bluuebunny/crossref_metadata_2025 huggingface dataset:
Two‐dimensional echocardiographic assessment of left ventricular stroke volume: Experimental correlation with thermodilution and cineangiography in normal and ischemic states
Authors: Gueret Pascal , Meerbaum Samuel , Zwehl Werner , Wyatt H. L. , Davidson Robert M. , Uchiyama Takahisa , Corday Eliot
Published: March 2007

Left ventricular stroke volumes derived by two‐dimensional echocardfography (20 echo) were compared with thermodilution and Cineangiography measurements in closed‐chest dogs before and one hour after proximal LAD occlusion. Stroke volume was calculated from end‐dlastolic and end‐systolic volumes reconstructed by two models: (1) Simpson's rule employing left ventricular length and five short‐axis cross‐sectional areas; (2) a simplified volume formula (V = 5/6 area · length), utilizing a single short‐axis area at either the mitral valve or midpapillary muscle level. The comprehensive Simpson reconstruction yielded a good correlation of 2D echo stroke volume against thermodilution (r = 0.89) over a range of normal (N = 14) and ischemic (N = 8) states. The simplified formula provided a satisfactory correlation (r = .90, N = 22) when using the midpapillary cross‐section, which encompassed the Induced ischemic dys‐synergy. In contrast, when using the mitral valve level cross‐section above the site of ventricular asymmetry, there was no significant statistical correlation. Comparison of Cineangiography with 2D echo volume reconstruction based on the simplified formula with the midpapillary muscle level section yielded good correlations for stroke volume (r = 0.87) and ejection fraction (r = 0.97). Intraobserver and interobserver variability of duplicate echo stroke volume measurements was 8% and 10%, respectively. We conclude that 2D echocardlography In dogs permits quantitatlon of left ventricular stroke volume in normal and ischemic states.
Can the human right ventricle create a negative diastolic pressure suggestive of suction?
Authors: Sabbah Hani N. , Anbe Daniel T. , Stein Paul D.
Published: March 2007

Pressure in the right ventricle (RV) as well as the right atrium (RA) and pulmonary artery (PA) were measured in 80 patients with catheter‐tip mlcromanometere and evaluated to determine If the pressures are compatible with the concept of RV diastollc suction. In 40 patients with normal PA pressure, minimal RV diastollc pressure that occurred during early filling, was negative (−2 ± 0.3 mm Hg) (mean ± SEM). In 29 patients with PA hypertension, minimal RV dlastolic pressure during expiration also was negative (−2 ± 0.7 mm Hg). In 11 patients with right ventricular failure, however, minimal RV diastolic pressure was positive (9 ± 2 mm Hg). These results indicate that the human right ventricle, in the absence of failure, has a negative early diastollc pressure, which may reflect RV diastollc suction.
Subvalvular left ventricular pseudoaneurysm: A rare complication of mitral valve replacement
Authors: Bassan Roberto , Jasbik Waldir , Souza Maria Angelica De , Nogueira Alvaro Alves , Luz Fabio S. Oliveira , Baldwin Brian J.
Published: March 2007

A patient who developed a subvalvular left ventricular paeudoaneurysm following mitral valve replacement is presented, the fourth such case in the literature. The etiology of this uncommon complication is felt to be caused by excessive surgical resection of the diseased nitral valve, which may weaken or cause rupture of the heart at the mitral annulus. The diagnosis can only be made by left ventriculography. Surgical treatment is indicated, because rupture of the pseudoaneurysm can occur.
Coronary artery dissection secondary to coronary arteriography: Presentation of three cases and review of the literature
Authors: Morise Anthony P. , Hardin Nicholas J. , Bovill Edwin G. , Gundel Walter D.
Published: March 2007

Three cases of coronary artery dissection secondary to coronary arteriography are presented. Two of these include autopsy material demonstrating medial degeneration in the coronary arteries, which may have predisposed these arteries to dissect The literature on catheter‐induced coronary artery dissection is reviewed and an analysis is presented.
Nonsurgical untangling of a multiple‐coiled flow‐directed catheter
Authors: Handler Bruce , Lam Wilfred
Published: March 2007

A multiple‐coiled, flow‐directed balloon‐tipped catheter was successfully untangled by hooking it with a tip‐deflector guidewlre. This nonsurgical technique was an effective means of untangling the catheter when previously reported techniques were not feasible.
A time‐saving technique in angiography of aortocoronary bypass patients
Authors: Arani Djavad T.
Published: March 2007

We have used the sidewinder catheter for selective cattwterization and anglography of aortocoronary bypass grafts and have been Impressed by the usefulness of this catheter. Selective anglography of vein grafts can be done easily and quickly wtth this catheter, with a very high success rate.
An accurate method for the continuous measurement of oxygen consumption in infants during cardiac catheterization
Authors: Ahrend Jacob , Damjanovic Dragana , Kerr Lorraine , Kappagoda C. Tissa
Published: March 2007

This paper describes the assessment of a method for measuring the oxygen consumption of infants and young children that is suitable for use in the cardiac Catheterization laboratory. It is based upon the open‐circuit technique and permits the continuous display of the oxygen consumption during the investigative procedures. The accuracy of the apparatus was assessed over the range 40‐200 ml/min, both in vitro and in vivo. It was found that the apparatus was free from systematic error and that it had a random error of approximately 2% of the measured value.
New family of preformed left atrial‐coronary catheters for retrograde left atrial catheterization and coronary and/or aortocoronary bypass angiography via brachial artery cutdown
Authors: Freeman D. Joe
Published: March 2007

