bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcatheter embolization of a leaking pseudoaneurysm of saphenous vein aortocoronary bypass graft
Authors: Kim Ducksoo , Guthaner Diana F. , Wexler Lewis
Published: March 2007

We present a case of successful transcatheter embolization of a leaking pseudoaneurysm of an autogenous saphenous vein aortocoronary graft that developed 9 years following bypass surgery.
Catheter fragmentation: A potential source of catheter embolus
Authors: Schmierer Jeffrey A. , Isner Jeffrey M. , Konstam Marvin A. , Salem Deeb N.
Published: March 2007

Aortic root angiography in the patient described in the present report was complicated by precipitious catheter occlusion. Analysis of the occluding fragment by infrared spectroscopy indicated that it was a urethane structure, suggesting that the occluding fragment resulted from spontaneous fragmentation of the polyurethane catheter. Experience with this patient thus documents the potential for nonblood catheter embolus.
Streptokinase thrombolysis of a chronically thrombosed mitral prosthetic valve
Authors: Gagnon R. M. , Beaudet R. , Lemire J. , Carignan L. , Guimond C. , Cousineau G.
Published: March 2007

Thrombus obstruction of a prosthetic heart valve is usually treated surgically. We report a well‐documented case of an obstructed mitral prosthetic valve where fibrinolytic treatment was successful. Furthermore the thrombus formation probably had occurred 6 months earlier. Thus fibrinolysis appears to be a safe alternative to surgery although late occurrence of thrombosis may be possible.
Intraoperative use of dual fiberoptic catheter for simultaneous in vivo visualization and laser vaporization of peripheral atherosclerotic obstructive disease
Authors: Lee Garrett , Ikeda Richard M. , Stobbe Daniel , Ogata Claire , Embi Abraham , Chan Ming C. , Reis Robert L. , Mason Dean T.
Published: March 2007

Since laser energy has been shown to produce controlled thermal injury to atherosclerotic plaques from postmortem human hearts, a 3‐mm diameter fiberoptic catheter was devised and tested for use in peripheral vessels. The catheter has channels for viewing, laser delivery, and suction/flushing. In five femoral or carotid arteries from three dogs implanted with near‐total human atherosclerotic obstructions, the fiberoptic catheter was capable of viewing and targeting the atherosclerotic plaque for laser irradiation. The plaque was vaporized using 5 watts with time exposures lasting from 2 to 5 sec from an argon‐ion laser. In three other animals each implanted with a 3‐ to 4‐cm long segment of human cadaver atherosclerotic vessel, the fiberoptic catheter clearly visualized the internal diseased vascular wall. Thus, this investigation provides the initial demonstration and practicality of applying a flexible dual fiberoptic catheter for simultaneous in vivo visualization and laser vaporization of peripheral atherosclerotic disease.
Outpatient coronary arteriography
Authors: Fierens Enrique
Published: March 2007

A total of 12,719 outpatient coronary angiograms have been performed, using the Sones Technique, at Butterworth Hospital in Grand Rapids, Michigan, over the past 14 years. A consecutive series of 5,107 of these outpatient angiograms were selected for review here. Sixty‐one percent of these patients were diagnosed with coronary artery disease. No deaths occurred in this series. Only 2.22% of patients in this series had complications. Outpatient coronary angiography is a safe, cost‐effective, and efficient diagnostic technique.
Reoperation for correction of anomalous origin of the left coronary artery from the pulmonary artery with return of left ventricular function
Authors: Savage Rodney W. , Glover Matthew U. , Utley Joe R.
Published: March 2007

An adult patient is presented in whom anomalous origin of the left coronary artery from the pulmonary artery was diagnosed in infancy. Initial treatment included a palliative poudrage procedure. Resulting widespread, dense adhesions were encountered during reoperation in adulthood and precluded direct reimplantation of the left coronary artery into the aorta. Instead, a tunnel within the pulmonary artery was constructed from the aorta to the left coronary ostium using a baffle of woven Dacron. Preoperative and postoperative studies showed improvement in ejection fraction and resolution of diaphragmatic hypokinesis.
Technical considerations for cardiac laboratory high‐definition video systems
Authors: Gray Joel E. , Wondrow Merrill A. , Smith Hugh C. , Holmes David R.
Published: March 2007

With the expanding use of video systems in diagnostic imaging a significant benefit could be obtained by applying this technology in the cardiac catheterization laboratory. Reduced radiation exposure to the patient and staff, reduced examination cost by the elimination of cine film and equipment (cameras, processors, etc), and instant replay of each injection would result in improved patient care. We discuss the technical parameters of a video system which we have found suitable for diagnostic purposes and describe how this system is used on a day‐to‐day basis. In addition, the technical aspects of higher bandwidth, higher line rate systems is presented, and we show that these more sophisticated systems provide no advantage over conventional high‐definition television and, in fact, degrade the diagnostic quality of the image.
Rapid progression of coronary stenosis in patients with unstable angina pectoris selected for coronary angioplasty
Authors: Kimbiris Demetrios , Iskandrian Abdulmassih , Saras Harry , Goel Inder , Bemis Charles E. , Segal Bernard L. , Mundth Eldred
Published: March 2007

