bluuebunny/crossref_metadata_2025 huggingface dataset:
Pseudo complications of cardiac catheterization: Update
Authors: Hildner Frank J. , Javier Roger P. , Tolentino Alfonso , Samet Philip
Published: March 2007

This prospective study was performed to determine whether complications that occur immediately before or after the time of scheduled catheterization are as much disease‐related as procedure‐related. During 24 months all complications associated with 1,606 diagnostic cardiac catheterizations were recorded if they occurred from 24 hours before the time the procedure was scheduled to 72 hours later, longer if complications were clearly procedure‐related. Pseudo complications are spontaneous medical or surgical incidents that occur during the 24‐hour period before catheterization is scheduled to be performed. Procedure‐related complications are incidents that occur during or after the catheterization procedure. There were 13 (0.81% ) procedure‐related complications but no deaths. There were 13 (0.81% ) pseudo complications including 4 (0.24% ) deaths. All complications were similar in nature except for 3 instances of vascular injury, which were procedure‐related. Pseudo complications occur as commonly as procedure‐related complications and at times are more severe. Complications occurring before catheterization are related to the underlying disease process and not medical intervention. It is likely that similar disease‐caused incidents occur after a catheterization and are not necessarily procedure‐related.
Aortic implantation of the anomalous left coronary artery from the pulmonary artery: One‐year angiographic follow‐up
Authors: Solana Luis G. , Massumi Ali , Mathur Virendra S. , De Castro Carlos M. , Garcia Efrain , Hall Robert J. , Cooley Denton A.
Published: March 2007

Surgical aortic reimplantation of the anomalous origin of the left coronary artery from the pulmonary artery in a 16‐year‐old boy is reported. One‐year angiographic follow‐up showed patency of the reimplanted coronary ostium, normalization of left ventricular segmental wall motion and volume, and reduction in the caliber of the right coronary artery.

This is the surgical correction procedure of choice in anatomically feasible cases.
Somatotype and idiopathic mitral valve prolapse
Authors: Zema Michael J. , Chiaramida Salvatore , Defilipp Gary J. , Goldman Mitchell A. , Pizzarello Roy A.
Published: March 2007

Records from 18 subjects with angiographic idiopathic mitral valve prolapse, 28 subjects with merely exaggerated posterior mitral leaflet systolic bulging, and 100 subjects with normal hemodynamic and angiographic findings were compared with regard to age, sex, height, weight, ponderal index (height/3 weight), auscultatory and echocardiographic abnormalities. Chest x‐ray films available for subjects with mitral valve prolapse were reviewed.

The ponderal index of subjects with mitral valve prolapse (13.1 ± 0.8) differed from that of subjects with merely exaggerated posterior mitral leaflet systolic bulging (12.6 ± 0.7) (P < 0.02) and from that of subjects without angiographic abnormality (12.3 ± 0.8) (P < 0.001). The three groups differed in ponderal index when equated statistically for age, height, weight, and sex (P < 0.001). Among mitral valve prolapse patients, an asthenic habitus occurred independent of the presence of thoracic skeletal abnormalities.
Right ventricular aneurysm: Clinical and laboratory features
Authors: Walker Steven S. , Binkley Philip F. , Neiger David , Fulkerson Phillip K. , Bush Charles A. , Unverferth Donald V. , Leier Carl V.
Published: March 2007

A 45‐year‐old woman presented with dyspnea on exertion, two episodes of ventricular tachycardia, a prominent left parasternal impulse, and an unusual cardiac silhouette on chest roentgenogram. Echocardiography and cardiac catheterization demonstrated the presence of a large right ventricular aneurysm. The clinical and laboratory features of the right ventricular aneurysm are discussed.
The brachial artery method to transluminal coronary angioplasty
Authors: Dorros Gerald , Stertzer Simon H. , Bruno Michael S. , Kaltenbach Martin , Myler Richard K. , Spring Donald A.
Published: March 2007

The development of a brachial artery guiding catheter for (percutaneous) trans‐luminal coronary angioplasty is described. Three‐hundred angioplasty procedures were attempted with 196 (65%) via the branchial and 104 (35%) via the femoral artery. The coronary stenosis was crossed in 202 attempts (67%); in 138 via the brachial (70%) and 64 via the femoral artery (62%). A successful angioplasty occurred in 117 via the brachial (85%) and in 50 via the femoral artery (78%). Successful angioplasty of the left anterior descending artery was equally effective with either technique. Successful angioplasty of the right coronary artery was more difficult (P < 0.05) using the femoral artery. An unsuccessful angioplasty with one technique was occasionally overcome by use of the other technique. No brachial artery complications were encountered. The brachial method to transluminal coronary angioplasty is an acceptable and complementary alternative to the femoral technique. Those laboratories contemplating percutaneous transluminal coronary angioplasty may desire to utilize both approaches.
Stress myocardial imaging in patients with mitral valve prolapse: Evidence of a perfusion abnormality
Authors: Butman Samuel , Chandraratna P. A. N. , Milne Norah , Olson Harold , Lyons Kenneth , Aronow Wilbert S.
Published: March 2007