A previously described preformed No. 7 Oucor catheter for retrograde left atrlal catheterizatlon was modified for coronary anglography and used In 358 consecutive patients, 22 of whom had 26 of 51 previous aortocoronary bypass grafts still patent in 42 patients these catheters were also employed for retrograde left atrial catheterlzation. Sixty percent of right coronary, 96% of left coronary, and 96% of aortocoronary bypass anglography attempts were successful. Complete left heart study and anglography were accomplished with one catheter in ten patients (2.8%), with two catheters in 200 patients (55.9%), with three catheters in 132 patients (36.9%), and with more than three catheters In 16 patients (4.5%). Except in 4 of 12 patients with aortic valve deformities, left atrial catheterlzation was achieved whenever attempted. The complication rate was within acceptable limits. Average left heart and angiography procedure and fluoros‐copy times were respectively 29.4 and 6.5 minutes. In addition to reconfirming usefulness for retrograde left atrial catheterlzation, these data demonstrate this family of catheters is useful for coronary–particularly left–and aortocoronary bypass angiography.
Improvement in the design of preshaped coronary catheters
Authors: Farrehi Cyrus
Published: March 2007

Because of the slanted relationship between the origins of coronary arteries and the adjacent sinus, a nonplanar angle of 45 degrees is proposed to be incorporated In the distal part of the preshaped coronary catheters that need the aortic valve for direction toward the coronary ostla. This angulation will Improve the catheter function and reduce the risk of coronary angiography.
A new lack of twist for the judkins left coronary catheter
Authors: Hirshfeld John W. , Untereker William J. , Goldberg Sheldon , Dlenel Nicholas H. , Drew Thomas , Lozner Eugene
Published: March 2007

We have developed a modified Judkins left coronary arteriography catheter. The catheter is fabricated from 7 French thin‐walled tubing made of extruded polyethylene. This tubing has a larger lumen diameter than either the 7 French or 8 French torque‐control tubings used for standard Judkins coronary arteriography catheters. The large lumen substantially improves the pressure‐flow characteristics of the catheter. Accordingly, it is considerably easier to inject contrast medium through this tubing. Although this tubing has no torslonal rigidity, the lack of torque‐control has proved to be an advantage rather than a detriment in the use of the catheter. Based on an experience of over 2,000 studies with this catheter, we feel that it is superior to standard torque‐control catheters for left coronary anglograms.
Radiographic anatomy of the internal mammary arteries
Authors: Singh Ram N.
Published: March 2007

The radiographic anatomy of the IMAs is described based on bilateral selective arteriography in 100 patients with coronary artery disease. The right and left IMAs were identical in caliber in their mid portions in 94% of cases. Fifteen percent of the IMAs measured less than 2 mm in luminal diameter at the level of the fourth costal cartilage. The side branches showed a great deal of variability and asymmetry in their origin and distribution. The understanding of the radiographic anatomy of the IMA and its branches is helpful in preoperative appraisal and is crucial for postoperative evaluation of the IMA grafts.
The role of intra‐aortic balloon pump in the management of patients with main left coronary artery disease
Authors: Vijayanagar R. , Bognolo Diego A. , Eckstein Paul F. , Toole John C. , Natarajan P. , Mukherjee D.
Published: March 2007

Seventy‐five patients with ≥70% stenosis of the left main coronary artery (LMCA) were treated surgically between January 1974 and February 1980. The group consisted of 57 men and 18 women with a mean age of 62.8 years. All patients were symptomatic with angina pectoris, and 64 (85%) had unstable angina. Twenty‐nine patients (38.6%) had electrocardiographic evidence (ECG) of old myocardial infarction (MI) and only six (8%) had a normal resting ECG. Preoperative exercise testing was done in 22 of the 75 patients. The stress test was positive in all patients, 17 (77%) of whom had > 2 mm ST depression; 90.6% (68/75) had significant right coronary artery disease. The intra‐aortic balloon pump (IABP) was inserted preoperatively in only four patients (5%) and was required in two additional patients postoperatively. The IABP was inserted preoperatively in four patients because of medically refractory angina and not on the basis of coronary anatomy alone. An average of three grafts per patient were inserted. There were three (4%) postoperative myocardial infarctions and two (2.6%) deaths. During the follow‐up period, which comprised 105 patient‐years, there was one myocardial infarction and one death. These data indicate that successful surgical treatment of left main coronary artery disease can be achieved with low mortality and that routine preoperative insertion of IABP is unnecessary.
Tricuspid stenosis masquerading as right ventricular failure in a patient with a prosthetic mitral valve
Authors: Borow Kenneth M. , Henschke Claudia , Sloss Laurence J. , Wynne Joshua
Published: March 2007

Echocardiographic, phonocardiographic, and pulse tracing recordings demonstrated clinically unsuspected tricuspid stenosis in a 53‐year‐old man with a prosthetic mitral valve and signs of right heart failure. Physiologic correlates of the patient's heart sounds and diastolic murmur were studied by simultaneous M‐mode echocar‐diograms and phonocardiograms. Cardiac catheterization and subsequent valve surgery confirmed the presence of tricuspid stenosis. It is important to consider the diagnosis of tricuspid stenosis in all patients with a history of rheumatic mitral valve disease who develop findings suggestive of right ventricular failure.
A safe, rapid method of transfemoral retrograde left ventricular catheterization in valvular aortic stenosis
Authors: Little William C. , Arciniegas Joaquin G. , Mantle John A.
Published: March 2007