We studied the course of coronary stenosis in the first 62 patients (45 men and 17 women) referred for coronary angioplasty in the interval between the diagnostic arteriogram and the preangioplasty coronary arteriogram. In 42 patients, the stenosis was in the left anterior descending artery, in 17 patients in the right coronary artery, in one patient in the left circumflex, and in two patients in the vein graft. Twenty‐six patients had stable angina pectoris, 34 patients had unstable angina, and two patients had no angina. The coronary stenosis did not change significantly in any patient with stable angina. Conversely, the stenosis progressed in nine of the 34 patients with unstable angina (26.5%). In five of the nine patients with progression, total occlusion ensued. In four of the five patients total occlusion occurred within the 45‐day interval between the diagnostic and the preangioplasty coronary arteriogram. New or increased preexisting collaterals to the occluded vessel developed in all five patients with total occlusion. None of these patients had clinical or electrocardiographic evidence of myocardial infarction or significant changes in ventricular function. Angiographic evidence of thrombi was seen in ten of 34 patients with unstable angina (29%). We concluded that coronary artery stenosis in patients with unstable angina pectoris is progressive in a significant number after a short time. The cause of progression of coronary stenosis in patients with unstable angina is unknown. Since in a significant number of patients with unstable angina coronary thrombus was suggested by angiography, coronary thrombosis superimposed on coronary atherosclerosis may play a significant role in this syndrome. Further prospective studies are needed, including repeat coronary arteriograms to evaluate the cause of unstable angina, define the role of coronary thrombosis, and evaluate the efficacy of more aggressive treatment adding the use of prolong heparin and antiplatelet agents prior to coronary angioplasty.
Effects of angiographic contrast medium on left ventricular function: Evaluation by contrast angiography and radionuclide angiography
Authors: Mattleman Steven , Hakki A‐Hamid , Iskandrian Abdulmassih S. , Kane Sally A.
Published: March 2007

The purpose of this study was to evaluate the effect of angiographic contrast medium on left ventricular (LV) function in 26 patients undergoing diagnostic cardiac catheterization. Beat‐by‐beat analysis during contrast ventriculography showed that the ejection fraction (EF) was lower in the last beats than in the first beats (P <.02). Radionuclide angiograms were obtained the day before, as well as 15 to 65 minutes after catheterization, which included contrast ventriculography and coronary anteriography. The EF by radionuclide angiography was lower after catheterization than before (43 ± 14% vs 47 ± 17%, P <.01). The EF decreased by ≥ 5% in 11 of the 26 patients (42%) after catheterization. The decrease in EF in some patients was observed up to 65 minutes after catheterization and was not associated with symptoms or ST‐T changes. The EF decreased in only one of nine patients who received nitroglycerin during catheterization, whereas it decreased in 10 of 17 patients who did not receive nitroglycerin (P <.05). The EF decreased in 9 of 14 patients (64%) who had normal resting LV function, whereas it decreased in only 2 of 12 patients (17%) who had abnormal resting function (P <.05). Thus, contrast material may depress LV function up to 1 hr and is more frequent in patients with normal resting EF. The use of nitroglycerin during catheterization may mask this effect.
Single versus biplane right and left ventricular volumetry: A cast and clinical study
Authors: Formanek A. , Schey H. V. M. , Ekstrand K. E. , Velasquez G. , D'Souza V. J. , Glass T. A.
Published: March 2007

True volume (y) and measured volume (x) determined from 23 right and 22 left normal human casts in four biplane angiographic positions and in their eight single‐plane components were used to find the correction factor (b) by regression through the origin (y = bx). The correction factors were applied to human studies to assess the validity of the various biplane and single‐plane modalities in vivo. The casts studies yield excellent correlations in both right and left biplane methods (right volumetry: 0.555 ≤ b ≤ 0.708, 0.917 ≤ r ≤ 0.954, 4.10 ≤ SEE ≤ 6.01 left volumetry: 0.748 ≤ b ≤ 0.825, 0.974 ≤ r ≤ 0.982, 4.81 ≤ SEE 5.79). Good results were obtained with single‐plane volumetries as well (right volumetry: 0.316 ≤ b ≤ 0.887, 0.750 ≤ r ≤ 0.917, 10.75 ≤ SEE ≤ 18.96; left volumetry: 0.728 ≤ b ≤ 0.881, 0.897 ≤ r ≤ 0.976, 5.73 ≤ SEE ≤ 11.97). The correction factors for the single‐plane studies depend much more strongly on the spatial position relative to the radiographic system, particularly in the case of the right ventricular volumes. Thus, the application of the appropriate correction factors is mandatory. The human studies (141 left and 60 right volumetric studies in various single‐plane and biplane projections) showed a larger scatter of single‐plane values, more pronounced for the right ventricle. In certain disease conditions, single plane volumetric studies using cast‐derived correction factors cannot be used to obtain meaningful results.

Correction factors for the following single or biplane mode volumetry are presented for the first time: biplane hepatoclavicular view (right and left ventricle), biplane long axial oblique view (right ventricle), and their single‐plane components; lateral and 60° Left Anterior Oblique (LAO) single plane for the left‐sided measurements, Postero‐Anterior (PA), lateral, and 60° LAO for the single‐plane right‐sided calculations.
Myocardial infarction in the distribution of a patent anomalous left circumflex coronary artery
Authors: Edelstein Josef , Juhasz Robert S.
Published: March 2007

Anomalous origin of the left circumflex coronary artery is the most common congenital coronary artery anomaly. Myocardial infarction has been seen in the distribution of this anomalous vessel. This has been noted most typically when the vessel is atherosclerotic. Sudden death and myocardial infarction, however, also have been seen in a case without atherosclerotic involvement.

