation,
of both
33 of the
these
cases
1 1 months
caseS
Findings.-In
in
the
deviation
RGs
were
were
obtained.
mentioned
briefly
Films
in
an
were
additional
10.
A.
Postero-anterior
slightly
of
the
more,
than
enlarged.
apex
was
there
was
ings
segment
were
apex
usually
is commonly
artery
view.-In
The
of
not
usually
greater
seen
in the
the
usually
either
left
most
of
the
presence
of
diminished
on
the
of
the
in
lungs
feature
in the
Taussig3
due
that
cardiac
The
arterial
was
heart
usually
the
lower
of
Fallot.
border
noted.
to the
characteristic
lungs
fine,
anastomoses27
was
in size
but
tetralogy
(left
of
Fallot.
The
of
pulmonary
lower
limits
could
mottled
not
the
Furtherborder
pulmonary
vascular
of normal.
have
and
or only
elevation
cardiac
concavity
not
the
ventricular)
A moderate
was
normal
elevated,
in the
left
or at the
flow
either
slightly
found
of
slightly
blood
RGs.
to bronchial
reported
states
tetralogy
upper
the
was
as that
fullness
diminished
stated
the
cases,
heart
as striking
cases,
basis
the
been
reticulated
a prominent
mark-
In some
definitely
pattern
roentgenologic
cases.
in tricuspid
atresia
the
great
vessel
shadow
is usually
narrow
in the
662
HERBERT
frontal
projection.
somewhat
B.
mentioned.
right
anterior
out
posterior
that
oblique
C. Other
the
left
H.
commented
that
reported
cases,
the
general,
this
view
was
one
the
heart
the
number
of cases
Thus,
greater
does
ALWAY
the
aortic
the
not
shadow
presence
appear
is often
of
to be
a narrow
an
important
for
of
the
fact
the
tion,
the
roentgenographic
need
not
be
studies,
the
may
apex
give
the
auricles,
oblique
reported
was
was
the
the
left
diagnosis.
that
into
not
has
by
the
made
forward
view
conclusions.
in establishing
projected
She
cases,
definite
statement
lateral
view.
is expressed
the
any
of
to project
at fluoros-
what
utilized
was
con-
in a sufficient
diagnosis
best
demonstration
of
atresia
in
postero-anterior
lower
tricuspid
that
of
the
of the
tetralogy
the
of
enlarged
be made
and
significance
left
left
1.
in the
frontal
right
a large
left
have
and
lateral
by the observation
the
small
et al.26
oblique
are:
shown
the
Cooley
frontal,
of
of
in
and
auricle
of
or visualization
that
border
evidence
in the
should
left
is somewhat
there
is somewhat
the
Fallot.
frontal
The
ventricle
projecview
left
and
anterior
of absence
of
ventricle.
atresia
the
and
cardiac
from
adequate
right
findings
three
In
presence
border
ventricular)
appearance
tricuspid
auricle,
the
view
the
heart
anomaly
helpful
the
The
(left
Angiocardiography.-Brown4
of
is not
atresia,
that
the
anterior
this
to permit
view
the
lower
dissimilar
of the
studies
border.
oblique
that
left
strikingly
view
left
cardiac
sufficiently
ventricle.
fact
of
to be evaluated.
fullness
enlargement
the
in
oblique
right
the
by failure
in
posterior
anterior
the
stressed
enlargement
tricuspid
right
of
shadow
utilized
proved
the
region
except
oblique
the
not
right
of
in
sidered
aortic
of
case
has
is suggested
ventricular
views.-The
at least
right
of
In
ventricle
to
the
displacement
anterior
D.
ROBERT
has
third
view.-Taussig
rudimentary
pointed
copy
one
anterior-oblique
or
significantly
In
however,
about
was
AND
feature.
Left
small
In
shadow
diagnostic
ABRAMS
Neuhauser,7
enlarged.
mediastinal
L.
ventricle.
The
et al.26
of
seen
shown
equally
have
of the
pointed
out
a communication
of the
in the
well
adequate
opacification
2. Nonvisualization
best
With
of sequential
Cooley
projection.
angiocardiographic
projections.
demonstration
ventricle,
ventricle,
reported
lateral
in the
right
ventricle,
projection.
frontal
that
between
3. The
or lateral
projec-
tions.
Cardiac
Catheterization.-Studies
although
they
septal
may
defect
with
be highly
and
inability
suggestive.
intracardiac
They
to catheterize
the
right
CASE
Case
she
1.
