bluuebunny/crossref_metadata_2025 huggingface dataset:
Permanent pacemaker implantation in the cardiac catheterization laboratory: The subclavian vein approach
Authors: Hess David S. , Gertz Edward W. , Morady Fred , Scheinman Melvin , Sudduth Bonnie K.
Published: March 2007

During a 36‐month period, 171 permanent pacemaker procedures were performed in the cardiac catheterization laboratory by invasive cardiologists. This included 111 initial pacemaker system implants, via the percutaneous subclavian vein approach, 45 pulse generator changes, and 15 miscellaneous procedures. In no case did subclavian vein puncture result in pneumothorax, hemothorax, or brachial plexus injury. In patients undergoing initial lead placement, the dislodgment rate was 0.8% over a 16‐month follow‐up period. The reoperation rate for causes other than premature battery depletion was 5.4% during the first 12 months. The implantation of permanent pacemakers can be safely and effectively accomplished by experienced invasive cardiologists in the cardiac catheterization laboratory. In our series not only was continuity of patient care improved, but also medical costs were reduced.
First‐pass radionuclide angiocardiography in the determination of left‐to‐right cardiac shunt site in children
Authors: Tian Jia‐He , Murray I. Provan C. , Walker Brenda , Hoschl Radmil , Choy Daniel , Freeman Anthony
Published: March 2007

To ascertain if the level of a left‐to‐right cardiac shunt can be reliably established by first‐pass radionuclide angiocardiography with 99mTc‐pertechnetate, 102 children have been studied; 19 without a shunt, 26 with an atrial septal defect (ASD), 45 with a ventricular septal defect (VSD), and 12 with a patent ductus arteriosus (PDA). Time‐activity curves were generated over the right atrium and ventricle, and several quantitative parameters were derived from the curves. It was concluded that in the absence of right‐sided valvular incompetence, the time‐activity curves show the greatest abnormality in the cardiac chambers distal to the left‐to‐right shunt. The right ventricular curve is typically altered in ASD but cannot be relied upon to differentiate VSD or PDA. The identification of ASD is assisted by the use of two of the parameters, the count ratio C4:C1 and time ratio T2:T1.
Aneurysm of a saphenous vein bypass graft associated with aneurysms of native coronary arteries
Authors: Bramlet Dean A. , Behar Victor S. , Ideker Raymond E.
Published: March 2007

Aneurysm formation in saphenous vein aortocoronary bypass grafts is an extremely rare complication of coronary artery bypass surgery. Aneurysms of native coronary arteries are found in a small percentage of patients at autopsy. Reported is a case with multiple coronary artery aneurysms in which a dissecting aneurysm of the saphenous vein bypass graft also developed following coronary artery bypass surgery. This is the first report of such association.
Severe thrombocytopenia as a result of contrast left ventricular angiography
Authors: Wein Paul , Handler Martin , Chadda Kul D.
Published: March 2007

A case report of a 29‐year‐old Hispanic male who developed an acute thrombocypenic reaction immediately following a cardiac catheterization using Hypaque‐M radiographic dye. Laboratory studies immediately post‐catheterization revealed a platelet count of 11,000 with a subsequent further drop to a low of 4,000. A need for the prompt identification and possible causes of this unusual reaction are discussed. Recovery occurred following treatment with corticosteroids.
Long‐term survival despite multiple complications of acute myocardial infarction
Authors: Davies A. B. , Hogg M.
Published: March 2007

A 71‐year‐old woman sustained an anterior myocardial infarction resulting in a large apical aneurysm, a ventricular septal defect, and mitral regurgitation, which did not incur hospital admission at that time. Surgical repair was successfully performed ten months later because of moderate effort dyspnea and in the assumption that prognosis would be improved.
Use of a personal computer in the measurement, calculation, and reporting of noninvasive cardiac data
Authors: Abdulla Abdulla M. , Henke John S. , Stefadouros Miltiadis A. , Watkins Laurence O. , Frank Martin J.
Published: March 2007

Echocardiography, phonocardiography, and carotid pulse tracings enable the cardiologist to measure and calculate over 40 different noninvasive parameters including cardiac chamber size, indices of left ventricular performance, and estimates of mean left atrial pressure. However, the entire procedure requires meticulous measurements and time‐consuming calculations, particularly when some of the data must be corrected for heart rate or body size. Because of this, many busy noninvasive cardiac laboratories routinely calculate only a few select parameters in most patients. To solve this problem, we used a personal computer system and developed a program that allows rapid, accurate measurement, calculation, display, reporting, magnetic storage, and retrieval of noninvasive cardiac data. The computer is not dedicated to these tasks alone and with appropriate software can also be used for other clinical, educational, office management, and research purposes.
Percutaneous vs surgical placement of intra‐aortic balloon assist
Authors: Singh Arun K. , Williams David O. , Cooper George N. , Riley Raymon S. , Karlson Karl E.
Published: March 2007

Fifty‐three patients required IABP over a one‐year period. The type of insertion (percutaneous vs surgical) was used randomly. The hemodynamic effect, complication rate, and inability to insert the balloon were similar in both groups. Besides less trauma and cost‐effectiveness, the most important advantage of percutaneous over surgical balloon insertion is shorter time interval between decision and insertion which thus allows faster stabilization of ischemic heart patients.
Automated blood pressure measurement during ergometer exercise in children
Authors: Alpert Bruce S. , Flood Nadine L. , Balfour Ian C. , Strong William B.
Published: March 2007

