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A Critical Analysis of the Clinical Value of Angiocardiography in Congenital Heart Disease

Postgraduate Medical School of London

A. G. MacGregor, M.D., B.Sc., M.R.C.P., F.R.F.P.S. and E. J. Wayne, M.D., Ph.D., M.Sc., F.R.C.P.

Royal Infirmary, Sheffield

This excerpt was created in the absence of an abstract.

Angiocardiography is not a routine diagnostic method for indiscriminate use in all cases of congenital heart disease. Its value in different lesions varies widely. Full clinical assessment is therefore essential to decide whether angiocardiography is likely to help.

In the majority of cases of the tetralogy of Fallot, the diagnosis can be made by clinical means alone. Angiocardiography amplifies and confirms the diagnosis. It amplifies it by adding accurate anatomical information, which is of value to the surgeon in planning an operation. It demonstrates the relative position of the subclavian and pulmonary arteries and the relative size of the pulmonary arteries on the two sides, which are important details if an anastomotic operation is to be carried out. Where a pulmonary valvotomy is planned, angiocardiography is of less value, since clear demonstration of the site of the stenosis is only occasionally achieved by venous angiocardiography.

The differential diagnosis of the tetralogy of Fallot from rarer cyanotic malformations may be impossible by clinical methods, and in such cases angiocardiography is essential.

In this group of diseases, which includes that of Eisenmenger's syndrome, atrial-septal defect with reversed interatrial shunt, and patent ductus arteriosus with right to left shunt, angiocardiography has proved somewhat disappointing as a diagnostic method in our experience. It demonstrates an interatrial shunt or right ventricular-to-aortic shunt but does not differentiate Eisenmenger's syndrome from patent ductus arteriosus with right to left shunt, nor does it always exclude the tetralogy of Fallot. Cardiac catheterisation is an essential additional method of investigation in these cases.

^* Now at the London Hospital.

Now at the University of Edinburgh.

Accepted for publication January 1, 1953.

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