E.G. : A 5 wk.
steadily
cyanotic,
lost
murmurs
and
did
not
Unipolar
were
heard.
Hgb.
gave
Supracardiac
border
vascular
3 ) , and
posteriorly,
as
well.
thought
In
addition,
performed
vena
at
increased
the
to
in
edge
be
to
but
am-tic
failed
with
L oblique
10
up
of
crying.
was
palpable
cc.
to
its
Routine
to
in
conclusive,
the
view,
of
35%
point
in
at the
level
the
the
in
LAO
junction
to
were
the
probably
in-
(Fig.
2
lateral
1).
Heart
view
R ventricular
border
projected
far
clear.
into
the
umbilicus
deviation.
view
( Fig.
in
cardiac
injected
axis
P-A
view
abnormally
with
percussion.
examination,
and
and
and
showed
no
the
view
posterior
poorly
of the
showed
enlargement
diodrast#{174}
of
enlarged
roentgenologic
LAO
fields
taken
Examination
was
enlarged
widen
were
wk.
Heart
massively
Lung
studies
R auricular
enlargement.
cava
be
shadow
marked
the
not
of an interauricular
Feedings
age
hypertrophy.
heart
narrow,
to
with
Liver
birth.
at
the
cc. Electrocardiographic
the
L ventricular
inferior
cyanotic
hospitalized
clear.
are
presence
REPORTS
L ventricular
was
was
indicating
the
of
anterior
Angiocardiography,
demonstrated
were
showed
pedicle
there
was
the
ventricle.20
was
17 gm./100
evidence
well
infant
Cyanosis
Lungs
was
fluoroscopy,
extended
enlargement
no
and
she
infant.
pulsate.
films
female
until
nourished
leads
eluding
( Fig.
weight
poorly
No
old
catheterization
demonstrate
heart
the
on
R
the
femoral
initial
vein,
film.
TRICUSPID
FIG.
1.
Case
1.
P-A
view.
Heart
is
Great
FIG,
2. Case
1.
On
the
second
film,
and
L ventricle,
was
the
possibility
revealed
that
minimal
taken
at
well
view.
vena
opacification
(Fig.
in
4).
cava
the
is
sec.,
the
of
are
abnormally
clear.
the
anteriorly.
spine.
side
also
into
the
fields
bulges
behind
aorta
emptied
region
border
projects
The
Lung
narrow.
heart
border
approximately
663
enlarged.
shadow
Anterior
heart
opacified
inferior
the
massively
vessel
LAO
Posterior
ATRESIA
of
was
the
heart,
including
visualized.
L auricle.
R auricle,
These
Review
suggesting
of
the
the
findings
the
films,
presence
auricle
suggested
however,
of
tricuspid
atresia.
The
ratients
tricuspid
The
a large
ventricular
FIG.
FIG.
condition
atresia,
4. Case
wall
3. Case
remained
atrial
poor
septal
was
of
1. L lateral
normal
view.
of
heart
she
died
pulmonary
thickness
Anterior
at 2 sec.
1. Angiocardiogram
and
defect,
LAO
is clearly
4 days
atresia
but
heart
view.
seen.
the
border
after
and
R
ventricular
projects
Opacification
Aorta
admission.
a patent
Autopsy
ductus
cavity
forward
arteriosus
was
disclosed
(Fig.
essentially
5).
an
prominently.
of inferior
is visualized.
vena
cava
and
L side
664
HERBERT
endothelial-lined
through
slit.
the
the
of
the
in
5.
the
Case
birth.
1.
2.
present.
entire
precordium.
gm./100
and
of
the
examination
In
producing
A Potts
This
the
LAO
operation,
Case
count
RH.:
in
In
the
a
LAO
the
Lungs
cyanotic
the
distant
from
filling
of
the
the
chest
heart
spine.
fluoroscopy
anterior
projected
to
at
with
establish
border
but
the
to
posterior
considered,
supply
infant,
failed
cardiac
projected
was
blood
arteries.
leads
view,
border
immediate
their
pulmonary
unipolar
oblique
almost
received
left
incapacitated
and
cardiac
ALWAY
and
markedly
deviation
and
there
flat
anterior
and
Anterior
seen
at
below
the
cmm.
and
L ventricular
7)
at the
is alive
on
of
(Fig.
and
ECG
the
.
of
relatively
findings
and
because
of
the
wall.
aorta,
margin,
The
further
murmur
was
heard
suggested
was
well
contour
and
presence
followed
atresia:
roentgenographic
of
the
and
20
slight
L lower
the
aortic
of a small
cardiac
shadow
R ventricle.
improvement.
