The Development of Rib Notching After Surgical Intervention in Congenital Heart Disease

Reference is made to those conditions which may be associated with notching of the ribs. In Fallot's tetralogy a mechanism is known to exist by which such changes rarely occur. An account is given of two cases of congenital heart disease in which the rib lesions were produced by an entirely different mechanism. The feature of these cases is that the rib notching, absent before operation, appeared only on the side of thoracotomy after division of the subclavian artery, a step in the Blalock pulmonary-systemic anastomosis. It is concluded that the erosions developed as a result of the participation by the intercostal arteries in a collateral circulation to the arm. Angiocardiographic studies in Case 1 support this conclusion. Although no similar observations have apparently been reported it seems unlikely that these cases are unique.