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Safe and permanent closure of patent ductus arteriosus (PDA) can be accomplished with an ivalon plug introduced by catheterization from the femoral artery. The authors' experience thus far obtained from treating more than a hundred patients suggests that the technique described in this paper is a feasible alternative to the surgical approach. A prerequisite has been the size and shape of the PDA, the lumen of which had to be conical in shape and smaller than the lumen of the femoral artery. Now safe closure of oversized PDA complicated by pulmonary hypertension has become possible, using a plug designed with a special mechanism for anchorage to the PDA. The technique of this closure is described in detail in this report of its successful use in a 50-year-old woman patient with an oversized, calcified PDA complicated by pulmonary and systemic hypertension and cystic lung disease. Treating such high-risk cases with transfemoral closure means real improvement in therapy over surgical treatment.

Es werden die angiographischen Befunde in zwei Fallen von Aortenbogensyndrom auf entzundlicher Basis und bei einem Fall von arteriosklerotischer Obliteration beider Arteriae subclaviae ausfuhrlich dargestellt. Im Hinblick auf die heute prinzipiell mogliche Verbesserung der zerebralen Durchblutung durch gefaschirurgische Eingriffe wird auf die Bedeutung einer gezielten angiographischen Untersuchung der supraaortischen Aste zur exakten Ermittlung der verbliebenen Restzirkulation hingewiesen. Die Angiographie ist die einzige diagnostische Methode, die etwas uber die Operabilitat eines Aortenbogensyndroms aussagen und den Operationserfolg belegen kann. The angiographic findings in two cases of aortic arch syndrome of inflammatory origin are described together with a single case of arteriosclerotic obliteration of both subclavian arteries. In view of the possibility of improving the cerebral circulation by vascular surgery it is important to obtain selective angiographic demonstration of the supra-aortic vessels for an exact evaluation of the remaining circulation. Angiography is the only diagnostic method which can be used to assess operability in cases of the aortic arch syndrome and to prove the success of the operation. Les auteurs demontrent les angiographies de 2 cas de syndrome de la crosse de l'aorte d'origine inflammatoire et d'un cas d'une obliteration par arterio-sclerose des deux arteres sous-clavieres. En tenant compte de l'amelioration actuellement possible de la circulation cerebrale par des interventions chirurgicales sur les vaisseaux, les auteurs soulignent l'importance de l'examen angiographique dirige des branches de la crosse aortique afin de determiner exactement l'etat du reste du reseau vasculaire. L'angiographie est la seule methode de diagnostic qui permet de poser le pronostic de l'operabilite d'un syndrome de la crosse de l'aorte et de verifier le succes de l'operation. Se describen detalladamente los hallazgos angiograficos en dos casos de sindrome del cayado aortico de naturaleza inflamatoria y en un caso de obliteracion arteriosclerotica de ambas arterias subclavias. Teniendo en cuenta que actualmente es posible mejorar la vascularizacion cerebral por medio de intervenciones quirurgicas a nivel del sistema vascular del encefalo, se senala la importancia del examen angiografico selectivo de los troncos supraaorticos para la valoracion exacta de la circulacion residual presente. La angiografia es el unico procedimiento diagnostico que puede decir algo acerca de la operabilidad de un sindrome de arco aortico y que puede fundamentar el resultado quirurgico.

A new technique for the transvenous implantation of a specially designed atrial sensing electrode is described. In combination with a ventricular stimulating electrode and an atrial-controlled pacemaker, the method enables synchronization of atrial with ventricular activity. The atrial sensing electrode is put into the right atrial appendage through a preshaped radiopaque Teflon applicator catheter. Two hooks on the electrode tip provide for safe and secure anchoring of the electrode tip to trabeculae of the atrial appendage. The technique has been used for synchronous P wave pacing in 12 patients with complete atrioventricular block, most of them suffering from AdamStokes attacks. Three additional patients with sinoatrial block were treated by means of anchored atrial electrodes. Observation periods of up to 39 months showed no dislocation of any of the anchored atrial electrodes, and performance in all patients was faultless.

Percutaneous transluminal angioplasty (PTA) is intimately linked with the name of CT Dotter [1]. In the late 1960s we introduced with good results our caged balloon (to treat occlusions of pelvic and lower extremity arteries) [5]. The development of newer types of catheter by Dr. Gruntzig has resulted in a major breakthrough and the present significance of PTA [3]. He was the first to dilate a coronary stenosis successfully [2]. Although more than a thousand patients worldwide have so far been treated by percutaneous transluminal coronary angioplasty (PTCA), it is still a method that must be used with great caution if it is not going to fall into disrepute [4,6]. Only a prolonged period of objective analysis of all results will allow us do define more clearly its indications and contraindications. During the last 2 1/2 years we have applied PTCA only 40 times. We have selected patients who would otherwise have had to undergo bypass procedures.

Patent ductus arteriosus was the first inborn cardiac defect ever eliminated by percutaneous transvascular therapy. The method, results, and complications of Ivalon plugging of the ductus in 208 patients between 5 and 62 years old and treated between 1967 and 1985 are described. Permanent closure was accomplished in 197 patients (94.7%). The following particular benefits are obtainable from the method: no need for thoracotomy; local anesthesia applicable to 65% of all cases; 30 mm average time of intervention; only moderate invasiveness to the patients; only 7 days of hospitalization; good cost-benefit ratio.

Transluminal angioplasty was carried out in a series of 100 consecutive patients with ischemic disease of the legs. One hundred twenty-one procedures were done with initial success in 76% and long-term success (more than 2–7 years) in 37–40%. Benefits obtained from angioplasty were assayed clinically in all and by follow-up arteriography in 35 patients. Angioplasty was found to be most successful in patients over 40 with short segmental occlusive disease limited to the superficial femoral artery. Maintenance anticoagulant therapy appeared to improve the chances for lasting patency. In properly chosen patients, transluminal angioplasty should be considered the primary treatment for vascular occlusive disease in the legs.