3 yr.
persistent
studies
the
was
Roentgenologic
by marked
age
was
over
segment
of
since
toes
Hgb.
deviation.
artery
at the
in tricuspid
pulsate.
fullness
the
1 yr.,
not
ventricle.
cyanosis
and
pulmonary
was
left
thumbs
L axis
There
V.,
of
did
showed
L.
persistent
clubbing
R ventricular
This
age
auricle.
systolic
concave
6).
right
and
ECG
a
continuity
mo.
costal
(Fig.
the classical
boy
noted
blowing
enlargement,
border
deviation
of
was
projection
he
age
A.,
R.
A high-pitched
on the child
old
the
million
was
and
view.
cyanosis
9.5
frontal
view,
6 mo.
situ.
cardiac
the
L axis
A
axis
narrow
clear.
was
case illustrates
R ventricle
3.
of
no
finger-breadths
performed
This
right
markedly
first
were
4
persisted,
polycythemia,
band.
small
vessels
marked
minimal
apex
improvement
of a small
fields
RBC
a relatively
Comment:
and
was
Liver,
showed
elevation
atretic
great
in
examination,
Lung
cc.
was
specimen
infant
physical
already
border.
: An
view
an
posterior
of
H.
of transposition.
Autopsy
S.H.
On
the
demonstrated
possibility
Case
and
ROBERT
with
problem
showed
transposition
LAO
which
eliminated
the
aorta,
of
the
was
hypertrophy.
the
possibility
shadow
artery
ECG
to
AND
communicated
presented
L ventricular
angiocardiogram
FIG.
case
anterior
Initially
which
enlargement.
presence
significantly
ABRAMS
pulmonary
ductus,
This
cardiac
vessel
Main
patent
Comment:
massive
L.
marked
suggesting
the
cyanosis
presence
enlargement.
had
been
cyanotic
since
about
24
hr.
after
birth.
At
that
time
TRICUSPID
RGs
were
made
Following
and
feeding.
was
At
consistent
dextrocardia
pulmonary
autopsy
revealed
Foramen
L pulmonary
Comment:
Roentgenologic
established
artery
by the
the
was
findings
segment
dextrocardia,
diagnosis
8).
died
and
failed
but
was
at
orifice,
He
massive
this
elevation
to clarify
not
used
thought
the
since
were
too
In
fingers
16 gm/lOU
not
noted.
poor
and
the
blood
R nipple.
and
toes
was
cc. ECG
was
fields
a risk
to
for
the
and
operation
dextrocardia,
a hypoplastic
from
showed
the
Roentgenologic
lung
addition
atresia
of
of the
nature
the
be
made.
crying
R ventricle.
the
aorta
clear
lung
into
the
enlargement.
those
apex
of
avascular
age.
carried
ventricular
of the
was
to
of
artery
arteriosus
child
of
moderately
7 mo,
region
of
Hgb.
was
with
examination
the
Clubbing
and
type
associated
Physical
in
hypertrophy
pulmonary
left
was
mo.
best
margin.
was
about
ductus
on
of
heard
dextrocardia,
undetermined
dyspnea
million/cmm.
of
(Fig.
age
costal
presence
a patent
There
the
of R ventricular
He
and
the
of 9.3
of
Severe
murmur
evidence
of tricuspid
patent
arteries.
pulmonary
complicated
have
was
count
segment
unimproved.
hypoplasia
ovale
concave
the
at
systolic
665
anomaly
persisted.
hospital
below
RBC
but
artery
discharged
the
a variable
an
cardiac
cyanosis
fingerbreaths
demonstrated
was
to
and
he had
time
of a congenital
nursery,
admitted
cyanosis
palpable
with
concave
the
that
examination
R and
was
deep
present.
and
the diagnosis
from
He
generalized
Liver
and
discharge
ATRESIA
of
child
dextrocardia,
heart.
Electrocardiographic
the
anomaly.
was
considered
fields,
Angiocardiography
too
poor
findings,
a surgical
might
risk.
666
HERBERT
L.
ABRAMS
AND
ROBERT
H.