Twenty‐four patients with mitral valve prolapse underwent cardiac catheterization, exercise testing, and exercise 201thallium scintigraphy. Of 10 patients with coronary artery disease, six had abnormal scintigrams. Two of these six had exercise‐induced reversible defects, two had defects that persisted during redistribution, and two had both reversible and persistent defects. Of 14 patients with normal coronary arteries, five had negative scintigrams. Of the remaining nine patients, two had exercise‐induced defects, and seven (50%) had defects involving the inferior or posterior wall that persisted during redistribution. Possible mechanisms for this latter finding are discussed. In contrast to previous reports, exercise 201thallium scintigraphy was not entirely successful in identifying patients with coronary artery disease in our patients with mitral valve prolapse.
Determinants of total body oxygen consumption in adults undergoing cardiac catheterization
Authors: Crocker Roderick H. , Ockene Ira S. , Alpert Joseph S. , Pape Linda A. , Dalen James E. , Lange Nicholas
Published: March 2007

Oxygen consumption was measured in 500 patients (151 F, 349 M, ages 12–84 yr.) undergoing routine cardiac catheterization. Sex, age, and heart rate were found to be the strongest predictors of oxygen consumption index (OCI). Males had higher OCI values than females at any age. Older patients of both sexes had lower OCI values than younger patients. Heart rate correlated directly with OCI. Treatment with pro‐pranolol correlated inversely with OCI. However, after correction for heart rate, there were no significant differences in OCI values between propranolol treated and non‐treated patients. A linear regression equation was developed using combinations of variables to predict OCI, and tables are presented for predicting OCI in those patients in whom this variable cannot be directly measured.
The role of coronary thrombosis in myocardial infarction: Further evidence shown by intracoronary thrombolysis with streptokinase
Authors: Gagnon R. M. , Morissette M. , Bensimon H. , Beaudet R. , Poirier N. , Noel C. , Presant S. , Lemire J.
Published: March 2007

Myocardial infarction is usually caused by a thrombus occurring on a significant coronary lesion.

A 60‐year‐old male was admitted with an acute evolving anterior myocardial infarction. Three hours after the beginning of chest pain, the electrocardiogram showed ST‐segment elevation in the anterior and lateral leads which persisted despite intravenous nitroglycerin (100 mcg/min). One hour later, an angiogram showed complete obstruction at the origin of the left anterior descending artery (LAD). After intracoronary streptokinase (250,000 units) the LAD opened and a 90% obstruction was seen at its origin. However, an anterior myocardial infarction occurred. One month later, an angiogram showed a slight irregularity at the origin of the LAD.

Thus, this case demonstrates that (1) a myocardial infarction may occur with a near normal coronary artery, and (2) a thrombus may occur at the site of a slight coronary irregularity.
Coronary arteriovenous‐arterial fistula
Authors: Singh Ram N.
Published: March 2007

A case of multiple arteriovenous fistulae is described in an adult with coronary artery disease. One of these fistulae drained into the anterior interventricular vein, which in turn communicated with and perfused an obstructed left anterior descending coronary artery.
Angiographic demonstration of coronary sinus thrombosis: A potential consequence of trauma to the coronary sinus
Authors: Hazan Marc B. , Byrnes Douglas A. , Elmquist Thomas H. , Mazzara James T.
Published: March 2007

Abnormalities of the coronary sinus are rarely encountered. A case is presented demonstrating for the first time the angiographic appearance of coronary sinus thrombosis. This may have been the result of surgical trauma during mitral valve replacement or inadvertent cannulation of the coronary sinus during right heart catheterization or pacemaker insertion. Although the clinical significance of coronary sinus thrombosis is uncertain, obstruction of coronary sinus blood flow should not be deleterious because of multiple anastomoses between the coronary sinus system and the anterior cardiac veins. Difficulty in cannulating the coronary sinus for physiologic studies should suggest the possibility of coronary sinus thrombosis, especially in patients who have undergone mitral valve replacement. This may be confirmed by observing the venous phase of selective left coronary arteriography. Finally, coronary sinus thrombosis may be important as a source of pulmonary emboli. The prevalence of this serious complication requires further study.
Long‐term survival following cardiac rupture with subsequent development of left ventricular pseudoaneurysm
Authors: Kolibash Albert J. , Magorien Raymond D. , Bush Charles A. , Vasko John S.
Published: March 2007

This report describes a patient who survived rupture of the left ventricular free wall following a myocardial infarction and who then subsequently went on to develop a pseudoaneurysm. The rupture became clinically recognized when the patient developed cardiac tamponade. A large hemopericardium was evacuated by performing a thoracotomy and a pericardiotomy. Although not evident at the time of the initial catheterization, a pseudoaneurysm developed over the ensuing months. The aneurysm was initially recognized by radionuclide angiography and confirmed by left ventricular angiography at a second cardiac catheterization. The aneurysm was successfully resected, and the patient was alive and functioning normally 18 months after rupture and 12 months after aneurysmectomy.
Transarterial pulmonary venous wedge arteriography in pulmonary atresia, ventricular septal defect, and intact atrial septum
Authors: Momma Kazuo , Takao Atsuyoshi , Shimizu Shuji , Satomi Gengi
Published: March 2007