We report our experience with the use of a standard left Amplatz coronary catheter and a guidewire to cross the aortic valve in 34 patients being evaluated for valvular aortic stenosis. A number 2 Amplatz left coronary catheter inserted via the femoral artery was positioned above the noncoronary aortic valve cusp with the tip aligned toward the aortic valve. This catheter allowed a soft‐tipped, Teflon‐coated guidewire to be guided through the aortic valve orifice. The catheter was then advanced over the guidewire into the left ventricle. This technique was successful within six minutes in 32 of 34 patients (94%). The stenotic aortic valve was crossed in less than two minutes in 15 patients (42%) and in less than four minutes in 31 (91%). The aortic valve was not crossed in two patients. Twenty‐one patients (62%) had an aortic valve area area of less than 0.75 cm2. There were no complications. We conclude that this technique provides a method for safe, rapid transaortic left ventricular catheterization in patients with aortic stenosis of all degrees of severity.
Percutaneous left ventricular angiography
Authors: Wong C. M. , Wong P. H. C. , Miller G. A. H.
Published: March 2007

Recurrence of persistence of heart failure in patients after mitral and aortic valve replacement is a difficult diagnostic problem. Clinical evaluation and noninvasive tests cannot always distinguish poor left ventricular function from paraprosthetic leak or persistent pulmonary vascular disease. Full evaluation by cardiac catheterisation may then be necessary but is difficult because of the inaccessibility of the left ventricle. Under these circumstances, left ventriculography by direct transapical puncture is an alternative to crossing the prosthesis by a catheter and may be the only way of obtaining diagnostic information. We describe our experience of left ventriculog‐raphy by percutaneous transapical passage of a flexible angiographic catheter (as distinct from a rigid angiographic needle) in 15 such patients (on 16 occasions). Non‐fatal complications occurred in three patients. The information thus obtained allowed a clinical decision to be made and distinguished the inoperable from the operable group. Surgery was subsequently performed in seven patients with beneficial results.
Percutaneous intraaortic balloon insertion in patients with aortoiliac disease
Authors: Nichols Allen B. , Weiss Melvin B. , Casarella William J. , Bregman David
Published: March 2007

A new technique for percutaneous insertion of intraaortic balloon catheters in patients with tortuous or narrowed external iliac arteries is described. This method uses a long (45 cm) 12F sheath, which extends up to the descending aorta and protects the iliac artery and aorta from injury during insertion of the balloon catheter. Insertion of intraaortic balloon catheters was not possible by conventional percutaneous technique in six patients with severe acute myocardial ischemia. Use of the long sheath approach permitted rapid and successful institution of circulatory support in these patients.
A coronary pressure‐recording and contrast‐delivery system for percutaneous transluminal coronary angioplasty
Authors: Dorros Gerald , Spring Donald A.
Published: March 2007

A simple, double‐transducer, coronary pressure recording and contrast‐delivery system is described for use in percutaneous transluminal coronary angioplasty with either the Sones or the Judkins technique. The materials are all readily available in most cardiac catheterization laboratories.
Analysis of the complications of cardiac catheterization over nine years
Authors: Gwost Jim , Stoebe Tom , Chesler Elliot , Weir E. Kenneth
Published: March 2007

The mortality and morbidity associated with cardiac catheterization at the Minneapolls VA Modical Center has been analysed over a period of nine years (1971–1979) In order to identity correctable problems, obtain accurate data for patient information, and allow comparison with other institutions. In common with reports from other cather laboratories, the mortality has fallen from 0.74% (952 patients) between 1971 and 1975 to 0.24% (819) patients between 176 and 1979. There has been a similar deciline in the combined incidence of myocardial infarction and carebral embolism from 1.05% to 0.24% over the same period. Our patients with ischemic heart disease included many at high risk of complications in that three vessel disease was present in 53% and the ejection fraction was loss than 50% in 24% of cases. In order to ensure that the best standards of cardiac catheterization are maintained, we agree with a recent auggestion that there should be a national survelliance program monitoring fatality and complication rates in catheterization laboratoris.
Left main stem coronary artery dissection during coronary angiography
Authors: Kruyswijk H. H. , Müller E. J.
Published: March 2007

This paper describes a case of dissection of the main stem of the left coronary artery during coronary angiography with an uneventful clinical course. As far as we know, only one comparable case has been reported before. A brief survey of the pertinent literature is presented. Some possible pathogenetic factors are considered. No specific preventive or therapeutic measurement can be recommended.
The relationship between left ventricular functional response to isometric exercise and asynergic contraction and diastolic stiffness
Authors: Ludbrook Philip A. , Gowda Siddhesh , Tiefenbrunn Alan J. , Reed Frank R.
Published: March 2007

