THE TECHNIC of subclavian-pulmonary or aortic-pulmonary anastomosis for the classic case of congenital pulmonary stenosis has been fairly well standardized. Unpredictable findings at operation necessitate use of improved variations in surgical procedures. The following 2 cases illustrate emergency deviations in surgical technic necessitated by anomalies of the pulmonary artery.
Case 1.
—T. K., a girl aged 7 years, weighing 43 pounds (19.5 Kg.), was admitted to the Children's Memorial Hospital, Oct. 12, 1948. She had been mildly cyanotic since birth, became dyspneic on slight exertion and after walking about one block would squat in characteristic fashion.Physical examination revealed a frail child with cyanosis visible only in the lips, fingers and toes. Suffusion of the conjunctiva was moderate; clubbing of the fingers and toes was minimal. A loud, harsh systolic murmur was heard at the left third interspace along the edge of the sternum. An accompanying thrill was palpable.Fluoroscopic