Transarterial pulmonary venous wedge arteriography was performed in four cases of pulmonary atresia (PA), ventricular septal defect (VSD), and intact atrial septum. In two cases, only the left pulmonary artery was visualized by selective injection to the patent ductus arteriosus (PDA) or Blalock‐Taussig anastomosis (B‐T shunt), and the right pulmonary artery was opacified by transarterial retrograde pulmonary arteriography. In two other cases, with nonfunctioning B‐T shunt, the pulmonary artery was not opacified by either aortography nor by injection into the B‐T shunt. Transarterial pulmonary vein wedge arteriography visualized a confluent pulmonary artery. Transarterial pulmonary vein wedge arteriography was a useful and safe procedure for opacifying the pulmonary artery that could not be visualized antegradely in VSD, PA, and intact atrial septum.
A safe and rapid technique for retrograde catheterization of the left ventricle in aortic stenosis
Authors: Laskey Warren K. , Untereker William J. , Kusiak Victoria , Martin Jack L. , Groh William C. , Hirshfeld John W.
Published: March 2007

The present report describes our experience in 82 patients with a pigtail‐straight guide wire system for crossing stenotic aortic valves. The technique was successful in 95% of all attempts and the average fluoroscopic time was three minutes. There were no major complications of the procedure. The technique allowed for consistent, high quality ventriculograms in 73 patients enabling us to define the severity of concomitant mitral regurgitation in 27 of the patients, as well as a preoperative ejection fraction in all 73 patients. We conclude that the technique as described is a safe and efficient way to obtain both hemodynamic and angiographic information at minimum risk in patients with severe aortic stenosis.
Pulsed doppler echocardiographic detection of mitral regurgitation in mitral valve prolapse: Correlation with cardiac arrhythmias
Authors: Shah Abid A. , Quinones Miguel A. , Waggoner Alan D. , Barndt Robert , Miller Richard R.
Published: March 2007

The incidence of mitral regurgitation in mitral valve prolapse was studied retrospectively in 88 consecutive hospital based patients with mitral valve prolapse using pulsed Doppler echocardiography. Pulsed Doppler findings of turbulence in the left atrium were predictive of angiographic findings of mitral regurgitation in 31 patients. On 24‐hr Holter monitoring, patients with mitral valve prolapse and mitral insufficiency had a higher prevalence of ventricular arrhythmias than patients without mitral insufficiency (61 vs 22%; P < 0.02). Detection of mitral insufficiency identified individuals with mitral valve prolapse who are at higher risk of ventricular arrhythmias.
Myocardial ischemia in patients with fixed occlusive coronary artery disease secondary to vasospasm in the “normal” vessel
Authors: Mautner Richard K.
Published: March 2007

Seven patients with significant fixed occlusive coronary artery disease had coronary artery spasm in a “normal” vessel. All patients had one or more episodes of rest angina and six had exertional angina as well. Four sustained previous myocardial infarction. During spontaneous angina, five patients had ST‐segment elevation in the inferior electrocardiographic leads. One patient had ST‐segment elevation in anterior leads. During angiography, spasm was demonstrated in the right coronary artery in three patients and in the left anterior descending coronary artery in one patient. This study emphasizes the interaction of fixed and vasospastic disease and has strong implications concerning the management of patients with ischemic heart disease.
Transluminal coronary angioplasty complicated by coronary artery perforation
Authors: Kimbiris Demetrios , Iskandrian Abdulmassih S. , Goel Inder , Bemis Charles E. , Gehl Leonard , Owens John , Segal Bernard L.
Published: March 2007

Transluminal coronary angioplasty may be associated with complications resulting from the dilatation catheter and inflation of the balloon. The most common complications are dissection, occlusion, and coronary spasm. We report an unusual complication of coronary artery perforation by the dilatation catheter resulting in acute pericardial tamponade. The complication was immediately recognized and confirmed by dye injection and hemodynamic measurements. Pericardiocentesis was performed, followed by successful coronary bypass surgery. The reasons for the perforation are unclear. We postulate that the acute angle of the perforated vessel was an important factor for this complication. The importance of a standby cardiac surgeon and operating room is emphasized.
Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS)
Authors: Fisher Lloyd D. , Judkins Melvin P. , Lesperance Jacques , Cameron Airlie , Swaye Paul , Ryan Thomas , Maynard Charles , Bourassa Martial , Kennedy J. Ward , Gosselin Arthur , Kemp Harvey , Faxon David , Wexler Laura , Davis Kathryn B.
Published: March 2007

Eight hundred seventy arteriograms from the Coronary Artery Surgery Study (CASS) were independently read by readers at two different clinics to evaluate the reproducibility of the interpretation of coronary arteriograms. Among proximal segments, the interpretation of lesions of the left main coronary artery were the least reproducible, P < .02. When one angiographer reads a stenosis of 50% or more in the left main coronary artery, it is estimated that a second reader will report no lesion 18.6% of the time. In 94.7% of the films, the number of significantly (≥70% stenosis) diseased vessels was the same for both readers (72.1%) or differed by one vessel (22.6%). The reproducibility of interpretation of films of good or acceptable quality or completeness was better than the reproducibility of readings of arteriograms judged to be of poor quality or incomplete studies. The mean absolute difference between readings of the percent stenosis decreased over the time of the patient enroliment, 1975 to 1978. This may have resulted from major collaborative efforts made during the course of the study to improve the quality of angiography and to standardize the reading of the cine films.
Coronary artery catheter‐induced spasm
Authors: Lafia Paul , Dincer Bulent
Published: March 2007

A patient developed a lesion in the proximal and mid right coronary artery during cardiac catheterization. Following the administration of nitroglycerin, repeat right coronary angiography showed a normal right coronary artery. Therefore, distal lesions associated with catheter‐induced spasm in the same coronary artery should not always be considered “fixed” lesions; but rather, they may be due to spasm.
Fever, chills, and hypotension following cardiac catheterization with single‐ and multiple‐use disposable catheters
Authors: Jacobson Jay A. , Schwartz Charles E. , Marshall Hiram W. , Conti Marlyn , Burke John P.
Published: March 2007

