bluuebunny/crossref_metadata_2025 huggingface dataset:
The provocation of coronary artery spasm
Authors: Chahine Robert A.
Published: March 2007

On the basis of the overall experience, the provocation of coronary artery spasm with ergonovine is thought to be a highly sensitive and specific test for coronary artery spasm in Prinzmetal's variant angina. In spite of occasional complications, in experienced hands the procedure is considered to be safe. The challenge remains to determine the value of this and other provocative interventions in assessing the role of spasm in other aspects of ischemic heart disease, particularly in patients with critical atherosclerotic lesions.
Quantitation of left ventricular wall motion in normal subjects: Comparison of various methods
Authors: Bhargava Valmik , Warren Sanford , Vieweg W. V. R. , Shabetai Ralph
Published: March 2007

Computer‐assisted analysis of percent change in the square root of area in each of 12 consecutive 30‐degree, pie‐shaped ventricular segments was obtained in 48 normal subjects who underwent cardiac catheterization and left ventriculography. The information obtained permitted establishment of objective confidence limits for normal left ventricular regional wall motion. As an index of dynamic changes in segmental wall motion, the percent change in the square root of area method compared favorably with existing radius, area, hemichord, and chord methods. It also possessed a variety of theoretical advantages over these techniques: 1) large numbers of points were analyzed, 2) wall motion disorders in all areas except base were evaluated, 3) taking the square root of area's percent change provided both area information with least splay and an average measure of radius.
Cardiomyopathies characterized by evidence of resistance to left ventricular inflow
Authors: Maron Barry J. , Long Linda , Moller James H. , Edwards Jesse E.
Published: March 2007

Restrictive cardiomyopathy characterized by evidence of left ventricular inflow obstruction was studied in four cases—one child and three adults. In three of the cases, including the child, there was pathologic evidence of hypertrophic cardiomyopathy with asymmetric septal hypertrophy. In the fourth case, no cardiac disease was identified as the anatomic basis for the inflow restriction. This latter case broadens the concept of restrictive cardiomyopathies.
Comparison of biplane and single plane left ventricular volumes in atrial septal defect
Authors: Fraker Theodore D. , Wise N. Kent , Harrell Frank E. , Behar Victor S.
Published: March 2007

The close agreement between biplane (BP) and single‐plane (SP) angiographic estimates of left ventricular (LV) volumes results from the similarity of the minor axes measured in the right anterior oblique (RAO) and left anterior oblique (LAO) views. Disease states that alter LV geometry may change the length of one minor axis more than the other, producing a discrepancy between BP and SP volumes. To examine this hyposthesis, angiographically derived volumes in 21 patients with atrial septal defects (ASD) in which the LV appears to be compressed and flattened by an enlarged right ventricle, were compared to 100 normal control patients. In the control patients, the median SP estimate of end‐diastolic volume (EDV) was 7.6% larger than the BP determination, whereas in patients with ASD, the median SP EDV estimate was 16.7% larger than the BP EDV (P<0.0001). The SP end‐systolic volume (ESV) underestimated the BP value by 3.4% in controls but overestimated the BP ESV in patients with ASD by 4.3% (P<0.02). The overestimate of the SP EDV and SP ESV when compared to the BP volumes may be due to changes in either the minor axes or the appearance of the longest major axis in the LAO view. The longest major axis was found in the RAO view in 99% (99/100) of normals and 95% (20/21) of ASD patients (PNS). The median ratio of RAO to LAO end‐diastolic minor axes, however, was 1.07 in the normals and 1.17 for ASD patients. The median ratio of end‐systolic minor axes was 0.97 for controls and 1.04 for ASD patients.

Compression of the LV in patients with ASD shortens the LAO minor axis, resulting in a significantly greater SP overestimation of LV volume than occurs in normals. The degree of SP volume overestimate was not predicted by the magnitude of the left‐to‐right shunt or pulmonary pressure. This source of error affects all SP methods for determining left ventricular volume, including radionuclide techniques using static images.
A simplified method for the calculation of left ventricular volume by equilibrium radionuclide angiography
Authors: Slutsky Robert , Battler Alexander , Gerber Kenneth , Gordon Donald , Phd John Verba , Peterson Kirk , Murray I. Provin , Ashburn William
Published: March 2007

We have recently reported on the relationship between left ventricular (LV) volume (V) determined by contrast ventriculography (CV) and corresponding volume units calculated from LV region‐of‐interest counts obtained from ECG gated equilibrium radionuclide angiographic (EQ) time‐activity curves. We corrected the absolute number of counts at end‐diastole (ED) and end‐systole (ES) for the number of processed cardiac cycles, acquisition time, and counts in plasma at the time of the data acquisition. To evaluate a simpler method, which merely involves correcting for counts in whole blood rather than plasma, we studied 15 patients prospectively prior to CV. Each patient underwent EQ using 15–20 mCi of 99mTc‐human serum albumin. Ten ml of blood were withdrawn at the midpoint of each study. Four ml were suspended above the scintillation camera detector to determine the “blood” radioactivity concentration. For comparison, the remaining 6 ml were centrifuged to yield 0.1 ml of plasma and counted separately in a well counter. ED and ES counts were obtained by using a standard commercial semi‐automatic computer program with a varying LV region‐of‐interest edge tracking algorithm. Radionuclide derived volume units by both methods were correlated with CV volume, yielding the following results: when counting plasma, for EDV, r = 0.94, and for ESV, r = 0.95; using the simpler blood counting method, for EDV, r = 0.93, and for ESV, r = 0.94. We conclude that LV volume can be calculated using count‐derived radionuclide volume units.
Left atrial electrograms recorded through the patent foramen ovale
Authors: Shapiro Jerome B. , Kaltman Alfred J.
Published: March 2007

