bluuebunny/crossref_metadata_2025 huggingface dataset:
Left atrial volume estimation by two‐dimensional echocardiography
Authors: Schabelman Sergio , Schiller Nelson B. , Silverman Norman H. , Ports Thomas A.
Published: March 2007

We examined 12 patients aged six months to 76 years by echocardiography to determine left atrial volume. The results were compared with angiographic left atrial volumes calculated by the biplane Simpson's rule method. Three two‐dimensional planes were used: precordial long axis, apical two‐chamber, and four‐chamber. Area outlines were traced using a light pen computational system providing single plane area length estimates of left atrial volume. The two apical left atrial outlines were combined, and Simpson's rule method was used to calculate left atrial volume. M‐mode echocardio‐grams performed on these patients were used to estimate left atrial volume. As the resuits of covariance analysis showed that there was no significant difference in the line of regression in systole and diastole, these data were pooled for subsequent comparison with angiography.

The closest correlation with angiography was the biplane Simpson rule method with the echocardiographic left atrial volume (Y) = 1.0, angiographic volume (X) + 6.3 ml, r = 0.86. The single plane area length estimates also correlated well with angiography, but correction factors were required. M‐mode estimates of left atrial volume could only correlate to angiography using a power function y = 3.7 X1.80, r = 0.69.

We conclude that left atrial volume can be determined by two‐dimensional echocardiography and that this technique is superior to M‐mode echocardiography.
Percutaneous central venous catheterization performed by medical house officers: A prospective study
Authors: Bo‐Linn George W. , Anderson David J. , Anderson Kenneth C. , McGoon Michael D.
Published: March 2007

We prospectively determined the complications of percutaneous central venous catheterizations performed by medical house officers in 302 patients. We also analyzed the factors affecting the success and complication rates of such invasive procedures. The central vein was successfully catheterized in 363 (77% ) of 470 attempts. The internal jugular and subclavian vein approaches were significantly more successful (86% ) than the external jugular vein approach (61%, P < 0.001 by X2). The success rate improved significantly when catheterization was attempted under elective circumstances (P < 0.003) and also after the vein was initially located with a small‐gauge needle (P < 0.001). Our results suggest that efforts should be abandoned after the third unsuccessful pass with a large‐gauge needle in the same site. Complications of catheter insertion included bleeding (ten patients), hematoma (15 patients), inadvertent arterial punctures (14 patients), iatrogenic pleural effusions (four patients), and pneumothoraces (eight patients). No complications appeared to have a major adverse effect on a patient's clinical course. The inexperienced operator (fewer than 25 prior catheterizations) has a success rate equal to that of the more experienced operator (more than 25 prior catheterizations), but he may be more likely to produce a complication. Medical house officers can perform percutaneous central venous catheterizations with a high rate of success and at low risk to the patient.
A fluoroscopic method to confirm proper catheter position to measure pulmonary artery wedge pressure
Authors: Smucker Mark L. , Lipscomb Kirk
Published: March 2007

The proper position of a catheter to measure pulmonary wedge pressure is usually confirmed by measuring the oxygen saturation of withdrawn blood. However, this method of confirmation is tedious and frequently unsuccessful. A fluoroscopic method to confirm proper catheter position to measure wedge pressure was tested. Between 2 and 5 ml of contrast medium was injected into the artery distal to the catheter tip. Lack of movement for 15 seconds after injection indicated proper catheter position. As judged by the saturation of withdrawn blood and by comparison of wedge and left atrial or ventricular pressure, the fluoroscopic method of confirmation was correct in 71/75 attempts. Thus the flouroscopic method of confirmation of proper catheter position is simple, rapid, and reliable.
What is the appropriate “dress code” for the cardiac catheterization laboratory?
Authors: Leaman David M. , Zelis Robert F.
Published: March 2007

In order to determine the effect of the manner of dress by personnel and observers on cardiac catheterization‐related infections, a retrospective survey was undertaken of 107,203 catheterization procedures done during the calendar year prior to this survey. An analysis of 55,976 cutdowns and 53,578 percutaneous procedures was performed (some subjects had both procedures performed). A total of 379 infections in 109,554 entrance sites were reported for an overall incidence of infection of 0.35%. There were 33 infections at the percutaneous site (incidence = 0.06%) and 346 at the cutdown site (incidence = 0.62%). The manner of dress of personnel not involved with catheter manipulation and of the observers had no relationship to the incidence of infection when the percutaneous technique was used. When cutdowns were performed, there was a lower incidence of infection in those laboratories where all personnel and observers were required to wear a mask, cap, and gown (17,311 cutdowns, 83 infections, 0.48% infection rate) than in those laboratories where none of these was required (15,170 cutdowns, 109 infections, 0.72% infection rate) (P < 0.025). Laboratories which did 150 or less cutdowns/year had more infections than those laboratories performing more than 150/year (P < 0.0001). Our data suggest that the risk of infection from cardiac catheterization is more closely correlated with the volume of studies done in the laboratory than in the manner of dress of the laboratory personnel and visitors in the laboratory. However, the wearing of full “sanitary clothing” will help decrease the infection rate in cutdowns.
Selective coronary arteriography: A clinical comparison of two contrast agents
Authors: Shirey Earl K. , Sones F. Mason , Greenstreet Richard L.
Published: March 2007