ALWAY
DISCUSSION
Routine
clinical,
to establish
depend,
roentgenographic
the
diagnosis
however,
The
blood
either
an
flow
From
atresia
is from
defect
or
septal
left
(1 )
if an
interventricular
tary
right
ventricle
( 2)
the
then
the
ventricle
the
septal
artery,
pulmonary
right
are
usually
pre-operative
sufficient
diagnosis
way
the
may
blood
a patent
left
and
pass
may
ductus
through
to
or
ventricular
(3 )
or
left
ways:
a rudimen-
normal
septum
arteriosus
the
in three
through
hypoplastic
or the
auricle
thence
be supplied
may
is either
be atretic,
of
to the
ovale
circulation
which
may
auricle
foramen
is present
artery
is by
the
a patent
defect
however,
flow
studies
A definite
pulmonary
to a pulmonary
pulmonary
atresia.
studies.
in tricuspid
the
electrocardiographic
tricuspid
on additional
interauricular
ventricle.
and
of
in
size;
intact,
and
the
bronchial
arteries.
These
different
tations.
Thus,
ment
and
in
logic
produce
variations
between
pulsation
tricuspid
group.
may
opening
a presystolic
findings
cyanotic
pathways
if the
atresia
of
do
Differential
the
the
not
in the
auricles
liver
margin.
distinguish
diagnosis
on
the
and
there
In
this
depends
clinical
is small,
roentgen
may
be
manifes-
hepatic
enlarge-
general,
however,
the
malformation
from
others
electrocardiographic
and
physical
of
the
roentgeno-
findings.
Electrocardiographic
atresia
is the
left
axis
the
great
Fallot
Findings.-The
only
congenital
In
deviationl4,15,1719
vessels
and
Sokolow
whose
left
axis
and
statement
cardiac
ECG
1939
deviation
cyanotic
cases
these
had
tricuspid
osus,
and
the
with
left
atresia,
axis
two
has
one
had
the
tricuspid
with
associated
a patient
with
transposition
of
A child
with
the
tetralogy
of
and
associates.2C
described
ECGs
by
Gasul
in congenital
left
heart
ventricular
a truncus
tetralogy
that
group
reported
or
had
frequently
cyanotic
deviation.
been
unipolar
deviation
while
remaining
axis
ECG
of
made
in the
et al.28
left
on
Edgar,3#{176}in a study
Six
Ash
showed
been
has
malformation
hypertrophy.
arteriosus
of
and
Fallot
disease,
with
found
Three
a patent
associated
of
ductus
arteri-
patent
ductus
arteriosus.
It
is apparent,
congenital
then,
heart
disease
Conversely,
out
Of
literature,
was
three
none
was
may
left
study
in the
show
the
deviation
and
artery
deviation
young
left
axis
deviation
of tricuspid
not
tricuspid
except
always
may
be seen
without
infant.
The
in
a cyanotic
child
with
deviation.
Taussig
atresia.
manifest
atresia
deviation
hypertrophy.
congenital
of
usually
of age.
left
in very
present
axis
young
left
axis
infants
deviation
authors
left
standard
The
cardiac
ventricular
for
with
tricuspid
reported
Patient
in
in the
E.G.,
however,
use
defects
projection.
presence
of
cases,
relatively
of unipolar
is of
hypertrophy
early,
further
in
not
be
leads
electrocardiographic
importance
vertical
it may
precordial
in that
hearts
showing
this
may
right
axis
leads.3
frontal
the
is manifest
In these
Findings.-Classically
elevation
segment
axis
1 1 months
presence
in the
less
as
ventricular
Roentgenologic
Fallot
of
in a very
cyanotic
in the
enlarged
axis
left
as late
show
no
cases
need
of
of age.
although
apparent
presence
be diagnostic
atresia
that
the
7 weeks
Thus,
the
not
tricuspid
pointed
1947
atresia.
that
need
the
is concave.
of
apex
The
the
The
slightly
because
lung
heart
appearance
greater
of
fields
is
may
fullness
normal
in
resemble
of
the
left
the
enlarged
left
are
relatively
avascular.
size
that
of
or
but
the
tetralogy
lower
ventricle.
cardiac
The
In
the
slightly
of
border
pulmonary
left
anterior
TRICUSPID
oblique
view,
enlargement.