The presence of a patent foramen ovale allows direct recording of a left atrial (LA) electrogram. Three patients are reported in whom simultaneous high right atrial (HRA), coronary sinus (CS), and direct LA electrograms were obtained. In two patients with normal surface ECG P waves the direct LA lead depolarized before the CS or low RA. The HRA to LRA and HRA to CS conduction times were similar to those reported previously. In a patient with a prolonged surface ECG P wave, the direct LA electrogram occurred late and after low RA depolarization.

Recording LA electrograms through a patent foramen ovale is a useful technique, and these defects should be sought in all patients undergoing electrophysiological study.
Evaluation of a new catheter‐mounted electromagnetic velocity sensor during cardiac catheterization
Authors: Nichols Wilmer W. , Pepine Carl J. , Conti C. Richard , Christie Leonard G. , Feldman Robert L.
Published: March 2007

Pulsatile blood flow was measured with an electromagnetic catheter‐tip velocity transducer in the main pulmonary artery or ascending aorta of 37 patients. This catheter also contains micromanometers for high‐fidelity arterial and ventricular pressure measurements. We found that great vessel blood flow velocity patterns were similar to those obtained by other methods. Cardiac output, calculated from the product of mean flow velocity and vessel cross‐sectional area, was compared with output determined by dye dilution in 28 patients. The correlation coefficient was 0.93 and the regression equation y = 0.93 × + 0.26 liter/min (SEE = 0.8 liter/min). In the remaining nine patients, the flowmeter output was calibrated, in cm3/sec, by reference to simultaneous dye‐dilution cardiac output determination [5]. Output was then changed by exercise or β‐blockade and measured again by dye dilution. These values were compared to output simultaneously obtained by electromagnetic flowmeter (n = 19). In the patient subgroup of 19 subjects, the correlation coefficient was 0.94 and the regression equation y = 0.87 × + 0.49 liter/min (SEE = 0.72 liter/min). No complications were associated with the use of the catheter. These results suggest that the multisensor catheter offers a safe, reliable technique for obtaining high‐quality pulmonary artery and ascending aortic blood flow and pressure and ventricular pressure waveforms in conscious man.
Regional pressure differences in the left ventricle
Authors: Falsetti Herman L. , Verani Mario S. , Chen Ching‐Jen , Cramer James A.
Published: March 2007

Theoretically, if blood is to have directional flow and different magnitudes of velocity, pressure should be distributed in the left ventricle (LV) as a function of both space and time. Thus, regional pressure differences (RPD) were examined in the LV of 20 open‐chested dogs. High‐fidelity transducers were implanted through stab wounds at three positions in the LV: the base (B), equator (EQ), and apex (APX). Simultaneous, high‐fidelity LV pressures were compared in each region under rest conditions and during graded infusions of isoproterenol and propranolol. In the baseline condition, there were slight but significant differences between the APX and B in end‐diastolic pressure (EDP), peak systolic pressure (PSP), peak dp/dt and Vmax. At rest, the largest RPD between the APX and B in PSP was 9 mm Hg (mean ± 1 SE = 2.1 ± 0.5), and the largest during diastole was 5.1 mm Hg (mean ± 1 SE = 1.2 ± 0.4); the largest difference in Vmax was 30.5% (mean ± 1 SE = 10.8 ± 2.4). During isoproterenol infusion the RPD in PSP were accentuated; the largest seen was 84 mm Hg between APX and B (mean ± 1 SE = 15.7 ± 4.5). The largest difference in Vmax between B and APX was 188% (mean ± 1 SE = 48.5 ± 9.4). Propranolol obliterated these RPD. These results indicate that there are significant RPD in the LV cavity; during systole the highest pressures decrease sequentially from the apex to the equator and to the base; during diastole these RPD are of lesser magnitude. These RPD affect all derived pressure indices, and these changes can be Increased or decreased by drug interventlon. These results are important for two reasons: 1) the position of catheters in the LV cavity is important when pressure dependent LV parameters are compared in different conditions; and 2) in any force balance analysis of the left ventricle it is important to note that force generation by the left ventricle is an active process that transmits regional pressure differences to the LV cavity.
Evaluation of pattern recognition rules for the apex of the heart
Authors: Brower R. W.
Published: March 2007

The observer variability and accuracy of rules for the automatic recognition of the left ventricular (LV) apex are reported. To form a data base for examining this problem 18 co‐workers were asked to independently identify the apex of 79 left ventriculograms (LVgrams) in the 30‐degree right anterior oblique projection at end‐disastole (ED) and end‐systole (ES), and to assign a confidence score from 0% to 100% for each apex. The group consisted of five clinical cardiologists (G1), six trained analysts (G2), and seven other experienced observers (G3). The LVgrams were selected to include those from 31 normal individuals and those from 48 patients with mixed akinesis/dykinesis as coded by conventional scoring techniques. There was no significant difference in the confidence for the ED vs ES apices. However, confidence of G1 was significantly lower than that of G2. The standard deviation in the observer‐detected apex correlated (r = −0.92) with the mean observer confidence, which suggests a basis for quantifying “confidence” in the automated apex detection. The apex determined with respect to the superior aspect of the aortic valve proved superior to all other tested methods. The concept of “peakedness index” is introduced and used to estimate observer variability.
Effects of coronary artery narrowing, collaterals, and left ventricular function on the pattern of myocardial perfusion
Authors: Iskandrian Abdulmassih S. , Segal Bernard L. , Haaz William , Kane Sally
Published: March 2007