The measurement of systolic and diastolic blood pressure during exercise is often difficult to perform due to patient motion and environmental noise. We evaluated an automated system of blood pressure determination in 121 children undergoing cycle ergometer stress testing. The system (Critikon Model 1165) utilized acoustic transduction, with electrocardiogram gating and microprocessor signal filtering. One observer measured the blood pressure values from the same arm as the automated system; this observer was blinded to the readout of the system. The correlation coefficients for systolic blood pressure at rest, during exercise, and during recovery were all > 0.91, and improved with the use of a stethophone adapter. This system can eliminate intraobserver variation as well as the necessity for the technician or physician to direct attention away from the electrocardiogram and patient during stress testing.
Transseptal left heart catheterization: Utility of a sheath technique
Authors: Laskey Warren K. , Kusiak Victoria , Untereker William J. , Hirshfeld John W.
Published: March 2007

This report describes our experience with a modified sheath transseptal catheter system. The sheath technique allows for introduction of various catheters into the left heart, including a uniquely designed pigtail catheter intended for use with this system. Fifty‐three patients underwent successful transseptal catheterization, 44 of whom had severe native aortic valve stenosis and seven with suspected prosthetic aortic valve dysfunction. The technique provides optimal ventriculographic and hemodynamic information as well as improved access to the left heart in patients with aortic valve disease.
Effects of selective injection of contrast media on coronary artery diameter
Authors: Hill James A. , Feldman Robert L. , Conti C. Richard , Pepine Carl J.
Published: March 2007

The purpose of this study was to quantify the effect of Renografin‐76 on eplcardial coronary artery diameters, during selective coronary anglography. Using 105 mm‐photospot angiograms taken at 0,1, and 5 min, 99 coronary segments from ten patients were measured. Comparing the anglograms at 1 and 5 min to the control anglograms, a7 ± 7% and 6 ± 7% (both p = NS) change in diameter respectively was noted. Comparing the 1 and 5 min anglograms, there was no significant change (‐1 ± 7%). Measurements were found to be very reproducible. This study shows that there is a trend toward dilation of the coronary arteries during selective coronary anglography, but this did not reach statistical significance and probably is not clinically important.
Use of ventriculography in assessing performance and oxygen consumption of the left ventricle: Response to altered afterload
Authors: Bove Alfred A. , McGinnis Andrew W. , Michele John L.
Published: March 2007

Using ventriculography, we assessed the relationship between performance, blood flow, and oxygen consumption of the left ventricle in seven anesthetized dogs. Ventricular loading was varied between increased and decreased afterload by intra‐aortic infusion of angiotensin and acetylcholine. Intact ventricular performance was measured by computer‐based analysis of biplane left ventriculograms. Myocardial blood and flow distribution was determined by radioactive microspheres, and oxygen consumption was measured by coronary arteriovenous oxygen difference times blood flow. When left ventricular systolic pressure rose, tension‐time index, stress‐time index, stroke work, and minute work derived from the ventriculogram increased significantly; end diastolic volume increased; and ejection fraction decreased. Inverse responses occurred to a smaller degree when left ventricular pressure was reduced. With increased pressure, myocardial blood flow and oxygen consumption changed proportionately to minute work. Correlation coefficients between oxygen consumption and stroke work (0.782), oxygen consumption and minute work (0.769), oxygen consumption and tension‐time index (0.792), and between oxygen consumption and stress‐time index (0.740) all indicate that performance measures obtained from ventriculograms can be used to estimate changes in oxygen consumption during acute afterload changes. These measurements can be applied to data obtained from clinical catheterization studies in man and suggest that changes in myocardial performance and oxygen consumption can be estimated from ventriculographic data.
Right ventricular size and function: The discrepancy between cardiac blood pool imaging techniques
Authors: Hooper Wayne , Horn Mathew , Moser Kenneth , Neveu Connie , Costello Dennis , Bhargava Valmik , Taylor Andrew , Slutsky Robert
Published: March 2007

The purpose of this study was to evaluate a number of equilibrium radionulide methods for analyzing right ventricular size and function, in an attempt to determine if any of a variety of approaches could accurately characterize right ventricular hemodynamics. Fourteen patients being clinically evaluated for coronary artery disease (N = 9), congestive cardiomyopathy (N = 2), valvular disease (N = 2), or intracardiac shunts (N = 1) underwent biplane contrast right ventriculography following gated blood pool imaging. Four radionuclide techniques were examined and included: (1) a semiautomatic edge‐detection algorithm using a variable right ventricular region‐of‐interest and a right ventricular apical end diastolic background; (2) a fixed right ventricular end‐diastolic region‐of‐interest with a C‐shaped background; (3) the same fixed end‐diastolic right ventricular region‐interest with a right ventricular end‐diastolic apical background; and (4) both right ventricular end‐diastolic and end‐systolic regions‐of‐Interest with a background chosen lateral to the left ventricle. Right ventricular end‐diastolic volume was obtained by correcting end‐diastolic counts by frame time, the number of processed heart beats, and blood radioactivity. The results illustrate the wide discrepancy among these methods. The correlation coefficients comparing right ventricular ejection fractions by radlonuclide methods 1 to 4 with contrast ventriculography were 0.23, 0.74, 0.40, and 0.42, respectively. For right ventricular end‐diastolic volumes, the correlation coefficients were 0.90, 0.72, 0.90, and 0.92, respectively. While these techniques may be useful for analyzing serial changes in right heart function and size, further investigation is needed before right ventricular equilibrium radionuclide techniques can be acceptably utilized in clinical practice, particularly in individual subjects.
Coronary artery spasm occurring late after vein graft surgery
Authors: Singh Ram N. , Varat Murray A.
Published: March 2007

