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Gross morphology and histology of the heart in Siren lacertina are examined. This work is the first histological study of the heart in this species and for that matter in the Sirenoidea. The gross study is the only complete, modern work on the heart. The heart of Siren is composed of the partially septate sinus venosus, two atria, partially septate ventricle and conus arteriosus. The truncus arteriosus is transitional between cardiac and vascular systems. Many characteristics in the heart are studied, including the relation of chambers one to the other, connective tissue ligaments stabilizing the heart within the pericardial cavity and organization of cardiac muscular trabeculae and connective tissue bands. Additional structures examined

This is a collection of papers from a conference held at the University of Maryland, Baltimore, that highlights major controversies in the surgical management of seven common congenital heart defects. An additional section concerns techniques of profusion and hypothermia. Both sides of controversial issues are discussed by authorities. The section on transposition of the great arteries includes a detailed description of the technique and results of the Mustard procedure by Trusler and the advantage of the Senning procedure by Brom, and Yacoub tells why he abandoned the baffle procedure and went to anatomic correction. Ebert presents his excellent results on primary repair of truncus arteriosus and stresses the importance of early operation, while the child is in reasonable condition. The section on the repair of an atrioventricular septal defect by Carpentier, Danielson, and Bjork presents both sides of the use of a single vs two-patch technique. Perhaps the most interesting

Among the many malformations of the heart and of the great vessels, those arising because of failure of the aorticopulmonary septum to develop constitute a group both interesting and small. Shapiro1accepted only two cases as genuine examples of this defect, while Humphreys2in a comprehensive review cited two more, adding a fifth of her own. Both of these authors included the case reported by Preisz,3an inclusion the wisdom of which I question. The most recent report of an authentic truncus communis was by Beaver.4It is impossible from the meager data given by Motta5to reach any conclusion as to the real condition present in his 5 day old subject. Since a careful study of malformed hearts constitutes a major portion of the experimental work on cardiac embryology, I feel justified in reporting a rather unusual example of this rare defect. REPORT OF

Congenital bicuspid aortic valves are of two types, those consisting of two normal cusps and those in which one of the two cusps is subdivided by a ridge of congenital origin into two segments. The first type is evidently due to improper development of the endocardial swellings in the truncus arteriosus that form the rudimentary cusps or possibly to faulty growth of the aortic septum which normally bisects the two lateral endocardial cushions. In the second type there is maldevelopment of a commissure due to arrested growth of the annulus fibrosus and of the projections of the annulus that normally form the commissural cusp margins. The congenital ridge thus represents an abortive and deformed commissure. A recent survey of records of 3,300 consecutive autopsies at the Institute of Pathology of the University Hospitals of Cleveland revealed 18 cases of congenital bicuspid aortic valve. Nine of these occurred among newborn and

PERSISTENT truncus arteriosus is one of the few congenital cardiovascular anomalies for which complete surgical repair has not yet been accomplished, but the anomaly is theoretically correctable. 1 Repair requires (1) closure of the ventricular septal defect in such a fashion as to make the truncus originate exclusively from the left ventricle and therefore act as the aorta, (2) disconnection of the pulmonary artery from the truncus, and (3) creation of an outflow from the right ventricle to the pulmonary artery. Reconstruction of the pulmonary artery and the outflow tract of the right ventricle poses the most challenging surgical problem. Since increased pulmonary vascular resistance is present in such patients, elevated pulmonary arterial pressures persist at least for some time after surgery; thus, significant pulmonary regurgitation would ensue unless a "pulmonary valve" was inserted at surgery. As an alternate solution to prosthetic construction of a right ventricular outflow in truncus