The radiopacity and complications of meglumine iothalamate 52% and sodium iothalamate 26% (Vascoray®) were compared with those of meglumine diatrizoate 66% and sodium diatrizoate 10% (Renografin®‐76) in 2258 patients with and without cardiac disease. There was no difference in radiopacity and the type and incidence of adverse reactions were similar, but the frequency was significantly higher (p < 0.05) with Vascoray® in patients with constrictive pericarditis, dissecting aortic aneurysm, and primary pulmonary hypertension. The difference in the frequency of hypotension, sinus bradycardia, and transient asystole in the Renografin®‐76 and Vascoray® groups was statistically significant. Ventricular arrhythmias occurred in 6% of the patients with primary myocardial disease compared to an average of 0.7% in those without this cardiac abnormality (p < 0.01), but there was no significant difference in the frequency in the two contrast agent groups. All reactions were treated and the studies were performed without mortality. Results of this study show that iothalamate formulation with sodium to meglumine ratio of 1:2 containing 410 mEq/L of sodium (Vascoray®) is suitable and safe for clinical use for roentgenographic studies of the heart, and coronary artery circulation.
Anomalous right coronary artery arising from left mainstem
Authors: Husaini S. Nayeem , Beaver Wayne L. , Wilson Ian J. , Lach Ralph D.
Published: March 2007

Various coronary artery anomalies occur in both symptomatic and asymptomatic individuals. We have described a unique case of an aberrant right coronary artery arising from the left mainstem, resulting in clinical myocardial infarction in the absence of coronary atherosclerosis. Though different anomalies of the right coronary artery have been described, we feel this case is unique in that the right coronary artery arises from the left mainstem, truly forming a single coronary artery.
Usefulness of left ventricular wall thickness‐to‐diameter ratio in thallium‐201 scintigraphy
Authors: Manno Bruno , Hakki A‐Hamid , Kane Sally A. , Iskandrian Abdulmassih S.
Published: March 2007

The ratio of left ventricular wall thickness to the cavity dimension, as seen on thallium‐201 images, was used in this study to predict left ventricular ejection fraction and volume. We obtained rest thallium‐201 images in 50 patients with symptomatic coronary artery disease. The thickness of a normal‐appearing segment of the left ventricular wall and the transverse diameter of the cavity were measured in the left anterior oblique projection. The left ventricular ejection fraction and volume in these patients were determined by radionuclide ventriculography. There was a good correlation between thickness‐to‐diameter ratio and ejection fraction (r = 0.80) and endsystolic volume (r = −0.71). In 18 patients with a thickness‐to‐diameter ratio less than 0.70, the ejection fraction was lower than in the 16 patients with thickness‐to‐diameter ratio greater than or equal to 1.0 (22 ± 2% versus 49 ± 3%, mean ± SEM, p <0.001). Similarly, in patients with a thickness‐to‐diameter ratio less than 0.70, the end‐diastolic and end‐systolic volume were higher than in the remaining patients with higher thickness‐to‐diameter ratios (p < 0.02, p < 0.001, respectively). All 18 patients with a thickness‐to‐diameter ratio less than 0.70 had ejection fractions less than 40%; 14 of 15 patients with a thickness‐to‐diameter ratio greater than or equal to 1.0 had an ejection fraction greater than 40% (p < 0.001). The remaining 16 patients with a thickness‐to‐diameter ratio of 0.7–0.99 had intermediate ejection fractions and volumes.

Our results indicate that the left ventricular wall‐thickness‐to‐diameter ratio, as measured from rest thallium‐201 images may be useful in categorizing patients as having either abnormal or normal left ventricular ejection fractions and volumes.
Use of the fluid column in a cardiac catheter for emergency pacing
Authors: Meester Geert T. , Simoons Maarten L. , Slager C. J. , Kint Peter P. , Spaa Walter , Hugenholtz Paul G.
Published: March 2007

Given the not infrequent need for intracardiac pacemaking during intensive cardiac care, a new type of cardiac pacemaker has been designed and tested [1]. With this pacemaker the heart can be stimulated through the fluid column of any conventional catheter, provided it is filled with a 0.9% NaCl solution. This fluid column pacemaker (FCP) is of the “constant current” type. The FCP was tested in 37 animals, in 30 patients in sinus rhythm, and also in two critical patients. In addition to the pacemaker circuit, a special connector was designed, enabling a fast, effective, and safe contact between patient and pacemaker. The FCP is considered to be ideally suited for use in emergency cardiac pacing in intensive care units and other areas where sudden bradycardias may occur and where intrathoracic catheters are inserted for a variety of reasons.
Nitroglycerin‐induced coronary vasoconstriction
Authors: Dalal J. J. , McCans J. L. , Parker J. O.
Published: March 2007

Nitroglycerin is routinely used during coronary angiography for its vasodilating effects. An unusual case is described in which nitroglycerin induced severe coronary artery spasm. Interpretation of coronary angiograms after nitroglycerin should be made with caution.
Clinical evaluation and application of cardiac laboratory high‐definition video systems
Authors: Holmes David R. , Smith Hugh C. , Gray Joel E. , Wondrow Merrill A.
Published: March 2007