We evaluated effects of the degree of diameter narrowing of the coronary arteries (50–69%, 70–89%, ≥90%); extent of coronary disease [one‐vessel disease (1VD), two‐vessel (2VD), three‐vessel (3VD)]; collaterals; and left ventricular function on the pattern of exercise thallium‐201 perfusion in 121 patients; 30 patients with normal coronary angiograms, 37 with 1VD, 24 with 2VD, and 30 with 3VD. Fifteen patients had Q waves on ECG, 29 patients had akinetic segments on the left ventriculogram, and 46 patients had collaterals. The results suggest the following: 1) Patients with 59–69% narrowing of one vessel have normal exercise perfusion. 2) All patients with 1VD have abnormal exercise perfusion if the degree of narrowing is ≥90%, unless the right coronary artery (RCA) is the vessel involved. 3) Patients with 2VD and 3VD generally have abnormal exercise perfusion unless all the narrowings are <90%, or the RCA is the only vessel with ≥90% narrowing, or the stress is submaximal. 4) Collaterals do not protect against development of abnormal exercise perfusion; they feed the most severely narrowed vessel, and perfusion abnormalities are ordinarily seen in the distribution of such severely narrowed vessels. 5) Neither the presence of Q waves on the ECG nor an akinetic segment on the left ventriculogram correlates with defects in the redistribution images; residual defects may be seen in the delayed images despite the absence of prior myocardial infarction, and normal images may be seen despite the presence of akinetic segments in the left ventriculogram.
Myocardial infarction following acute aortic dissection
Authors: Khan Rahman , Amaram Sudhir , Gomes Joseph A. , Kelen George J. , Lynfield Joshua , El‐Sherif Nabil
Published: March 2007

Acute aortic dissection may present a clinical picture simulating myocardial infarction, including electrocardiographic changes. The mechanism underlying this mode of presentation has not heretofore been documented during life. We present here for the first time, a patient with acute aortic dissection and the clinical picture of acute myocardial infarction, where the mechanism of infarction has been demonstrated, by preoperative angiographic studies, probably to be due to compression of the extramural portion of the right coronary artery by the false channel of the dissecting hematoma.
Normal left ventricular function with total occlusion of right and left main coronary arteries
Authors: Goldberger Ary L. , Costello Dennis L. , Moores William Y.
Published: March 2007

This report describes a unique case of normal left ventricular function in a patient with total proximal occlusion of the entire native coronary circulation in addition to an occluded left anterior descending bypass graft. Coronary flow was maintained by a sequential saphenous vein graft to the obtuse marginal and posterior descending arteries, with collateral filling of the left anterior descending vessel. Myocardial function was preserved, presumably because of the relatively gradual process of native coronary occlusion, allowing time for development of adequate collateral perfusion.
Pressurized contrast delivery for coronary arteriography
Authors: Sosa Julio A. , Cameron Stephen
Published: March 2007

A system is described for eliminating negative pressure source of air bubbles within a closed‐circuit arrangement for dye delivery in coronary angiography. Replacing the usual manual pressure created by an aspirating syringe, this system pressurizes the reservoir bottle by means of a cuffed bag, double‐lumen, one‐way piercing spike and a 0.2 μm filter.
The clinical and hemodynamic significance of mitral regurgitation in coronary artery disease
Authors: Zeldis Steven M. , Hamby Robert I. , Aintablian Agop
Published: March 2007

To evaluate the significance of mitral regurgitation in coronary artery disease (CAD), clinical, electrocardiographic, and angiographic data in 100 coronary artery disease patients with mitral regurgitation were compared to data in 100 coronary artery disease patients without mitral regurgitation. Mitral regurgitation was mild (1+) to moderate (2+) in 94 patients. Heart failure, cardiomegaly, and anterior myocardial infarction were more common in mitral regurgitation patients than in controls (33 vs 4; 47 vs 8; 22 vs 5, respectively, P <0.001). The frequency of inferior myocardial infarction was equal in both groups. Significant left anterior descending and circumflex disease was equally frequent; however, right coronary disease was more frequent in patients with mitral regurgitation (87 vs 68, P <0.001). Total vessel occlusions and triple‐vessel disease were more frequent in patients with mitral regurgitation (113 vs 78, P <0.01; 60 vs 40, P <0.001, respectively). No localized area of asynergy was more common in patients or controls, but left ventricular aneurysms and generalized hypokinesis were more common in patients with mitral regurgitation (6 vs 0; 23 vs 2; P <0.001).

