bluuebunny/crossref_metadata_2025 huggingface dataset:
Left internal mammary—left ventricular fistula after vineberg operation
Authors: Kronzon Itzhak , Schloss Michael , Glassman Ephraim
Published: March 2007

This communication presents an unusual complication in a patient who underwent the Vineberg procedure with the formation of an internal mammary to left‐ventricular fistula, which caused a new apical diastolic murmur. This represents a previously unreported etiology for the appearance of an apical blowing diastolic murmur.
Aortic atresia with normal left ventricle distinctive angiocardiographic findings
Authors: Freedom Robert M. , Culham J. A. G. , Rowe Richard D.
Published: March 2007

The distinctive angiocardiographic findings in a patient with aortic atresia and normal left ventricle are presented. This diagnosis was initially made at 6 days of age. Because the infant was felt to be a potential candidate for ventriculo‐aortic reconstitution, she underwent construction of a pulmonary artery—descending thoracic aorta anastomosis and bilateral pulmonary artery banding to prevent intractable congestive heart failure and pulmonary vascular obstructive disease. Her second hospital admission at 16 months of age was necessitated because of increasing cyanosis despite excellent growth and development. Repeat hemodynamic and angiocardiographic investigations were performed; these and pertinent pathologic observations are the subject of this report.

Aortic atresia, ventricular septal defect, and a normally developed left ventricle is uncommon, occurring in only 7 of 148 patients with aortic atresia in the Cardiovascular Registry of the Hospital for Sick Children. Selective aortography will demonstrate a hypoplastic ascending aorta in all cases of aortic atresia. However, the epicardial distribution of the left coronary artery system will differ, depending on the size of the left ventricular cavity. Selective left ventricular cineangiocardiography will reveal the size of the left ventricle in the patient with aortic atresia, ventricular septal defect, and normal left ventricle. The muscular subaortic atresia caan be profiled in the lateral or left anterior oblique angiocardiograms in these patients. Finally, possible methods of „physiological”︁ repair of this defect are discussed.
Atypical late cardiac tamponade after mitral valve replacement: Case presentation with hemodynamic and echocardiographic observations
Authors: Orzan Fulvio , Guttin Jorge , Dear Wayne E.
Published: March 2007

A patient developed oliguria, peripheral edema, and dyspnea 5 days after mitral valve replacement. Chest roentgenogram and echocardiogram suggested pericardial effusion. Although pulsus paradoxus was absent, cardiac tamponade was suspected and subsequently confirmed during pericardiocentesis. Before pericardiocentesis right and left ventricular diastolic pressures were equal, as well as intrapericardial and right atrial pressures. The left ventricular cavity was reduced in size on the echocardiogram. Interventricular septal motion was normal. Pericardiocentesis normalized the hemodynamics and allowed the left ventricle to reexpand. Certain atypical features are tentatively explained as the combined effect of constrictive and effusive components caused by intrapericardial hemorrhage.
Longitudinal angulation in coronary arteriography: Apparatus and evaluation
Authors: Frederick Philip R. , Fry W. Harry , Russell J. Gordon , Marshall Hiram W.
Published: March 2007

When good visualization of the left coronary artery and proximal branches is difficult, the longitudinally angulated projection has proved useful. An accessory for achieving this angulation with a conventional angiographic table and without sacrificing the advantages of video monitoring and the protection of lead vinyl shielding is described.
Pediatric cardiac angiography using a 4 French Catheter
Authors: Keane John F. , Freed Michael D. , Fellows Kenneth E. , Fyler Donald C.
Published: March 2007

Thirty specially designed 4 French pigtail white Teflon catheters 50 cm in length were utilized for angiography using the retrograde arterial approach in 26 infants and children. Angiographic opacification was considered very satisfactory. Apart from one episode of temporary occlusion of the right coronary artery ostium, there were no other significant complications. The catheters were introduced percutaneously in 21 instances and distal pulses were palpable in 18 patients by the second day after catheterization. At postcatheterization testing with increasing volumes and flow rates, the first rupture occurred, delivering 13 ml at 13 ml/second. On testing an additional 15 catheters using fixed volumes of 5, 10, and 15 ml at increasing flow rates, rupture first occurred at 34, 22, and 18 ml/second, respectively. We conclude that this small catheter is relatively safe and satisfactory for the retrograde arterial approach in the study of infants and children.
Antegrade left heart catheterization
Authors: Waldman J. D. , Pappelbaum J. S. , Turner S. W.
Published: March 2007

Retrograde arterial catheterization has been the standard approach to hemodynamic and angiographic evaluation of the left ventricle and systemic arterial system. An alternative approach—antegrade left heart catheterization—is reported that circumvents arterial puncture.

During cardiac catheterization from the femoral vein in 18 children with normally related great arteries who had interatrial communications, a balloon‐tipped catheter was looped in a „clockwise”︁ fashion through the left atrium and left ventricle and into the ascending aorta. In 17 children the maneuver was rapidly accomplished without complications; it proved possible to perform in an infant with a hypoplastic left ventricular cavity, and was employed to perform a renal arteriogram.