Recognition of pyrogen reactions in patients studied with multiple‐use cardiac catheters led to recommendations regarding their cleaning and ultimately to the expensive practice of discarding catheters after a single use. Primarily because of cost considerations, our laboratory continued to clean and reuse catheters through 1981. This afforded an opportunity to assess the endemic rate of adverse reactions associated with this practice. We prospectively evaluated 341 patients who were studied with single‐use or multiple‐use catheters. The overall incidence of adverse reactions was: hypotension 27%, fever 3%, chills 3%, and all three 0.6%. There were no statistically significant increases in these reactions associated with the reuse of catheters. Bacterial infection did not appear responsible for these reactions, and it is possible that they were due to angiographic dye. We conclude that careful cleaning and reuse of catheters does not create an obvious increase in the risk of infection, and it appears to play a minor role, if any, in the development of other adverse reactions.
Subclavian artery to pulmonary circulation fistulas
Authors: Auge J. M. , Bosch X. , Crexells C. , Oriol A.
Published: March 2007

A case of right subclavian artery to pulmonary circulation fistula is described. A review of the literature surprisingly reveals that until December 1981 only three other cases involving the subclavian artery have been reported. Only one of these and the case described here seem likely to be of congenital origin.
Primary pulmonary hypertension: M‐mode and two‐dimensional echocardiographic findings
Authors: Berger Bruce C. , Walinsky Paul , Carey Phyllis
Published: March 2007

In two young men subsequently found to have primary pulmonary hypertension, echocardiographic findings suggested an atrial septal defect. Additionally, contrast echocardiography demonstrated right‐to‐left shunting at the atrial level. Cardiac catheterization demonstrated severe pulmonary hypertension with patent foramen ovale. Thus, primary pulmonary hypertension may result in findings similar to atrial septal defect on echocardiography, particularly if a foramen ovale is present.
Assessment of the magnitude of aortic regurgitation by dye injection into the descending aorta
Authors: Haneda Takashi , Shirato Kunio , Ohe Masatoshi , Kanazawa Masaharu , Ishikawa Ken , Hashiguchi Ryoichi , Kanda Hitoshi , Koiwa Yoshiro , Takishima Tamotsu
Published: March 2007

A technique simpler than the angiographic method for estimating aortic regurgitant volume was tried with 31 patients with aortic insufficiency. During cardiac catheterization, we injected dye into the descending aorta while recording the dye dilution curve in the left ear. The distance between the aortic arch and the tip of the catheter at the lowest point from which the injected dye could be detected in the left ear was rated in terms of the number of corresponding vertebral bodies. This “distance score” closely correlated with the regurgitant stroke volume and with the fraction to total stroke volume, which were measured by angiocardiography (r = 0.927, p < 0.001; and r = 0.900, p < 0.001, respectively). The correlation coefficients of the aortographic grade to those parameters were not as high as they were in the relationship of the score to the same parameters. Therefore, these results indicate that the “distance score” is a practical method for assessing the magnitude of aortic regurgitant volume.
Maximal postextrasystolic potentiation following multiple extrasystoles: A simple means of myocardial assessment
Authors: Cragg Andrew , Einzig Stanley , Rholl Kenneth , Rysavy Joseph , Castaneda Wilfrido , Amplatz Kurt
Published: March 2007

To obtain consistent, reproducible postextrasytolic potentiation (PESP), a single closely coupled extrasystole (ES) must be introduced using tranvenous pacing. We hypothesized that multiple ES (spontaneous or catheter induced) produce maximal PESP at all coupling intervals (CI). Differences in PESP between single and double ES were assessed in dogs at varying CI by two different methods [systolic time intervals‐PEP/LVET, and endocardial markers‐ejection fraction (EF)]. Single ES produced variable decreases in PEP/LVET (−8.6 ± 2.7% (SE) to −22.9 ± 4.0%) depending on the CI duration. Double ES produced maximal decreases (−26.0 ± 1.2%) at all CI. A similar relationship was noted for EF following single ES (8.6 ± 2.7% to 43.0 ± 4.0%) and double ES (42.9 ± 1.3%). Double ES produced maximal PESP at all CI. This finding may allow simple myocardial assessment during routine left ventricular catheterization without simultaneous right ventricular catheterization.
Comparison between the gorlin formula and a simplified formula to measure the severity of pulmonic stenosis
Authors: Hare Thomas W. , Hakki A‐Hamid , Iskandrian Abdulmassih S.
Published: March 2007

In a previous study we showed that the Gorlin formula for measuring the valve areas in patients with stenotic mitral or aortic valves can be simplified without loss of accuracy. The simplified formula states that the valve area is equal to cardiac output (liters/min) divided by the square root of the pressure gradient across the valve. In this study we compare the Gorlin formula and the simplified formula in measuring the valve areas in 12 patients with congenital pulmonic stenosis. There was an excellent correlation between the two methods (r = 0.98, y = 0.07 + 1.16x, P < 0.001). Therefore the simplified formula can be used in measuring the severity of pulmonic stenosis. This method is simpler and easier to memorize than the Gorlin formula.
Echocardiographic and hemodynamic findings in isolated symptomatic coarctation of the aorta in infancy
Authors: Mace Sharon E. , Hirschfeld Stephen S. , Riggs Thomas W.
Published: March 2007