Either augmentation or impairment of left ventricular function has previously been reported in different patients, in response to isometric exercise. To identify the mechanisms associated with these disparate responses, the effects of submaximal sustained handgrip upon left ventricular systolic and diastolic properties were studied in 29 patients during diagnostic catheterization. In 16 patients (group I), ejection fraction, mean Vcf, and the mean systolic ejection rate remained constant, while the ratio of peak systolic pressure to end systolic volume increased significantly from 2.81 ± 0.6 to 3.17 ± 0.6 ml/mm Hg. In 13 patients (group II) ejection fraction declined from 0.6 ± 0.03 to 0.51 ± 0.03, Vcf from 0.96 ± 0.09 to 0.85 ± 0.09 circ/sec, mean normalized systolic ejection rate from 1.79 ± 0.1 to 1.50 ± 0.09 sec−1, and the peak systolic pressure to end systolic volume ratio from 2.23 ± 0.3 to 1.99 ± 0.3 (p < 0.05 for each). Systemic arterial mean pressure increased similarly by 19% and 21 % in groups I and II, respectively (p < 0.05 for each). Systemic vascular resistance increased significantly by 23% in group I and by 5% in group II (p < 0.05). Left ventricular end diastolic volume declined from 85.4 ± 7 to 77.3 ± 11 ml/m2 in group I, while end diastolic and end systolic volumes increased by 13% and 35%, respectively in group II (p < 0.05 for each). In both groups, baseline exponential pressure‐volume relations were similar, though higher intercepts of the pressure‐volume relations upon the Y‐axis suggested greater “diastolic tone”, and steeper volume‐normalized pressure‐volume elasticity relations indicated “stiffer” left ventricular chambers in group II patients. While the incidence of coronary artery disease was similar, both the severity and extent of left ventricular asynergy were greater in group II patients.

We conclude that dilatation and deterioration of left ventricular ejection function in response to isometric exercise are causally related to, and comprise a useful predictor of, severe underlying left ventricular asynergy and impaired chamber distensibility.
Premature closure of prosthetic mitral valves as a consequence of gravity
Authors: Busch Ulrich W. , Pechacek Leonard W. , Garcia Efrain , Mathur Virendra S. , Hall Robert J.
Published: March 2007

To determine the influence of gravity on premature closure of prosthetic mitral valves, we studied 17 patients in whom this phenomenon had been observed during routine examination. All patients were in atrial fibrillation and none had aortic incompetence. Patients were studied in multiple positions by means of simultaneous echocardiography, phonocardiography, and cinefluoroscopy. In all patients premature closure was observed when the atrial side of the prosthesis was below the ventricular side, resulting in a downward motion of the occluder inside the valve cage. When patients were studied in positions in which the atrial side of the valve was higher than the ventricular side, premature closure never occurred, even during extremely prolonged diastolic periods. Since minor positional changes, which were found to determine whether premature closure occurred or not, are unlikely to produce significant alterations in pressure and flow across the mitral orifice during diastole, we conclude that position‐dependent premature closure of prosthetic mitral valves in patients with atrial fibrillation is best explained by the effect of gravity on the prosthetic occluder. Examination of such patients in multiple positions should be helpful in distinguishing premature valve closure caused by aortic regurgitation from gravity‐related presystolic closure. Inability to produce premature closure in patients in whom it had previously been demonstrated in the presence of similar R‐R intervals may even prove useful in diagnosing new orifice obstruction.
Sequential study of left ventricular function in aortic valvular stenosis
Authors: Cha Se Do , Naeem Sheikh M. , Maranhao Vladir , Gooch Alden S. , Koehler Eugene
Published: March 2007

To assess the progression of aortic valvular gradients (AVG) and their relation to left ventricular function, 21 patients with aortic valvular stenosis were studied sequentially by cardiac catheterization and left ventriculography. All AVG were obtained from the left ventricle to ascending aortic pullback tracings. The ejection fraction and mean velocity of circumferential fiber shortening were obtained from left ventriculograms. A new onset of syncopal episode was helpful to predict the progression of AVG in five patients, but in others the progression of aortic stenosis was generally not predictable. The left ventricular contractility of these patients was usually normal, but seven patients exhibited the progressive impairment that was not proportional to the change of AVG and was clinically unrecognized. Also, the left ventricular function may deteriorate in the absence of progression of the aortic valvular gradient. Thus, serial hemodynamic studies could be indicated in patients with mild to moderate aortic stenosis even in the absence of new symptoms and signs.
Asynchronous segmental early relaxation of the left ventricle
Authors: Mizuno Kyoichi , Esente Paolo , Giambartolomei Alessandro , Gensini Goffredo G.
Published: March 2007

Asynchronous left ventricular segmental early relaxation (SER) is an angiographic finding with unclear pathophysiological mechanism. We analyzed 158 consecutive, technically adequate left ventricular cineangiograms of patients undergoing diagnostic cardiac catheterization. Patients with valvular disease, cardiomyopathy, or borderline coronary artery disease (50‐74% lumen diameter reduction) were excluded. The patients were divided according to the presence or absence of coronary artery disease, segmental early relaxation, and left ventricular asynergy. Significant coronary artery disease was detected in 127 patients (80%), segmental early relaxation in 63 (40%), and asynergy in 85 (54%).

Forty‐five percent of patients with unobstructed arteries and 38% with significant coronary artery disease exhibited segmental early relaxation. Twenty‐nine percent of patients with coronary artery disease and no asynergy, had segmental early relaxation, while this phenomenon was present in patients with coronary artery disease and asynergy.

