Rapid biplane angiocardiography in the tetralogy of Fallot.

Surgery of the heart is becoming increasingly intracardiac; it is, therefore, more important than ever to gain an accurate knowledge of the anatomical and functional changes during the whole of the cardiac cycle, before operative treatment is contemplated. In Fallot's tetralogy interest has chiefly-been centred on the outflow tract of the right ventricle. The prognosis as well as the indications for operation depend to a large extent on the functional capacity of this chamber. This information has been gained primarily by catheterization of the heart and the results have been correlated with the morphological studies obtained by means of angiocardiography. However, there has often been some discrepancy in the results obtained with these two different methods of examination and diagnosis. Even when the results of a necropsy are available the anatomy and the function have often markedly disagreed. The necropsy findings naturally vary with the stage of rigor mortis. In the angiocardiographic examinations often only one picture, or at the most only two separate pictures, of each visualized heart chamber are obtained, and, furthermore, the information thus obtained portrays the static anatomy of the heart. In order to get a wide knowledge of the dynamics of the heart, it is imperative to carry out a continuous objective recording of this organ in life. Such a large part of the intricate heart mechanism is intrinsic to the heart that an accurate concept of its activity is made difficult if one studies merely the movements of the heart silhouette by kymography or even directly at operation. Various reports on the rapid method of angiocardiography with synchronous photography in two projections at right angles and simultaneous electrocardiographic recordings have been presented previously from Norrtulls Hospital and its advantages in the study of heart disease have been pointed out. This report is based on an angiocardiographic study of 23 cases of Fallot's tetralogy using the rapid biplane method. A short review of anatomical and patho-physiological aspects of this disease is presented, and following this a discussion of the importance relative to surgical treatment.