Echocardiographic findings and cardiac catheterization data were evaluated in 18 infants less than 1 year old in order to define anatomical or pathophysiological features that were associated with early cardiac decompensation. The infants could be divided into three groups: Group I (10 patients) had left ventricular dilatation and depressed contractility in response to the severe systemic hypertension. Group II (3 patients) had marked myocardial hypertrophy in response to the systemic hypertension. Group III (5 patients) were the youngest patients and had findings of right ventricular volume overload and pulmonary hypertension. This study demonstrates that, in early infancy, the ventricular response to simple coarctation of the aorta is variable in infants in a state of cardiac decompensation. The different echocardiographic and hemodynamic findings may be a consequence of the lesion exerting its influence at various stages of the patients' intrauterine or postnatal life. In most patients, resection of the coarctation results in rapid normalization of the echocardiographic findings.
Transpulmonary artery correction of anomalous origin of the left coronary artery by saphenous vein graft
Authors: Fisher Jeffrey , McDonald Garth , Brinker Jeffrey , Neill Catherine A. , Donahoo James S. , Baughman Kenneth L.
Published: March 2007

A transpulmonary saphenous vein graft was used to repair an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Postoperative cardiac catheterization revealed correction of the previous systemic arterial to venous shunt and a patent intrapulmonary artery conduit. The patient has experienced substantial symptomatic and functional improvement from the operation despite development of mild pulmonary outflow obstruction. Saphenous vein transpulmonary artery correction for ALCAPA offers an alternative surgical approach and may be the procedure of choice when anatomy or prior surgery preclude the more standard modes of revascularization.
Angioplasty catheter communication mimicking coronary arterial dissection
Authors: Kern Morton J. , Sorensen Sherman G. , Petru Michael A. , Richards Kent L.
Published: March 2007

We report a case in which a sudden communication between the pressure and balloon inflation lumens of a percutaneous transluminal angioplasty (PTCA) catheter angiographically mimicked dissection of the coronary artery. This case illustrates a previously undescribed catheter artifact that must be differentiated from other complications of PTCA.
Regional left ventricular wall motion abnormalities in chronic volume overload
Authors: Donato Marisa Di , Barletta Giuseppe , Mori Fabio , Fantini Fabio
Published: March 2007

Computer‐assisted analysis of left ventricular (LV) wall motion has been performed in 12 patients (pts) with chronic volume overload and in seven normal subjects. All pts were in sinus rhythm, without congestive heart failure and without coronary artery disease at selective coronary angiography; 30° right anterior oblique ventricculograms were employed in each case. Thirty‐six radiants were automatically traced and the percent shortening of each radiant was calculated using two different reference methods (fix and floating methods).

In valvular heart disease (VHD) pts LV volumes were significantly increased, and ejection fraction and LV eccentricity were significantly reduced. LV eccentricity inversely correlated with LV volumes.

VHD pts showed regional LV abnormalities. Inferoapical and anterior wall motion was significantly reduced (two‐sample t‐test P < 0.05) using the fix method. With this method a significant inverse correlation between percent shortening of the radiants correspondent to the inferoapical region and end‐diastolic and end‐systolic volumes was found; a significant direct correlation was found with LV systolic eccentricity. Ejection fraction directly correlated with the percent shortening of radiants correspondent to both the anterior and inferior regions.

The role of LV “dynamic geometry” alterations as a possible cause for the observed regional LV wall motion abnormalities is emphasized.
Tunneled (“bridged”) left anterior descending coronary artery in a newborn without clinical or morphologic evidence of myocardial ischemia
Authors: Visscher Daniel W. , Miles Brian L. , Waller Bruce F.
Published: March 2007

Tunneled epicardial coronary arteries have been presumed congenital in origin, but morphologic or angiographic documentation of myocardial bridging at birth is lacking. This report describes a 42‐day‐old infant with a lengthy tunneled left anterior descending coronary artery observed at necropsy that produced no apparent clinical cardiac dysfunction during life despite sinus tachycardia. These observations support the concept that myocardial bridges may be congenital in origin, and suggest length of tunneling and tachycardia may not be adverse factors for myocardial bridges in infancy.
Bicuspid aortic valve morphology when associated with coarctation of the aorta
Authors: Folger Gordon M. , Stein Paul D.
Published: March 2007

Thirteen children and young adults with coarctation of the aorta as their principal cardiovascular abnormality, 11 with bicuspid aortic valves, were evaluated by orifice‐view aortography to evaluate their aortic valvular morphology. For comparison 30 individuals with aortic valvular deformities but without coarctation of the aorta were similarly studied. Two distinct forms of bicuspid valves could be identified characterized by either the appearance of gross inequality of size of the two valve leaflets or an appearance wherein each leaflet closely approximated the size of the other, thus equally bicuspid. Excepting two individuals with normal, tricuspid, aortic valves, all of the patients with coarctation of the aorta had equally bicuspid aortic valves which contrasted to the group without coarctation in which the unequally bicuspid type predominated. This difference in bicuspid aortic valve morphology associated with coarctation of the aorta suggests a different developmental process involving the aortic valve as opposed to the situation in individuals without coarctation.
Repair of an iatrogenic aortoatrial fistula
Authors: Ladowski Joseph S. , Hardesty Robert L.
Published: March 2007