A patient with classic effort angina and high‐grade, fixed proximal coronary atherosclerosis underwent a single saphenous vein graft to a large, dominant right coronary artery (RCA). After being asymptomatic for 1 1/2 years, she had several episodes of rest angina culminating In Prinzmetal angina and ventricular fibrillation. Electrocardiographic changes occurred in the RCA distribution. Symptoms subsided with oral nifedlpine therapy. Angiography revealed intact vein graft and coronary circulation. The patient has done well for a follow‐up period of 7 months.
Percutaneous transluminal angioplasty of an anomalous left circumflex coronary artery arising from the right sinus of valsalva
Authors: Schwartz Leonard , Aldridge Harold E. , Szarga Carol , Cseplo Rose‐Marie
Published: March 2007

This case report describes a patient with isolated stenosis of an anomalous circumflex artery with evidence of left ventricular lateral wall ischaemia. Percutaneous dilatation of this vessel was successfully performed and was facilitated by removing the tip of a standard guiding catheter permitting selective cannulation of the anomalous ostium. Similar innovations in the standard angioplasty technique may permit its application in other unusual anatomical situations.
Quantitative coronary angiography during intracoronary streptokinase in acute myocardial infarction: How long to continue thrombolytic therapy?
Authors: Feldman Robert L. , Crick William F. , Conti C. Richard , Pepine Carl J.
Published: March 2007

An Intracoronary Infusion of streptokinase is often administered in patients with acute myocardial infarction. To address the question of how long intracoronary streptokinase should be infused, we studied 13 patients with symptoms and electrocardiographic findings suggesting an evolving myocardial infarction. We used subselective catheterization techniques and made quantitative angiographic measurements of the percentage of reduction of coronary artery (CA) diameter before intracoronary streptokinase therapy, immediately after reperfusion was established, and at the completion of streptokinase infusion. Before intracoronary streptokinase and after intracoronary nitroglycerin, nine patients had 100% obstruction of the CA in the “infarct‐related vessel.” In seven patients reperfusion was established (25 ± 21 min, mean ± SD) at which time CA diameter was reduced by 77 ± 22%. The streptokinase infusion was then continued until repeated films (every 10 to 15 min) suggested no further change at the site of CA obstruction (93 ± 68 min). The percentage of CA diameter reduction when streptokinase infusion was discontinued was 55 ± 32%; this value was less (P < 0.05) than that observed early after reperfusion. These data show that after initial reperfusion was achieved by the use of intracoronary streptokinase, additional streptokinase lessened the reduction of CA diameter. Residual thrombus may be present at the narrowed CA site early after reperfusion, and further “cleanup” can be achieved by prolonging streptokinase infusion.
Estimation of mixed venous oxygen saturation
Authors: French William J. , Chang Potter , Forsythe Sarah , Criley J. Michael
Published: March 2007

Pulmonary artery oxygen saturation (PA) was measured directly and estimated from venal cavae samples in 175 adults without intracardiac shunts to ascertain which of four formulas (MV1, MV2, MV3, or MV4) best estimated mixed venous oxygen saturation. Because the formula MV1, which favored IVC samples, most closely approximated pulmonary artery saturation, we recommend its use to estimate systemic flow in patients with left‐to‐right shunts. In addition, a difference between directly measured PA and calculated MV1 of 6% or greater indicates the presence of a left‐to‐right shunt in 97% of cases.
Massive dilatation of the atria and coronary sinus in a child with restrictive cardiomyopathy and persistence of the left superior vena cava
Authors: Sapire David W. , Casta Alfonso , Swischuk Leonard E. , Casta Daisy
Published: March 2007

A two‐year‐old child with massive cardiomegaly was proved to have restrictive cardiomyopathy. A literature search has shown only two other cases of this in young children. All three have had massive biatrial dilatation with nearly normal ventricular function. This case is the first with clearly defined echocardiography and complicating diagnostic features associated with persistence of a left superior vena cava.
Single catheter technique for accurate cardiac outputs from left ventricle
Authors: Sanders Michael , Onah Joseph , Lichstein Edgar , Hollander Gerald , Greengart Alvin , Rivera Marcos
Published: March 2007

We report our experience in cardiac output measurements using a single catheter for left ventricular green dye injection with sampling from the side arm of a femoral artery introducer sheath. This technique is compared to thermal dilution (20 patients) and pulmonary artery green dye injection (20 patients). There were no significant differences between the single catheter left ventricular method and the other two accepted methods for measuring cardiac output.
Catheter for visualization of patent ductus arteriosus
Authors: Endrys Jiří , Horký Josef , Yousof Abdul M.
Published: March 2007

We have developed a new catheter for transvenous angiography in patent ductus arteriosus (PDA) that has given excellent results in 31 patients (age range seven months to 17 years). Optimal selective opacification of PDA is due to maintaining the catheter side holes in close proximity to the PDA and to rapid delivery of relatively large volumes of contrast medium into the ampulla of the PDA without the catheter recolling. The venous route of catheter insertion precludes possible arterial injury.
Nonsurgical technique for removal of catheter fragments from the pulmonary artery
Authors: Tanaka Minoru , Iyomasa Yohtaro
Published: March 2007