ABNORMALITIES in the circulatory system have frequently been recorded in the Salientia. O'Donoghue (1931) lists forty-eight accounts of such anomalies, all in Rana temporaria. Of these records, nine concern a transverse anastomosis joining the two external jugular veins; six were of abnormal abdominal veins; and seventeen others described anomalies in the posterior caval and renal portal veins. Only five of the forty-eight concern the arterial system, and of these, four are of abnormal pulmonary arteries. The fifth records the absence of the right systemic aorta posterior to the origin of the subclavian artery. The presence of a fifth aortic arch in Rana temporaria and the absence of a right anterior vena cava in Rana esculenta are described by O'Donoghue (1933). A subsequent paper by the same author (1935) gives twenty-two additional instances of variations in the vascular system of Rana temporaria. Only two of these records, an abnormal occipital and an abnormal subclavian, concern arteries. Venous abnormalities in the Indian frog (Rana tigrina) have been observed by Khatib (1938), and an abnormal renal-portal in the American bullfrog (Rana catesbeiana) is described by Jnanendra (1938). Many of the reported cases of abnormal vascular systems in frogs represent the retention of certain palingenetic vessels. The anomaly here described, in an adult male specimen of Rana cates'beiana Shaw, is an extremely radical one, not readily explainable. It appears to be the only record of an arterial anomaly in the American bullfrog. The specimen here described is apparently normal in all respects except for the absence of one of the aortic arches and certain compensatory alterations in a second arch. The principal arteries showing the modifications are illustrated in Figure 1. The conus arteriosus branches normally and the right truncus arteriosus divides to form the carotid, systemic and pulmo-cutaneous arches, all of which proceed normally. The left truncus arteriosus, however, gives rise to only a carotid and a pulmo-cutaneous arch, the systemic arch being entirely lacking on this side. The dorsal aorta is consequently formed by the posterior extension of the right systemic arch only, and is in this way suggestive of the condition seen in birds. The vessels of the left side then arise as follows: The enlarged carotid arch bifurcates to form the external and internal carotid arteries. The external carotid branch, which is of smaller diameter but longer than normal, comes off just beyond the division of the truncus arteriosus and runs forward to serve the thyroid, tongue, and muscles 6f the hyoid apparatus. The internal carotid runs forward and lateral to the point where it would correctly enter the roof of the mouth. Instead of entering at this point it continues laterally, finally giving rise to an enlarged occipito-vertebral branch. The remainder of this internal carotid then continues posteriorly as the subclavian. The palatine, cerebral carotid, and ophthalmic arteries which normally result from the breaking up of the internal carotid are lacking. The absence of these vessels seems to be compensated for in part by similarly

To the Editor.— Persistent truncus arteriosus in an uncommon congenital cardiac anomaly with a poor prognosis. Recent advances in surgical technique have made corrective surgery possible in some children who survive until the age of 3 or 4 years. For this reason palliative procedures designed to tide these children over until that time are of increasing interest. The following is a report of an unusual palliative operation in a neonate with a persistent truncus arteriosus, reduced pulmonary blood flow, and severe cyanosis. Report of a Case.— The patient was admitted to the Boston Floating Hospital at 6 days of age, weighing 6 lb 8 oz. She was obviously cyanotic but in no acute distress. Pertinent physical findings were a normal heart size and a pansystolic murmur over the entire precordium with an early diastolic component. Cardiac catheterization revealed a large ventricular septal defect, with equal pressures in both ventricles and

AS ISOLATED malformations, persistent truncus arteriosus and atresia of the aortic arch are unusual cardiovascular anomalies. The presence of both conditions in an individual has been reported in only two previous cases in the recent literature. 1,2 The diagnosis was made prior to death in one of these cases. 1 The purpose of this report is to describe the second case of persistent truncus arteriosus with associated aortic atresia in which the diagnosis was made premortem. Report of a Case A 3,200 gm (7 lb 1 oz) Negro male was born at term to a 16-year-old primigravida following an uncomplicated pergnancy and delivery. The infant appeared in good condition at birth, but a systolic murmur was noted on the first examination at 10 hours of age. At 3 days of age, the infant was noted to have marked tachypnea and very slight cyanosis of his mucous membranes and nail beds.