Since coronary artery disease subgroups are difficult to compare in terms of left ventricular mechanics, two groups of normal patients, 15 with and 14 without segmental early relaxation, were further evaluated: Left ventricular pressure, heart rate, dPdT, left ventricular diastolic volume and wall thickness were not significantly different. Left ventricular end‐systolic volume index was 30.3 ± 4.6 ml/m2 in patients with segmental early relaxation and 22.5 ± 5.1 ml/m2 in those without segmental early relaxation (p < 0.01), while peak wall stress was 332.4 ± 66.6 dynes/cm2 × 103 and 272.2 ± 47.1 dynes/cm2 × 103, respectively (p < 0.02). A third group of patients with segmental early relaxation and coronary artery disease had a repeat left ventricular angiogram after nitroglycerin: Segmental early relaxation disappeared in 12 (group A) and persisted in 4 (group B). After nitroglycerin, end‐systolic volume index decreased by 22% ± 8% in group A and by 1% ± 8% in group B (p < 0.005), while wall stress decreased by 24% ± 12% in group A and did not change in group B (p < 0.01). We conclude that segmental early relaxation, is (1) a very common finding (40% of the entire group); (2) frequent among normals (48%); (3) not a reliable predictor of coronary artery disease; (4) appears to be directly related to end‐systolic volume index and wall stress; (5) disappears following nitroglycerin when this drug decreases end‐systolic volume index and wall stress.
Assessment of left ventricular function by first‐pass radionuclide angiography in patients with poor left ventricular function
Authors: Iskandrian Abdulmassih S. , Segal Bernard L. , Kane Sally A. , Hakki A‐Hamid , Brice Claudia
Published: March 2007

One‐hundred consecutive patients with poor left ventricular systolic function (ejection fractions of ≤ 0.30) were selected (1) to determine the accuracy and reproducibility of radionuclide angiography (RNA) in estimating the ejection fraction and wall motion abnormalities; and (2) to define the spectrum of wall motion abnormalities and the prevalence of resectable aneurysms. All RNA studies were performed with the first‐pass technique by means of a computerized multicrystal scintillation camera. Twenty‐five patients underwent cardiac catheterization, left ventriculography, and coronary angiography. In these 25 patients there was fair correlation in the measurements of the ejection fraction (r = 0.59; y = 0.59 × + 0.06, p < 0.01) and good correlation in the measurement of left ventricular end‐diastolic volume (r = 0.91). Wall motion analysis in these 25 patients showed that there were 50 hypokinetic segments, 18 akinetic segments, and 7 dyskinetic segments as defined by contrast angiography, compared with 54 hypokinetic, 17 akinetic, and 4 dyskinetic segments as defined by RNA studies. Eighteen patients had either akinesia or dyskinesia by contrast angiography compared to 16 patients by RNA. Only one of the 25 patients was considered a candidate for aneurysmectomy.

Of the remaining 75 patients who did not undergo cardiac catheterization, 15 patients each had dyskinetic segments, 25 patients had at least one akinetic segment, and 35 patients had neither akinetic or dyskinetic segments. Only three of the 75 patients were possible candidates for aneurysmectomy.

Fifteen patients underwent a second RNA study at least one week after the initial study, with excellent reproducibility results (r = 0.91; y = 1.01 × − 0.01, P < 0.001). Ten patients underwent two RNA studies, one in the anterior projection and one in the right anterior oblique projection. Both projections proved to be comparable in assessing wall motion and ejection fraction. The right ventricular ejection fraction assessed in ten patients was depressed in all.

We conclude: In patients with poor left ventricular function: (1) First‐pass radionuclide angiography with a multicrystal camera provides reliable and reproducible assessment of the regional and global functions of the left ventricle; and (2) resectable ventricular aneurysms are rare; therefore, the suspicion of ventricular aneurysm may be a poor indlcation for either radionucllde anglography or contrast angiography. However, since radionucllde angiography is safer and more cost effective it should be considered the procedure of choice in screening such patients.
Left atrial size and left ventricular function in coronary artery disease: An echocardiographic‐angiographic correlative study
Authors: Hamby Robert I. , Zeldis Steven M. , Hoffman Irwin , Sarli Patricia
Published: March 2007

M‐mode echocardiography was used to determine left atrial size in 100 patients with coronary artery disease undergoing cardiac catheterization. Patients were divided in two groups on the basis of left atrial diameter (≥ 40 mm in 40 patients and < 40 mm in 60). Patients with larger left atria had a higher frequency of electrocardiographic evidence of left atrial abnormality (p < 0.01) and myocardial infarction (p < 0.001). Pulmonary capillary wedge and left ventricular end‐diastolic pressures were higher (p < 0.005) in patients with larger left atria. An abnormal end‐diastolic volume (>100 ml/M2) was observed in 13 patients with enlarged left atria compared to none with normal left atrial size (p < 0.001). Triple vessel disease was more frequent (63% vs 32%) and single vessel disease less frequent (10% vs 37%) in patients with larger left atria (p < 0.005). Abnormal left ventricular contractile patterns were noted in 45% of patients with normal left atrial diameters compared to 80% in those with an enlarged left atrium (p < 0.001). An abnormally low ejection fraction (< 0.5) was observed in 25% and 80%, respectively, in patients with normal and enlarged left atria (p < 0.001). Of 58 patients with normal ejection fractions, only 17% had left atrial diameters ≥40 mm compared to 71% of 42 patients with abnormally low ejection fractions (p < 0.001). Of 18 patients with left atrial diameters > 42 mm, only two had normal ejection fractions. The mean ejection fraction for patients with left atrial diameters <40 mm was 0.63 ± 0.13 compared to 0.41 ± 0.18 for those with diameters ≥40 mm (p < 0.001). The sensitivity, specificity, and predictive value for an enlarged left atrium in identifying an abnormal ejection fraction were, respectively, 71, 83, and 75%. These findings indicate that M‐mode echocardiographic left atrial enlargement is a useful marker of advanced hemodynamic and anglographic abnormality in patients with coronary artery disease.
Diagnosis of aortico‐pulmonary window by two‐dimensional echocardiography
Authors: Donaldson R. M. , Ballester M. , Rickards A. F.
Published: March 2007

The accurate localization of a small (5 mm) aortico‐pulmonary window by 2DE is described. The findings were confirmed angiographically and at surgery.