In this report the authors describe a new technique for nonsurgical retrieval of an embolized catheter fragment without free ends in the pulmonary artery using a “forceps with three grasping prongs.” This method is extremely promising for retrieval of catheter fragments in the pulmonary artery, especially when the free ends are not accessible.
The minimum error in estimating coronary luminal cross‐sectional area from cineangiographic diameter measurements
Authors: Richard Spears J. , Sandor Tamas , Baim Donald S. , Paulin Sven
Published: March 2007

A formal analysis of the error associated with the use of radiographic diameter measurements in estimating the luminal area of an elliptically‐shaped coronary cross‐section was performed. When two views are available, the maximum potential error was found to decrease rapidly as the angle between the views increased to 90°, but this error was small (< 25%) for orthogonal views only for mild degrees of ellipticity (major/minor axis ratio < 2). Since, for each successive doubling of the number of radiographic views, a stepwise reduction in the potential error by an approximate factor of only one‐half was found, a large number of views is required to eliminate the potential error associated with diameter assessment of highly elliptical lumena.
Regional sequential motion in the normal left ventricle: Nonuniform apical motion
Authors: Leighton Richard F. , Dennis Nelson A. , Andrews Lee T. , Gupta Manohara
Published: March 2007

Timing of the onset and sequence of systollc regional wall motion was examined in the digitized left ventricular cineanglograms of 13 patients with anglographlcally normal coronary arteries and left ventricular function. Distance‐time curves for anterior and inferior wall segments, the aortic valve plane, and apex point were compared to the volume‐time curve in each ventricle. No significant differences were found in the onset of motion for the wall segments or for descent of the aortic valve where the sequence of motion was generally uniform. At the apex point, however, the onset of motion was significantly delayed. In addition, reduced velocity of motion in the first half of systole was followed by high velocity motion in the latter half. This apparent nonuniform apical motion may be explained by a geometric relationship of normally contracting myocardial wall fibers adjacent to a thin apical point which has relatively little or no contractile motion of its own.
Unsuspected vascular disease: A potential limitation to the use of the intra‐aortic balloon
Authors: Zeldis Steven M. , Wilkens Jaemes M. , Goodman Mark , Delaney Thomas
Published: March 2007

Since vascular tortuosity or stenosis may preclude placement of the Intra‐aortic balloon, 63 consecutive patients (37 men) having routine Judkins' cardiac catheterization had an aortogram prior to withdrawal of the last catheter. No patient had a history of claudication, palpable aneurysms, pulse deficit, or bruit. No complications occurred.

Significant peripheral vascular disease was found in ten patients: three had aortic, one had iliac, and six had femoral stenosis or tortuosity. All were men. The age of patients with peripheral vascular disease was 61.4 ± 7.7 years, while those without were 56.9 ± 9.3 years (P = NS). No difficulty was encountered entering the femoral artery in any patient; there was difficulty advancing the catheter in five of ten (50%) patients with peripheral vascular disease and in three of 54 (6%) patients without (P < 0.002). Fifteen patients without peripheral vascular disease had normal coronary arteries, while none with peripheral vascular disease was normal. In patients with coronary disease, the number of vessels involved was the same in both groups.

Peripheral vascular disease that might preclude placement of the Intra‐aortic balloon occurs in 14% of patients undergoing cardiac catheterization and 18% of patients with coronary artery disease. Aortography may be safely performed and should be considered during routine cardiac catheterization in patients who may require Intra‐aortic balloon placement.
Significance of precordial ST‐segment depression in acute transmural inferior infarction: Coronary angiographic findings
Authors: Haraphongse Mant , Jugdutt Bodh I. , Rossall Richard E.
Published: March 2007

Coronary arteriographic findings in patients with acute transmural inferior infarction were studied from 57 patients (51 men and 6 women). Their ages ranged from 28 to 72 years with a mean of 50 years. Twenty‐six patients (Group A) had minimal (less than 0.1 mV) or no precordial ST‐segment depression. Thirty‐one patients (Group B) had precordial ST‐segment depression of 0.1 mV or more. The two groups showed consistent differences in frequency of the left anterior descending artery (LAD) stenosis, multivessel disease, mean peak plasma creatinine phosphokinase (CPK, IU/L), and mean ejection fraction. For Group A vs B, these differences were: LAD stenosis, 31% vs 68%, multivessel disease, 35% vs 81%, mean peak plasma CPK, 1283 versus 1904, and mean ejection fraction, 60.5% vs 45.3%. The incidence of abnormal anterolateral and posterobasal wall motion in Group B was more (p < 0.01 and p < 0.05 respectively) than in Group A. All patients in Group B who had precordial ST‐segment depression of 0.3 mV or greater, had LAD stenosis. There was no relation between the duration of ST‐segment depression and the presence of LAD stenosis. Also, there was no correlation between the presence of collateral circulation and the development of ST‐segment depression. The Group B patients tended to have more complications in the acute phase and in the follow up period (p < 0.05) than did those in Group A.

It is concluded that precordial ST‐segment depression in acute inferior wall infarction is probably related to anterior injury due to LAD stenosis and these patients were shown to have more severe coronary artery disease, more depression of their ejection fractions, and more myocardial damage than patients without this finding.

