bluuebunny/crossref_metadata_2025 huggingface dataset:
Midgut volvulus in children
Authors: Kealey W D C , McCallion W A , Brown S , Potts S R , Boston V E
Published: March 2007

Midgut volvulus secondary to intestinal malrotation usually presents within the first month of life, typically with persistent bilious vomiting1. Diagnostic delay may result in midgut infarction and death. Malrotation may, however, remain quiescent during early childhood and present later in life. Over a 15-year interval, seven patients presented with midgut volvulus well beyond infancy. These cases illustrate important features in presentation which may not be familiar to general surgeons in district general hospitals who may have to deal with this problem.
Repeat hepatectomy for recurrent hepatocellular carcinoma
Authors: Nagasue N , Kohno H , Hayashi T , Uchida M , Ono T , Yukaya H , Yamanoi A
Published: March 2007

This study evaluated the results of repeat hepatectomy for recurrent hepatocellular carcinoma (HCC) and delineated the limitations of such a treatment strategy. Of 290 patients who had radical hepatic resection, 167 had intrahepatic tumour recurrence. Fifty patients underwent a second hepatectomy. Third and fourth hepatectomies were carried out on six and two patients respectively. There were 36 men and 14 women. Age ranged from 32 to 77 years (mean 59.1 years). Liver cirrhosis was present in 38 and chronic hepatitis in 12 patients. Operative death occurred in four patients (8 per cent) after a second and in one of six after a third hepatectomy, compared with 4.5 per cent after first hepatectomy. The five postoperative deaths were attributed to either Child grade B or C liver disease, or severe intraoperative bleeding. The 5-year survival rate was better in these 50 patients (41 per cent) than in 117 patients who were treated otherwise (7 per cent). The present study indicates that repeat hepatectomy may be useful for recurrent HCC. It is indicated principally for patients with a solitary tumour and Child grade A liver disease.
Sisters with familial adenomatous polyposis affected with thyroid carcinoma, desmoid tumour and duodenal polyposis
Authors: Kashiwagi H , Konishi F , Kanazawa K , Miyaki M
Published: March 2007

After prophylactic surgery for colonic polyposis, upper gastrointestinal cancer and desmoid tumour are the main causes of death in patients with familial adenomatous polyposis (FAP). Two sisters with FAP who developed multicentric carcinoma of the thyroid, desmoid tumour and duodenal polyposis are presented.
Day-case laparoscopic hernia repair
Authors: Evans D S , Ghaneh P , Khan I M
Published: March 2007

Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3·5 h, up to five patients (mean 4·4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2–18 months).
General surgery with a special interest in vascular surgery: Changing patterns of workload
Authors: Whiteley M S , Ray-Chaudhuri S B , Cornes J , Michaels J A , Galland R B
Published: March 2007

Prospective surveys of workload were carried out during 1989, 1990 and 1995. Analysis of outpatient referrals, inpatients and operations performed over periods of 3 months was undertaken and the changing patterns of general surgical and vascular surgical workload noted. The number of outpatient referrals rose throughout the study period because of a significant increase in the number of patients with both varicose veins and other vascular problems. There was an increase in the number of emergency admissions for vascular disease. The number of patients having general surgical operations fell; there was a corresponding increase in the number for arterial and venous disease. The general surgical component of a general surgical unit with a vascular interest is gradually declining, as increased numbers of patients with vascular problems are being referred and managed.
Changing patterns in aortoiliac reconstruction: A 7-year audit
Authors: Whiteley M S , Ray-Chaudhuri S B , Galland R B
Published: March 2007

A prospective vascular audit was performed in this hospital between 1988 and 1994. There was a substantial increase in the number of vascular reconstructions (78 in 1988; 141 in 1994). Aortobifemoral grafts for occlusive disease comprised 18 per cent of the operations in 1988 and 0·7 per cent in 1994 (95 per cent confidence interval 0·086–0·259). There was a corresponding increase in the number of extra-anatomic grafts (from 3 to 20·6 per cent). There was a threefold increase in the number of percutaneous angioplasties performed for iliac occlusive lesions (14 in 1988; 41 plus 13 iliac stent procedures in 1994). This had no impact on the total rate of surgical intervention for aortoiliac disease, although it probably aided the shift to extra-anatomic reconstruction by dilatation of the donor side. To investigate whether this change is national, rather than local, graft sales figures were obtained from two vascular graft companies; these confirmed a national trend away from aortobifemoral grafting and provide some evidence to support an increase in extra-anatomic bypass grafting.
Prospective study of carotid endarterectomy and contralateral carotid occlusion
Authors: Da Silva A F , McCollum P , Szymanska T , De Cossart L
Published: March 2007