Although 2DE will probably not avoid angiographic studies required in some patients to exclude associated congenital abnormalities, the ability of this technique to accurately localize an aortico‐pulmonary window and distinguish it from other anomalies of the great arteries is of significant clinical importance.
Origin of both coronary arteries from the same sinus of valsalva: Report of two cases
Authors: Keren Andre , Tzivoni Dan , Granot Chaim , Yalon Shaul , Stern Shlomo
Published: March 2007

Origin of both coronary arteries from the same sinus of Valsalva was found in two patients. In one patient the right coronary artery opened from the left sinus of Valsalva, coursed between the pulmonary artery and aorta, disclosed a 95% obstruction in its proximal third with good runoff. The portion of the artery between the aorta and pulmonary artery showed cyclic narrowing during systole. In the second patient the left coronary opened from the right sinus of Valsalva, the left main trunk crossed anteriorily the pulmonary artery conus, and both the circumflex and the left anterior descending branches showed significant narrowing. In both patients the arteries shared a common sinus with two separate orifices, both had a bicuspid aortic valve, and in both, nonaberrant coronary vessels also had stigmata of atherosclerosis.
Pediatric arterial catheterization using a 3.2 french catheter
Authors: Keane J. F. , Fellows K. E. , Lang P. , Fyler D. C.
Published: March 2007

Retrograde arterial catheterization was performed in 105 infants and small children (median age 6 mo) using a 3.2 French pigtail catheter made of ultrathin walled white Teflon. Three catheter lengths were used, (40, 50, and 65 cm). Pressure recordings and ease of sampling were judged excellent in all. All 118 angiograms (60 ventricular) were performed without complication except for two episodes of external catheter rupture. Angiographic quality was rated excellent in 41 %, good in 39%, fair in 18%, and poor in only 2%. Among the 81 patients in whom only this catheter was used percutaneously, pedal pulses were lost in 5%. Postcatheterization testing identified ranges of volume and flow‐rate characteristics which included 8 ml at 15 ml/sec (40 cm length), at 11 ml/sec (50 cm length), and at 9 ml/sec (65 cm catheter). We conclude that this small catheter is relatively safe and satisfactory for retrograde catheterization of infants and small children.
Dorros‐spring pressurizer: An inflation device for use in transluminal angioplasty procedures
Authors: Spring Donald A. , Dorros Gerald
Published: March 2007

A simple hand‐operated balloon inflation device has been developed for use in coronary and peripheral transluminal angioplasty procedures. This device is compact, portable, and easily sterilized and eliminates the need for compressed gas, pneumatic pistons, carbon dioxide cartridges, or a complex holder or mounting apparatus. This device, the Dorros‐Spring pressurizer, provides for precise control of pressures which inflate the angioplasty dilatation catheters by means of an hydraulic salinecontrast system.

This inflation device has been used in over 150 coronary and 100 peripheral transluminal angioplasties without the occurrence of failure of mechanical components or loss of calibration.
The multicentric character of normal left ventricular wall motion. Implications for the evaluation of regional wall motion abnormalities by contrast angiography
Authors: Goodyer Allan V. N. , Langou Rene A.
Published: March 2007

Current radiologic approaches to evaluation of regional ventricular wall motion generally employ rectilinear hemichords (“hemiaxes”) or radial hemichords (“chords”) defined by the presumptions that wall segments move either perpendicularly toward the ventricular long axis, or toward some common center, respectively. In order to test these presumptions, the end‐systolic and end‐diastolic frames of 17 normal right anterior oblique (left) ventriculograms were analyzed, using a digitizer and a computer. The motion vectors of 47 points on each ventriculographic perimeter were defined by centers (located along the ventricular long axis). Twenty average centers were found which could be represented by three centers, for six regions of the normal angio‐graphic silhouette. Computer models of abnormal regional wall motion, using three centers, disclosed appreciable discrepancies among the chord, hemiaxis and rectilinear area methods, particularly for the apical and basal wall regions. The model data suggest that the wall region, iself, dictates the center which should be used for measuring an abnormality of regional wall motion.
Ventricular fibrillation complicating pacemaker insertion in acute myocardial infarction
Authors: Mooss Aryan N. , Ross William B. , Esterbrooks Dennis J. , Nair Chandra , Mohiuddin Syed , Sketch Michael H.
Published: March 2007