The major advantage of antegrade left heart catheterization is avoidance of complications related to arterial puncture. The antegrade approach also avoids right arm cut‐down in children with coarctation of the aorta.
The nonsurgical retrieval of intracardiac foreign bodies — an international survey
Authors: Bloomfield Dennis A.
Published: March 2007

An international survey of nonsurgical retrieval of intracardiac foreign bodies provided data on 180 published and unpublished cases.

The data was analyzed to evaluate the respective merits and drawbacks of the 3 basic retrieval techniques, the snare, the wire basket, and the endoscopy forceps, the routes and methods of insertion, the success rate, and the complications. Eighty percent of foreign bodies were polyethylene central venous pressure catheters, cut in two by the needle introducer. The site of lodgement of these fragments was predictable and determined by the site of entry and length of the fragment. The basic retrieval instruments and their modifications are described. Operating instructions are detailed together with adjunct methods of repositioning fragments for easier retrieval. Factors associated with the small percentage of unsuccessful retrieval attempts include fragments totally in the distal pulmonary artery, extravascular lodging sites, chronically‐implanted fragments, and pacemaker‐catheter fragments.

For the vast majority of cases, however, these simple and uncomplicated techniques have been highly successful and widely utilized in the nonsurgical retrieval of intracardiac foreign bodies.
Aortic root motion determined by ultrasound: Relation to cardiac performance in man
Authors: Burggraf Gary W. , Mathew M. Thomas , Parker John O.
Published: March 2007

The purpose of this study was to determine if aortic root systolic anteroposterior excursion measured ultrasonically is related to cardiac performance. Aortic motion was 9 ± 1.5 mm (mean ± SD) in 30 normal subjects (range 7–12 mm). Ten patients with coronary artery disease and congestive failure and 10 with congestive cardiomyopathy had significantly smaller values of 4 ± 1.2 and 5 ± 1.7 mm, respectively (P < 0.001). In 28 subjects undergoing cardiac catheterization, aortic root motion correlated positively with stroke volume (r = 0.59), but did not correlate significantly with ejection fraction. By increasing heart rate in 14 subjects from 75 to 174 beats/min with atrial pacing, stroke volume decreased from 81 ± 22 to 34 ± 14 ml/beat and aortic excursion from 10 ± 1.6 to 5 ± 1.5 mm (P < 0.001). This study has shown: (1) Aortic root motion less than or equal to 6 mm indicates left ventricular dysfunction; (2) stroke volume correlates positively with, but cannot be accurately predicted from, root motion.
Proof by catheterization of mitral valvular origin of a systolic click
Authors: Towne William D. , Patel Ramesh , Cruz Jairo B. , Mirrer Brooks , Kramer Neil E.
Published: March 2007

A patient with a loud intermittent midsystolic click presented a problem in differential diagnosis between mitral valve prolapse (intracardiac origin of the click) and left pneumothorax (extracardiac origin). External phonocardiography performed at the time of cardiac catheterization revealed that this loud midsystolic click disappeared whenever a catheter was positioned across the mitral valve. It reappeared whenever the catheter was removed from the transmitral position. Selective left ventriculography confirmed the diagnosis of mitral valve prolapse.
Significance of momentary pressure changes during isovolumic relaxation
Authors: Sabbah Hani N , Khaja Fareed , Anbe Daniel T. , Stein Paul D.
Published: March 2007

Sudden momentary fluctuations of left ventricular, aortic, right ventricular, and pulmonary arterial pressure were noted during isovolumic relaxation of the respective ventricles. The presence of such transients raised questions related to their meaning and significance. The purpose of this report is to emphasize the nonartifactual nature of these pressure transients and to describe their origin and significance in the cardiac cycle. Pressure transients were observed in 31 of 32 patients with normal aortic valves, and in 17 patients with normal pulmonary valves in whom right‐sided measurements were made. Such transients, however, were absent on the left ventricular and aortic pressure recordings of three patients with calcific aortic stenosis. These sudden changes in pressure are indicative of momentary compressions and rarefactions of the blood that occur within the ventricles and their respective arterial chambers. Whenever present, pressure transients were noted to occur coincident with the major aortic or pulmonary components of the second sound. Since intraarterial sound pressure is derived from the pressure signal by filtering the low frequencies and amplifying the high frequencies, one can deduce that intraarterial sound pressure is in fact a representation of these pressure changes. The recognition of these pressure transients on an otherwise smooth ventricular, aortic, or pulmonary arterial pressure places in proper perspective their role in the production of the second heart sound.
Case report of congenital tricuspid insufficiency
Authors: Pernot C. , Hoeffel J. C. , Henry M. , Piwnica A.
Published: March 2007

Congenital tricuspid insufficiency is a rare disease secondary to malformations of the tricuspid valve and of their chordae tendinae. Diagnosis is difficult but worthwhile, since surgery can be performed. We report one case repaired by surgery.
Extrinsic compression of the heart by tumor masquerading as cardiac tamponade
Authors: Wynne Joshua , Markis John E. , Grossman William
Published: March 2007

A patient with known intrathoracic tumor presented with findings suggestive of cardiac tamponade. At cardiac catheterization, the entire heart was displaced superiorly and anteriorly by the tumor mass, and this accounted for the observed cardiac hemodynamics, in the absence of discernible pericardial effusion.
Calcification in an intramyocardial mass lesion: Isolated calcification of an accessory papillary muscle in a patient with mitral prolapse
Authors: Klein G. J. , Kostuk W. J. , Black L. , Ahuja S. P.
Published: March 2007