These data suggest that mitral regurgitation is most often mild, but is associated with significant left ventricular dysfunction and advanced CAD.
Hemodynamic assessment of the lonescu‐shiley pericardial xenograft in the mitral position
Authors: Febres‐Roman P. R. , Haas J. M. , Cowen G. D.
Published: March 2007

While the very low thrombogenicity without anticoagulant therapy and generally good durability of the lonescu‐Shiley bioprosthesis has been demonstrated, further hemodynamic assessment is necessary. The present study assessed cardiac function and heterograft performance during right and left heart catheterization at rest and exercise (three to six months postoperation) of eight patients with severe mitral stenosis and/or regurgitation prior to surgery. We found, comparing pre‐ and postoperative resting values, that mean pulmonary artery pressure decreased (32 ± 2.7 to 22 ± 3.5 mm Hg; P < 0.02), cardiac index increased (2.1 ± 0.09 to 2.5 ± 0.13 liters/min/m2; P < 0.01), pulmonary wedge pressure decreased (21 ± 2.3 to 13 ± 1.8 mm Hg; P < 0.01), and the clinical status (NYHA) improved markedly. Mean diastolic gradient across the pericardial xenograft was 6.1 ± 1.1 mm Hg at rest and 14.6 ± 2.3 mm Hg on exercise. The calculated xenograft surface area was 1.7 cm2 at rest and 2.0 cm2 during exercise. No regurgitation was detected in seven of eight patients. Thus, mitral lonescu‐Shiley bioprosthesis provide excellent heterograft function.
Pulsed doppler echocardiographic findings in total anomalous pulmonary venous drainage to the coronary sinus
Authors: Pickoff Arthur S. , Sequeira Rafael , Ferrer Pedro L. , Tamer Dolores , Bennett Vicki , Fojaco Rita , Gelband Henry
Published: March 2007

The pulsed Doppler echocardiographic (PDE) findings in a premature cyanotic infant with total anomalous pulmonary venous return to the coronary sinus are reported. Features that suggested the diagnosis of total anomalous pulmonary venous return were 1) an area of systolic‐diastolic turbulent flow posterior to the apparent left atrial border, which was interpreted as representing the convergence of pulmonary venous return to a common pulmonary vein, and 2) systolic and diastolic turbulent flow within the right atrium suggesting pulmonary venous return through the coronary sinus. We suggest that PDE should be included as part of the evaluation of cyanotic infants in whom the diagnosis of total anomalous pulmonary venous return is considered.
Pulsed doppler echocardiographic diagnosis of patent ductus arteriosus: Sensitivity, specificity, limitations, and technical features
Authors: Stevenson James Geoffrey , Kawabori Isamu , Guntheroth Warren G.
Published: March 2007

To determine the diagnostic features, sensitivity, and specificity of pulsed Doppler echocardiographic (PDE) diagnosis of patent ductus arteriosus (PDA), 110 infants with heart disease were examined by PDE from the precordial and suprastenal notch approaches. On precordial examination, PDA was diagnosed upon recording of diastolic ductal flow into the pulmonary artery. From the suprasternal approach, PDA was suspected upon recording of continuous turbulent flow in the right pulmonary artery. A PDA was proved by invasive means in 45 of 110 cases. Precordial PDE had diagnosed PDA in 43 of 45 cases. In eight of 110, continuous turbulent flow was present in the pulmonary artery from the precordial approach, but no PDA jet was recorded. In two of eight, PDA was present, and in six of eight others systemic‐to‐pulmonic communications were present. Precordial PDE diagnosis of PDA had a sensitivity of 96%, specificity of 100%, positive predictive index of 100%, and negative predictive index of 97%. From the suprastenal notch approach, PDA was suspected in 51 cases, with six false‐positive diagnoses, yielding a sensitivity of 100%, specificity of 91%, positive predictive index of 88%, and negative predictive index of 100%. Since the diastolic ductal jet flowing into the pulmonary artery was specific for PDA in all patients in whom it was recorded from a precordial approach, that approach and diagnostic feature, with sensitivity and positive predictive index of 100%, would seem preferred for PDE diagnosis of PDA. This would be especially important if the PDE diagnosis of PDA were to be used in place of invasive documentation of PDA, and in the differential diagnosis of PDA and other systemic‐to‐pulmonic communications. The suprastenal approach, while not specific for PDA, may have the advantage of sensitive detection or exclusion of a variety of systemic‐to‐pulmonic communications.
Quantitative radionuclide angiocardiography
Authors: Scholz Peter M. , Rerych Stephen K. , Moran Jon F. , Newman Glenn E. , Douglas James M. , Jones Robert H. , Sabiston David C.
Published: March 2007

This study introduces a new method for calculating actual left ventricular volumes and cardiac output from data recorded during a single transit of a radionuclide bolus through the heart, and describes in detail current radionuclide angiocardiography methodology. A group of 64 healthy adults with a wide age range were studied to define the normal range of hemodynamic parameters determined by the technique. The normal radionuclide cardiac index averaged 3.25 ± 0.75 liters/min/m2, the end‐diastolic volume index was 62 ± 16 ml/m2, the stroke volume index was 40 ± 9 ml/m2, and the ejection fraction was 0.66 ± 0.07. Radionuclide angiocardiograms were performed in patients undergoing cardiac catheterization to validate the measurements. In 33 patients studied by both techniques on the same day, a close correlation was documented for measurement of ejection fraction (r = 0.89) and end‐diastolic volume (r = 0.89). Determination of the linear regression equation for the end‐diastolic volumes obtained by the two methods (EDVcath = 1.26 × EDVRN − 7.56) permitted correction of end‐diastolic volume and provided an approach for calculation of stroke volume and cardiac output. To validate the method of volumetric cardiac output calculation, 33 simultaneous radionuclide and indocyanine green dye determinations of cardiac output were performed in 18 normal young adults and correlated closely over a range of 4–17 liters/min (r = 0.94). These independent comparisons of radionuclide measurements with two separate methods document that initial transit radionuclide angiocardiography accurately assesses left ventricular function.
Transvenous biopsy of mediastinal lymphoma invading the superior vena cava
Authors: Meltzer Richard S. , Stebbins Robert , Hunt Sharon A. , Billingham Margaret E.
Published: March 2007