Temporary transvenous pacing catheters were placed in 101 patients with acute myocardial infarction (Ml) for the management of bradyarrhythmias or conduction disturbances. Fourteen (14%) patients (group A) developed ventricular fibrillation (VF) at the time of pacing catheter manipulation in the right ventricle. Compared to the remaining 87 (86%) patients (group B), the patients in group A were younger (56.1 vs 65.8 yrs, P = 0.007). Thirteen (92.8%) of 14 patients in group A had inferior MI compared to 58 (66.6%) of 87 patients in group B (P = 0.04). All but one patient in group A had pacemaker insertion within 24 h of the onset of symptoms of Ml compared to 55 (63%) of 87 in group B (P = 0.02). In 12 of the 14 patients in group A, following defibrillation and intravenous bolus administration of lidocaine, the pacing catheter was positioned in the right ventricle without further episodes of VF. It is concluded that (1) in patients with acute MI temporary transvenous pacemaker insertion may be complicated by VF; (2) VF is most likely to occur in younger patients with inferior MI infarction when the pacing catheter is inserted within 24 h of the onset of symptoms of infarction; and (3) administration of an intravenous bolus of lidocaine may be effective in preventing the induction of VF by catheter manipulation.
Cardiac catheterization dye does not affect serum thyroid hormone concentrations or tsh secretion
Authors: Kleinmann Richard E. , Sternthal Elliot , Starobin Oscar , Braverman Lewis E.
Published: March 2007

The iodinated contrast agents used in oral cholecystography impair peripheral iodo‐thyronine‐5′‐deiodinase activity, resulting in a transient decrease in serum 3,5,3′‐triio‐dothyronine (triiodothyronine, T3) and in increases in serum 3,3′,5′‐triiodothyronine (reverse T3 rT3) and thyroxine (T4) concentrations. A related iodinated contrast agent, diatrizoate, is employed in coronary angiography. The effect of diatrizoate (Renografin‐76®) on serum T4, rT3, and thyroid stimulating hormone (thyrotropin, TSH) concentrations and the TSH and T3, responses to thyrotropin releasing hormone (TRH) were evaluated in seven euthyroid patients before and on the fifth day following coronary angiography. No significant changes were observed. Thus, diatrizoate, in contrast to the oral cholecystographic agents, appears to have little or no clinically important effect on thyroid hormone metabolism in man.
Right atrial myxoma with atrial septal defect: A case report and review of the literature
Authors: Natarajan Ponnuswamy , Vijayanagar Raghavendra R. , Eckstein Paul F. , Bognolo Diego A. , Toole John C.
Published: March 2007

We report the case of a 63‐year‐old woman presenting with progressive dyspnea of insidious onset culminating in severe central cyanosis. Conventional studies including M‐mode echocardiography did not point to the diagnosis. At cardiac catheterization a large right atrial myxoma producing partial dynamic tricuspid obstruction was discovered along with an atrial septal defect with a right to left shunt. After successful surgical excision of the tumor and repair of the atrial septal defect, the patient has been totally relieved of her presenting symptoms.
Failure of clinical response to prostaglandin e1 in a cyanotic infant with congenital absence of the ductus arteriosus
Authors: Hamilton Wade T. , Lacina Samuel J. , Bharati Saroja , Lev Maurice , Arcilla Rene A.
Published: March 2007

A cyanotic newborn with virtual pulmonary atresia who failed to improve with prostaglandin E1 (PGE1) infusion, was found at autopsy to have congenital absence of the ductus arteriosus. Such infants require immediate alternative management, since short‐term palliation using PGE1 is not effective.
Anomalous origin of the right coronary artery from the ascending aorta above the left coronary sinus
Authors: King Bernard D. , Ambrose John A. , Stein Jonathan H. , Ro Jae H. , Herman Michael V.
Published: March 2007

Ectopic origin of the right coronary artery is an infrequent anomaly. We report a case in which the right coronary artery arose from the ascending aorta above the left sinus. This anomaly was associated with a bicuspid aortic valve. Techniques for delineation of the ectopic origin of the right coronary artery are discussed.
Acquired internal mammary‐to‐coronary artery communication
Authors: Singh Ram N. , Varat Murray A.
Published: March 2007

An unusual case of spontaneous development of anastomosis between the right internal mammary artery and right coronary artery was discovered by internal mammary arteriography. This appeared to have been promoted by coronary occlusion. Perfusion was sufficient to preserve myocardial function of the inferior wall.
Percutaneous embolic occlusion of an inadvertent surgical aortocoronary vein fistula
Authors: Grollman Julius H. , Lund Harold G. , Redington John V.
Published: March 2007

The previously recommended approach to inadvertent surgically placed aortocoronary vein fistula has been patient observation or surgical closure with rebypass. A third alternative, percutaneous embolic occlusion, is reported here and is recommended for use by those experienced with embolic techniques in situations where repeat bypass is not necessary and the existence of the fistula is felt to be detrimental to the patient's condition.
A simple method for insertion of multiple catheters through a single venipuncture site
Authors: Cooper M. Wayne
Published: March 2007

We have recently developed a technique for the insertion of multiple catheters or electrodes through a single venipuncture site. This technique has been applied in 22 consecutive cases without significant bleeding or hematoma at the site of insertion.
Mortality related to cardiac catheterization and angiography
Authors: Kennedy J. Ward , Baxley William A. , Bunnel Ivan L. , Gensini Goffredo G. , Messer Joseph V. , Mudd J. Gerard , Noto Thomas J. , Paulin Sven , Pichard Augusto D. , Sheldon William C. , Cohen Marc
Published: March 2007

During a 14‐month period, 75 deaths occurring in relation to 53,581 cardiac catheterizations were consecutively and prospectively reported to the Registry Committee of the Society for Cardiac Angiography. Three of the patients died several days after their catheterization from an unrelated cause and are excluded from this analysis. There were 21 patients (group I) who arrived at the laboratory in extremis and whose deaths were expected irrespective of the catheterization. Most of these patients suffered from recent myocardial infarctions and cardiogenic shock, or had complex congenital malformations. In 35 patients (group II), a cardiovascular complication occurring during the catheterization resulted in death. In 16 patients (group III) catheterization seemed uneventful, but death occurred suddenly 10 min to 10 h after the procedure. Of these 16 patients, eight had left main coronary artery obstruction ≥ 90%, five had three‐vessel disease all with 90% obstructions, one had 2‐vessel disease both with 90% obstructions, and two had critical aortic stenosis.