That
by
the
Case
straightened
findings
classical
was
vessel
shadow.
view
position
an
aorta.
the
of transposition
The
great
In
the
anterior
of
right
ventricular
heart
border
it was
posterior
always
in
all
heart
left
thought
that
behind
spine
ventricular
far
the
an
was
enlarged
an
transthere
no
of
the
root
right
prominent
suggested
anterior
made
to the
The
great
left
only
anterior
part
narrow
fields,
not
artery
postero-anterior
in
lung
suspected.
strongly
pulmonary
widen
view,
in
demonstrated
a strikingly
clear
oblique
was
The
to
the
represented
the
right
in the
with
it extended
enlargement
of
is clearly
heart
failed
with
but
this
the
vessels,
anterior
border,
present
of
however,
the
absence
projections.
configuration
in conjunction
possibility.
the
2.
are not
shadow,
This,
of
Case
of the great
vessel
667
suggests
by
enlarged
Indeed,
that
Although
the
massively
concave.
unlikely
presence
the
was
border
illustrated
findings
at fluoroscopy.
straightening
of
heart
not
resembled
oblique
anterior
are
roentgenologic
1 . The
segment
view
the
These
ATRESIA
auricle,
extension
enlarged
left
yen-
tricle.
The
portion
an
enlarged
the
anterior
sign
may
of
to
ventricular
transposition
of
dextraposed
aorta,
In
great
the
noted
was
aorta
right
in
ventricle.
congenital
When
vessels,
or
be
in
smooth
straight
aorta
the
presence
anterior
size
of
the
is most
useful
in
In
1, the
region
border
at autopsy
the
to be
prominence
of
proved
to be misleading.
This
ventricular
shadow
to project
anomalies
is anteriorly
of
right
shown
Thus,
cardiac
the
continuity
chamber
placed
of
a right-sided
the
aortic
and
left
anterior
in
the
ventricle
becomes
in
which
as
in
right
complete
aorta
right
or
oblique
more
of
ventricular
view.
difficult
to assess
projection.
Angiocardiography
diagnosis
is obscure.
The
that
the
of
drainage
fact
possibility
revealed
nosis
be
may
a relatively
situations,
this
also
is present.
there
forming
such
in
may
the
to the
hypoplastic
to the ascending
aorta
in that failure
of the right
misleading
aorta
anterior
the
in relation
enlargement
shadow,
projecting
and
border
further
the
heart
auricle
heart
be
anterior
the
right
the
of
Case
right
auricle
of
presence
tricuspid
of
did
the
inferior
early
faint
those
not
cases
of
right
to
opacify
into
the
appear
vena
cava
right
which
the
auricular
are
atypical
and
ventricle
was
significantly
left
Review
and
the
opacified.
brought
auricle.
opacification
in which
never
up
the
of the
films
the
diag-
suggested
atresia.
CONCLUSION
Because
the
surgery,
the
In
cases
most
antemortem
criteria
be recognized
with
left
the
absence
atresia.
axis
of
findings
is by
axis
of
no
on
right
ventricle
may
be
atresia
their
limitations-must
lead
the
ECG
need
obscured
be
the
to
an
only
does
not
may
unequivocal
of
not
in the
corrective
clearly
exclude
cardiac
delineated.
diagnosis.
But
of
cyanotic
tricuspid
the
atresia.
it must
type
Conversely,
the
possibility
of tricuspid
The
presence
of an under-
conventional
of
to
anomaly
be conclusive.
method
lead
be
cardiac
pathognomonic
studies
may
tricuspid
a congenital
means
deviation
roentgenologic
angiocardiography
will
combination
deviation
left
of
diagnosis-and
classical
the
Similarly,
developed
cases,
the
that
diagnosis
for
examination.
establishing
the
In
diagnosis
atypical
conclu-
sively.
For
the
diagnostic
to clarify
the
danger
intensely
procedures
the nature
may
be far
cyanotic
should
young
be
of the anomaly.
less than
infant
performed
Although
in conservative
whose
immediate
whenever
some
prognosis
conventional
risk
management
is attached
of-such
is poor,
methods
to these
cases.
have
special
failed
procedures,2
. 668
HERBERT
L.
ABRAMS
AND
ROBERT
H.
ALWAY
SUMMARY
The
recent
reported
literature
cases
are
on
congenital
described.
The
tricuspid
atresia
generally
is reviewed.
accepted
Three
diagnostic
previously
un-
discussed
and
criteria
are
to
Blalock-Taussig
elaborated.
ACKNOWLEDGM
Dr.
Ann
Purdy
permitted
the inclusion
ENT
of Cases
2 and
3.
REFERENCES
1. Taussig,
Helen
tion,
2.
