Prophylactic Irradiation of the Lung

Situs inversus totalis is a rare congenital anomaly, as demonstrated by mass radiographic screening in Norway which yielded an incidence of 1 in 10,000.@ Single coronary artery is also rare; a recent review suggested an incidence of 4 in 10,000.' The chance of these two lesions occurring simultaneously is thus about 4 in 1 x 108. Hypertrophic subaortic stenosis is uncommonly as sociated with other cardiac anomalies.° The constella tion of defects in the above case is therefore unique. In this patient, the unusually mild, longterm, clinical course is attributed to infundibular stenosis resulting in a natural “¿ banding― of the pulmonary outflow tract. This is analogous to surgical banding of the pulmonary artery in order to prevent massive pulmonary blood flow and pulmonary hypertension in neonates deemed too young for closure of a ventricular septal defect.7 The weakness, chest pain, and syncope which devel oped in our patient at age 35 are attributed to the combination of left ventricular outflow obstruction and ventricular septal defect rather than to any effects of the single coronary artery which was widely patent anglo graphically. Complete surgical correction of the defects resulted in marked improvement in the hemodynamic and clinical states. The development of aortic regurgitation after surgery