This study evaluated a new high line rate (1,023‐line) high band‐width (10 MHz) system, compared it to our high‐definition, 525‐line video system, and compared both video systems to 35‐mm cine angiography in 117 patients undergoing clinically indicated coronary angiography. The subjective image quality of the 1,023‐line video system was not significantly better than that of the 525‐line system. High line rate, high band‐width systems may have theoretical advantages, but the increased noise level under clinical angiographic conditions reduces their diagnostic quality. Comparison between video (all modes) and cine images resulted in cine being rated as the best modality, but the differences were slight. Radiation levels required for video imaging, however, were significantly less than those required for cine recording. Current clinical and computer interactive uses of video systems in the cardiac laboratory are described. The eventual role and potential replacement of cine recording by video tape systems will depend on continued developments in video recording techniques.
Cross‐Sectional echocardiographic diagnosis of azygos continuation of the inferior vena cava
Authors: Huhta James C. , Smallhorn Jeffrey F. , Macartney Fergus J.
Published: March 2007

Azygos continuation of the inferior vena cava has importance for both the invasive diagnosis of congenital heart disease by catheterization and for surgical treatment. Cross‐sectional echocardiography was used to examine 1,000 patients (1 day to 16 years, mean 3.3 years) who also had angiographic or surgical confirmation. Twenty‐eight patients (3%) had azygos continuation (left 13, right 14, bilateral 1) and, in 26 patients, the hepatic portion of the inferior vena cava was absent. Azygos continuation was prospectively detected in all and was directly visualized in subcostal scans as a venous structure posterior to the aorta coursing behind the heart and not entering the inferior aspect of either atrium in 26/28 (93%). Azygos connection to the ipsilateral superior vena cava or atrium was correctly predicted in all. The inferior vena cava was visualized in all patients without azygos continuation, except one neonate with omphalocele.

We conclude that cross‐sectional echocardiography can accurately detect azygos continuation of the inferior vena cava and predict its side and connection.
Structural and functional abnormalities of the left ventricle after closed mitral valvotomy
Authors: Mohan Jagdish C. , Reddy K. Srinath , Mukhopadhyaya Sima , Bhatia Madan L.
Published: March 2007

Left ventricular apical aneurysms were observed in six of 84 (7.1%) patients consecutively catheterised after closed mitral valvotomy for relief of mitral stenosis. All these patients had angiographically normal coronary arteries. Such aneurysms represent a potential source of cardiovascular complications.
Left ventricular endomyocardial biopsy in children with the transseptal long sheath technique
Authors: Rios Billy , Nihill Michael R. , Mullins Charles E.
Published: March 2007

Left ventricular endomyocardial biopsies were obtained in 19 infants and children using a long sheath as an introducer after transseptal puncture of the atrial septum. From July 1982 to August 1983, 19 patients, ages 7 months to 12 years (mean = 4.6 years), underwent both right and left ventricular biopsies with only one failure. The long sheath technique allows positioning of the bioptome in different areas of the left ventricular chamber. Right ventricular biopsies were also obtained with the long sheath technique in 11 other patients.
Inotropic effects of ionic contrast media: The role of calcium binding additives
Authors: Murdock David K. , Walsh John , Euler David E. , Kozeny Greg , Scanlon Patrick J.
Published: March 2007

Renografin‐76 (RG76) regularly depresses myocardial contractility during coronary angiography. Angiovist‐370 (AV370) is a contrast medium similar to RG76 except the calcium sequestering agents sodium citrate and EDTA in RG76 have been replaced by calcium EDTA (an additive that does not bind additional calcium). To determine if the calcium sequestering agents contribute to the mechanical depression produced by ionic contrast media, this study compared the inotropic response of RG76 to that of AV370. Additionally, saline solutions containing sodium citrate + EDTA and calcium EDTA at concentrations found in the respective contrast media were also compared. In 10 open chest dogs the percent change and duration of the inotropic response following intracoronary injections of RG76 and AV370, as well as solutions of sodium citrate + EDTA and calcium EDTA were compared using Walton‐Brodie strain gauges. Injections, 2 cc, of RG76 and AV370 produced a biphasic response characterized by an initial negative inotropic response followed by a more prolonged positive inotropic response. The magnitude (67 ± 3% vs 59 ± 2%; p < 0.001) and duration (34 ± 3 vs 24 ± 2 sec; p < 0.001) of the initial negative inotropic response was greater with RG76 than with AV370. The magnitude of the secondary positive inotropic response with RG76 was not different from that obtained with AV370 (31 ± 12% vs 28 ± 10%; p > 0.3). This positive response was not affected by b̃‐adrenergic blockage with 0.2 mg/kg of timolol. Similarly, 4 cc of sodium citrate + EDTA produced a significantly greater magnitude (56 ± 5%) and longer (42 ± 7 sec) negative inotropic response than calcium EDTA (17 ± 2% and 15 ± 3 sec) or 0.9% saline (18 ± 8% and 13 ± 2 sec; p < 0.001). The results suggest that the calcium sequestering agents sodium citrate + EDTA produce significant negative inotropic effects contributing to the mechanical depression produced by RG76. However, the calcium binding additives are not solely responsible for the depression in contractility produced by ionic contrast media. Contrast media lacking calcium binding additives may be preferable for coronary angiography.
Successful result from delayed streptokinase administration: Subtotal thrombotic occlusion in a subsequently normal coronary artery
Authors: Osborn Larry A. , Cooper M. Wayne
Published: March 2007