This is a case report of a 45‐year‐old man who suffered a myocardial infarction after strenuous and sustained physical effort and who was found to have nonatherosclerotic coronary arteries with an anomalous left circumflex coronary artery arising from the right sinus of Valsalva.
Ergonovine provocative testing: Description of a “double catheter technique”
Authors: Nakhjavan Fred K. , Yazdanfar Shahriar
Published: March 2007

Since coronory arteries should be immediately accessible during ergonovine provocative testing (EPT), a double catheter technique is described. Using the catheter sheath technique from the right and left femoral arteries, right and left Judkins' catheters are introduced into each femoral artery. Selective coronary cineangiography during EPT is thus rapidly performed without the delay of exchanging catheters. Should coronary arterial spasm occur during the test, nitroglycerin can be administered into the coronary artery without delay.
Prolonged application of pressure in transluminal coronary angioplasty
Authors: Kaltenbach Martin , Beyer Joachim , Walter Stefanie , Klepzig Harald , Schmidts Ludwig
Published: March 2007

We investigated the morphologic structure and fluid content of atherosclerotic specimens of fresh human postmortem artery segments before and after application of a pressure of 5 atmospheres simulated by a weight of 5 kg per 1 cm2. After applying pressure in nonorganized atheromata, we noticed a marked reduction in thickness while in fibrotic atheromata we observed only smaller differences in thickness. Reduction in fluid content was significantly more pronounced in nonorganized atheromatous tissue. Reduction in thickness was closely related to reduction in weight (i e, fluid content). The time of pressure application necessary to achieve the optimal result averaged 60 sec. The conclusions drawn from these experiments were incorporated into clinical application of coronary angioplasty. Prolonged balloon inflation was applied to the last 400 out of a total of 600 coronary angioplasty procedures, performed between October 1977 and October 1983. Stenoses not sufficiently responsive to balloon inflation periods of 5–10 sec were exposed to periods of 60 sec (30–120 sec). The number of “non dilatable” stenoses was 15% with the standard short pressure procedure, but only 5% with the prolonged pressure application. No serious complications related to prolonged pressure application were observed. Thus, from experimental data and clinical experience the application of longer pressure periods appears justified and beneficial.
Pulmonary wedge angiography for the evaluation of the pulmonary vascular bed in congenital heart disease
Authors: Fujiyama Jun‐Ichi , Yoshida Yoshiro , Ogata Hiroshi , Kato Taku , Kuteken Osamu , Oyama Kotaro
Published: March 2007

Pulmonary wedge angiograms (PWA) were analyzed qualitatively and quantitatively to evaluate the pulmonary vascular bed in 40 patients with congenital heart disease. The patients were divided into four groups: group 1, normal pulmonary hemodynamics; group 2, increased pulmonary blood flow; group 3, pulmonary hypertension (PH); and group 4, PH with elevated pulmonary vascular resistance. The PWA were analyzed for tapering, pulmonary circulation time (PCT) index, and vascular image.

The tapering was normal in groups 1 and 2 and was more rapid in groups 3 and 4. The PCT index was slightly lower in groups 3 and 4 than in groups 1 and 2. With 100% oxygen, the tapering became less severe and the PCT index increased in group 3. However in group 4, these parameters did not improve with 100% oxygen, suggesting that more advanced vascular changes had developed.

These studies confirm the usefulness of the PWA in evaluating the pulmonary vascular bed of patients with congenital heart disease and PH.
Evaluation of patients with coronary artery disease during exercise: The relation between extent of disease and perfusion deficit
Authors: Hakki A‐Hamid , Depace Nicholas , Iskandrian Abdulmassih S.
Published: March 2007

The purpose of this study was to assess the relation between the extent of coronary artery disease (CAD) and size of exercise‐induced myocardial hypoperfusion in 79 patients with angiographically documented CAD. None of the patients had Q‐wave myocardial infarction. Fifty patients had one‐vessel disease, ten had two‐vessel disease, and 19 patients had three‐vessel or left main disease.

From a scintigraphic functional standpoint, patients were classified into two groups: 28 patients (35%) had large perfusion defects and 51 patients (65%) had small defects. The size of the thallium‐201 perfusion defect during exercise was assessed as the perimeter of the defect in each projection expressed as a percentage abnormality of the total left ventricular perimeter in that projection. The average abnormality from the three projections was used in the final analysis. Eleven patients with large defects (39%) had one‐vessel disease and 12 patients with small defects (24%) had multivessel disease. Stepwise multivariate discriminate analysis identified the number of diseased vessels (F = 13.9), the change in systolic blood pressure from rest to exercise (F = 10.8), the exercise heart rate (F = 9.1), and exercise electrocardiographic response (F = 7.8) as significant associates of the size of the perfusion defect (predictive accuracy = 70%).