The earliest recorded ECG is most valuable in identifying the high risk patients. The presence of LAD stenosis in patients with inferior wall infarction who have precordial ST‐segment depression of 0.3 mV or more are likely.
Exercise radionuclide ventriculography in evaluating successful transluminal coronary angioplasty
Authors: DePuey E. Gordon , Boskovic Dejan , Krajcer Zvonimir , Leatherman Louis , Angelini Paolo , Sonnemaker Robert E. , Burdine John A. , Springer Arthur
Published: March 2007

To evaluate the ability of transluminal coronary angioplasty (TCA) to relieve myocardial ischemia, 44 patients with single vessel disease underwent exercise gated radionuclide ventriculography (GRNV) before and 2.8 ± 1.3 days following angiographically successful TCA. Pre‐TCA GRNV was abnormal in 11 of 14 patients with right coronary artery (RCA) stenosis and 24 of 30 with left anterior descending (LAD) stenosis. Following TCA there was an increase in exercise duration from 500 ± 288 sec to 625 ± 273 sec (P < 0.001), and in maximum double product from (209 ± 69) × 102 to (263 ± 70) × 102 (P < 0.001). The number of patients with stress‐induced ST‐T abnormalities decreased from 13 to 4 (P < 0.05), and the number with chest pain during exercise decreased from 18 to one (P < 0.001). Whereas resting ejection fraction was unchanged (0.58 ± 0.10 vs 0.59 ± 0.11) following TCA, the ejection fraction at peak exercise increased from 0.61 ± 0.13 to 0.66 ± 0.12 (P < 0.001). Of 24 patients with resting abnormalities, regional wall motion improved in 13. In 22 of 31 patients with stress‐induced asynergy, the wall motion response to exercise improved (P < 0.001). Of 19 patients restudied angiographically and with exercise GRNV at 6–12 months, restenosis of ≥ 50% had occurred in six, four of whom had abnormal studies. In six in whom the degree of stenosis of the dilated artery had remained ≥20% the exercise GRNV study remained normal. It is concluded that GRNV is helpful in documenting the improvement in resting left ventricular function and functional reserve in patients with angiographically successful TCA. In the limited number of patients with late follow‐up studies, data suggest that GRNV may be a valuable test to detect restenosis.
Aneurysm of the interatrial septum occurring as an isolated anomaly
Authors: Lazar Anthony V. , Pechacek Leonard W. , Mihalick Michael J. , Decastro Carlos M. , Hall Robert J.
Published: March 2007

We report a case of aneurysm of the atrial septum occurring as an isolated abnormality in a patient with atypical chest pain. Apical two‐dimensional echocardiography demonstrated phasic bulging of the fossa ovalis region of the atrial septum into the right atrium. Biplane cineangiography confirmed the presence of a large septal aneurysm in an otherwise normal heart. The incidence, pathogenesis, and complications of this unusual anomaly are briefly discussed.
Fracture of a polyurethane cardiac catheter in the aortic arch: A complication related to polymer aging
Authors: Schneider Ricky M. , Fornes Raymond E. , Stuckey William C. , Gilbert Richard D. , Peter Robert H.
Published: March 2007

An undated Cordis Ducor polyurethane coronary catheter fractured and separated in the aortic arch during a cardiac catheterization, and was removed with an intravascular retriever. The recovered specimen appeared brittle, prompting an investigation of the effects of aging on the tensile strength of 91 polyurethane catheters manufactured by Cordis and the United States Catheter and Instrument Company (USCI). Cordis catheters have stable tensile strength for five years from manufacture, but then deteriorate substantially by seven years, particularly at the bond between the catheter tip and the stainless steel‐reinforced catheter body. The deterioration is associated with the microscopic appearance of deep cracks in the catheter lumen wall. USCI catheters showed a modest but significant loss of tensile strength by three years after manufacture at the catheter bond. It would seem prudent to place a three‐year expiration date on USCI polyurethane catheters, similar to those already on Cordis catheters.
A catheterization technique for reproduction of a human atherosclerotic lumen within the dog coronary artery in vivo
Authors: Spears J. Richard , Crawford Donald W. , Serur Juan , Grossman William , Paulin Sven
Published: March 2007

Reproduction of a human atherosclerotic lumen within the arterial lumen of an intact animal would facilitate angiographic and hemodynamic studies of stenoses. Accordingly, a male silicone rubber cast of a human atherosclerotic lumen was obtained from a cadaver artery, and a thin‐walled replicate arterial phantom was constructed from the cast by use of a rapidly polymerizing liquid plastic. The casting properties of both materials were such that the topography of the arterial lumen was duplicated precisely in the phantom with 20 x microscopic detail preserved. The phantom was coated with a banzalkonium‐heparin solution and introduced over a guidewire into an epicardial segment of a coronary lumen of the dog. Similarly, a larger phantom was placed within the dog femoral artery either directly via an arteriotomy or indirectly via a catheterization technique. Since the plastic material used to make a phantom had the same radiographic density of tissue, the angiographic appearance of an intra‐arterial phantom was that of a human stenosis.
Overestimation of mitral valve gradients obtained by phasic pulmonary capillary wedge pressure
Authors: Hosenpud Jeffrey D. , McAnulty John H. , Morton Mark J.
Published: March 2007

We investigated the relationship between left atrial (LA) and pulmonary capillary wedge pressure (PCW) in order to define the clinical settings in which PCW may be used to approximate LA pressure and to determine the cause and significance of difference between LA and PCW pressures. Nineteen patients who at cardiac catheterization had LA, PCW, and left ventricular (LV) pressures recorded, had mitral valve gradients and areas determined. Mean PCW and LA pressures correlated well (r = 0.94). Phasic PCW consistently overestimated the MV gradient and underestimated the MV area compared to LA pressure, (8 ± 4 versus 4 ± 3 mm Hg, p < 0.001, 1.3 ± 0.3 versus 1.6 ± 0.3 cm2, p < 0.005, respectively). Three patients had abnormal MV prosthesis function assessed by PCW pressure but not by LA pressure. Diastolic MV gradients between PCW and LV were caused or increased by a slowed y descent in the PCW tracing. Using the PCW pressure may falsely elevate MV gradients and falsely reduce MV areas and lead to incorrect clinical action.
Coronary artery obstruction due to blunt chest trauma with residual angina pectoris
Authors: Loss David M. , Macmillan Robert M. , Maranhao Vladir
Published: March 2007

