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To the Editor: Dr. Friedman's comment on the physical signs in supravalvular aortic stenosis is a useful one, and one which had escaped my notice. It was not present in either of the patients discussed. The abstract in Circulation 28 (part 2):760, 1964, by Lurie and Mandelbaum points out that in one patient with valvular stenosis, the pressure in the right arm was greater than in the left. In addition, it is well known that multiple anomalies of the great vessels are present and, therefore, a variation in pressure between the arms might be expected in this disease. The first patient discussed in this paper did, in fact, have a narrowing of the innominate artery, and on several occasions the pressure in the right arm was lower than the left. It seems more likely that the anatomic variations will take precedence over the hypothesis so neatly demonstrated by Drs. Lurie
EISENBERG R. RE: SUPRAVALVULAR AORTIC STENOSIS. Am J Dis Child. 1965;109(3):262–263. doi:10.1001/archpedi.1965.02090020263017
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