We conclude that the size of hypoperfused myocardium during exercise is variable in patients with CAD. Discriminate analysis identified the extent of CAD, exercise heart rate, change in systolic pressure from rest to exercise, and exercise electrocardiographic response as significant associates of the size of the defect.
Myocardial perforation due to temporary transvenous pacing catheters in pediatric patients
Authors: Harris J. Peter , Nanda Navin C. , Moxley Richard , Manning James A.
Published: March 2007

Over a 13‐year period, 18 pediatric patients received temporary transvenous pacing catheters for symptomatic bradycardia due to complete atrioventricular block or sinoatrial node dysfunction. Right ventricular wall perforation occurred in two patients. The utility of two‐dimensional echocardiography in the detection and assessment of myocardial perforation by temporary pacing catheters is discussed.
Transcatheter blade atrial septostomy
Authors: Rao P. Syamasundar
Published: March 2007

Six infants, four with transposition of the great arteries and one each with mitral atresia and tricuspid atresia, who did not improve following balloon atrial septostomy are presented. Each patient underwent transcatheter blade atrial septostomy with resultant improvement of interatrial mixing (immediate improvement in three transposition patients and delayed improvement in one) or interatrial obstruction (in the mitral and tricuspid atresia patients). It is suggested that blade atrial septostomy is a safe and effective technique for nonsurgical palliation of congenital heart defects to enlarge a restrictive interatrial communication, especially if balloon atrial septostomy has not been successful.
Lymphoma of the heart
Authors: Wong David W. H. , Guthaner Diana F. , Gordon Elaine P. , Mitchell R. Scott
Published: March 2007

A case of malignant lymphoma involving the heart is reported. The patient presented with symptoms of cardiac decompensation. The echocardiographic findings of an echogenic mass arising from the pulmonary valve as well as demonstration of soft tissue density diffusely infiltrating the heart and mediastinum was confirmed by computer tomography and angiography. Although the findings on the noninvasive studies were highly indicative of tumor involvement, the temporal association of the symptoms to a motor vehicle accident lead to the erroneous diagnosis of intracardiac and mediastinal hematoma.
Anomalous separate origin of the septal perforator coronary artery from the left sinus of valsalva
Authors: Palomo Andres R. , Schrager Bernard R. , Chahine Robert A.
Published: March 2007

The anomalous separate origin of the first septal perforator from the left sinus of Valsalva is described. Previously documented anomalous origins of the septal perforator include the left main coronary artery, the right coronary artery, the right sinus of Valsalva, a diagonal coronary artery, the circumflex coronary artery, and its obtuse marginal branch. We could not find any previous description of the septal perforator originating from a separate ostium in the left sinus of Valsalva.
Microcomputer analysis of indicator dilution curves to determine qp/qs
Authors: Latson Larry A. , Balyeat Elaine , Lewis Robert
Published: March 2007

We developed and tested, in an animal model, a method for collecting and analyzing indicator dilution curves to determine the pulmonary‐to‐systemic flow ratio (Qp/Qs) using a programmable microcomputer. Curves were digitized in real time by an analog to digital converter. A gamma variate curve fitting algorithm, similar to that used in nuclear cardiology, was used to determine the area under primary and recirculation portions of a single cardiogreen dye curve. A ratio of these areas was used as a measure of Qp/Qs. In an animal model simulating patent ductus arteriosus, there was close correlation of Qp/Qs measured by the Fick method and by the microcomputer method (computer Qp/Qs = 0.95 × Fick Qp/Qs + 0.22, R = 0.97, N = 14, SEE = 0.14). The computer method of measuring Qp/Qs is rapid, easily repeatable, and does not require catheter manipulation. Therefore, it may be particularly useful in the clinical cardiac catheterization laboratory for studying the effects of interventions on Qp/Qs.
Left atrial size, pressure, and v wave height in patients with isolated, severe, pure mitral regurgitation
Authors: Pizzarello Roy A. , Turnier Jocelyne , Padmanabhan Vellore T. , Goldman Mitchell A. , Tortolani Anthony J.
Published: March 2007

In recent years, some concepts regarding the etiology and hemodynamics present in the syndrome of mitral regurgitation have changed. Coronary artery disease and mitral valve prolapse have replaced rheumatic heart disease as the most frequent cause of mitral regurgitation. Hemodynamic studies have shown that tall V waves in the pulmonary capillary wedge tracings are neither specific nor sensitive in detecting the presence of mitral regurgitation.

In this study, we evaluated the role of various clinical, echocardiographic, and hemodynamic findings with regard to left atrial (LA) size, pressure, and V wave height. We found that the mean pulmonary capillary wedge pressure (PCW) and V wave height for the subset of patients with acute mitral regurgitation (PCW = 24.1 ± 10.9; V = 41.2 ± 20.7 mm Hg) was similar to the subset with chronic mitral regurgitation (PCW = 17.9 ± 7.5; V = 32.0 ± 18.2 mm Hg). In addition, we found that there was a significant logarithmic relationship between the LA size and the duration of the mitral regurgitation (y = 1.404 [log X] + 3.948; R = 0.678; p < 0.0005). Lastly, we found that LA size, compliance, regurgitant volume, and regurgitant valve orifice area all increase with time.
Anaphylactoid reaction to angiographic contrast media: Recurrence despite pretreatment with corticosteroids
Authors: Mohan J. C. , Reddy K. S. , Bhatia M. L.
Published: March 2007

A case who developed severe and potentially fatal reaction to an angiographic contrast medium despite adequate pretreatment with steroids for 2 weeks is reported. This is the second such case reported in the English literature.
Hemodynamic profile of constrictive pericarditis produced by a massive right pleural effusion
Authors: Dell'Italia Louis J. , Walsh Richard A.
Published: March 2007