Cardiac catheterization in a 50‐year‐old male with mitral leaflet prolapse revealed a filling defect with calcification in the high posterolateral wall. At surgery, the lesion was found to be a calcified accessory papillary muscle with thickened, calcified chordae to the posterior leaflet. The calcification and fibrosis were felt to be due to friction lesions between elongated chordae and the endocardium. Intracardiac calcification in mitral leaflet prolapse may suggest calcified mitral apparatus.
Use of prostaglandin E1 for emergency palliation of symptomatic coarctation of the aorta
Authors: Graham Thomas P. , Atwood Gerald F. , Boucek Robert J.
Published: March 2007

Prostaglandin E1 (PGE1) was infused into the pulmonary artery in a 1‐day‐old infant with symptomatic coarctation. Umbilical artery pressure rose from 50/40 mm Hg before infusion to 83/48 mm Hg after infusion, indicating significant improvement in lower‐body perfusion. Successful coarctation repair was performed during continued PGE1 infusion. To our knowledge, this is the first reported patient in whom PGE1 has been used for successful emergency palliation of symptomatic coarctation.
Artifact production with micromanometers used to record intracardiac pressure and sound
Authors: Brown C. M. , Holmes J. R.
Published: March 2007

In horses experimental right and left heart catheterization using a catheter with two microtransducers 9 cm apart, usually in a transvalval position produced pressure and sound artifacts that confounded the diagnosis. Most were probably due to malpositioning resulting in movement through a valve during recording or impingement on the valve cusps or the chordae tendineae or lodgement in the apex of the heart. The recognition of these artifacts is particularly important in studies of large animals in which catheter siting cannot be monitored by radiography.
Transmural myocardial infarction in the absence of coronary arterial luminal narrowing in a young man with single coronary arterial anomaly
Authors: Joswig B. C. , Warren S. E. , Vieweg W. V. R. , Hagan A. D.
Published: March 2007

Reported is a case of single coronary arterial anomaly (SCAA) with its origin from the right sinus of Valsalva as demonstrated by selective coronary arteriography. No branches coursed between the great vessels. Electrocardiography and vectorcardiography were consistent with inferior wall myocardial infarction, although subsequent coronary arteriograms were free of luminal narrowing.

While this is an infrequently recognized isolated coronary anomaly, it may carry significant risk of myocardial ischemia. This risk may not depend alone upon the passage of a branch of SCAA between the great vessels. Evidence of precocious ischemic heart disease should alert the angiographer to look for anomalous coronary anatomy.
An inexpensive computer‐aided system for quantitative echocardiography
Authors: Rhea Thomas C. , Boucek Robert J. , Petty Dolores , Nelson James H. , Graham Thomas P.
Published: March 2007

A comprehensive system has been developed to quantitatively analyze standard M‐mode pediatric echocardiograms. It utilizes relatively inexpensive hardware together with a telephone coupling to a time‐sharing computer. A complete patient report on the study is printed out upon completion, and all the data are digitally stored for future research computations. Initial and operating costs for this system are significantly less than for any comparable one available.
Computer analysis of oximetry data in cardiac catheterization
Authors: Gillette Paul C. , Meester G. T. , Hoare M. D. , Zeelenberg C. , McNamara D. G. , Hugenholtz P. G.
Published: March 2007

An on‐line computer technique is described for the detection and quantitation of left‐to‐right shunts. The computer used Student's t test to evaluate the probability that variations in right heart oxygen saturations were due to left‐to‐right shunts. The computer method was found to compare favorably to the present step‐up method of detecting left‐to‐right shunts. The computer also calculated pulmonary blood flow, systemic blood flow, their ratio, and shunt blood flow as accurately as standard methods, as evidenced by correlation coefficients of 0.98, 0.94, 0.95, and 0.71 between the computer and hand calculations.
Morphological and topographical variations of the outlet chamber in complex congenital heart disease: An angiocardiographic study
Authors: Freedom Robert M. , Rowe Richard D.
Published: March 2007

The outlet chamber of the human heart can show considerable variations in its morphology and topography (relationship to main ventricular chamber), and such variations in anatomy and spacial relationship may be predictive of the associated intracardiac anatomy. Although there is considerable debate about whether the position of the outlet chamber is indicative of the type of bulboventricular loop (whether D‐ or L‐), a right‐sided and anterior outlet chamber has different implications than a left‐sided, superior, and more posterior positioned one. The inflows into the outlet chamber can vary anatomically, and progressive changes in the calibers of these communications can adversely alter the natural history. One or both of the greak vessels, or neither, or a persistent truncus arteriosus can originate from the outlet chamber, and any significant morphological change in the outlet chamber may or may not adversely affect either the pulmonary or systemic blood supply, or both. Finally, any consideration of the outlet chamber raises important conceptual difference in terminologies. At present, there is not unanimity as to what constitutes either an outlet chamber (as compared to a “small right ventricle” in tricuspid atresia) or a single (primitive) ventricle. Any discussion of the morphological and topographical variations of the outlet chamber must be viewed with respect to the terminology employed.
Hemodynamic assessment of the new aortic carpentier‐edwards bioprosthesis
Authors: Lee Garrett , Grehl Todd M. , Joye James A. , Kaku Roy F. , Harter Wynn , Demaria Anthony N. , Mason Dean T.
Published: March 2007