A 41‐year‐old man developed persistent angina pectoris following blunt trauma to his chest. Three months after the injury coronary angiography demonstrated 80% obstruction of the mid‐left anterior descending coronary artery. There was no evidence of atherosclerosis in the remaining coronary arteries. Therefore the assumption is made that blunt trauma can induce incomplete coronary occlusion resulting in classic angina pectoris in apparently otherwise normal coronary arteries. The suggested mechanism of injury to the coronary vessel is either intimal tear and/or subintimal hemorrhage with incomplete luminal thrombosis.
An improved method for transseptal left ventricular catheterization
Authors: Kawachi Kanji , Kitamura Soichiro , Oyama Choken , Koh Shigeo , Morita Ryuichi , Kawashima Yasunaru
Published: March 2007

It is difficult to perform a retrograde left ventricular catheterization in patients having an aortic valve replacement. An improvement of the conventional transseptal catheterization (Brockenbrough method) led to a better success rate of catheterization. The fulcrum of the improved catheter was located 7 cm from the tip. Its curvature was approximately 270°. Its tip was bent inward to form a pig‐tail shape to prevent myocardial injury. This catheterization was performed 33 times in 32 patients. A 97% success rate was achieved.

An exercise loading test was performed with a bicycle ergometer while this catheter was maintained in the left ventricle of a patient placed in a supine position. The catheter was well retained in the left ventricle and produced a minimal number of arrhythmias during exercise. The modification of this catheter has proved to be a better method of left ventricular catheterization in patients with an aortic valve replacement.
Balloon occlusion angiography in critically iii neonates
Authors: Fiddler Garrick I. , Partridge John B.
Published: March 2007

The use of balloon occlusion of a vessel during angiography is described in small ill babies. There were no complications associated with the technique, and angiographic visualisation of structures proximal to the balloon was improved especially in aortic arch anomalies.
A method of maintaining thermal homeostasis during cardiac catheterization in newborns
Authors: Giroud Jorge , Pickoff Arthur S. , Garcia Otto L. , Wolff Grace S. , Tamer Dolores
Published: March 2007

This device has been designed to maintain thermal homeostasis in newborns undergoing cardiac catheterization. It is easily constructed from materials available in any hospital, and it is safe and effective. It consists of a warming coil and a delivery unit made from Plexiglas which encloses the patient. In addition to maintaining a neutral thermal environment, it allows for the selection of any desired oxygen concentration by simply blending the gas mixture before warming and delivery. Since using this device we have had no problems or complications related to thermal stress during catheterization of the neonate.
Cardiac complications in vascular procedures: Comparison of percutaneous angioplasty and surgery
Authors: Mohr Rephael , Smolinsky Aram , Morag Benyamina , Bass Arie , Rubinstein Zalman J. , Adar Raphael
Published: March 2007

Percutaneous transluminal angioplasty (PTA) is currently recommended to high risk cardiac patients as a relatively safer procedure compared to reconstructive peripheral vascular surgery (RPVS). In order to evaluate this approach we studied the incidence of cardiac complications in 86 consecutive patients undergoing peripheral vascular procedures. 45 patients (Group I) underwent RPVS and 41 (Group II) PTA. The two groups were comparable regarding age, sex, the location of vascular lesions, the incidence of previous MI (Group I—40%, Group II—46%), and the incidence of angina pectoris (I—25%, II—29%). No special treatment or monitoring was used for patients with ischemic heart disease (IHD) in the PTA group. Successful revascularization was achieved in 36 (80%) of the surgical patients and 25 (61%) of the patients who underwent PTA. There were two anginal attacks, two MIs, and one cardiac death in group I compared to six anginas, three MIs, and one death in Group II. These differences are not statistically significant. It is concluded that PTA carries a definite risk of cardiac complications in patients with known IHD.
An accurate and simplified method to calculate angiographic left ventricular ejection fraction
Authors: Tortoledo Francisco A. , Fernandez Genaro C. , Quinones Miguel A.
Published: March 2007

An accurate and simplified method to calculate left ventricular (LV) ejection fraction (EF) derived from the ellipsoidal formula for LV volume calculation is described. The LV minor axis (D) is obtained from the average of three equidistant LV diameters at end‐diastole (Ded) and end‐systole (Des), and the shortening fraction of D2 (%δD2) calculated as (D2ed – D2es)/D2ed. EF is calculated as EF = [ δD2 + ([1 – δD2] × δL)] × 100, where δL = the shortening fraction of the long axis. The coefficient of correlation between the EF by this method and the EF derived from measurements of LV volumes with the area‐length method was 0.98, SEE = 3.57% (n = 50). No significant over‐ or underestimation was observed according to the regression equation Y = 0.922x + 0.82. Thus, this simplified method allows accurate LVEF calculation without the need for planimetry of LV area.
Comparison of the effects of nitroprusside and nitroglycerin on coronary size
Authors: Feldman Robert L. , Day R. Michael , Hill James A. , Conti C. Richard , Pepine Carl J.
Published: March 2007

Nitroglycerin and nitroprusside are known to differ in their relative degree of systemic arterial and venous dilation. Nitroglycerin has been shown to be a potent large‐vessel coronary dilator, but the effects of nitroprusside on coronary artery size are unclear. Accordingly, we studied coronary artery angiographic responses to both nitroprusside and nitroglycerin in 12 patients. Diameters of left coronary artery segments were measured by quantitative angiography before and during an intravenous infusion of nitroprusside and after sublingual nitroglycerin when both drugs were administered in doses adjusted to achieve similar reductions in aortic pressure.