We report a 29‐year‐old female who presented with thyrotoxicosis and a massive right pleural effusion. Cardiac catheterization in the presence of the effusion revealed equalization of abnormally elevated right and left heart filling pressures. Repeat study after thoracentesis demonstrated normal intracardiac pressures, which were unchanged by volume loading with normal saline. This case report suggests that both extrinsic cardiac chamber compression produced by the large unilateral effusion and ventricular interdependence altered diastolic function of the right and left ventricle in a manner resembling constrictive pericarditis or restrictive cardiomyopathy.
Angioscopy in vivo
Authors: Cortis Bruno S. , Hussein Hany , Khandekar Chandra Shekhar , Principe Joseph , Tkaczuk Roman N.
Published: March 2007

Recent developments in optical instrumentation have made possible the direct, three‐dimensional viewing of intravascular structures. Using an angioscope (the Trimedyne Optiscope, Trimedyne Inc., Santa Ana CA) and a xenon cold lamp (the Xenon Cold Light Fountain, Karl Storz Endoscopy America, Inc., Culver City, CA), the authors have visualized, without complications, the normal orifices of various arteries and their bifurcations in 12 dogs, the atherosclerotic aortas of eight post mortem humans, and the coronary arteries of six post mortem humans. Potential applications of the instruments include more accurate diagnosis of occlusive diseases of the blood vessels, evaluation of such interventional procedures as angioplasty, intraoperative assessment of anastomoses, and safer laser surgery. The angioscope also enables the physician to combine pressure recording and dye injection simultaneously with the visualization of the inner walls of the vessels.
Peripheral arterial contrast echocardiography: A new method for the detection of left‐to‐right shunting patent ductus arteriosus
Authors: Oguchi Kouki , Ortiz Edgardo , Misawa Hitoshi , Agata Yotaro , Hiraishi Satoshi , Nishida Hiroshi , Yashiro Kimio
Published: March 2007

A modified echocardiographic method (peripheral arterial contrast echocardiography, PACE) using suprasternal notch (SSN) echocardiography and rapid hand injection of 5% glucose solution through peripheral arteries is introduced. This method was used to determine the presence of a left‐to‐right shunting via patent ductus arteriosus (PDA) in 50 patients with various congenital heart disease among neonates, infants, and young children. Echocardiographic findings were compared with cardiac catheterization/angiography, surgery, and/or autopsy. Diagnosis of PDA made by PACE was sensitive in 98.5% and specific in 100% of cases. Thus, the PACE examination is a reliable bed‐side technique to detect qualitatively the presence or absence of a left‐to‐right shunting PDA accompanied with acyanotic or cyanotic heart disease.
Balloon‐Occlusion pulmonary cineangiography for diagnosing pulmonary embolism
Authors: Benotti Joseph R. , Ockene Ira S. , Alpert Joseph S. , Dalen James E.
Published: March 2007

For the angiographic diagnosis of pulmonary embolism (PE) we performed balloon‐occlusion pulmonary cineangiography in ten consecutive patients. The technical aspects of the balloon‐occlusion cineangiographic technique are reviewed, and its complementary role in the diagnosis of PE are outlined and illustrated with several examples.
Reproducibility of ventricular function measurements by contrast angiography
Authors: Trobaugh Gene B. , Hallstrom Alfred P. , Ward Kennedy J.
Published: March 2007

Interobserver reproducibility of single plane contrast angiographic measurements of end‐diastolic volume (EDV/m2), end‐systolic volume (ESV/m2), stroke volume (SV m2), and ejection fraction (EF) was studied in two groups of patients. The first group (n = 42) was an unselected, consecutive series of patients in which the calculations of volume were performed manually, representing day‐to‐day results from a clinical quantitative angiographic laboratory. The second group (n = 31) was selected on the basis of optimal filming technique and volume calculations were performed digitally with the aid of a computer. This group characterizes the reproducibility that could be attained for investigational purposes. In the selected group, interobserver reproducibility of four regional ejection fractions was determined. The correlation coefficient (r), standard error of the estimate (Sy.x), average difference, and 95% confidence limits are given. Measurement variation accounted for 9–15% of the variance in this study for EDV/m2 (consecutive series), indicating that caution is needed when relating contrast angiographic measurements to other (e.g., noninvasive) measures of volume by simple linear regression.
Aneurysms of the left main coronary artery: A report of three cases and review of the literature
Authors: Smith Mikel D. , Cowley Michael J. , Vetrovec George W.
Published: March 2007

Coronary artery aneurysms have been reported to occur in 1–2% of most large angiographic series. However, aneurysms of the left main coronary artery (LMCA) are extremely rare. Only eight previous cases of LMCA aneurysms have been reported, and only one of these cases was felt to be atherosclerotic in etiology. The clinical findings in three hypertensive females with LMCA aneurysm diagnosed at angiography are presented, along with a review of the literature.
Distal coronary power injection during percutaneous transluminal coronary angioplasty
Authors: Sanders Michael , Shani Jacob , Saviano George , Rivera Marcos
Published: March 2007

A modification of the standard percutaneous transluminal coronary angioplasty (PTCA) procedure is described using a power injector instead of a hand‐held syringe for distal coronary contrast injections. This system was used in 215 dilatations without complications related to the power injector. We found this system to simplify the PTCA procedure and allowed for improved distal visualization even with the steerable PTCA catheters containing an intraluminal guide wire.
Nomogram for calculation of stenotic cardiac valve areas from cardiac output and mean transvalvular gradient
Authors: Nigri Antonio , Martuscelli Eugenio , Mangieri Enrico , Voci Paolo , Danesi Alessandro , Sardella Rino , Feroci Luciano , Reale Attilio
Published: March 2007

In 15 patients (group 1) with isolated mitral stenosis and in 14 patients (group 2) with isolated aortic stenosis the stenotic valve areas were calculated according to: (A) Gorlin's formula; (B) Hakki's simplified formula, using mean mitral gradient by planimetry or peak‐to‐peak aortic gradient; (C) the three‐point simplified formula, using mean gradient calculated by the three‐point method for both mitral and aortic valve.