This report describes successful results from intracoronary streptokinase administered beginning 6 hr after onset of symptoms to a 32‐year‐old male with subtotal vessel occlusion by thrombus. Coronary angiography 26 days later demonstrated normal vessels. We conclude that 1) duration of symptoms beyond 3–4 hr should not preclude the use of thrombolytic therapy in evolving myocardial infarction, 2) this patient exemplifies the higher incidence of subsequently demonstrated normal coronary arteries in patients under age 35 with acute myocardial infarction; arterial spasm and platelet aggregation are the most likely causes of coronary occlusion in these patients.
Posterior descending artery origin from the left anterior descending: An unusual coronary artery variant
Authors: Clark Vivian L. , Brymer James F. , Lakier Jeffrey B.
Published: March 2007

We recently observed the unusual origin of the posterior descending from the left anterior descending coronary artery in three patients undergoing coronary angiography. These three cases are presented and the clinical implications of this variation are discussed.
Isolated aortic stenosis with severe pulmonary hypertension
Authors: Riegel Norman , Ambrose John A. , Mindich Bruce P. , Fuster Valentin
Published: March 2007

Severe pulmonary hypertension is rare in patients with aortic stenosis. When present, it usually implies either associated mitral valve disease, poor left ventricular function, or pulmonary disease. In this case report, severe pulmonary hypertension was present in a patient with isolated aortic stenosis and normal left ventricular systolic function. Pulmonary hypertension was probably related to left ventricular diastolic dysfunction. Following successful aortic valve replacement, pulmonary pressures declined but symptoms of shortness of breath persisted and the patient still required daily diuretics.
A less traumatic catheter for coronary arteriography
Authors: Van Robert A. Tassel , Gobel Fredarick L. , Rydell Ba Mark A. , Vlodaver Zeev , Maccarter Dean J.
Published: March 2007

A deformable soft‐tipped angiographic catheter has been designed and developed to reduce vascular trauma during coronary arteriography. In order to test the ability of the catheter tip to glide over vascular endothelium, the coefficient of resistance was tested using fresh human aortic tissue. The mean frictional coefficients of resistance (FRc) for the soft‐tipped catheter, as compared with two commonly used catheters (N = 10/group), were .78 ±.08 units for the soft‐tipped catheter and 1.10 ± .10 (p < .006) and .98 ± .10 (p < .034) for the conventional catheters. This demonstrates a significant 23% reduction in FRc with the soft‐tipped catheter. The ease of penetration into a wax media was also measured using the soft‐tipped catheter and compared with the same two conventional catheters. The indentation depths for the soft‐tipped catheter and the two other catheter groups (N = 7/group) were 140 ± 18 m̈m, 246 ± 15 m̈m and 318 ± 20 m̈m, respectively. This represents a 56% decrease in indentation depth with the soft‐tipped catheter.

Histologic studies in canines have demonstrated considerably less endothelial damage and subsequent intimal proliferation in the aorta and coronary ostia with the soft‐tipped catheters compared with control catheters.

It is concluded that a soft‐tipped angiographic catheter is less traumatic to vascular tissue and may offer a safer approach to intravascular studies.
The use of an exchange guide wire in coronary angioplasty
Authors: Dervan John P. , McKay Raymond G. , Baim Donald S.
Published: March 2007

Of 84 consecutive patients referred for coronary angioplasty, an exchange length (260 cm) guide wire was used in 17 (20%) to allow serial passage of different sized dilatation catheters. Exchanges were performed for the following reasons: 1) inability to cross the stenotic segment with a full‐sized dilatation catheter, with exchange for a smaller catheter to permit initial dilatation followed by a second exchange to reintroduce the full‐sized balloon catheter; 2) premeditated initial use of a low‐profile balloon catheter in severe stenosis, with subsequent exchange to a full‐sized balloon catheter; 3) inability to achieve a satisfactory reduction of the transstenotic gradient or angiographic stenosis with the initial dilation catheter, requiring subsequent passage of a larger balloon catheter into the partially dilated segment. Eighteen of 19 attempted exchanges and 18 of 19 angioplasty procedures were completed successfully.

The use of exchange guide wires permits multiple recrossings of a dilated segment, allows safe serial passage of different sized balloon catheters, and obviates the need for renegotiating difficult proximal coronary anatomy. The exchange guide wire techique can be applied safely and effectively to coronary angioplasty and provides an additional option in the successful completion of movable guide wire angioplasty procedures.
Injection of contrast medium within the interatrial septum: An unusual complication of right atrial angiography
Authors: Markiewicz Walter
Published: March 2007

A 56‐year‐old male with right ventricular dysplasia underwent right atrial angiography. Though the catheter tip appeared to be in the right atrial cavity, an appreciable amount of contrast medium dissected the interatrial septum, resulting in unusual radiologic and ultrasonic patterns.
Endomyocardial biopsy: A review of the literature
Authors: Przybojewski Jerzy Z.
Published: March 2007

A review of the literature relating to endomyocardial biopsy (EMB) is presented. This is considered important at this time since EMB is being utilized with increasing frequency, particularly for the diagnosis of myocarditis. The development of the technique is briefly outlined. Emphasis is placed on the clinical application of EMB in the various primary cardiomyopathies (dilated, hypertrophic, restrictive, and obliterative), the infiltrative secondary cardiomyopathies (amyloidosis, sarcoidosis, hemochromatosis), myocarditis, as well as such conditions as adriamycin cardiotoxicity, cardiac transplant rejection, and Kawasaki disease. More controversial application of EMB in primary mitral valve prolapse (Barlow's syndrome), idiopathic ventricular arrhythmias, and the elucidation of the enigmatic finding of angina with angiographically normal coronary arteries is detailed. Experience with immunological and biochemical investigation of biopsy material, as well as with virus isolation and drug assays in the myocardium, is alluded to. Complications encountered with this procedure are also discussed, and its future role is contemplated.
Combined medical and mechanical recanalization in acute myocardial infarction
Authors: Erbel Raimund , Pop Tiberius , Meinertz Thomas , Kasper Wolfgang , Schreiner Gerd , Henkel Bernd , Henrichs Karl Jürgen , Pfeiffer Claudia , Rupprecht Hans Jürgen , Meyer Jürgen
Published: March 2007