Dilation of the left coronary artery was observed after nitroprusside and after nitroglycerin. Degrees of dilation were similar in the various left coronary artery segments after either nitroprusside or nitroglycerin. In general, segments located more proximally dilated less than those located more distally after either agent.

We conclude that both nitroprusside and nitroglycerin are potent dilators of large epicardial and of smaller intramuscular coronary artery segments. The magnitude of dilation of all measured left coronary artery segments appeared remarkably similar with nitroprusside and nitroglycerin given in doses that produced a similar reduction in aortic pressure.
Catheter separation during coronary angiography
Authors: Reddy C. V. R. , Khan R. , Feit Allen , Gordon David , Sherif Nabil El
Published: March 2007

Complete fracture and separation of a right coronary Judkins catheter during coronary angiography is presented. The possible mechanism underlying the separation and retrieval of the catheter fragment is described.
Diurnal changes and reproducibility of corrected sinus node recovery time
Authors: Thormann Jochen , Schlepper Martin , Kramer Wilfried
Published: March 2007

Corrected sinus node recovery time (CSRT) has been found unreliable in identifying all cases of sick sinus syndrome. Since other factors than sinus node dysfunction might add to the pathologic significance of the CSRT, we assessed it in 15 patients (nine group I patients with “prolonged” CSRT max = 3,196 + 2,740 msec and six group II patients with “short” CSRT max = 367 + 79 msec) at 0800, 1100, 1400, 1700, 2000, and 2300 hours with atrial overdrive stimulation rates (AST) of 90, 110, 140, 170, and 200 bpm on three consective days using a loop‐mounted stable atrial electrode. Only with AST ≧ 140 beats per minute (bpm) did all CSRTI values prove prolonged (≧ 560 msec). CSRTI values at corresponding time intervals were reproducible with AST ≧ 140 bpm (day 1 vs 2 vs 3, P > .05), but not at AST 90 bpm and 110 bpm (P < .05); CSRTII results, however, varied from day to day (< .05) due to less scatter of single results. CSRTI results increased progressively with AST 90, 110, and 140 bpm from 301 + 256 msec by 60% for each pacing rate up to 785 + 848 msec. With AST ≧ 140 bpm, the pattern of CSRT changes was inconsistent; this was also reflected by the distribution of the mean maxima of CSRTI: For 0800 hours at AST 140 bpm = 822 + 937 msec; for 1100 hours at AST 200 bpm = 824 + 1446 msec; for 1400 hours at AST 140 bpm = 780 + 814 msec; for 1700 hours at AST 170 bpm = 1,099 + 1,008 msec; for 2000 hours at AST 200 bpm = 1,156 + 1,280 msec; and for 2300 hours at AST 170 bpm = 1,021 + 1,102 msec.

We conclude therefore that the optimal diagnostic yield for sick sinus syndrome testing is influenced by the time of the day and the AST used for CSRT testing.
Resting and exercise hemodynamics in constrictive pericarditis and a case of cardiac amyloidosis mimicking constriction
Authors: Robbins Mitchell A. , Pizzarello Roy A. , Stechel Richard P. , Chiaramida Salvatore A. , Gulotta Stephen J.
Published: March 2007

The resting and exercise hemodynamics in seven patients with pericardial constriction and in one patient with cardiac amyloidosis are described. Equalization of left and right heart diastolic filling pressures was observed in all cases, both at rest and during exercise. This hemodynamic response, although typical, should not be considered pathognomonic of pericardial constriction.
Early segmental thinning of the left ventricular wall following regional ischemia
Authors: Sabbah Hani N. , Stein Paul D.
Published: March 2007

To explore possible mechanisms of left ventricular early segmental relaxation, complete occlusion of the left anterior descending coronary artery (LAD) was produced in seven open‐chest dogs and partial occlusion of the LAD was produced in six openchest anesthetized dogs. Regional wall thickness was measured both in an ischemic and a normally perfused zone using implanted ultrasonic crystals. Two to three seconds following complete LAD occlusion, thinning of the ischemic wall occurred prematurely during isovolumic relaxation. The extent of premature thinning became more prominent 5 to 10 sec following LAD occlusion. Early thinning of the ischemic wall preceded thinning of the normally perfused wall by 110 ± 10 msec. Partial occlusion of the LAD produced a 33 ± 6% reduction of coronary flow and a 23 ± 4% reduction of systolic wall thickening in the ischemic region. Systolic thickening of the nonischemic wall was unchanged relative to the preocclusion period. Premature early thinning of the mildly ischemic wall preceded thinning of the normally perfused segment by 90 ± 8 msec. The observation that ischemia can produce segmental early thinning of the ventricular wall may have implications in understanding the mechanism of the angiographic observation of the segmental early relaxation phenomena in patients with coronary artery disease.
Rapid visualization of the right coronary artery with an anterior–inferior ostium
Authors: Loss David M. , Maranhao Vladir , Goldberg Harry
Published: March 2007