Although glutaraldehyde‐preserved porcine aortic Hancock heterografts have lower thromboembolism incidence than mechanical aortic valves, Hancock xenografts provide less functional aortic outflow orifices and thereby greater transvalvular gradients than mechanical prostheses. The newly developed aortic Carpentier‐Edwards porcine heterografts comprise a thin‐walled Elgiloy flexible metal stent covered with Teflon which provides somewhat wider internal orifices than aortic Hancock valves of the same external annulus diameter. Since aortic Carpentier‐Edwards xenografts have not been clincially evaluated previously, the present study assessed cardiac function and heterograft performance (1.7 months postoperation) and clinical status (4.2 months postoperation) of 19 patients with severe aortic stenosis and/or regurgitation prior to surgery. Left ventricular end‐diastolic pressures decreased (17 to 9 mm Hg), cardiac index remained normal, and clincial symptomatology diminished markedly. Mean peak transxenograft systolic pressure was only 16 mm Hg (valve area 1.73 cm2), without meaningful regurgitation. Thus aortic Carpentier‐Edwards bioprostheses provide generally excellent heterograft function which appears more favorable than previous reports of Hancock xenografts.
Effects of dextran infusion on left ventricular volume and pressure in man
Authors: Burggraf Gary W. , Parker John O.
Published: March 2007

The purpose of this investigation was to quantitate the changes in left ventricular volume and end‐diastolic pressure that occur with rapid infusion of 500 ml of low molecular weight dextran, and thus to study left ventricular pressure‐volume relationships. Left ventricular pressure and echocardiographic dimensions were recorded before, during, and following dextran infusion in eight patients with normal left ventricular function. With the infusion of dextran, left ventricular end‐diastolic pressure rose progressively from 10 ± 3 mmHg (mean ± SD) to 24 ± 5 mmHg, whereas end‐diastolic volume increased from 95 ± 23 ml to 118 ± 26 ml (24%). These results serve to emphasize the steepness of the left ventricular pressure‐volume relationship at end‐diastole in subjects with normal ventricular function when in the supine position.
Determination and importance of the magnification factor in the calculation of ventricular volume: Development of a simple, accurate method
Authors: Cascade Philip N. , Wajszczuk Waldemar J. , Kerin Nicholas Z. , Mantel Joseph , Rubenfire Melvyn
Published: March 2007

A study of single‐plane right anterior oblique left ventricular angiography was undertaken to determine the importance of obtaining correct positioning of a magnification grid and to develop a simple but accurate technique to minimize magnification errors. Theoretical and experimental volume determinations demonstrated 3% to 28% volume errors for grid placement errors ranging from 1 centimeter to 5 centimeters. An experiment was designed whereby cross table lateral radiographs of the chest were taken during contrast injections of the left ventricle. The relative position of the left ventricular center was found at a point 66% of the distance from the anterior to the posterior margin of the heart. Finding this point on noncontrast lateral films of the chest for positioning of a square centimeter grid should yield a more accurate determination of the magnification factor than other current emperic methods.
Plasma norepinephrine concentration in the coronary sinus in cardiomyopathies
Authors: Haneda Takashi , Miura Yukio , Miyazawa Kozui , Honna Takao , Arai Tohru , Nakajima Toshiyuki , Miura Takuji , Yoshinaga Kaoru , Takishima Tamotsu
Published: March 2007

In order to evaluate the cardiac sympathetic nerve tone in cardiomyopathies, plasma norepinephrine concentration in the coronary sinus (NECS) and artery (NEA) was measured by THI method in five patients with the hypertrophic type (HCM) and in seven with the congestive type (CCM); six patients with functional murmur served as controls. NECS was 182 ± 39 ng/liter (SEM) in HCM, 288 ± 47 in CCM, and 306 ± 65 in controls. The NECS – NEA difference (Δ) was 9 ± 22 ng/liter in HCM, −57 ± 34 in CCM, and 81 ± 29 in controls. Norepinephrine overflow into the coronary sinus, which was calculated by multiplying coronary sinus plasma flow by Δ, was 0.54 ± 0.86 ng/min/100gm, −2.81 ± 1.47, and 3.73 ± 1.77, respectively. Norepinephrine overflow and Δ were significantly lower in CCM than in controls. The results suggest that an excessive sympathetic discharge does not exist in HCM and that cardiac sympathetic activity is reduced in CCM.
A review of commercial computer‐based systems in the cardiac catheterization laboratory (1977)
Authors: Covvey H. Dominic , Olley Peter M. , Wigle E. Douglas
Published: March 2007

Currently at least nine companies are marketing computer‐based products in North America to support on‐line data acquisition, processing, and reporting in the cardiac catheterization laboratory. A tenth company is preparing a new offering to succeed an earlier product.

The companies surveyed include Beehive (BEE), Electronics for Medicine (E for M), Hewlett‐Packard (H/P), Honeywell (HON), Medlab (MED), Mennen‐Greatbatch (M‐G), Midwest Electronics (MID), Philips (PHIL), and Siemens (SIE). Artronics is in the process of product development and was unable to respond. General Electric appears to be considering an announcement.