The three‐point method is definitely easier to use than planimetry.

The values (mean ± SD) of mitral valve areas in group 1 patients were, respectively: (A) 1.56 ± 0.63 cm2; (B) 1.56 ± 0.55; (C) 1.51 ± 0.53. The values of aortic valve areas in group 2 patients were: (A) 0.91 ± 0.63; (B) 0.77 ± 0.41; (C) 0.88 ± 0.52. An excellent correlation was shown between the valve area calculated by Gorlin's formula and both Hakki's simplified formula and the three‐point simplified formula. For aortic valve area the correlation is even better if the mean gradient by the three‐point method is used instead of the peak‐to‐peak gradient.

On the basis of the simplified formula, a nomogram was constructed which allows an immediate calculation of valve areas from cardiac output and transvalvular gradient.
Percutaneous brachial catheterization using a modified sheath and new catheter system
Authors: Pepine Carl J. , Von Gunten Curt , Hill James A. , Culp John R. , Feldman Robert L. , Rubin Michael , O'Brien John T.
Published: March 2007

An alternative method for left heart catheterization via the brachial artery, without cutdown, is described. Percutaneous brachial catheterization was done with a modified 7F side‐arm sheath with check valve. A modified 7F high flow catheter was developed employing characteristics of both multipurpose and Sones catheters. The technique was used in 100 patients for left heart catheterization, in patients with and without aortic valve disease, for left ventricular angiography and selective coronary angiography. There were no failures or serious complications. All puncture sites were managed with 15–20 minutes of compression using only a blood pressure cuff or finger pressure. Bleeding was controlled with restoration of the radial pulse in all but one patient, who had severe peripheral brachial atherosclerosis. Cutdown and thrombectomy performed before he left the laboratory using standard catheterizations techniques promptly restored blood flow. It is our impression that this technique facilitated outpatient catheterizations, repeat catheterizations at sites of previous cutdowns, and reduced patient discomfort.
Estimation of the effects of angioplasty on coronary stenosis using quantitative video angiography
Authors: Bove Alfred A. , Holmes David R. , Owen Robert M. , Bresnahan John F. , Reeder Guy S. , Smith Hugh C. , Vlietstra Ronald E.
Published: March 2007

In this study, we compared stenosis severity by quantitative coronary angiography from video and cine images with visual estimation in 14 patients, who underwent PTCA. Both cine and video analysis demonstrated a change from 65.2 ± 2.5 to 36.5 ± 3.1% diameter stenosis following PTCA, whereas visual estimation (average of three observers) showed improvement from 89.9 ± 1.7 to 36.0 ± 3.2%. Percent area stenosis from quantitative angiography showed improvement from 87.9 ± 1.8 to 56.4 ± 5.8. These data indicate that visual assessment overestimated percent diameter of severe lesions. To determine if video analysis could provide rapid quantitative assessment of PTCA results, we compared percent diameter and percent area stenosis by video with cine (diameter: correlation coefficient, 0.82; slope, 0.79; area: correlation coefficient, 0.86; slope, 0.83). These results indicate that video‐based measurements are not different from cine‐derived measurements. Quantitative coronary angiography provides an accurate estimate of changes produced by PTCA and can be performed rapidly and accurately on video images, thus making results available during the PTCA procedure.
Digital subtraction coronary angiography using high‐pass temporal filtration: A comparison with cineangiography
Authors: Bray Bruce E. , Anderson Fred L. , Hardin Carl W. , Kruger Phd Robert A. , Sutton Richard B. , Nelson James A.
Published: March 2007

Selective coronary angiograms were obtained using a real‐time high‐pass temporal filtration digital subtraction technique with videotape storage and display and compared to simultaneously recorded 35‐mm cineangiograms for 32 stenotic lesions in 15 patients. Both methods were evaluated by three independent observers using caliper measurement of percent diameter reduction for each lesion. There was a good correlation between the two imaging methods for individual observers, though considerable variability was seen, r = .73, standard error of estimate (SEE) = 9.1%. The average severity of stenosis and the interobserver variability were similar between methods. This digital subtraction technique for selective coronary angiography compares favorably with a conventional film‐based technique for evaluation of coronary stenoses and offers advantages of real‐time image processing, limited tolerance to patient motion, and relatively small digital memory requirements. In addition to further improvements in image quality, more objective computer‐aided scoring methods are needed to reduce the variability in lesion analysis.
Congenital pericardial defect diagnosed by computed tomography
Authors: Salem Deeb N. , Hymanson Alan S. , Isner Jeffrey M. , Bankoff Mark S. , Konstam Marvin A.
Published: March 2007