A patient with uncommon potential to contain the extraluminal path of an aortic perforation, due to adhesions from previous operation, survived perforation of the ascending aorta and creation of an aortoatrial fistula at cardiac catheterization. The method of repair is described and discussed herein.
Transcatheter laser dissolution of human atherosclerotic plaques: A model for testing catheters and techniques
Authors: Gessman Lawrence , Reno Charles , Maranhao Vladir
Published: March 2007

We constructed a model of the human arterial circulation that can be used to test laser angioplasty catheters and techniques on obstructed human coronary arteries under simulated physiologic conditions of blood pressure and flow. In this model system, a balloon‐tipped catheter with a central, 0.02‐cm light fiber was used to deliver 4 W of laser energy to two obstructed human cadaver coronary artery segments and four normal dog femoral artery segments. Flushing the catheter with saline during the lases minimized lateral thermal tissue damage. Channels were created in the obstructed arteries that were twice the diameter of the light fiber used to lase. One of four dog arteries perforated, underscoring the potential hazards of the procedure and the need for laser catheters that are flexible and capable of precise alignment.
The brachial artery method to peripheral transluminal angioplasty
Authors: Dorros Gerald
Published: March 2007

The brachial artery method to peripheral (percutaneous) transluminal angioplasty is described. A total of 232 angioplasties were attempted using the brachial and femoral artery techniques with a success achieved in 204 cases (88%): in 167 of 176 (95%) stenoses, and in 37 of 56 (66%) occlusions. 114 attempts were made via the brachial artery method with a success achieved in 109 (96%): in 98 of 102 (96%) stenoses, and in 11 of 12 (92%) occlusions. 68% of the attempts were made in the ileofemoral system with a success achieved in 73 cases (94%): in 66 of 70 (94%) stenoses, and 7 of 8 occlusions. All of the attempted renal, subclavian, and superficial femoral artery stenoses were sucessfully dilated. One local brachial artery complication was encountered. The brachial artery method to peripheral transluminal angioplasty is an acceptable and complementary alternative to the transfemoral technique.
Coronary artery dissection secondary to coronary arteriography: Case report and review
Authors: Feit Alan , Kahn Rahman , Chowdhry Imtiaz , Reddy C. V. R. , Piccone Vincent , Blanche Carlos , El‐Sherif Nabil
Published: March 2007

A case of catheter‐induced proximal dissection of an angiographically normal left coronary artery is reported. Dissection was not associated with pressure damping and myocardial ischemia was delayed until 1 hour after dissection occurred. Prompt recognition of this entity is essential as emergency revascularization is the treatment of choice when significant amounts of myocardium are threatened.
Isolated anomaly of the left anterior descending coronary artery
Authors: Dalal J. J. , West R. O. , Parker J. O.
Published: March 2007

An isolated anomaly of the left anterior descending coronary artery arising from the right sinus of Valsalva is described. A review of the literature shows that isolated anomalies of this vessel are very rare. However, the inability to visualize this vessel from the left sinus of Valsalva warrants careful search of the right sinus.
Severe aortic‐valve stenosis unmasked by amateur running
Authors: Waller Bruce F. , George Kathryn T. , Olson John F. , King Alice D.
Published: March 2007

Three men aged 35, 55, and 60 years had asymptomatic underlying aortic‐valve stenosis unmasked by amateur running or jogging. All three men underwent aorticvalve replacement and two of the three have resumed mild exercise programs. Congenially abnormal aortic valves were found in two of the three patients. Amateur exercise may uncover an underlying cardiovascular abnormality perhaps sooner than might be apparent without exercise.
Digital venous angiography in the diagnosis of pulmonary thromboembolism
Authors: Gutierrez Fernando R. , Biello Daniel , McKnight Robert C.
Published: March 2007

Twenty‐five patients with the clinical suspicion of pulmonary thromboembolism underwent venous digital subtraction angiography (DSA) concurrently with selective conventional pulmonary angiography and the results were compared by two independent observers. Our conclusion is that venous DSA lacks adequate specificity and sensitivity for the diagnosis of pulmonary thromboembolism in subsegmental pulmonary arteries. Any benefit derived from this slightly less invasive technique is far outweighed by the decrease in technical detail when compared to the selective film screen method.
Radionuclide diagnosis of cerebrospino‐pericardial communication after ventriculoatrial catheter placement for hydrocephalus
Authors: Henry G. William , Perry J. Randolph , Stiles Alan D. , Lawson Edward A. , Long Walker A.
Published: March 2007

A 1‐month‐old male child with a previously placed ventriculoatrial catheter presented with severe cardiorespiratory distress secondary to cardiac tamponade. A cerebrospino‐pericardial communication from right atrial perforation by the catheter was diagnosed quickly and easily by a radionuclide injection of the proximal shunt reservoir.
Prolonged coronary vasoconstrictor effect of ergonovine maleate
Authors: Kurnik Peter B. , Spadaro James J. , Nordlicht Scott M. , Tiefenbrunn Alan J. , Ludbrook Philip A. , Courtois Michael R.
Published: March 2007