A unique diverticulum of the basal region of the right ventricle ruptured spontaneously, leading to unexpected death in an infant with persistent truncus arteriosus. Initial symptoms, including cyanosis and tachypnea, appeared to be corrected by digitalization. Later clinical manifestations resembling upper-respiratory tract infection also disappeared shortly before death. Roentgenographic examination showed enlargement of the heart, prominent pulmonary vascular markings, and, eventually, the diverticulum. Additional anatomic findings include agenesis of pulmonary artery, bronchial artery hypertrophy, and two congenital diverticula of right ventricle, with rupture and hemopericardium.

A very rare form of apparent congenital absence of the tibia is presented in which duplication of a distal limb ray, rather than deletion, was found. Previous report of an associated truncus arteriosus has not come to my attention. Spontaneous mutation or idiopathic teratogenesis is hypothesized in the absence of a known etiologic agent.

This text attempts to survey the field of cardiovascular surgery, summarizing the most significant developments of the past two decades. A correlation between clinical features and operative findings is well presented. Throughout the text the pathologic physiology is stressed in each case to corroborate the findings of diagnosis, natural history, and therapy. Among the 24 chapters, 20 are devoted to specific lesions, grouping aortic valvular lesions with left ventricular outflow tract abnormalities. The remaining four chapters are concerned with methods of diagnosis, extracorporeal circulation, preoperative and postoperative care, and heart transplantation. Because of the continuous expansion of the field of cardiovascular surgery, the text may be destined for rather early obsolescence as new techniques appear. For example, the treatment for persistent truncus arteriosus is discussed as being questionably surgical, whereas during the past year the operative correction of this anomaly has been successfully accomplished in a growing number of cases.

Relief of right ventricular obstruction in tetralogy of Fallot often requires, in addition to infundibular resection, the insertion of an outflow-tract prosthesis. In certain instances correction of such malformations necessitates enlargement of the pulmonary artery by extension of a diamond-shaped right ventricular patch across the pulmonic valve ring for a considerable distance into this vessel. More severe pulmonary artery hypoplasia and varieties of persistent truncus arteriosus may be amenable to correction only if the main pulmonary artery is completely replaced by some type of graft. The results of experiments in which a vascular prosthesis was inserted between the right ventricle and a branch of the pulmonary artery have been reported previously.1A description of the technique and hemodynamic consequences attending replacement of the main pulmonary artery with a valveless graft comprise the subject of the present report. Method Adult mongrel dogs weighing 10 kg. to 16 kg. were anesthetized

Truncus arteriosus (TA) is a rare congenital condition defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. We discuss the unique case of a 28 year-old female patient with unrepaired TA and interruption of the aortic arch who underwent cardiovascular magnetic resonance (CMR).

Background Repair of truncus arteriosus in early infant period has become standard practice in many centers. We report the current clinical outcomes of primary repair of truncus arteriosus in early infancy at a single institution. Methods A retrospective analysis of 31 patients with mean age 2.6 ± 1.3 months (range, 15 days–6 months), and mean body weight 3.4 ± 0.6 kg (range, 2.6–4.7 kg) who underwent primary repair of truncus arteriosus. Data were collected regarding demographics, anatomy, operative data, cardiac intensive care unit, and last available follow-up. Results There were four hospital deaths (12.9%); three of them were due to pulmonary hypertension. At median follow up of 8 months (range, 1–100 months) after surgery, there was no late death. One patient was reoperated on for right ventricle-to-pulmonary artery (RV-to-PA) conduit replacement, residual ventricular septal defect repair, and truncal valve repair. One patient was reoperated on twice for truncal valve repair and later on truncal valve replacement. Three patients required percutaneous balloon dilation and stenting of pulmonary artery branches. Conclusions Truncus arteriosus can be performed in early infancy with acceptable perioperative mortality and morbidity. Pulmonary hypertension continues to be a risk factor of mortality.