A total of 700 patients who had carotid endarterectomy (CEA) in the UK and Ireland during a 6-month interval between March and August 1994 were studied prospectively. Some 108 patients (15·4 per cent) had a contralateral internal carotid artery occlusion. Previous reports have shown an associated stroke rate of about 10 per cent in these patients. This study assessed complications and outcome for patients undergoing CEA with contralateral internal carotid artery occlusion compared with those without. The indications for surgery were comparable between the two groups although the patients with occlusion had a slightly higher incidence of arrhythmia and stroke. Intraoperative shunts were used in a significantly higher proportion of those with occlusion (83·3 versus 64·7 per cent, P = 0·0001). The combined death and stroke rate for patients with occlusion was 5·6 per cent compared with 2·4 per cent for the remainder (P not significant). On the basis of the present data, CEA with a contralateral carotid artery occlusion carries only a slight increase in the rate of postoperative stroke and death. This increase was not statistically significant and is lower than that reported previously.
Management cost of acute limb ischaemia
Authors: Braithwaite B D , Jones L , Heather B P , Birch P A , Earnshaw J J
Published: March 2007

The cost of attempting limb salvage in patients who presented with acute lower limb ischaemia was recorded prospectively for 20 months. Seventy-five patients were admitted during the study; 45 were treated primarily by radiological intervention and 18 had primary surgery. The remainder were treated conservatively. Patients who had primary surgery required fewer visits to the operating theatre than those who had primary thrombolysis, but there was no difference in the total time that the theatre or radiology suite was occupied: median 2·3 (10th centile range 1·5–5·0) h and 3·0 (2·0–5·0) h respectively. Median (range) cost of disposables for performing surgery was £82 (58–169) and for thrombolysis was £407 (252–596). When the costs of using the theatre or radiology suite were included, the costs of both treatments were similar: surgery £683 (309–1438) and lysis £861 (611–1244). Median (10th centile range) inpatient stay for surgical patients was 9 (3–18) days and for those having thrombolysis 11 (2–29) days. Median (10th centile range) costs for bed occupancy were similar in both groups: surgery £2497 (643–9115) and lysis £2189 (902–6020). Mean cost for attempting limb salvage by surgery was £3429 (1094–10 065) compared with £3230 (1543–8353) for thrombolysis.
Prospective evaluation of dynamic contrast enhanced magnetic resonance imaging in the evaluation of fistula in ano
Authors: Beckingham I J , Spencer J A , Ward J , Dyke G W , Adams C , Ambrose N S
Published: March 2007

Forty-two patients with a suspected diagnosis of fistula in ano underwent prospective comparison of digital rectal examination, dynamic contrast enhanced magnetic resonance imaging (DCEMRI) and surgical exploration. There were five discordancies: DCEMRI showed an ischiorectal abscess and track with no enteric connection in one patient who at operation was found to have a well epithelialized primary fistula. Four patients with fistulas on DCEMRI had no enteric opening found at surgery and were treated as having sinuses. Long-term follow-up has shown failure to heal in all patients and further surgery confirmed missed fistula. Compared with final outcome measures DCEMRI had a sensitivity of 97 per cent and specificity of 100 per cent in the detection of fistula. DCEMRI also identified more secondary tracks and was more accurate at identifying complex fistulas than either digital rectal examination alone or surgical exploration.
Oesophagogastrectomy for iatrogenic perforation of oesophageal and cardia carcinoma
Authors: Adam D J , Thompson A M , Walker W S , Cameron E W J
Published: March 2007

A casenote review identified 18 patients with carcinoma of the oesophagus and gastric cardia who underwent transthoracic oesophagectomy after instrumental perforation. Oesophagectomy was performed within 48 h in ten patients (early surgery group) and after a median delay of 22 (range 5–48) days in eight patients (delayed surgery group). All patients underwent resection via left thoracolaparotomy with immediate intrathoracic anastomosis using the stomach in 17 of 18 patients. There were no anastomotic leaks. Significant postoperative complications occurred in five of ten of the early group with two in-hospital deaths and a mean survival of 551 days. Six of eight patients in the delayed group developed postoperative complications with two in-hospital deaths and a mean survival of 297 days. Transthoracic resection with immediate intrathoracic anastomosis can be performed without anastomotic leakage but there is high associated respiratory morbidity. The timing of oesophagectomy has little effect on hospital morbidity or mortality rates but early surgery is associated with better long-term survival.
Cardiac complications after hepatic resection
Authors: Yanaga K , Takenaka K , Yamamoto K , Nishizaki T , Shirabe K , Shimada M , Kawahara N , Chishaki A , Sugimachi K
Published: March 2007