The products have been compared on the basis of the functions they support. System features and a spectrum of capabilities are noted. With the differences will come a finite problem in system selection to be faced by each laboratory considering such technology.

Finally, an average cost per patient processed ranging from a minimum of $20.00 to $37.00 is considered relative to the problem of cost‐benefit justification. Although the analysis done here is relatively superficial, it does not appear possible to cost‐benefit justify such systems. Therefore it would appear that work must be done to explore their potential in enhancing the effectiveness of various types of laboratories, to reduce their cost, or to seriously challenge their value.
Diagnosis of left atrial tumors by coronary angiography and left ventriculography
Authors: Shapiro Jerome B. , Kronzon Itzhak , Winer Howard E.
Published: March 2007

The left ventriculograms and pulmonary and coronary angiograms of eight patients with left atrial (LA) tumors were reviewed. The patients' ages ranged from 52 to 65 years. In each case the tumor was outlined during left ventriculography. Coronary arteriography allowed visualization of tumor vessels in six cases (six of seven myxomas). Two of the patients had significant coronary obstructions.

It is concluded that a left ventriculogram is a sensitive diagnostic test for the presence of LA tumors. Coronary arteriography is indicated in patients with LA tumors in this age group and is likely to provide independent evidence of the presence of an LA tumor.
Idiopathic hypertrophic subaortic stenosis and ventricular preexcitation
Authors: Kerin Nicholas Z. , Blonder Ronald , Wajszczuk Waldemar J. , Rubenfire Melvyn
Published: March 2007

Two patients who had idiopathic hypertrophic suBAortic stenosis (IHSS) and type A ventricular preexcitation were studied and showed variations of the subvalvular flow gradients. The increase in subvalvular gradient, occurring at a time when preexcitation developed, was associated with significant increase of the systolic murmur and the systolic anterior motion of the mitral valve.

In patient 1, the significant increase in subvalvular gradient during ventricular preexcitation was also confirmed by catheterization of the left side of the heart. The increase of the gradient with the development of the ventricular preexcitation was apparently due to decreased end‐diastolic volume. The importance of ventricular volume considered as a variable affecting outflow tract gradient in idopathic hypertrophic suBAortic stenosis is emphasized.
Cor triatriatum with mitral regurgitation in a 52‐year‐old male
Authors: Leavitt Timothy W. , Nixon J. V.
Published: March 2007

The clinical, echocardiographic, and cineangiographic features of the oldest known living case of cor triatriatum are presented. Mitral regurgitation, also found in this patient, has been reported on only two previous occasions to coexist with otherwise uncomplicated cor triatriatum. The value of two‐dimensional echocardiography in the identification of this congenital anomaly is confirmed.
The effect of supine rotation on left ventricular dimensions in man: A study using radio‐opaque epicardial markers
Authors: Vine Donald L. , Todd Edward P. , Cole James S. , Zeok John V.
Published: March 2007

It has been reported that patient rotation into the left lateral decubitus position (30° rao) produces significant changes in the regression equations used for left ventricular volume determination and that normal values for echocardiographic left ventricular dimensions obtained from supine patients differ from those obtained after rotation. The purpose of this study was to establish whether patient rotation is associated with changes in left ventricular size and systolic function. The distances between left ventricular epicardial markers attached at the time of cardiac surgery were measured using biplane cineradiography in 14 patients in order to determine left ventricular dimensions before and after rotation. Supine epicardial left ventricular dimensions were not significantly different from those obtained with the patient rotated 30° rao. These results suggest that reported changes in invasive and noninvasive measurements of left ventricular function associated with patient rotation are not primarily due to changes in left ventricular size.
Left main coronary artery ostial stenosis: Clinical markers, angiographic recognition and distinction from left main disease
Authors: Salem Bakr I. , Terasawa Masahisa , Mathur Virendra S. , Garcia Efrain , De Castro Carlos M. , Hall Robert J.
Published: March 2007

Among 1254 patients with coronary artery occlusive disease (CAOD) who underwent cardiac catheterization studies in our laboratory from 1975 through 1977, 114 (9%) had significant (≥50%) stenosis of the left main coronary artery (LMCA). Thirty‐four of the 114 (29.8%) had stenosis of the LMCA ostium (2.7% of all CAOD patients). Clinical, hemodynamic, and angiographic data of the 34 patients were analyzed. Unstable angina was more frequent in these patients, most of whom were in functional classes III and IV, than those with other LMCA lesions. Of the 18 who underwent treadmill exercise testing, results were positive in 16 (11 of whom had ST segment depression ≥2 mm Hg), negative in none and indeterminate in two. By avoiding overlapping the coronary ostium with the sinus of Valsalva without significant foreshortening of the LMCA during angiography, LMCA ostial stenosis was recognizable in all patients in the moderate left anterior oblique position only and not in other projections. Coronary arteriography was performed without occurrence of ventricular fibrillation, infarction, or any other morbidity or mortality in the 34, as well as in the entire group of 114 patients with LMCA disease. To ensure a safe procedure, left ventricular filling pressure was monitored constantly via a catheter in the pulmonary artery, and patients experiencing sharp increases following coronary injections were promptly treated with nitroglycerine. Coronary artery bypass, with an average of 3.2 grafts per patient, was performed in 30 patients with a survival of 97% and only one death in a patient who underwent aortic valve replacement and triple bypass. Stenosis of the ostium of the LMCA is not an uncommon lesion in patients with CAOD and should be suspected in all patients whose symptoms are severe. Coronary angiography, performed with adequate precautions, as well as aortocoronary bypass, can be accomplished successfully.
Intracardiac M‐mode echocardiography for continuous left ventricular monitoring: Method and potential application
Authors: Conetta D. A. , Christie L. G. , Pepine Carl J. , Nichols Wilmer W. , Conti C. Richard
Published: March 2007