Malignant disease in the mediastinum often presents as superior vena cava syndrome. In this emergency setting, expeditious tissue diagnosis is frequently of extreme importance. We report a case where tissue diagnosis was obtained by cardiac biopsy technique.
Demonstration of abnormal proximal conduction system by his bundle electrocardiography in a patient with a single ventricle
Authors: Sohi Gurbachan S. , Flowers Nancy C.
Published: March 2007

His bundle electrocardiography in a patient with a single ventricle and 2:1 block showed the block to be proximal to the His bundle. The sinus node recovery time was normal. In addition, there was suggestive evidence of a functionally and/or structurally abnormal accessory pathway. The role of His bundle electrocardiography in a patient with a single ventricle in defining the function of various portions of the conduction system was thus demonstrated.
Safe transthoracic left ventricular puncture performed with echocardiographic guidance
Authors: Vignola Paul A. , Swaye Paul S. , Gosselin Arthur J.
Published: March 2007

Retrograde aortic left ventricular pressure recording is difficult to obtain and often unreliable in the presence of a mechanical aortic valve prosthesis. Under echocardiographic guidance, we have safely performed transthoracic left ventricular puncture for pressure recording in seven patients with an aortic valve prosthesis. The transducer is placed at the left sternal border and then slid laterally until the right ventricular cavity and interventricular septal echoes disappear, but before the echoes from the left lung are recorded. The chest wall is marked and the transducer is angled until the mitral valve echoes are identified. The transducer angle and direction are recorded with external markers, and the left ventricular cavity depth is measured. An 18‐gauge needle is then inserted the determined depth into the left ventricle, guided exactly by the echocardiographic external markers. The procedure was successful in each patient on the first attempt without a single complication.

We conclude that this technique affords the operator greater control when left ventricular pressure must be recorded by transthoracic puncture and that it may reduce the risk of potentially serious complications.
A new technique in advancing the catheter from the left atrium to the left ventricle
Authors: Wennevold A.
Published: March 2007

A technique is described by which a catheter is advanced from the left atrium to the left ventricle during a right heart catheterization via the leg.

A loop in the catheter is created by the clockwise twisting of the catheter while it is gently pushed against the posterior left wall of the left atrium. The catheter is then pulled back and is twisted counter‐clockwise. The catheter has to be soft, and biplane fluroscopy is required.

During a 16‐month period 162 consecutive infants and children had heart catheterization performed, during which a pediatric NIH catheter was passed to the left atrium. The loop‐technique was attempted in 95 patients and was successful in 66 patients. One or two attempts were usually sufficient. No complications were encountered apart from two brief episodes of bradycardia.

The technique is easy to perform with a reasonable success rate. It seems most useful in infants in whom 5F catheters are used.
Transfemoral snaring of broken catheters from the right heart in small infants
Authors: Chung Kyung J. , Chernoff Harvey L. , Leape Lucian L. , Kreidberg Marshall B.
Published: March 2007

Successful retrieval of embolized central venous catheter fragments from the right heart was accomplished in two small infants weighing 2100 and 4050 Gm respectively. The catheters had been broken off at the site of entry into the vein and migrated to right atrium. A 5F end‐hole Cook catheter with 0.018 inch diameter, 125cm long Curry snaring wire with flexible mid‐segment was successfully utilized through the femoral vein percutaneously to remove the foreign body without complication.
New preshaped catheter for investigation of aortic stenosis by femoral approach: A study of 100 cases
Authors: Crochet D. , de Laguerenne J. , Petitier H.
Published: March 2007

The authors describe their technique of catheterization of the left ventricle in aortic stenosis by a femoral approach based on a newly designed double‐curved catheter. The method has been used successfully in 87 of 100 consecutive cases. The advantages and drawbacks of the method are discussed.
The diagnostic accuracy of combined clinical and noninvasive cardiac evaluation: Comparison with findings at cardiac catheterization
Authors: Alpert Joseph S. , Sloss Laurence J. , Cohn Peter F. , Grossman William
Published: March 2007

The accuracy of combined clinical and noninvasive cardiac diagnostic evaluation was prospectively examined in 108 consecutive patients referred to the heart station for echocardiographic examination prior to cardiac catheterization. History, physical examination, scalar electrocardiography, chest roentgenography, phonocardiography and pulse recording, and M‐mode echocardiography were employed by the heart station cardiologist, who assigned one or more diagnoses to each patient. In addition, one of three management strategies was proposed for each patient: 1) surgery without cardiac catheterization; 2) medical therapy without cardiac catheterization; or 3) cardiac catheterization for clarification of the diagnosis. The results of the combined clinical and noninvasive evaluation were independently reviewed for each patient and compared with the diagnosis determined by cardiac catheterization, results of cardiac surgery, and total hospital course. Diagnostic predictions employing combined clinical and noninvasive cardiac evaluation were completely correct in 86% of patients, and management strategy was correct in 97% of individuals. In approximately one‐half of all patients full cardiac catheterization or coronary arteriography was recommended. All management strategy errors and two‐thirds of diagnostic errors occurred in patients with mitral regurgitation, aortic regurgitation, or coronary artery disease.