Complete or partial absence of the pericardium is a relatively rare disorder. While physical examination, electrocardiogram, and chest x‐ray may suggest the diagnosis, definitive noninvasive diagnosis has until recently not been possible. In the patient described in the present report, the basis for chest pain initially attributed to myocardial ischemia was established noninvasively by computed tomographic examination of the chest to be congenital absence of the left pericardium. Experience with this patient emphasizes the fact that one of the known bases for nonischemic chest pain—congenital pericardial defects—can be precisely defined by contrast‐negative computed tomographic imaging.
Use of a personal computer with an automatic noninvasive ambulatory blood pressure monitoring device
Authors: Prisant L. Michael , Carr A. A. , Henke John S. , Futrelle Rn Elizabeth S.
Published: March 2007

Automatic ambulatory blood pressure monitoring is a valid and reliable tool for intermittent noninvasive assessment of blood pressure over a 24‐hour period. However, reporting devices to retrieve data from the recording device are dedicated to one task and are expensive. Because of this, we have developed computer programs for a popular inexpensive microcomputer that retrieves data from the Del Mar Pressurometer III, an R‐wave gated automatic ambulatory blood pressure monitoring device. Furthermore, the derived data may be edited, computed to derive statistics, stored, retrieved, displayed, and reported in both numerical and graphical format. This same hardware is used for multiple other tasks.
Hemodynamic evaluation of stenotic cardiac valves: I. Effect of ventriculography and atropine on mitral stenosis
Authors: Angel Juan , Domingo Enric , Soler‐Soler J. , Anivarro Inocencio
Published: March 2007

Mitral area is the parameter used for quantitating mitral stenosis (MS) severity. When mitral gradient (MG) is low and reduction of mitral valve area (MVA) might be critical, interventions presumably increasing mitral valve flow (MVF), such as stress or atrial pacing, have been carried out. The purpose of this study was to analyze in 28 patients the combined effect of left ventriculography (LVG) and intravenous atropine (ATR) in the hemodynamic evaluation of MS. The rationale for combining these two interventions is to add up the ATR‐positive chronotropic effect to the LVG potentiation of cardiac output. The LVG plus ATR markedly accelerated heart rate (from 80 ± 14 to 104 ± 18 bts/min, P < 0.001), mildly increased cardiac index (from 2.6 ± 0.6 to 2.9 ± 0.6 1/min/m2, P < 0.05), and importantly increased MVF (from 136 ± 30 to 172 ± 46 ml/bt, P < 0.001). Pulmonary wedge pressure increased (from 14 ± 5 to 21 ± 5 mmHg, P < 0.001). because of an important increment of MG (from 12± 6 to 18 ± 7 mmHg, P < 0.001). None of six cases with mild MS (MVA > 1.5 cm2) and nine of ten cases with severe MS (MVA ± 1.0 cm2) had MG after LVG plus ATR > 12 mmHg. The remaining case with severe MS and the two cases (out of 12) with moderate MS having MG after LVG plus ATR ± 12 mmHg had, at surgical evaluation, noncritically reduced MVA.
Quantification of mitral valvular incompetence
Authors: Lopez J. F. , Hanson S. , Orchard R. C. , Tan L.
Published: March 2007

The hemodynamic and angiographic data of 147 individuals were analyzed in an attempt to assess the value of three techniques used in the diagnosis of mitral incompetence. One hundred patients had clinical evidence of mitral incompetence (group A) and 47 had normal hemodynamics (group B). The degree of mitral incompetence was assessed in all 147 individuals by two methods: determination of a regurgitant index (RI) using indicator dilution curves and determination of a regurgitant fraction (RF) using left ventricular volumes. In 26 patients of group A and 26 individuals in group B mitral incompetence was also assessed by cineangiocardiography. Each of these methods was compared with the clinical and hemodynamic evidence of mitral valvular incompetence. Both the determination of RI by dye dilution curves and RF by angiocardiography were found to be useful in separating normal individuals from patients with mitral valvular incompetence. Severe mitral incompetence is associated with an RI > 35% and with an RF > 55%. The degree of incompetence by either method was not well correlated with any independent hemodynamic variable. The use of cine angiocardiography to quantify the degree of mitral incompetence was found to be too subjective, depending on the observer, and thus less useful.
Ventricular fibrillation during coronary angiography: Reduced incidence in man with contrast media lacking calcium binding additives
Authors: Murdock David K. , Johnson Sarah A. , Loeb Henry S. , Scanlon Patrick J.
Published: March 2007

The intracoronary injection of contrast media during coronary angiography occasionally results in ventricular fibrillation. Experimental studies have implicated the calcium sequestering agents, sodium citrate and EDTA in Renografin 76 (RG76), as contributing to this complication. Angiovist 370 (AV370) is a contrast medium similar to RG76 except that it contains disodium calcium EDTA instead of EDTA and sodium citrate. To determine if contrast media lacking sodium citrate and EDTA will result in a lower incidence of ventricular fibrillation in man, this investigation compared the incidence of contrast media‐induced ventricular fibrillation in patients undergoing coronary angiography with RG76 to that with AV370. Group A consisted of 2,500 consecutive patients undergoing coronary angiography with RG76 and group B consisted of 2,000 subsequent consecutive patients in whom AV370 was employed as the contrast medium. There was no significant difference between groups A and B with respect to the volume of contrast media used per patient (153 ± 49 ml vs 154 ± 45ml), age (58.4 ± 10 vs 58.6 ± 10 years), sex (70% male vs 70% male), ejection fraction (59 ± 17 vs 60 ± 20), history of mitral valve disease (5.8% vs 7.1%), history of aortic valve disease (6.7% vs 6.5%), prior coronary artery bypass graft surgery (6.6% vs 7.3%), or extent of coronary artery disease.

