Wedge Pulmonary Arteriography in Congenital Heart Disease

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Abstract
Seven normal subjects and 39 patients with congenital cardio-pathies involving both right and left cardiac cavities and the great vessels were studied by wedge pulmonary arteriography. The results were then correlated with the cardiac catheterization findings and the information furnished by conventional venous angiocardiograms. Multiple and rapid exposures were made with a Schonander film-changer. The diameter of the main artery supplying the small pulmonary segment injected, the morphologic pattern, the circulation time of the segment studied, and the fastest and overall average circulation times were determined. Five distinct morphologic patterns emerged. In addition to descriptions of these patterns, the authors also describe those of restricted pulmonary circulation as in pulmonary stenosis and the tetralogy of Fallot. The normal diameter of the initial artery was 1,345 micra; the average diameter was slightly more in cases of significant left-to-right shunt, even larger in cases complicated by high pulmonary resistance, and slightly less than normal in pulmonary stenosis and tetralogy of Fallot. The circulation time of the segment injected (0.39 second in normal subjects) was shorter in left-to-right shunt and prolonged in obstructive pulmonary vascular lesions or at the level of the outflow tract of the right ventricle. In general, there was a direct relationship between the segmental and the overall pulmonary circulation times.

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