A technique of combined medical and mechanical recanalization was employed in 96 patients with acute transmural myocardial infarction. The mean time between onset of symptoms and admission to hospital was 170 ± 65 min (χ ± SD). After 10 ± 16 min, 250,000 U streptokinase was administered intravenously for 20 min. Intracoronary thrombolysis was commenced within 38 ± 14 min. First coronary angiograms demonstrated reperfusion, an open vessel in 25/96 patients (26%). In 15/71 patients (21%) reperfusion occurred during thrombolysis therapy, before mechanical recanalization could be performed. Recanalization was achieved mechanically in 37/71 patients (52%) with occluded coronary vessels. In 8/71 patients (11%) mechanical recanalization failed but the vessel opened during thrombolysis. In 12/96 patients (12%), the coronary vessel remained occluded. Thus, reperfusion could be achieved in 88% of the patients. Reperfusion rate was 76% in the first 38 patients and 95% subsequently. After reperfusion, coronary thrombi were found in 25/96 patients (26%) but dissolved during thrombolysis in 16/25 patients (64%). Peripheral coronary embolism was observed in 3/25 patients (12%). For the whole group, reocclusion occurred in 8/84 patients (10%).

By combined medical and mechanical recanalization, the recanalization rate could be increased with low reocclusion rate. Trends showed an improvement in regional and global left ventricular function in patients with anterior myocardial infarction.
Ventricularization of right atrial wave form in amyloid restrictive cardiomyopathy
Authors: Gowda Siddhesh , Salem Bakr I. , Haikal Majed
Published: March 2007

Two patients with biopsy‐proven amyloid restrictive cardiomyopathy were presented. Both cases showed ventricularization of an elevated right atrial pressure wave form in absence of tricuspid regurgitation. Possible explanations for this finding as well as its clinical implications are discussed.

This observation indicates that ventricularization of right atrial pressure wave form could be a useful hemodynamic sign in amyloid restrictive cardiomyopathy in absence of tricuspid regurgitation. Furthermore, such a finding does not seem to be specific for tricuspid regurgitation.
Combined cardiac catheterization and carotid cineangiography: An analysis of complications
Authors: Kramer John R. , Abi‐Mansur Pierre S. , Goormastic Marlene , Phillips Daniel F.
Published: March 2007

Two hundred fifty‐three patients underwent cardiac catheterization with selective cineangiography of the carotid arteries. Diagnostic angiograms of both the right and left carotid arteries were obtained in 240 patients (95%). Of these, 217 patients (90%) were studied without complication, 18 (8%) had minor complications, and five (2%) had major complications. Four of the five major complications occurred in patients with bilateral carotid atherosclerosis obliterans. Variations of catheterization technique used in an effort to reduce risk are discussed.
Percutaneous angioplasty of internal mammary artery graft stenosis: Case report and discussion
Authors: Zaidi Adnan R. , Hollman Jay L.
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) was successfully used for the first time in 1977. With experience, its application broadened to include multiple lesions, complex anatomical stenoses, multiple vessels, and saphenous vein aortocoronary bypass grafts. This case demonstrates successful internal mammary graft angioplasty with continued long‐term (eight months) success, documented angiographically.
A new femoral bypass graft catheter
Authors: Simmons Charles R. , Willis William H.
Published: March 2007

A three‐dimensional left coronary bypass graft catheter with a sidewinder configuration is described. It is best suited for superior origins of left coronary bypass grafts. This graft catheter has been used successfully from the femoral route in more than 620 patients without serious complications. The method for using this catheter from the femoral route is described.
New principles for optimum left ventriculography
Authors: Hildner Frank J. , Furst Ariel , Krieger Richard , Chengot Matthew , Javier Roger P. , Tolentino Alfonso O. , Samet Philip
Published: March 2007

Left ventriculography has become the single most important procedure in the evaluation of cardiac function. This study reevaluated the refinements of catheter and power injector technology to assess recommendations of past years and establish new principles for optimum ventriculography. Ventriculograms from 102 patients undergoing left heart catheterization and coronary arteriography for coronary, valvular, and myocardial heart disease served as the test sample. Three styles of #7F high‐flow 110‐cm pigtail catheters were utilized. One had 12 sideholes while the other two had six sideholes positioned nearer the base of the curl. Analysis of ventriculographic quality of each angiogram was performed by three of the authors independently and subsequently together. Five variables were analyzed for their effect on the diagnostic quality of the angiogram: (1) 6‐hole catheters, (2) 12‐hole catheters, (3) volume of contrast, (4) flow rate, and (5) location of injection. Once these analyses were complete, the effect of combinations of these variables was tested to determine their effect on angiographic quality. The first combination included contrast volume and flow rate. The second combination compared contrast volume and flow rate when utilized with 6‐ or 12‐hole catheters. The third combination tested the 6‐ and 12‐hole catheters in the apex or inflow locations. A multivariate contingency analysis was used to define relationships between the variables and the quality of the angiogram obtained.