Combined clinical and noninvasive evaluation results in accurate diagnostic information adequate for the formulation of appropriate management strategies in the majority of patients, but many individuals with cardiac disease still require invasive evaluation for complete diagnosis.
Limitations of post‐extrasystolic potentiation in assessing regional myocardial viability in man
Authors: Slack John D. , Landon John K. , Cole James S. , Hanley Henry G. , O'Connor William
Published: March 2007

To investigate the usefulness of regional response to post‐extrasystolic potentiation as a predictor of left ventricular viability in patients with coronary artery disease, 46 patients underwent calibrated biplane left ventricular cineangiography during which a single, timed ventricular premature contraction was introduced.

Results: Of 758 normal or hypokinetic segments, 486 (64.1%) showed a positive response to post‐extrasystolic potentiation. Of 116 akinetic or dyskinetic segments, only 51 (43.9%) showed a positive response to post‐extrasystolic potentiation (P <0.001). Because akinetic or dyskinetic areas would not be expected to respond to post‐extrasystolic potentiation based on animal laboratory data, alternative explanations were sought to explain such positive response in man. Analysis of percent change in chord length of normal or hypokinetic segments adjacent to akinetic or dyskinetic segments that did or did not respond to post‐extrasystolic potentiation revealed (10.2% ± 1.2%) vs (1.3% ± 0.7%) improvement, respectively (P <0.001) (mean ± SE).

Conclusion: Passive rather than active events may be responsible for “improved” regional wall motion following post‐extrasystolic potentiation in akinetic or dyskinetic regions. If unrecognized, these factors may lead to improper interpretation of “intervention ventriculography” utilizing post‐extrasystolic potentiation.
Refractory variant angina controlled with combined drug therapy in a patient with a single coronary artery
Authors: Phaneuf Denis C. , Waters David D. , Dauwe Franz , Théroux Pierre , Pelletier Guy , Mizgala Henry F.
Published: March 2007

A young man with a single left coronary artery and refractory variant angina is described. Spontaneous coronary artery spasm developed during coronary arteriography at the site of a 50% fixed left anterior descending coronary artery stenosis. Frequent episodes of rest angina with transient ST segment elevation persisted in hospital in spite of treatment with three different calcium antagonist drugs. Symptoms disappeared only when the combination of nifedipine, diltiazem, isosorbide dinitrate, and nitroglycerin ointment were given. Ergonovine testing was used to objectively assess the response to treatment.
The use of a microcomputer in the evaluation of echocardiograms
Authors: Menke James A. , Von Behren Patricia A. , Bashiru Mohammed , Bada Henrietta S. , Khanna Narinder N.
Published: March 2007

A low‐cost microcomputer system is used to calculate cardiac parameters from echocardiographic (Echo) measurements and produce a chartable report. The system is simple, uses Basic language, and provides for data storage.
Early experience of transluminal coronary angioplasty (TCA) by the brachial artery (the sones technique in transluminal angioplasty)
Authors: Angelini Paolo , Leatherman Louis , Springer Arthur , Krajcer Zvonimir , Lufschanowski Roberto , Stamatiou Eleftherios , Wagner Ephraim , Armbrust Charles , Leachman Robert
Published: March 2007

Sixteen translumlnal coronary angioplasty procedures (TCA), eight right coronary artery (RCA) and eight left anterior descending coronary artery (LAD), by the brachial artery cut‐down approach, were attempted with 9/16 (56%) immediate successes and 2/16 (12%) early recurrences. The procedure success rate for RCA obstructive lesions, 6/8 (75%) was greater than for LCA obstructions, 3/8 (38%). In six unsuccessful procedures the balloon catheter could not be advanced into the lesion, and in one unsuccessful procedure dissection of the coronary artery proximal to the lesion occurred. The brachial (Sones) technique for transluminal coronary angioplasty permits the use of softer guiding catheters for selective probing and approach to the coronary lesion but may be more likely to induce coronary spasm. Complete and high‐resolution pre TCA anglograms with multiple views to disclose the exact anatomy of the coronary artery and Its lesion Is essential to ensure successful dilatation.
Biochemical measurements of endomyocardial biopsies
Authors: Unverferth Donald V. , Fertel Richard H. , Altschuld Ruth , Magorien Raymond D. , Lewis Richard P. , Leier Carl V.
Published: March 2007