During a period of 94 months between 1985 and 1993, 474 hepatic resections were performed in 451 patients, of whom 23 (5 per cent) had cardiac problems: ischaemic heart disease in 16 (previous myocardial infarction in five and angina pectoris in 11), arrhythmic disorders in three, valvular disease in three (previous mitral valve replacement in two) and hypertrophic cardiomyopathy in one. The cardiac patients had a higher incidence of cardiac complications (24 versus 0 per cent, P< 0·0001) including two myocardial infarctions, and of non-cardiac complications consisting of postoperative liver failure (16 versus 4 per cent, P<0·01) and bile leak (16 versus 5 per cent, P = 0·02), as well as hospital death (16 versus 3 per cent, P< 0·001). However, long-term survival was similar in the two groups. Patients with preoperative cardiac conditions appear to be at increased risk for early postoperative morbidity and mortality after hepatic resection.
Pilonidal sinus: Experience with the Karydakis flap
Authors: Kitchen P R B
Published: March 2007

A personal series of 141 patients with postanal pilonidal sinus was treated by the Karydakis operation. Each sinus was totally excised with a vertical eccentric elliptical excision. A thick flap was created by undercutting the medial edge and advancing it across the midline so that the whole suture line was lateralized to reduce the risk of recurrence. Follow-up was achieved in 114 patients for 1–108 months; 79 (69 per cent) were followed for more than 18 months. Overall there were five recurrences (4 per cent) which required further surgery. Thirty-three patients (23 per cent) were referred following recurrence or failure of healing after previous surgery elsewhere; all were cured by this method. The Karydakis operation has a low recurrence rate because it produces a shallow midline furrow free from scar or suture holes which is less vulnerable to hair penetration than a midline wound.
Selective approach to the treatment of oesophageal cancer
Authors: Junginger T , Dutkowski P
Published: March 2007

Between September 1985 and December 1994, 322 patients with oesophageal cancer were treated. Of the 190 patients who underwent operation, 173 had an oesophageal resection; in 124 this was performed as an abdominothoracic resection and in 49 by the transhiatal approach. The assessment of radicality after histological examination revealed a curative (R0) resection in 121 patients (70 per cent) and a palliative (R1-R2) resection in 52 (30 per cent). Prognosis was correlated with the extent of mediastinal lymph node dissection. In 77 patients with stage pT1–3 pN0–1 pM0 the 5-year survival rate was 40 per cent after abdominothoracic resection with two-field lymph node dissection and zero after transhiatal resection (P = 0·01). The authors propose a differentiated surgical approach involving abdominothoracic resection with two- field lymph node dissection for patients with limited tumours (pT1–3 pN0–1 M0) if the operative risk is tolerable. Transhiatal resection appears to be effective only in patients with early tumours (Union Internacional Contra la Cancrum stage 0).
Laparoscopic ultrasonography during cholecystectomy
Authors: Röthlin M A , Schöb O , Schlumpf R , Largiadèr F
Published: March 2007

The routine use of intraoperative cholangiography during cholecystectomy has been debated extensively. Intraoperative ultrasonography was a quick, efficient alternative in open cholecystectomy. A prospective controlled trial to evaluate its usefulness in laparoscopic cholecystectomy is reported. Two groups of 100 patients each were examined during operation with laparoscopic ultrasonography and intraoperative cholangiography. In the first group an adapted urethral probe was used and in the second group a new specialized laparoscopic probe. Intraoperative cholangiography followed immediately after laparoscopic ultrasonography in each patient. In group 1 bile duct stones (n = 4) were detected with a sensitivity of 100 and 75 per cent, a specificity of 98 and 99 per cent, and an overall accuracy of 98 per cent for both ultrasonography and cholangiography. In group 2, 11 patients demonstrated common duct calculi. The sensitivity, specificity and overall accuracy for laparoscopic ultrasonography and intraoperative cholangiography were 91 and 64 per cent, 100 and 100 per cent, and 99 and 96 per cent respectively. The differences between groups 1 and 2 and between ultrasonography and cholangiography were not significant. Variations in the anatomy of the bile duct were observed in 21 patients in group 1 by laparoscopic ultrasonography and in 20 by intraoperative cholangiography. In group 2, 64 variations were demonstrated in 50 individuals by ultrasonography and 61 variations in 47 patients by cholangiography. Vascular variations were seen with ultrasonography in 22 and 24 patients in groups 1 and 2 respectively. In conclusion, laparoscopic ultrasonography (with either probe) proved as accurate as intraoperative cholangiography in detecting bile duct stones, and the specialized probe detected significantly more variations of the bile duct than the adapted probe.
A Western surgical experience of peripheral cholangiocarcinoma
Authors: Berdah S V , Delpero J R , Garcia S , Hardwigsen J , Le Treut Y P
Published: March 2007

