INJECTION OF THE BRONCHIAL CIRCULATION IN A CASE OF TRANSPOSITION

Abstract

The patient was aged 3 yrs. A systolic murmur, loudest in the tricuspid area, and conducted posteriorly and along the medial border of the left scapula suggested enlargement of the bronchial arteries. 20 hrs. after a Blalock operation the patient died. Necropsy revealed transposition of the great vessels, an interauricular septal defect and a large interventricular septal defect in the middle third of the septum. The injn. revealed that a considerable amt. of blood reached the pulmonary capillaries from the right sided aorta through the bronchial arteries and this was conveyed to the pulmonary arteries as a result of the enlargement and direct anastomoses of the vasa vasorum with the pulmonary artery lumina. The bronchial arteries were enlarged. The presence of enlarged bronchial arteries in congenital heart disease associated with patent pulmonary arteries suggests that the pulmonary vascular capacity is already utilized to its max. This was regarded as a contra-indication for further augmentation of pulmonary blood flow.