As independent variables, catheter style, volume of contrast, flow rate, and location of injection did not influence angiographic quality. However, the apex as a location of injection was the single most consistently important determinant of ventricular angiographic quality. Combination variables of contrast volume and flow rate did not affect angiographic quality. But when these were tested using 6‐ and 12‐hole catheters, high volume and low flow through a 6‐hole catheter achieved a result significantly better than all other combinations. Low flow rates were superior to high flow in nearly all combinations tested. The combination of 6‐hole catheter in the apex was substantially better than the 12‐‐hole in the inflow tract or any of the four other combinations. When total volume of contrast must be limited because of ventricular dysfunction, valvular heart disease, or renal disease, injection of relatively small amounts of contrast using low flow rates through a 6‐hole catheter positioned deep in the ventricle should permit a safe study to be diagnostically superior.
Myocardial preservation with alternate coronary artery occlusion and reversal of flow through collateral vessels
Authors: Thomas James D. , Gundel Walter D.
Published: March 2007

In 1980, a 46‐year‐old man suffered occlusion of his left anterior descending coronary artery with preservation of myocardium due to collateral flow from a patent right coronary artery. Six years later, unstable angina recurred, this time due to right coronary occlusion but with myocardial preservation due to reversal of collateral flow from his now recanalized left anterior descending artery.
Multiple vessel coronary angioplasty: Classification, results, and patterns of restenosis in 494 consecutive patients
Authors: Myler Richard K. , Topol Eric J. , Shaw Richard E. , Stertzer Simon H. , Clark David A. , Fishman Jodi , Murphy Mary C.
Published: March 2007

We report the immediate results and 6 month follow‐up data of 494 consecutive patients who underwent coronary angioplasty in two or more major epicardial arteries. Clinical success was achieved in 95% of the 494 patients. The technical success rate for the 1,117 vessels dilated was 89%, defined as at least a 35% reduction (mean = 53%) of the initial percent diameter stenosis and a decrease in the transstenotic gradient to ≤15 mmHg (mean = 9 mmHg). Complications of the procedure included emergency bypass surgery (2.8%), myocardial infarction (3.0%), and hospital death (0.4%) inclusive. At least one of these complications (major cardiac event) occurred in 3.8% of patients. Prior to angioplasty, 46% of patients were in Canadian Cardiovascular Society Class II, 42% in Class III, and 12% in Class IV. Follow‐up clinical evaluation (mean follow‐up period of 16.9 months) showed 83% of patients in Class I, 14% in Class II, and 3% in Class III. Of the 286 successful patients who have reached 6 month follow‐up plateau (mean follow‐up period of 20.5 months), 164 (57%) have so far had repeat coronary angiography and exhibited three different patterns: all lesions patent (N = 54), some lesions restenosed (N = 60), and all lesions restenosed (N = 32). There were 18 patients with new vessel lesions (not previously dilated). Logistic regression analyses demonstrated that clinical factors including diabetes (P <.05), hypercholesterolemia, (P <.01), new onset angina (P <.05), current smoking (P <.01), and morphologic and technical factors such as preangioplasty diameter stenosis > 95% (P <.05) and higher balloon inflation pressure (P <.05) were predictive of increased risk of recurrence. Patients were classified into two groups based on the anatomy of the target lesions. In Group A (N = 217), patients had a single lesion in each of the vessels to be dilated; Group B (N = 277) patients had a complex lesion in at least one of the vessels dilated. Group B patients were more likely to develop recurrence (P <.05). Of the original 494 patients, 488 (99%) are alive. Coronary angioplasty (either initially or with repeat PTCA) has been the definitive treatment in 453 of the 494 patients for an overall success of 92%. Thus multiple vessel coronary agioplasty can be performed effectively with a high angioplasty success rate and relatively low complication rate and excellent clinical prognosis. Patterns of restenosis appear to be related to clinical, morphologic, and technical factors.
Visualisation of left atrial thrombi by coronary arteriography
Authors: Hubbard W. N. , Hine A. L. , Rubens M. , Donaldson R. M.
Published: March 2007

Abnormal vascularity in the region of the left atrial appendage was demonstrated by coronary arteriography in 5 patients with mitral stenosis. Subsequently, three of these patients proceeded to operation, and left atrial thrombi were confirmed in all three cases. Neovascularity must be differentiated from congenital fistulae, tumours, and coronary artery disease. Thrombus in the left atrial appendage is difficult to diagnose even with the use of cross‐sectional echocardiography and may occasionally be demonstrated by coronary arteriography.
Myocardial damage following coronary air embolism during coronary angiography
Authors: Amar Ronnie , Halon David A. , Lewis Basil S.
Published: March 2007

Coronary air embolism may go unnoticed or cause chest pain, electrocardiogram changes, and myocardial damage; it may mimic coronary spasm [1,2]. We report a patient who sustained subendocardial myocardial infarction following intracoronary injection of air.
Clinical implication of inadvertent monitoring of pulmonary artery pressure via a “left atrial” catheter
Authors: Molajo Mrcp Adeniyi O. , Remington Shirley R. , Thomas William F. , Deiraniya Abdul K.
Published: March 2007