The purpose of this study is to investigate the validity of performing biochemical analyses on human endomyocardlal biopsies. One problem of such analyses is the decay of metabolites between the time of biopsy and the analyses. This was addressed by varying the time delay from biopsy to submersion in liquid nitrogen (‐200°C). Neither cyclic AMP or cyclic GMP changed significantly up to 90 seconds after biopsy. The reproduclblllty of the assays in human heart biopsies was determined by submitting paired samples from each procedure. The ATP content was determined by a fluorescent technique and was related to the protein and creative content. The average ATP of 25 paired samples was 12.3 nm per mg protein; the average difference between the paired samples was ‐0.6, and the 95%confidence Interval was 5.6 nm/mg protein. The average ATP‐to‐creatJne ratio was 0.25; the 95% confidence interval was 0.12. The cyclic AMP and cyclic GMP were found to average 3.3 and 0.25 femtomoles/mcg protein, respectively. The 95% confidence intervals were 1.8 and 0.12 fmoles/mcg protein. The problems of sampling error and blood and connective tissue contamination decrease the reliability of the biochemical analyses. Reproduclblllty is adequate, however, to acquire meaningful biochemical information on the human heart.
Aortic cusp involvement causing severe aortic regurgitation in a case of relapsing polychondritis
Authors: Sohi Gurbachan S. , Desai Amarjit M. , Ward Will W. , Flowers Nancy C.
Published: March 2007

A case with relapsing polychondritis is described where primary involvement of the aortic valve cusps produced severe aortic regurgitation requiring valve replacement. An aneurysmal dilatation of the ascending aorta developing later led to disruption of the prosthesis requiring re‐operation. Superior vena caval obstruction, an abdominal aortic aneurysm which ruptured and required resection, and obstructive lesions in common iliac arteries, presumably the result of the same process that involved the aorta and the cartilaginous structures, were also seen.
Sudden occlusion of a saphenous vein bypass graft relieved by direct injection of nitroglycerine
Authors: Baduini Giovanni , Marra Sebastiano , Angelino Pier Federico
Published: March 2007

An unusual case of sudden occlusion of a saphenous vein bypass graft to the right coronary artery, during a coronary angtographlc study, is presented. Such occlusion was relieved by direct intragraft nitroglycerine injection, as typically happens in case of coronary arterial spasm. A possible pathogenetlc mechanism, based on the present knowledge of platelet aggregation and the role of the powerful vasoactive agent Throm‐boxane A2, is discussed.
Percutaneous entry of the brachial artery for left heart catheterization using a sheath
Authors: Fergusson David J. G. , Kamada Roy O.
Published: March 2007

Percutaneous entry of the brachial artery using a sheath system has been attempted in 223 patients undergoing left heart Catheterization; successfully, In 212. After arterial puncture, a dilator and sheath are passed over a short guWewire. A number 7–80 cm Sones specially stiffened coronary catheter Is passed through the sheath, and left heart Catheterization Is performed in the usual manner. The study can usually be completed with this single catheter. Initial entry, as well as any needed catheter change, Is facilitated by the use of an inflatable sphygmomanometer cuff around the upper arm. Ease of manipulation and patient comfort have been satisfactory, and brachial artery spasm has not been encountered. There have been no major complications and a low incidence (∼ 1.5%) of brachial arterial occlusion.
Effect of informed consent and educational background on patient knowledge, anxiety, and subjective responses to cardiac catheterization
Authors: Freeman William R. , Pichard Augusto D. , Smith Harry
Published: March 2007

Thirty‐four patients undergoing elective cardiac catheterization were followed linearly with three questionnaires during their hospitalization to study some of the effects of informed consent. Patients learn about catheterization from the informed consent session conducted by a cardiology fellow. Several areas of knowledge deficiency were found. The emotional experience of hospitalization and the amount of knowledge about catheterization determined at the end of hospital stay is shown to be dependent on the educational level of the patient. Several recommendations are made for the conduct of the informed consent sessions to improve the knowledge of the less educated.
Assessment of left ventricular function in patients with isolated severe disease of the left anterior descending artery: Clinical, electrocardiographic, hemodynamic, and angiographic correlations
Authors: Iskandrian Abdulmassih S. , Weber Jan R. , Mundth Eldred D. , Downey Kathleen B. , Segal Bernard L. , Kimbiris Demetrios , Mintz Gary S. , Bemis Charles E.
Published: March 2007

The purpose of this study was to define the spectrum of left ventriculographic (LV) abnormalities in 60 patients with isolated ≥90% diameter narrowing of the left anterior descending artery (LAD). The patients were divided into three groups: Group I (26 patients) had normal left ventricular (LV) function with ejection fraction (EF) of >60% and no akinetic‐dyskinetic segment representing abnormal contracting segments (ACS) of the left ventricular wall; Group II (15 patients) had mild to moderate LV dysfunction with EF of 40–60% and an akinetic‐dyskinetic segment of < 30% of the end diastolic perimeter (0–30%; mean, 11.6%) and Group III (19 patients) had severe LV dysfunction with EF <40%, or an akinetic‐dyskinetic segment of ≥30 % (30–81%; mean, 41.5%) or both.

The data obtained from the history, physical examination, electrocardiogram (ECG), chest x‐ray studies, hemodynamic studies, left ventriculography, and coronary arteriography were entered and filed on a memory disc in an IBM 370‐168 computer.

