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To expand the search for central pulmonary arteries in six patients with absence of cardiac-pulmonary continuity, computerized axial tomography (CAT) of the chest was performed. The CAT scans were compared with previous arteriograms and pulmonary vein wedge angiograms. Three patients with type IV truncus arteriosus were studied, and none had a central, right or left pulmonary artery on CAT scan. However, two patients with tetralogy of Fallot with pulmonary atresia and a patent ductus arteriosus to the right lung demonstrated the presence of a left pulmonary artery. In addition, one child with truncus arteriosus with "absent" left pulmonary artery demonstrated a left pulmonary artery on the CAT scan. The CAT scan may therefore enhance our ability to search for disconnected pulmonary arteries in children with complex cyanotic congenital heart disease.

Results of gas endarterectomy of the right coronary artery were evaluated in 29 consecutive patients. There were one surgical and two early postsurgical deaths. All three had postmortem examination, and in two there was occlusion of the gas endarterectomy. Five patients did not have repeat catheterization. Twenty-one patients were completely re-evaluated and had repeat cardiac catheterization one to sixteen months after surgery (mean eight months). Ten patients (Group A) had gas endarterectomy without a saphenous vein graft to the right coronary artery. Only one patient had significant vessel patency. Eleven patients (Group B) had the combined procedure of a saphenous vein graft anastomosed to the segment of artery that had the endarterectomy. There was excellent graft patency in seven patients (64%) and good distal flow into the segment that had endarterectomy in six of the seven patients. In conclusion, gas endarterectomy is not of value unless it can be combined with a saphenous vein graft to provide good flow to the distal vessel that had endarterectomy. Results with the combined procedure suggest that even with a severely diseased artery, gas endarterectomy can often provide continuing distal runoff for the graft.

We studied plasma renin activity (PRA) in eight children before and after surgical correction of aortic coarctation. These eight children underwent a combination of low-sodium diet and diuresis before surgery, and PRA was measured shortly thereafter. Thirty-two to 51 months after successful surgical correction, PRA was measured again. The mean PRA was 21.4 +/- 1.3 ng/ml/hour (+/- SD) preoperatively and 5.5 +/- 1.5 ng/ml/hour postoperatively. These findings provide further evidence of the significance of increased renin-angiotensin activity in patients with aortic coarctation.