Because no accurate and readily applied method exists for continuous recording of left ventricular cavity dimensions and wall motion in man, we designed a catheter‐mounted echocardiographic probe. The purpose of this report is to describe the instrumentation, technique, limitations, complications and preliminary observations employing the probe in humans. The echo transducer built into a cardiac catheter allowed positioning in the right heart under fluoroscopy. The echo signals permitted continuous left ventricular cavity measurements at rest and during maneuvers. Our results suggest that intracardiac echo may be able to provide clear definition of motion patterns of the mitral valve and left ventricular walls. The ultrasonic catheter is an instrument that potentially offers a new technique for continuous monitoring of left ventricular size and motion.
Aortic vasa vasorum in cyanotic congenital heart disease
Authors: Jones R. S. W. , Culham J. A. G. , Freedom R. M.
Published: March 2007

Three cases of longstanding untreated cyanotic congenital heart disease are presented. In addition to collateral circulation from bronchial, intercostal, and inferior phrenic arteries, thoracic aortic vasa vasorum were visualized. We believe this may represent an additional collateral pathway to the lungs. The angiography of these cases is presented.
Massive hemoptysis secondary to flow‐directed thermodilution catheters
Authors: Haapaniemi John , Gadowski Raymond , Naini Mansoor , Green Henry , Mackenzie Douglas , Rubenfire Melvyn
Published: March 2007

Hemoptysis is an unusual complication of flow‐directed (Swan‐Ganz) catheters. Over‐inflation of the balloon with a shearing‐induced rupture of a small pulmonary artery, and the spear effect of the catheter tip appear to be the mechanisms in the two cases presented. Diligent care to avoid overinflation of the balloon in the pulmonary capillary wedge position by observation of the pressure waveform is critical. The spear effect that is frequently seen during insertion may be eliminated by deflating the balloon at the first appearance of the pulmonary artery waveform and gradual advancement of the catheter five to eight cm, when the balloon is then reinflated to obtain the wedge.
Recurrence of prinzmetal angina seven years following aortocoronary bypass surgery: A clinical and angiographic follow‐up
Authors: Crittin Jean , Mizgala Henry F. , Waters David D. , Theroux Pierre , Lesperance Jacques
Published: March 2007

A patient with Prinzmetal angina and ST segment elevation in the anterior ECG leads became asymptomatic after a 50% left anterior descending coronary artery stenosis was bypassed. However, seven years later Prinzmetal angina recurred but with ST segment elevation in the inferior ECG leads. Although the coronary bypass graft had remained patent, the proximal and distal left anterior descending coronary artery was occluded. No significant stenosis was present in the right coronary artery. Perhexiline maleate controlled his symptoms but when the drug was stopped because of side effects an acute inferior myocardial infarction occurred.
Percutaneous preformed single catheter coronary arteriography and its complications—10,000 cases
Authors: Vijay N. K. , Schoonmaker F. W.
Published: March 2007

The single preformed catheter has offered an alternative to the conventional approaches to study of the coronary circulation and ventriculography. It has the advantages of being introduced percutaneously without multiple changes for routine study or for provocative drug testing such as for spasm with Ergonovine maleate or muscular bridges with nitroglycerine. It requires no arteriotomy and has been associated with a low complication rate.
Quantitative coronary arteriography using 105‐MM photospot angiography and an optical magnifying device
Authors: Feldman Robert L. , Pepine Carl J. , Curry R. Charles , Conti C. Richard
Published: March 2007

A quantitative coronary arteriographic technique is described utilizing 105‐mm photospot angiography and a hand‐held optical magnifying device. This technique is rapid, accurate, and reproducible. We feel this technique has potential in evaluating coronary responses to acute interventions and in the long term evaluation of progression or regression of atherosclerotic disease.
Inexpensive radiation protective glasses
Authors: Dillon James C.
Published: March 2007

Using the services of a local optical supply house, fabrication and testing of eyeglasses of a high lead content that could be used to protect the eye from tha hazards of radiation were evaluated. Two separate types of eyeglasses were manufactured (a prototype followed by a second pair), and these were tested against a commercially available pair of radiation protective glasses. The protection offered by the locally manufactured pair of glasses exceeded the commercial pair and the cost savings are significant.
Evaluation of segmental left ventricular wall motion by equilibrium gated radionuclide ventriculography
Authors: Van Nostrand Douglas , Janowitz Warren R. , Holmes David R. , Cohen Howard A.
Published: March 2007

The ability of equilibrium gated radionuclide ventriculography to detect segmental left ventricular (LV) wall motion abnormalities was determined in 26 patients undergoing cardiac catheterization. Multiple gated studies obtained in 30° right anterior oblique and 45° left anterior oblique projections, played back in a movie format, were compared to the corresponding LV ventriculograms. The LV wall in the two projections was divided into eight segments. Each segment was graded as normal, hypokinetic, akinetic, dyskinetic, or indeterminate. Thirteen percent of the segments in the gated images were indeterminate; 24 out of 27 of these were proximal or distal inferior wall segments.