Analysis of the results showed: (1) more severe LV dysfunction is associated with increased incidence of large hearts, gallops, decreased cardiac output, and occlusion of the LAD. (2) ECG evidence of infarction is also associated with higher incidence of the abnormalities of the indices of LV dysfunction. (3) LAD occlusion (versus stenosis) has a higher incidence of severe LV dysfunction and prior infarction. (4) The site of LAD disease did not predict the extent of left ventricular dysfunction. (5) Collaterals did not protect against severe LV dysfunction.
Peak left ventricular pressure/volume (Emax) during exercise in control subjects and children with left‐sided cardiac disease
Authors: Alpert Bruce S. , Benson Lee , Olley Peter M.
Published: March 2007

The peak ratio of left ventricular systolic pressure/systolic volume (PV) has been shown to be a close approximation to Emax, an index of contractility independent of both preload and afterload. We studied 17 children with left‐sided cardiac disease during catheterization by a combined high‐fidelity catheter and m‐mode echocardiographic technique. Emax, indexed for body surface area, was calculated at rest and during supine exercise at 25% and 50% of maximal upright workload. In addition, we studied 15 control subjects with a noninvasive approximation of peak P/V, the peak systolic LV pressure/smallest systolic LV volume. Patients with left ventricular pressure overload showed an increased Emax, value at rest and a further increase with exercise. Patients with left ventricular volume overload or cardiomyopathy had a normal value of Emax, at rest and had only small increases with exercise. Patients with both volume and pressure overload had a resting Emax, value that was increased, but no further increase occurred with exercise. Emax, in children seems to be a sensitive index of contractility during physiologic stress and can be used to assess left ventricular functional reserve capacity both pre‐ and post‐operatively.
Echocardiographic diagnosis of right ventricular hypertrophy: Correlation with ECG and necropsy findings in 248 patients
Authors: Prakash Ravi
Published: March 2007

Measurements of right ventricular wall thickness (RVWT) by echocardiography and at necropsy correlated well (r = 0.83) in 36 patients. Echocardiography had a sensitivity of 93% and a specificity of 95% in diagnosing right ventricular hypertrophy (RVH) at necropsy; electrocardiography (ECG) had a sensitivity of 31% and a specificity of 85% in diagnosing RVH.

An additional 212 patients were studied by echocardiography and ECG. Based on echocardiographic criteria of RVH (RVWT ≥5 mm), 134 of 212 patients had RVH, and 78 were without RVH: the ECG had a sensitivity of 27% and a specificity of 88% for diagnosing RVH when correlated with the echocardiographic criteria. The mean dia‐stolic RVWT was 6.0 ± 1.4 mm in 134 RVH patients and 3.4 ± 0.8 mm in 78 no‐RVH patients (P < 0.05). Diagnosis of RVH was difficult by ECG in 73 patients due to conduction defects or old myocardial infarction; the RVWT measurements were useful in evaluating RVH in these patients.

We conclude that echocardiographic measurements of RVWT are useful in the diagnosis of RVH and are more sensitive than the ECG criteria in adults.
Acquired coronary‐to‐bronchial artery communication: A possible cause of coronary steal
Authors: Green Curtis E. , Kelley Michael J. , Higgins Charles B. , Bookstein Joseph J.
Published: March 2007

An unusual case of an acquired coronary‐to‐bronchial artery communication is presented. Collateral flow to the lung was provided by the right coronary circulation following obstruction of pulmonary blood flow by chronic pulmonary emboli. A coronary steal phenomenon may have caused an exacerbation of cardiac symptoms by further reducing already compromised coronary blood flow in a patient with atherosclerotic coronary artery disease.
Diastolic segmental coronary artery obliteration in constrictive pericarditis
Authors: Goldberg Emanuel , Stein Julius , Berger Marvin , Berdoff Russell L.
Published: March 2007

A patient with severe constrictive pericarditis demonstrated a new angiographic sign of segmental diastolic obliteration of an obtuse marginal branch of the circumflex system of the left coronary artery.
Influence of recording scale on determination of left ventricular end‐diastolic pressure
Authors: Hieb Barry R. , Krone Ronald J. , Lagler Regis G. , Oliver G. Charles
Published: March 2007

Left ventricular (LV) pressure waveforms for 20 beats, originally recorded at 200 scale (200 torr/10 cm) were rescaled by a computer system to represent the identical beats recorded at 40 scale (40 torr/10 cm). Both the original and the rescaled beats were independently evaluated by eight cardiologists who were unaware of the nature of the manipulated data. For each beat the average left ventricular end‐diastolic pressure (LVEDP) identified by the eight cardiologists was higher when analyzed on the 200 scale, with an average difference of 2.8 torr (P < 0.001). This scale‐dependence of pressure analysis has implications for the development of automated pressure analysis algorithms and for physician review of computer‐determined LVEDP data points.
Cardiac catheterization in infants through a venous cutdown sheath
Authors: Henry G. William , Harned Herbert S.
Published: March 2007

When percutaneous vascular access for cardiac catheterization of small infants fails, necessitating a cutdown approach, we cannulate the isolated vein (usually the great saphenous vein) with a guidewire, dilator, and sheath with subsequent introduction of the catheter through the indwelling sheath. We have used this technique in sixty‐one infants without complications and recommend this modified sheath approach because of the following advantages: ease of introduction of the introducer set and catheter, the ability to change catheters quickly, elimination of distal vascular spasm, reduction of vascular trauma induced by catheter manipulation, prevention of backflow bleeding at the catheter entry site, and possible reduction of catheterization time.
Photography of hemodynamic data on the cineangiocardiographic film
Authors: Koehler Eugene , Cha Se Do , Maranhao Vladir
Published: March 2007

This technical note describes a new, simple design to photograph the hemodynamic data on cineangiocardiographic film. The advantages are the convenience for reviewing the cardiac catheterization data and the storage of all datas in one place.