A patient is described in whom a left atrial catheter was inadvertently wedged in a pulmonary vein following mitral valve replacement. The pulmonary vein wedge pressure obtained approximated the pulmonary artery pressure and was suggestive of paraprosthetic mitral valve regurgitation.
Snare loop technique for removal of broken steerable PTCA wire
Authors: Watson Linley E.
Published: March 2007

Two cases are described of percutaneous removel of trapped, broken steerable PTCA guidewire. One case described breakage of a guidewire inside the ascending aorta leaving a free end, which is retrieved using the snare loop technique. The second case described retrieval of an intact yet unwound wire through the guiding catheter using a snare loop wire.
Spontaneous dissection of the left anterior descending coronary artery in a male with survival
Authors: Vacek James L. , Phelix Joan , Dunn Marvin
Published: March 2007

Spontaneous coronary artery dissection is a rare event, felt to be caused by intimal disruption and formation of a false lumen in the vessel wall. Compression of the true lumen by intramural hematoma may result in obstruction to blood flow, myocardial ischemia, infarction, and ultimately, death. We report the first instance (to our knowledge) of survival in a man with spontaneous dissection of the left anterior descending coronary artery.
Angiographic visualization of a right gastroepiploic artery‐left circumflex coronary artery graft
Authors: Black A. J. R. , Gibbons F.
Published: March 2007

A 41‐year‐old man who underwent coronary artery bypass grafting using a gastroepiploic artery graft to the left circumflex coronary artery is reported. Subselective angiography of the right gastroepiploic artery using a steerable guidewire and coaxial catheter system is described.
Coronary artery aneurysm formation following PTCA
Authors: Weston Mark W. , Bowerman Richard E.
Published: March 2007

Since its introduction in 1977, the number of procedures and indications for PTCA have grown. With this more frequent and broader use, new complications have been reported. This report describes the formation of a new coronary artery aneurysm at the PTCA site following dilatation. The pathogenesis of aneurysmal formation following PTCA is unknown.
Comparison of the performance of superflow (5F) and conventional 8F catheter for cardiac catheterization by the femoral route
Authors: Molajo Adeniyi O. , Ward Christopher , Bray C. L. , Dobson David
Published: March 2007

In order to determine whether the use of a smaller catheter would allow day‐case cardiac catheterization by the femoral route, the performance of the Superflow (5F) and the 8F catheters was compared in 34 adults who underwent left ventriculography and coronary angiography. As shown by the significantly lower fluoroscopy time [2.8 ± 1.2 min vs 4.5 ± 2.7 min, (m ± SD), p = 0.027] the 8F catheter was more maneuverable than the Superflow (5F) catheter. Poor left ventriculograms were obtained in a higher proportion of patients in whom the Superflow (5F) catheter was used. There was no significant difference in the time to achieve hemostasis at the puncture site in the two groups of patients (13 ± 5 min vs 10 ± 3 min, p = 0.09). It is concluded that the use of the Superflow (5F) catheter confers no advantage, while it is associated with longer screening time and poorer left ventriculograms.
Left main coronary artery embolism: A case report
Authors: Maddoux Gerry L. , Goss Jerome E. , Ramo Barry W. , Raff Gilbert L. , Heuser Richard R. , Shadoff Neal , Wilson John N. , Deane William M. , Hoyt Thomas W. , Fowler Burt N. , Gerety Richard L. , Hoffman Aaron Ronald
Published: March 2007

A 27‐year‐old man had recurrent myocardial infarction found to be due to coronary embolism to the left main coronary artery with downstream embolization. The presumed etiology of thromboembolism was idiopathic cardiomyopathy. A unique method of treatment with Fogarty catheter retrieval was used.
Coronary arteriographic findings in cocaine abuse‐induced myocardial infarction
Authors: Hadjimiltiades Stavros , Covalesky Veronica , Manno Bruno V. , Haaz William S. , Mintz Gary S.
Published: March 2007

A 31‐year‐old black man was admitted with an acute anterior myocardial infarction 20 minutes after IV cocaine abuse. Cardiac catheterization showed a totally occluded left anterior descending artery. Intracoronary and intravenous streptokinase resulted in thrombolysis: repeat angiography showed a normal anterior descending.
Hemodynamic and cardiac metabolic changes during nicardipine‐induced myocardial ischemia
Authors: Thomassen Anne R. , Bagger Jens P. , Nielsen Torsten T.
Published: March 2007

After 10 mg nicardipine IV a patient with stable angina developed chest pain and ST‐segment depression accompanied by excessive tachycardia, low arterial blood pressure, and initially decreased coronary sinus blood flow. Measurements of arterial concentrations and cardiac exchanges of lactate, glucose, free fatty acids, glutamate, and alanine showed alterations indicative of severe ischemia.
Percutaneous transluminal angioplasty of a surgically obstructed left internal mammary artery graft
Authors: Klein Allan L. , Marquis Jean‐Francois , Higginson Lyall A. J.
Published: March 2007

We describe a case of an angioplasty of left internal mammary artery. This case had had a recent surgery and was found to have a stenosis at the site of a surgical clip. This was successfully dilated, and the patient became asymptomatic. Follow‐up at one year revealed continual improvement.
Coronary angioplasty at the time of initial diagnostic coronary angiography in patients with unstable angina
Authors: Haraphongse Mant , Tymchak Wayne , Rossall Richard E.
Published: March 2007