There was exact agreement in 86% of the remaining segments. The sensitivity of the radionuclide technique for detecting normal versus any abnormal wall motion was 71%, with a specificity of 99%. Equilibrium gated ventriculography is an excellent noninvasive technique for evaluating segmental LV wall motion. It is least reliable in assessing the proximal inferior wall and interventricular septum.
Foreign body retrieval from the heart by two catheter technique
Authors: Khaja Fareed , Lakier Jeffrey
Published: March 2007

Foreign bodies that lodge accidentally in the heart or great vessels can be retrieved successfully without thoracotomy. This report describes retrieval of a 15‐centimeter‐long central venous catheter lodged in the right side of the heart. Two catheters were introduced to effect retrieval, one from the arm and the other from the leg. To our knowledge this approach has not been described previously.
Echocardiographic findings in cardiogenic shock due to right ventricular myocardial infarction
Authors: Elkayam Uri , Halprin Stanley L. , Frishman William , Strom Joel , Cohen Martin N.
Published: March 2007

The echocardiographic findings in a patient with cardiogenic shock secondary to acute right ventricular myocardial infarction based on typical clinical, electrocardiographic, and hemodynamic features are described.

The echocardiogram demonstrated a large RV/LV minor axis ratio caused by a volume overload of the right ventricle and an underfilled left ventricle. The interventricular septum showed abnormal movement, presumably due to right ventricular overload or severe disease of the left anterior descending coronary artery. Diminished septal systolic thickening, as seen in our patient, may be explained by extension of the infarct from the right ventricle to the adjacent part of the septum. Predominant right ventricular involvement can be a cause for a correctable hypotension in patients with acute myocardial infarction and should therefore be recognized early. The echocardiographic picture demonstrated in our patient, when considered in conjunction with the clinical status, can be useful for early diagnosis.
Ejection fraction derived by M‐mode echocardiography: A table and comments
Authors: Kessler Kenneth M.
Published: March 2007

Left ventricular ejection fraction is frequently quantitated by M‐mode echocardiography despite limitations, including 1) the ability to measure an accurate left ventricular short axis, 2) the mathematic and geometric assumptions used to derive the volumes from which the ejection fraction is calculated, and 3) the lack of applicability to asynergic ventricles. Nevertheless, using a cubed function or correction formula, ejection fraction can be calculated for symmetrically contracting, normally sized, and enlarged left ventricles. A table and accompanying comments are presented.
Distribution and severity of coronary artery disease in 500 patients with angina pectoris
Authors: Vieweg W. V. R. , Alpert J. S. , Johnson A. D. , Dennish G. W. , Nelson D. P. , Warren S. E. , Hagan A. D.
Published: March 2007

The distribution and severity of coronary disease in 500 patients with angina pectoris and at least one area of 50% or greater reduction of luminal diameter in a major coronary artery were compared with respect to patients' age and coronary arterial pattern. The coronary arterial patterns were separated into right (360 patients), mixed (89 patients), and left (51 patients) systems, depending upon the blood supply to the inferior surface of the left ventricle. The following relationships were noted:

In patients with angina pectoris, the distribution and severity of coronary artery disease is similar from the third to eighth decade.

Coronary arterial stenoses of 50‐70% or greater reduction of luminal diameter involve most frequently the proximal portion of the major vessels. Coronary artery disease is multivessel in nature in 80% of cases. In single vessel disease the left anterior descending artery is involved most frequently.

The left main coronary artery is moderately to severely obstructed less frequently in individuals with left (2%) as compared to right (8%) and mixed (10%) systems. Otherwise, the distribution of coronary artery disease is similar in right, mixed, and left systems.

Coronary artery disease is a diffuse rather than a focal process. As demonstrated by coronary arteriography, patients with coronary artery disease have smaller vessels throughout the arterial tree as compared with individuals free of evident coronary atherosclerosis.
Low‐cost comprehensive data system for cardiac patients
Authors: Melendez Libardo J. , Macdonald A. Craig
Published: March 2007

Functional systems to collect, store and retrieve clinical, hemodynamic, and angiographic information are needed to serve clinical research and quality control in the cardiac laboratory. Computers are ideally suited for this application, but high investment and maintenance costs are a barrier for their wider use.