W.
Gasul,
137:343,
B. M.,
young
4.
Grayzel,
S., Aortic
E. H.,
heart
pulmonary
amenable
anastomosis
successful
D.
and
Tennant,
artery
from
L. M.,
and
Marino,
with
Blackford,
of
opera-
in congenital
pulmonary
stenosis,
1948.
Fell,
M.,
malformations
1948.
infants
coronary
5.
of
Heart
J.A.M.A.
3.
Analysis
J. 36:321,
J., and Gibson,
Am.
Potts,
B.,
operation,
R.,
Congenital
pulmonary
Hoppe,
C. B., Tricuspid
78: 16,
atresia
artery,
of
tricuspid
10:791,
of case of tricuspid
L. D., Report
Report
of
2 cases
of
origin
of
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orifice
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Am.
atresia:
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and
anomalous
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atresia,
Methods
13:
123,
1934.
6.
Brown,
7.
Taussig,
J. W.,
Congenital
Helen
to
B.,
defective
Amolsch,
labium
9,
L.,
majus,
J.
Roberts,
Klein,
H.,
and
Rare
defect
Methods
11.
Holder,
E. C.,
and
with
Taussig,
Helen
11:275,
congenital
associated
with
1936.
malformations
tricuspid
of
atresia
or
heart
due
hypoplasia,
tricuspid
valve
complicated
by congenital
myxosarcoma
of
1937.
pulmonary
and
tricuspid
atresia
with
right
ventricular
1937.
malformation
of
heart
Virchows
with
Arch.
J., Congenital
Pick,
septal
L. J.,
associated
13.
of
24:777,
valve,
in
rudimentary
f. path.
development
of
301: 1, 1938;
Anat.
right
ventricle
J.
abstracted,
Tech.
1938.
ventricle,
Manhoff,
of
tricuspid
18:152,
right
12.
case
of
Childhood
1936.
atresia
Path.
Dis.
findings
ventricle
hypoplasia,
10.
Arch.
right
59:435,
Hosp.
Congenital
Arch.
pathological
of
Hopkins
A.
atresia,
and
development
Bull. Johns
8.
tricuspid
Clinical
defects
and Howe,
transposition
B.,
heart
and
patent
disease:
ductus
J. S., Congenital
of great vessels,
heart
Am.
Malformations
of
Congenital
Atresia
arteriosus,
of tricuspid
orifice, hypoplasia
of
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1939.
Tricuspid
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atresia
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New
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The
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Fund.
1947.
14.
Dunsky,
1., Tricuspid
heart,
15.
Arch.
Alexander,
atresia,
Path.
F.,
and
case,
17.
Robinson,
Am.
18.
Dushane,
Miale,
A.,
21,
Fell,
in
J. E., Dry,
adults,
E.
Swan,
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H.,
Arch.
22.
infants,
M.
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Clin.
T.
Staff
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Maresh,
35:604,
important
of Fallot,
aorta,
Logan,
congenital
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mt.
associated
cardiac
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G. B., Congenital
defects
of trilocular
of tricuspid
correlation
North
Davis,
causing
cyanosis
1947.
of tricuspid
orifice:
Report
of
valve
with
transposition
of great
vessels,
1948.
of some
America
32:879,
T. J., and
interventricular
M.,
conditions
27:64,
atresia
Custer,
septal
less common
C.
B.,
and
cyanotic
congenital
cardiac
1948.
G. S., Congenital
defects,
Am.
B.
and
1947.
A. L., Beno,
and
Surg. 59:445,
Pediat.
Four
J. E., Atresia
Howard,
interauricular
Geraci,
in
and
J. B., Millard,
with
20.
D.,
tetralogy
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75:575,
J. W., Clinical-pathologic
defects
19.
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from
Edwards,
transposed
1947.
White,
to be differentiated
16.
hypoplastic
43:412,
Casas,
R.,
tricuspid
Heart
J.
defect
and
Surgical
atresia
36:438,
probable
treatment
associated
1948.
of
tricuspid
tricuspid
atresia
atresia,
1949.
G.
J.,
and
Fisher,
G.
R.,
Criteria
of
operability
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in
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stenosis,
J.
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Campbell,
23.
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24.
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25.
Elster,
and
Hills,
T.
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J. W., Cyanotic
Heart
S. K.,
H.,
Angiocardiography
congenital
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ATRESIA
heart
atresia
in
disease,
of
pulmonary
II.