Fifteen episodes of contrast media‐induced ventricular fibrillation occurred in group A (incidence 0.6%) whereas two episodes occurred in group B (incidence 0.1%) (p < 0.02). Each patient was successfully defibrillated and no adverse sequelae resulted. Thus the present investigation suggests that the incidence of ventricular fibrillation during coronary angiography can be significantly decreased by using contrast media lacking sodium citrate and EDTA.
Diaphragmatic coronary lesion mimics significant coronary stenosis: A report of four cases
Authors: Haraphongse Mant , Rossall Richard E.
Published: March 2007

Diaphragmatic coronary stenosis is a rare coronary angiographic finding. It gives rise to an appearance of relatively severe obstruction and can lead to unnecessary surgical intervention or PTCA. We described four patients with this type of stenosis in whom the lesions proved to be hemodynamically insignificant as judged by the presence of only minor pressure gradients across them.
Modeling the isovolumic relaxation period
Authors: Bernardi Luciano , Uretsky Barry F. , Reddy P. S. , Boudreau Robert
Published: March 2007

The isovolumic relaxation period of the left ventricular pressure curve in man has been assumed to be best represented by an exponential decay. To determine which model most closely approximates the empiric pressure data of isovolumic relaxation in man, several models were compared. They included linear, exponential with a zero mmHg pressure asymptote, exponential with a variable asymptote, and second‐to fifth‐order polynomials. In addition, four different methods of computing parameters of isovolumic relaxation by the exponential model with a variable asymptote were tested. It was found that the isovolumic relaxation period approximates an exponential, that the theoretic asymptote is variable, and that the Levenburg‐Marquardt algorithm can be used efficiently to model this period.
Heparin elimination following continuous infusion during intra‐aortic balloon counterpulsation
Authors: Jacob Andrew S. , Steingart Richard H. , Schweger Marc J.
Published: March 2007

The decline of the activated partial thromboplastin time (APTT) following discontinuation of heparin infusion was measured in six intra‐aortic balloon pump (IABP) patients. The heparin infusion requirement was determined for eight other IABP patients during stable therapeutic anticoagulation. Following discontinuation of infusion, APTT declined with a relatively constant half‐life (t1/2 of 2.4 ± 0.08 hr, suggesting elimination by first‐order kinetics. In comparison, the t1/2 following single bolus doses has been shown to be markedly dose dependent, increasing from 30 min at low doses to 2 hr at very high doses. The heparin requirement for IABP patients was found to be 16 ± 2.5 U/kg/hr, similar to that reported for other clinical situations. The t1/2 of the APTT following discontinuation of heparin infusion can be used to time invasive procedures that would best be done with normal hemostasis.
Percutaneous balloon catheter angioplasty of coarctation of the abdominal aorta: Report of two cases
Authors: Schechter Charles , Angelini Paolo , Treistman Bernardo
Published: March 2007

Two patients with coarctation of the abdominal aorta are reported. They both underwent successful transluminal balloon angioplasty. The immediate and short‐term results have been excellent. This method and its role in the treatment of coarctation of the abdominal aorta are discussed.
Physiological nature of the internal mammary artery grafts
Authors: Singh Ram N.
Published: March 2007

A 4‐month postoperative anglographic study of an internal mammary artery (IMA) graft illustrates its capacity to regulate flow by changes in caliber in response to changes in coronary vascular resistance. This physiological adaptability may be one of the reasons for excellent long‐term results of in situ IMA grafts.
Dilated cardiomyopathy: Functional status, hemodynamics, arrhythmias, and prognosis
Authors: Costanzo‐Nordin Maria Rosa , O'Connell John B. , Engelmeier Richard S. , Moran John F. , Scanlon Patrick J.
Published: March 2007

The natural history of dilated cardiomyopathy is variable, and the prognosis difficult to predict. Several clinical and hemodynamic parameters have been proposed as prognostic indicators. Reports on the relationship between ventricular arrhythmias, degree of hemodynamic impairment, and sudden death are controversial. To define accurately the prognosis in dilated cardiomyopathy, 55 patients with this clinical syndrome underwent clinical evaluation, radionuclide ventriculography, echocardiography, 12‐lead electrocardiography, and 24 hr ambulatory monitoring, and the data thus obtained were evaluated based on predictive value. Over a follow‐up period of 14.1 ± 7.9 months, 11 patients (20%) died, all suddenly. Univariate analysis revealed that patients with more severe functional impairment (P = 0.0449), lower cardiac index (P = 0.0226), lower ejection fraction (P = 0.0426), and higher pulmonary artery wedge pressure (P = 0.0314) had greater mortality risk. Age, duration of symptoms, 12‐lead electrocardiographic abnormalities, and atrial arrhythmias were not predictive of higher mortality. The number of PVCs per hr, the occurrence of couplets, the degree of PVCs prematurity, and the presence, frequency, rate, and duration of ventricular tachycardia did not have prognostic significance. A stepwise discriminant analysis identified functional class, cardiac index, and presence or absence of multiform PVCs as the group of variables that together could more accurately predict outcome in our dilated cardiomyopathy patients. Using a formula derived from the results of this analysis, the outcomes of 36 of 49 patients (74%) was correctly predicted, with a specificity of 100% and a sensitivity of 70%.