Of the last 200 consecutive patients undergoing PTCA procedures at our institution, 29 (15%) had unstable angina; and angioplasty was performed at the time of diagnostic coronary arteriography. There were 26 males and three females with an age range of 31–82 (mean 57) years. Factors favoring PTCA at the time of initial coronary arteriography included clinical indications for revascularization, appropriate anatomy based on high‐quality fluoroscopy, and availability of emergency surgery if required. Of 34 coronary lesions in 29 patients, 19 involved the anterior branch of the left anterior descending coronary artery (LAD), eight the circumflex branch (Cx); and seven the right coronary artery (RCA). Five patients had two vessels dilated (one LAD + RCA, two LAD + Cx, and two RCA + Cx). Of the coronary artery lesions, 19 were concentric, seven were eccentric, 20 were single and discrete, six were long or multiple in the same vessel; eight vessels were totally occluded, and in nine patients there was good collateral circulation. Twenty‐nine (85%) arteries were successfully dilated. Of the unsuccessful cases, one was from failure to cross a totally occluded lesion, and three residual lesions and/or postdilatation pressure gradients remained significant. One patient required emergency aortocoronary bypass surgery because of total occlusion of the LAD immediately post‐PTCA. There were no postprocedural myocardial infarcts or deaths. It is concluded that, in selected patients with unstable angina, PTCA can be performed successfully and with low risk at the time of initial diagnostic coronary arteriography. This approach offers certain clinical financial advantages.
Successful combined percutaneous aortic balloon valvuloplasty and coronary angioplasty in two critically III patients
Authors: Hays Leonard J. , Tedesco Christine L. , Leatherman George F. , Smucker Mark L.
Published: March 2007

This report describes combined aortic balloon valvuloplasty and coronary angioplasty in two critically ill patients with aortic stenosis and coronary artery disease.
Systolic expansion of the aortic root: An echocardiographic and angiographic sign of aortic composite graft dehiscence
Authors: Josephson Richard A. , Singer Igor , Levine Joseph H. , Maughan Lowell , Pyeritz Reed E. , Gott Vincent L. , Weisman Harlan F. , Brinker Jeffrey
Published: March 2007

Precise diagnosis of aortic composite graft dehiscence may be difficult. We present a case illustrating this problem and its resolution. Two‐dimensional echocardiography and contrast ventriculography revealed a space adjacent to the aortic valve conduit that demonstrated marked systolic expansion. The dynamic variation of this space was secondary to communication with the left ventricular cavity caused by disruption of the composite graft valve ring. Thus, systolic expansion of the aortic root is a useful echocardiographic and angiographic sign of composite graft dehiscence.
Angiographic recognition of coronary ostial stenosis in nonspecific aorto‐arteritis
Authors: Kaul U. , Reddy K. S. , Narula Jagat , Nath C. S. , Mukhopadhyaya S. , Rajani M. , Bhatia M. L.
Published: March 2007

A 17‐year‐old girl was seen with acute anterior myocardial infarction resulting in congestive heart failure. Clinical examination followed by detailed investigation revealed diffuse nonspecific aorto‐arteritis, with left coronary ostial stenosis, which is a very rare association. The relevant literature is reviewed.
Single coronary artery: Right coronary artery originating from distal left circumflex
Authors: Sheth Mukesh , Dovnarsky Michael , Cha Se Do , Kini Panambur , Maranhao Vladir
Published: March 2007

This report describes a patient with single coronary artery, in whom the right coronary artery originated from the distal left circumflex. However, this anomaly was not of clinical significance based on atypical nature of chest pain, negative thallium exercise test and absence of coronary obstruction.
Assessment of aortic pressure‐volume relationships with an impedance catheter
Authors: Ferguson James J. , Miller Michael J. , Ba Peter Sahagian, , Aroesty Julian M. , Mckay Raymond G.
Published: March 2007

Volume measurements obtained with an impedance catheter (impedance volume measurements) have been used previously in determining pressure‐volume relationships in the right and left ventricles and in the right atrium. The purpose of the present study was to determine the utility of impedance volume techniques in the assessment of aortic pressure‐volume relationships in animals and humans. Experiments to develop this methodology were first performed in ten anesthetized dogs, with simultaneous measurements of aortic pressure (micromanometer), diameter (ultrasonic crystals), and impedance volume. Transient (20 sec) inferior vena cava (IVC) occlusion and nitroprusside infusion resulted in a reproducible series of aortic pressure‐volume and pressure‐diameter points. In each case changes in impedance volume closely paralleled changes in diameter. From the wide range of pressure‐volume points, it was possible to construct pressure‐volume plots for a single cardiac cycle, as well as longer loops over a 20–40 mm Hg pressure range. End‐systolic and end‐diastolic pressure‐volume points could subsequently be identified, which outlined a more precise pressure‐volume relationship that was linear in six cases and curvilinear in four cases, depending on the level of aortic pressure.

We extended these techniques to human subjects undergoing diagnostic cardiac catheterization. Studies using the impedance catheter in the aorta were performed in 11 patients. Aortic pressure‐volume curves were elicited during Valsalva maneuver to obtain data over a range wider than that of a single cardiac cycle. Measurements of relative volume were calibrated with simultaneous M‐mode echocardiography in three patients

We conclude that pressure‐volume relationships in the aorta can be assessed with impedance volume techniques, making possible in vivo measurements of arterial compliance. Potential nonlinearities in aortic P‐V relationships requrie that the assessment of aortic compliance encompass as much as possible of the physiologic range of pressure and volume.