The 51 unexpected deaths (groups II and III) were considered to be causally related to the procedure, a mortality rate of 0.10%. Subsets with an increased mortality rate (M), were patients with: (a) left main disease > 50% (M = 0.94%); (b) ejection fraction < 30% (M = 0.54%); (c) NYHA class III or IV (m = 0.24%); (d) age over 60 years (M = 0.23%); or (e) three‐vessel disease (M = 0.13%).

In conclusion, catheterization related mortality occurs mostly in patients with far advanced cardiac disease. Nearly 1/3 of the unexpected deaths occurred suddenly after a seemingly uneventful procedure. Close monitoring after catheterization of patients with similar characteristics (left main disease ≥ 90%, or three‐vessel disease all ≥ 90%) might disclose avenues for reducing mortality occurring after catheterization.
Interobserver variability in interpreting contrast left ventriculograms (CASS)
Authors: Wexler Laura F. , Lesperance Jacques , Ryan Thomas J. , Bourassa Martial G. , Fisher Lloyd D. , Maynard Charles , Kemp Harvey G. , Cameron Airlie , Gosselin Arthur J. , Judkins Melvin P.
Published: March 2007

Randomly selected left ventricular cineangiograms performed by 14 medical centers (clinical sites) participating in a large multicenter study of medical and surgical treatment of coronary artery disease (CASS) were systematically recalled and reread by one of four designated quality control centers. The end diastolic volume (EDV), end systolic volume (ESV), and ejection fraction (EF) calculated by the quality control center were compared with those calculated by the clinical site, and correlation coefficients of 0.71, 0.84, and 0.79, respectively, were obtained. Regional left ventricular (LV) wall motion abnormalities were assessed by dividing the LV wall as viewed in the right anterior oblique (RAO) and left anterior oblique (LAO) views into five segments each and grading the motion of each segment according to six categories of increasing abnormalities from normal to aneurysm. When discrepancies based on “nearest neighbor” differences in naming adjacent segments were eliminated and only marked differences of more than one degree of severity of wall motion abnormality were considered, interobserver differences were 7% and 10% for RAO and LAO segments, respectively. Agreement was less frequent in designating a segment “aneurysmal”. When each LV segment was assigned a numerical score based on increasing severity of wall motion abnormality and a total LV score for each ventriculogram computed, the quality control and clinical site readings were in good agreement with a correlation coefficient of 0.83.
Limitations of ergonovine testing in patients with variant angina
Authors: Mautner Richard K. , Iteld Bruce , Giles Thomas D.
Published: March 2007

Fourteen patients with variant angina underwent ergonovine testing during diagnostic coronary angiography. The clinical electrocardiographic or angiographic manifestations of coronary artery spasm could not be reproduced in six of these patients. Five patients had chest pain and transient ST‐segment elevation within 4 days of the ergonovine study, including three who developed coronary spasm in the catheterization laboratory. It appears that the sensitivity of ergonovine testing in the diagnosis of coronary spasm is lower than previously emphasized.
Effects of new calcium channel blocker of niludipine on the coronary hemodynamics, diastolic properties, and metabolic responses to tachycardia stress in patients with coronary disease
Authors: Kurita Akira , Isojima Kazushige , Mizuno Kyoichi , Aozaki Noboru , Kondo Shuji , Hosono Kiyoshi
Published: March 2007

A new calcium channel blocker, niludipine, was administered intravenously to nine patients with coronary artery disease in order to investigate its effects on left ventricular systolic and diastolic function, coronary sinus blood flow, and myocardial lactate metabolism. Coronary sinus pacing was performed in all patients and produced angina in six patients. Niludipine increased the resting heart rate from 75 ± 3 beats/min (mean ± SEM) to 82 ± 3 (NS) and decreased the left ventricular systolic pressure from 155 ± 4.7 mm Hg to 134 ± 2.8 (p < 0.05). Coronary sinus blood flow increased by 9%(NS). During pacing after niludipine, clinical improvement occurred in the six patients who had initially experienced angina. The extent of ischemic ST segment depression was decreased (−1.56 ± 0.27 mm to −0.78 ± 0.38, p<0.02) and myocardial lactate metabolism was improved. When pacing was terminated, niludipine suppressed the elevation of left ventricular end‐diastolic pressure compared to pretreatment values (16.2 ± 2.5 mm Hg vs 8.5 ± 0.9, p < 0.05) and decreased the left ventricular time constant T(26.4 ± 3.6 msec to 20.2 ± 2.4, p < 0.05). The results suggest that niludipine appears to be beneficial in reducing systolic and diastolic work of the left ventricle during pacing induced angina without a significant change in total coronary sinus blood flow. Niludipine appears to have less of a hypotensive and reflex tachycardic effect than nifedipine.