A low‐cost data processing and procedure reporting system was developed using a programmable calculator, a floppy disk drive, and a printer. Files have been started on 750 consecutive adult patients undergoing cardiac catheterization and angiography. Each file contains a clinical profile (CP), angiographic interpretation (Al), and hemodynamic data. CP and Al are coded according to a data base definition appropriate for patient care (procedure report) and research analysis. Data input is simplified by the use of multiple‐choice forms and prompts appearing on the calculator alphanumeric display. One floppy disk may hold 400 patient files. Immediate access to stored information for cross reference, computations, and statistical work is possible in all patients, a patient category, or an individual case. Stored items may be retrieved in coded form for analysis or translated into sentences to generate a multiple‐copy procedure report. Follow‐up information may be subsequently added to the patient file. Operation requires minimal training and little expertise in computer technology.
Fistulous communication between the left coronary artery and main pulmonary artery: A thirteen‐year follow‐up
Authors: Francis Charles K. , Sacheti Chandra K. , Cohen Robert B.
Published: March 2007

A patient with a fistula producing a 2:1 left‐to‐right shunt between the coronary arteries and pulmonary artery followed for 13 years is described. The patient remained asymptomatic and without significant electrocardiographic, hemodynamic, or angiographic changes. Large collateral vessels were demonstrated on initial and repeat angiographic studies. This case illustrates the natural history of coronary artery to pulmonary artery shunts and suggests that surgery may not be necessary, even in the presence of a very large communication.
Demonstration of an inadvertently created aorto‐coronary venous anastomosis: Evidence against the clinical effectiveness of retrograde coronary venous perfusion
Authors: Klinke W. Peter , Pepine Carl J. , Conti C. Richard
Published: March 2007

Arterialization of the coronary venous system has been suggested as a means of myocardial perfusion. We recently studied a patient with a saphenous vein aorto‐coronary venous bypass graft created inadvertently during surgery intended to bypass the anterior descending artery. We selectively injected contrast into this graft during balloon occlusion of the coronary sinus both before and after sublingual nitroglycerin. No arterial visualization was demonstrated from the vein and no evidence to suggest perfusion of the myocardium was found.
Anomalous origin of the right coronary artery from the pulmonary artery with large left‐to‐right shunt (anomalous right coronary artery)
Authors: Bermudez Gustavo A. , Abdelnur Roberto , Midell Allen I. , Replogle Robert
Published: March 2007

A coronary arteriovenous fistula was diagnosed in a 20‐year‐old white male because of a continuous murmur atypically located along the left sternal border. Cardiac catheterization revealed a large left‐to‐right shunt, and selective coronary arteriography established the precise anatomic diagnosis. The patient was treated successfully by surgical reimplantation of the anomalous coronary artery into the aorta and ligation of its origin at the pulmonary artery. The embryological and clinical features of this anomaly are discussed, and mechanisms for its production are suggested. Attention is called to our observation of an apparent male sex predilection of this anomaly from review of the literature, in addition to the present patient. This is apparently the fourth patient with this anomaly whose condition was diagnosed antemortem by selective coronary arteriography and the fourth to have been treated by aortocoronary anastomosis providing an additive supply for both the present and the future. This is also the second case in the literature to have the transplanted right anomalous coronary artery demonstrated by selective coronary arteriography. It is likely that, with increasing use of selective coronary arteriography in the diagnostic work‐up of cardiac patients, more cases will be discovered and treated surgically.
Catheter tip entrapment with avulsion of tip: A potential complication of percutaneous transfemoral catheterization through aortofemoral bypass grafts
Authors: Lipoff Jay I. , Killam Horace A. W.
Published: March 2007

A search of the literature revealed only one report [4] of catheter tip entrapment during percutaneous transfemoral catheterization in a patient with an aortofemoral bypass graft. We present another case.
Percutaneous left heart catheterization and coronary arteriography using a femoral artery sheath
Authors: Hillis L. David
Published: March 2007

Percutaneous left heart catheterization and coronary arteriography with a standard angiographic catheter introduced through a femoral artery sheath has been performed in over 200 patients during the past 12 months. The use of the sheath for catheter introduction and manipulation offers several advantages, including the capability of monitoring two arterial pressures with only one arterial puncture, the minimization of time in which the guidewire is intravascular, the capability of using all types of catheters from a femoral artery percutaneous approach, and, most importantly, the complete elimination of patient discomfort during catheter changes. The disadvantages of the sheath technique are relatively minor. Thus, percutaneous left heart catheterization and coronary arteriography through a femoral artery sheath can be performed safely and with relatively little trauma to the femoral artery.
Left heart catheterization and angiography via the percutaneous femoral approach using an arterial sheath
Authors: Barry William H. , Levin David C. , Green Laurence H. , Bettman Michael A. , Mudge Gilbert H. , Phillips David
Published: March 2007

An arterial sheath with a proximal hemostasis valve and a side‐arm extension tube was used in 562 consecutive patients undergoing cardiac catheterization and angiography via the femoral approach. Serious complications were rare. There was one death, one peripheral embolism, and one episode of delayed groin hemorrhage. The incidence of minor complications, including hematoma formation, in this series compares favorably with our own and the reported experience of others using the conventional percutaneous femoral approach. The sheath technique facilitated catheter exchanges and reduced patient discomfort. In addition, femoral artery pressure could be monitored via the side arm of the sheath during the catheterization. This proved helpful during retrograde catheterization of patients with aortic stenosis, as well as in detection of damping of coronary artery catheter tip pressure during coronary arteriography and hypotension following left ventriculography. Based upon this experience, use of an arterial sheath has become our standard practice when left heart catheterization is performed via the femoral approach, and the use of several different catheters is anticipated.