Angiography of the Thoracic Aorta and Coronary Vessels

The possibility of the direct injection of an opaque material into the aorta for its roentgenographic visualization has been demonstrated by dos Santos, Lamas, and Pereira Caldas (1, 2), Nelson (3), and others. These studies, however, have been limited to the abdominal aorta. Roentgenograms of the thoracic aorta have been obtained by other methods, as the injection of a contrast substance into the blood stream by way of the arm veins (4) and heart catheterization. The roentgenologic anatomy of the aorta has been studied in cadavers by Laubry, Cottenot, Routier, and Heim de Balsac (5) in France, by Snellen and Nauta (6) in Holland, and by Meneses Hoyos and Quesada (7) in Mexico City. In four cases, to be briefly reported here, good roentgenograms were obtained following direct injection of an opaque solution into the thoracic aorta, demonstrating the aorta, its main branches, the arteries of the neck, and the coronary vessels. The first patient in whom the procedure was employed was a young girl with a large cirsoid aneurysm of the neck, an associated arteriovenous fistula, a systolic murmur, slight cardiac enlargement, and rapid heart action. The heart condition was believed to be due to the presence of the arteriovenous fistula and the cirsoid aneurysm, but resection of the latter was considered difficult because of its apparent attachment to the subclavian artery. Arteriograms of the neck vessels following direct injection of opaque material into the thoracic aorta showed the complete independence of the artery supplying the aneurysm and containing the fistula. Resection was then carried out and the patient was restored to health. The cardiac murmur disappeared, and the heart size was shown roentgenographically to have diminished. The second patient was a girl with an unusual type of coarctation of the aorta, the stenosis being in the aortic arch between the point of origin of the innominate artery and that of the left carotid artery. When the attempt was made to introduce the contrast solution into the aorta, some escaped into the mammary artery and the existence of a collateral circulation was demonstrated. In the two remaining cases the procedure established the diagnosis of aneurysm of the descending aorta, excluding the possibility of a mediastinal tumor and thus preventing unnecessary surgical intervention with its attendant risk. Technic In three of the cases sodium pentothal anesthesia was used, 6 to 10 c.c. of a 2.5 to 5 per cent solution being injected in a vein of the arm, followed by doses of 2.0 c.c, as required. In one case local anesthesia with novocaine was employed. Needless to say, the services of a trained anesthetist are essential.