The duration of the coronary artery vasoconstrictor effect of ergonovine maleate is an important clinical parameter that has not been clearly defined. Since ergonovine is generally administered in incremental, cumulative doses and since this agent may have potentially serious toxic effects related to its vasoconstrictor properties, knowledge of duration of this effect is crucial to its safe and efficacious use. We present clinical evidence of ergonovine‐induced coronary artery spasm recurring after pharmacologic relief of a first episode of ergonovine‐induced spasm. Recurrent spasm occurred 18 minutes after a cumulative dose of 0.15 mg ergonovine and 14 minutes after intravenous nitroglycerin was given to ameliorate the initial spasm. Therefore, clinical monitoring of patients after ergonovine administration should be designed to identify a possibly prolonged duration of vasoconstrictor effect of the drug. Sequential doses of ergonovine at intervals of ten minutes or less should be recognized as having cumulative effect. The duration of action of pharmacologic agents utilized to alleviate ergonovine‐induced coronary artery spasm should exceed the potential duration of action of ergonovine in order to minimize the possibility of late spasm.
Single coronary artery with the right coronary artery arising from the first septal perforator
Authors: Meyers David G. , McManus Bruce M. , McCall David , Walsh Richard A. , Quaife Merton A.
Published: March 2007

A 50‐year‐old woman with chest pain and an exercise thallium‐201 scintigram positive for focal ischemia was found on coronary arteriography to have a heretofore unreported variant of single left coronary artery with the right coronary artery originating as a branch from the first septal perforator. Proximally, the aberrent vessel coursed through the ventricular septum at the level of the right ventricular outflow tract. A conus artery was absent and this is a possible basis for the focal basal ventricular ischemia and the patient's symptoms.
A simple technique for location of the coronary stenotic lesion in percutaneous transmural coronary angioplasty
Authors: Haraphongse Mant , Rottenfusser Judy , Rossall Richard E.
Published: March 2007

We have developed a technique (grid) for location of the stenotic coronary lesion in percutaneous transluminal coronary angioplasty (PTCA). It is simple, economical, and easy to use with no risk to the patient. Utilization of this technique provides for quick and accurate positioning of the balloon catheter in the coronary lesion during PTCA.
Simultaneous measurement of aortic and left ventricular pressures in aortic stenosis using a double lumen pigtail catheter
Authors: Stoebe Tom , Adicoff Arnold , Weir E. Kenneth , Chesler Elliot
Published: March 2007

This technical note describes a double lumen pigtail catheter that can facilitate measurement of the aortic valve gradient in patients with aortic stenosis. The catheter is passed retrograde into the left ventricle with the aid of a flexible guide wire. In two patients the measured gradient was not significantly different from that obtained using two systemic arterial catheters.
Significance of elevated MB creatine kinase in patients after cardiac catheterization
Authors: Rosenblum Andrew M. , Ludbrook Philip A. , Jaffe Allan S.
Published: March 2007

To clarify the etiology of elevations in plasma MB creatine kinase (CK) in patients after cardiac catheterization, we studied 32 consecutive patients undergoing cardiac catheterization and coronary arteriography. Total CK and MB CK were within the normal range in all patients prior to catheterization. Total CK activity rose from a mean of 61.46 ± 33.8 IU/1 (SD) to 141 ± 105 in the first sample after catheterization (p <.005) and 121.6 ± 92.4 in the second catheterization sample (p <.0005). The MB CK activity also rose from a mean of 3.2 ± 1.6 IU/1 prior to catheterization to a maximum value of 5.0 ± 2.9. The mean increase in MB CK, though statistically significant (p <.005), was only 1.8 IU/1. Only one patient's value for MB CK rose to outside of the normal range (>12) likely due to cardiac injury. Thus, our data document that marked elevations in MB CK after cardiac catheterization are unusual. They likely represent cardiac muscle injury rather than MB CK released due to skeletal muscle injury induced by the catheterization itself.
Subclavian artery to internal jugular vein fistula following percutaneous internal jugular vein catheterization
Authors: Merino‐Angulo J. , Cortazar J. L. , Saez‐Garmendia F. , Montejo M.
Published: March 2007

The percutaneous internal jugular vein approach is now a commonly performed procedure for central venous catheterization. Iatrogenic arteriovenous fistulae are a very infrequent complication. We report an asymptomatic subclavian artery to internal jugular vein fistula following two percutaneous internal jugular vein catheterization attempts.
Complete heart block during cardiac catheterization in a normal individual
Authors: Baird Charles L. , Borst Matthew P. , Maxfield Donna L.
Published: March 2007

A 44‐year‐old white male who developed third‐degree heart block during cardiac catheterization is presented. Right heart catheterization precipitated bifascicular block, right bundle branch block with left posterior hemiblock, and resulted in thirddegree heart block during the left heart procedure. It is recommended that multiple electrocardiographic lead monitoring be considered during cardiac catheterization in order to recognize more easily high‐risk conduction disturbances, ie a bifascicular block pattern with frontal plane axis shifts.
Modification of cradle angiographic tables to more easily obtain axial coronary views
Authors: Vetrovec George W. , Strash Alfred M.
Published: March 2007

With greater utilization of angled coronary views for better elucidation of coronary anatomy, many laboratories are still limited by the rotating cradle systems which make angulation for these views somewhat difficult. The following report describes a simple, inexpensive way to modify existing cradle structures to accommodate easy cranial angulation.
Temporal pattern of regional left ventricular wall motion in patients with segmental early relaxation
Authors: Sabbah Hani N. , Khaja Fareed , Brymer James F. , Stein Paul D.
Published: March 2007