We describe an approach for rapid visualization of the right coronary artery (RCA) with an anterior‐inferior ostium. The success rate of this method has been 100% without any complications. It decreases patient discomfort, reduces radiation exposure, and increases safety by decreasing procedure time.
Echocardiographic definition of right pulmonary venous connection at catheterization
Authors: Harris J. Peter , Nanda Navin , Stewart Scott , Alexson Chloe G. , Manning James A.
Published: March 2007

Traditional methods of identifying partial anomalous pulmonary venous connection to the right atrium in the presence of an atrial defect are not always reliable. Twenty patients were studied with a new technique in which the catheter is introduced into the right superior pulmonary vein followed by echocardiographic assessment of the catheter position in relation to the left atrium and atrial septum. The insertion site of the right pulmonary veins was detected in every patient and in ten patients has been verified at operation. This approach can be performed rapidly and appears to be accurate as well as reliable.
Validity of contrast hyperemia for clinical assessment of coronary flow reserve: The optimal dose of contrast medium and reproducibility of the technique
Authors: Mishima Masayoshi , Inoue Michitoshi , Hori Masatsugu , Tsujioka Katsuhiko , Kuzuya Tsunehiko , Kodama Kazuhisa , Nanto Shinsuke , Abe Hiroshi
Published: March 2007

The dose‐response relation of contrast medium‐induced hyperemic response in coronary blood flow (contrast hyperemia) was investigated to determine the optimal dose of contrast medium (CM, Urografin‐76®) for the assessment of coronary flow reserve in man. The great cardiac venous flow (GCVF) was determined with the continuous thermodilution method during the contrast hyperemia induced by the intracoronary injection of CM of three different doses, ie, 2, 4, and 6 ml/60 kg of body weight, into left coronary artery.

Submaximal coronary vasodilation could be obtained by intracoronary injection of 4 ml of CM with minimal changes in systemic hemodynamics. The contrast hyperemia with this dose of CM was reproducible and also closely correlated with that obtained during pacing‐induced angina. Thus, we conclude that the contrast hyperemic technique with intracoronary injection of 4 ml of Urografin‐76® could be a reliable method to assess the coronary flow reserve.
Hemodynamic changes after angiocardiography with a new low osmolar contrast medium (sodium‐meglumin‐joxaglat)
Authors: Theler August , Baur Facc Hans R.
Published: March 2007

We evaluated the hemodynamic effects of sodium‐meglumin‐joxaglat (Hexabrix®) compared to sodium‐meglumin‐diatrizoat (Urografin 76®) after left ventriculography in a double‐blind randomized study on 24 patients (12 patients per group). Hemodynamic measurements at rest and the extent of ischemic heart disease were comparable in the two groups. Measurements were made at rest and between the second and third minute, between the fifth and sixth minute, and between the eighth and ninth minute following injection of 0.7 ml/kg of contrast medium into the left ventricle. Additionally left ventricular volumes and ejection fraction of the second and fifth beat following the onset of injection were calculated. The discomfort was graded by the patients on a scale of 1–4. After 3 min there was a significant but comparable increase in right atrial, pulmonary artery, and pulmonary capillary wedge pressure (64, 35, and 61%, respectively for the Hexabrix® group and 61, 36, and 58% for the Urografin® group). Cardiac index and stroke volume index rose significantly higher in the Urografin group and left ventricular work index increased significantly only after injection of Urografin 76. Ejection fraction decreased 11% in the Hexabrix® group and 9% in the Urografin® group. The grade of discomfort was 1.83 ± 1 in Hexabrix® group and 2.83 ± 0.8 in the Urografin® group (p < 0.05). Thus, Hexabrix® represents an advance in angiocardiography, both from the subjective and objective standpoint.
Salutary effect of nifedipine in pacing‐induced angina: Relation to afterload reduction
Authors: Tiefenbrunn Facc Alan J. , Sobel Facc Burton E. , Ludbrook Facc Philip A.
Published: March 2007

To determine the mechanisms responsible for beneficial effects of nifedipine in pacing‐induced angina pectoris, 20 patients undergoing diagnostic cardiac catheterization were studied. Following left ventriculography and coronary arteriography, right atrial pacing was performed before and 30 min after administration of 20 mg of nifedipine sublingually. Heart rate was increased by 10‐beat‐per‐minute (bpm) increments every 90 sec until angina occurred. Electrocardiogram, central aortic pressure, and pulmonary arterial occlusive pressure were monitored continuously. Mean paced heart rate at the onset of angina was increased from 107 ± 12.6 bpm to 140.6 ± 19.9 (P <.001) after nifedipine. Systolic arterial pressure at the time of angina declined from 143 ± 20 mm Hg to 112 ± 23 mm Hg (P <.001). Consequently, the double product heart rate × systolic blood pressure was not changed significantly at the onset of chest pain (149 ± 28 mm Hg × 10−2 vs. 142 ± 28 mm Hg × 10−2). Pulmonary arterial occlusive pressure also did not change significantly (10.4 ± 4.4 vs. 10.5 ± 5.9 mm Hg). Thus, nifedipine decreased myocardial oxygen demand at a given heart rate by reducing left ventricular afterload, but did not increase the rate pressure product threshold for ischemic pain. These results indicate that peripheral arterial vasodilator effects of nifedipine, with a resultant decrease in myocardial oxygen requirements, account for its antianginal effect in this setting in patients with fixed obstructive coronary artery disease.