Observations
669
cyanotic
Overseas
and
congenital
4:
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heart
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173,
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J. Dis.
Am.
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79:692,
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26.
Cooley,
R. N.,
Sloan,
disease
of
heart
of
27.
right
ventricle,
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E.
genital
28.
Ash,
B.
ovale
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Sokolow,
Dotter,
progress:
of
and
heart
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great
showing
Edgar,
A.
ventricular
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marked
L.,
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aliviada
mediante
desde
its
to the
F. S., Death
de
un
el
Esta
hacia
cardiografico
autores
reportan
autores
Ia
que
grandes
tetralogia
Ia
presencia
Clay
como
and
242:753,
de
el
Webster
un
unico
del
de
and
de
of
con-
1950.
left
in infancy,
with
axis
patent
deviation,
de
electrocardiograma,
un
persistencia
del
eje
ventriculo
metodo
del
en
derecho
de
del
de
conducto
arterioso.
no
Ia presencia
ex#{225}men angio-
auricula
izquierda
uno
de
los
electrocardiograma
tamaiio
del
cianotico
de
con
con
tales
desviaci#{243}n
Ia
en
de
Streets
Ia
rutina
trans-
intrauricular,
presencia
todos
angicardiografico
eficaz.
tricuspidea,
como:
comunicaci#{243}n
el ex#{225}men radiologico
tricuspidea.
atresia
Viceversa,
se
derecho.
atresia
una
ocurre
cuales
ventriculo
de tipo
examen
y presencia
de
siempre
un
de
diagn#{243}stico
Fallot
persistente
Ia hemoglobina,
El
congenitas
de
ser
derecho.
patognomonico
cardiopatIas
cianosis
radiologica
del
puede
y Ia circula-
de
congenita,
eje
aumento
sugiere
una
derecha,
congenitas
otras
a veces
de
ventriculo
del
es
Diagn#{243}stico
Ia cual
izquierdo.
auricula
tetralogia
peque#{241}o. Se
diagn#{243}stico
1950.
aumento
ventriculo
del
electrocardiograma
se se#{241}alaque
54:527,
Criterio
Ia presencia
indic#{243} el
no
arteriosus,
con
particular
1950.
cianotico,
diagnostico,
tricuspidea
angiocardiografico
Ia asociaci#{243}nde cardiopatlas
Fallot
Ia
Ia izquierda
con
del
tipo
y evidencia
o estenosis
hacia
presentarse
with
J. 40:232,
Ia circulaci#{243}n pulmonar
por
significante
del
truncus
entre
tama#{241}o del
eje
puede
disease,
Heart
Radiology
de
sin valor
que
vasos,
Am.
congenita
progresiva
atresia
heart
value,
electrocardiograma,
consistentes
examen
Similarmente,
de
hypertrophy
y Evaluaci#{243}n
se caracteriza
Ia desviacion
el
Ia izquierda
tricuspidea.
dudosos
hypoplasia
diagnosis
J. Med.
congenital
comunicacion
de opacificacion
casos
de
combinaci#{243}n
los
eje
aparentemente
del
desviaci#{243}n hacia
atresia
tres
estiman
dicha
Ia
with
ABSTRACT
sistolicos
opacificaci#{243}n
embargo,
izquierda
posici#{243}n de
y en
sin
una
de soplos
ausencia
Ia ausencia
caso,
Los
hacia
Ia
con
radiologicos
este
in congenital
atresia
roentgenographic
angiocardiography,
Casos
peque#{241}o y aumento
demuestra
signos
En
de
del
derecho
izquierdo,
Los
or
authors.
cardiopatIa
generalmente
Ia izquierda
caracteriz#{243} por
ya
establecimiento
cardiopatIa
Tres
es una
in
diagnostic
following
de
tricuspidea
Ia ocurrencia
ventriculo
ventriculo
de
: Reporte
el nacimiento,
desviaci#{243}n
Angiocardiography
England
ventricular
V-leads
and
communication
Jackson,
estenosis
ci#{243}ngeneral.
in
New
left
of
hypertrophy
Personal
and
Tricuspidea
atresia
T.,
stenosis
advances
vessels,
SPANISH
La
H.
on tricuspid
1949.
and
to
C.,
Atresia
Bahnson,
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Reprints
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright 1951 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.
The online version of this article, along with updated information and services, is located on
the World Wide Web at:
/content/7/5/660
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright 1951 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.