The purpose of this investigation was to describe the temporal pattern of regional left ventricular (LV) wall motion in patients with segmental early relaxation (SER). Segmental early relaxation was demonstrated angiographically in seven patients undergoing diagnostic cardiac catheterization because of chest pain. In all patients, early relaxation of only the anterolateral wall was observed. The temporal pattern of regional wall motion was assessed from ventriculograms, obtained in the right anterior oblique projection, by measuring the lengths of the anterolateral minor axis chord and the corresponding diaphragmatic minor axis chord. The onset of lengthening of the anterolateral chord preceded that of the diaphragmatic chord by 110 ± 10 msec. Maximal shortening of the anterolateral chord during systole was 43 ± 4% and was coincident with a 32 ± 4% shortening of the diaphragmatic chord. During early relaxation, shortening of the anterolateral chord diminished to 17 ± 4% (P <.01); and was coincident with a 35 ± 4% shortening of the diaphragmatic chord (P <.05). Early relaxation of the anterolateral wall was followed by a transient augmentation of shortening of the anterolateral chord to 29 ± 3% (P <.001), whereas shortening of the diaphragmatic chord diminished to 32 ± 4%. Subsequently both chords returned to their initial end‐diastolic lengths. These preliminary observations indicate that early lengthening of the anterolateral segment is followed by a transient rebound of shortening which was only present in the segment that manifested early relaxation.
The thermodilution technique in on‐line computation of the left ventricular volumes on anaesthetized dogs
Authors: Kettunen Raimo
Published: March 2007

The thermal dilution technique and its suitability for automatic computation of left ventricular volumes were evaluated on 28 anaesthetized dogs. The end‐diastolic volume (EDV) was computed from ventricular washout curves in two ways, first utilizing the ratio between the indicator amount and its peak concentration (first ejection method); and secondly the ratio between stroke volume and ejection fraction with the latter obtained by subtracting the residual fraction from 1.0. The residual fraction was determined as the mean of ratios between successive steps of four ventricular ejections on the downslope of the curve (downslope method). The linear correlation coefficient between the EDV determinations (n = 366) was 0.926, and slope y = 1.14 × + 0.5 ml with 4.6 ml as standard error of estimate. The first ejection method gave on average 15% higher EDV values than the downslope method. When heart rate was increased by pacing from 88 to 240/min, both methods showed a reduction of the EDV, but the downslope method to a greater degree. When after load was increased but heart rate decreased by phenylephrine, the first ejection method but not the downslope method indicated an increase in EDV. Otherwise, when pronounced tachy‐ or bradycardia were avoided, ventricular volumes yielded by the two methods were comparable. Indicator injection did not substantially affect ventricular pressure dynamics. The first ejection method seems to be a simple means for repeated measurements of EDV even in the case of diseased hearts.
Sarcoidosis, pulmonary hypertension, and acquired peripheral pulmonary artery stenosis
Authors: Mangla Arun , Fisher Jeffrey , Libby Daniel M. , Saddekni Souheil
Published: March 2007

An unusual case of a young woman with sarcoidosis and pulmonary hypertension who developed new bilateral continuous murmurs and was found to have peripheral pulmonary artery stenoses is reported. The patient has improved symptomatically, radiographically, and hemodynamically on steroid therapy.
Percutaneous perfusion of occluded coronary arteries with blood from the femoral artery: A dog study
Authors: Meier Bernhard , Gruentzig Andreas R. , Dekmezian Roupen H. , Brown Joe E.
Published: March 2007

The idea of perfusing the distal coronary artery with arterial blood during balloon dilatation was implemented in early experimental coronary angioplasty but then abandoned. We pursued this concept in an animal model using a specially designed roller pump. The pump delivers blood from a femoral artery catheter through the central lumen of a balloon catheter occluding a coronary artery. Perfusion of large proximally occluded coronary arteries for at least 60 min was possible in 8 of 11 heparinized dogs. Hemolysis occurring in the pump system due to the small catheter lumen proved a minor problem. For a limited period of time, occluded coronary arteries can be adequately perfused with arterial blood by this percutaneous system that is readily applicable in any catheterization laboratory. Its use is conceivable not only for temporary treatment of acute complications during angioplasty but also for prolonged balloon dilatations of spastic or thrombosed coronary arteries.
Improved success rate of percutaneous transluminal graft and coronary angioplasty with the EL gamal guiding catheter
Authors: El Gamal M. I. H. , Bonnier J. J. R. M. , Michels H. R. , Van Gelder L. M.
Published: March 2007

In the period between October 1980 and December 1982 we evaluated the outcome of percutaneous transluminal graft and coronary angioplasty when a Judkins type guiding catheter (J gc) was initially used, but the lesion could not be passed and a subsequent attempt was made with the El Gamal guiding catheter (EG gc). Seven of twelve attempts to dilate stenotic coronary artery bypass grafts failed. The EC gc was tried in six, five were successfully dilated; one failed.

Our initial attempts to dilate a stenosed right coronary artery failed in 16 of 68 attempts. The EG gc was attempted in 14. We successfully dilated ten, two dissections required emergency coronary artery bypass grafting (CABG); two failed. Our initial attempts to dilate a left anterior descending artery stenosis failed in 14 of 109 attempts. Six lesions were passed when the EG gc was tried. Five were successfully dilated, and one acute dissection required emeregency CABG; eight failed. The EG gc is useful for transluminal angioplasty of stenosed aortocoronary bypass grafts. It increased the success rate of right coronary artery dilatation from 76–91%, but was of limited use in dilatation of left anterior descending lesions.