The aim of this retrospective study was to analyse outcome in 31 European patients operated on for peripheral cholangiocarcinoma between 1988 and 1995 (hilar cholangiocarcinoma was excluded). Before 1992, in addition to conventional resection, patients with irresectable tumour and with no extrahepatic metastasis underwent total hepatectomy with liver transplantation. Mild abdominal pain was the most frequent presenting clinical sign (11 of 31 patients) and jaundice was present in only four patients. Preoperative histological findings were available for 20 patients but the diagnosis was correct in only eight of these. Nineteen patients had curative surgery: 17 underwent conventional resection and two had total hepatectomy with liver transplantation. Major hepatectomy was performed in 12 of 17 cases, extended to the caudate lobe in five, to the bile duct confluence in four and to the retrohepatic vena cava in one. Postoperative mortality and morbidity rates were three and seven of 19 patients respectively, median survival was 15 months, and actuarial 1-, 2- and 5-year survival rates were 67, 40 and 32 per cent respectively. Twelve patients had only exploratory laparotomy because of the presence of extrahepatic metastasis or irresectable tumour. The invasive nature of peripheral cholangiocarcinoma can explain the limited number of resectable cases and the particularly unfavourable prognosis. Total hepatectomy does not provide survival benefit. Conventional surgery remains the only effective treatment, even for patients with advanced stage tumours.
Long-term follow-up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions
Authors: Tingstedt B , Isaksson J , Andersson R
Published: March 2007

Background

This study examined the natural course of patients following surgery for small bowel obstruction (SBO) caused by abdominal adhesions. In addition, a cost analysis was performed.

Methods

A retrospective analysis was undertaken of 102 patients who underwent surgery between 1987 and 1992 for intestinal obstruction due to abdominal adhesions.

Results

Median follow-up was 14 years. The 102 patients experienced 273 episodes of intestinal obstruction after the index operation, of which 237 involved inpatient readmissions; 47·3 per cent of the episodes resulted in further surgery. Single band adhesions were more common in patients with no previous abdominal surgery (P < 0·001). Some 52·0 per cent of the patients had undergone only one operation for SBO. A mean of 2·7 episodes per patient occurred after the index operation. The cost of adhesion-related problems in this study was €1 588 594 or €6702 per inpatient episode.

Conclusion

The readmission rate in a selected cohort of patients with proven intra-abdominal adhesions was higher than reported previously. The annual cost of adhesion-related problems in Sweden was estimated as €39·9–59·5 million, and the cost of inpatient readmissions was almost equal to that for gastric cancer.
Early introduction of laparoscopic sigmoid colectomy during residency
Authors: Daetwiler S , Guller U , Schob O , Adamina M
Published: March 2007

Background

Laparoscopic sigmoid colectomy for benign diseases is becoming the standard of care. However, few residency programmes incorporate the procedure. This study evaluated the safety and feasibility of the early introduction of laparoscopic sigmoid colectomy during residency.

Methods

From a database of consecutive laparoscopic sigmoid colectomies collected prospectively over 6 years, those for cancer and primary open sigmoid colectomies were excluded. Surgeons were categorized into five levels of experience in colonic surgery. Patient demographics, operative data, complications and conversion rates were assessed.

Results

A total of 262 sigmoid colectomies were performed by 13 surgeons. American Society of Anesthesiologists grade and diverticular disease classification were similar across the five experience levels. There were no significant differences in morbidity, mortality or readmission rates between experience levels. However, operative time (230 versus 145 min, P < 0·001) intraoperative blood loss (200 versus 100 ml, P < 0·001) and conversion rate (13·6 versus 2·1 per cent, P = 0·002) all decreased with increasing surgical experience (trainee versus trainer).

Conclusion

It is safe and feasible to introduce laparoscopic sigmoid colectomy to a structured residency.
Relation of the external branch of the superior laryngeal nerve to the superior pole of the thyroid gland: An anatomical study
Authors: Naidoo D. , Boon J.M. , Mieny C.J. , Becker P.J. , van Schoor A.‐N.
Published: March 2007

The external branch of the superior laryngeal nerve (ELN) is intimately associated with the superior thyroid artery (STA) in relation to the superior pole of the thyroid gland, rendering it vulnerable to injury during the ligation of this vessel during thyroidectomy. Although most texts acknowledge the fact that the nerve is in close relation to the STA, there has not been an anatomical study to relate the position of the ELN to the superior pole of the thyroid gland. The aim of this study was to determine the shortest distance, from the most superior point of the thyroid gland, to the ELN. Bilateral micro‐dissection on 43 adult cadavers, excluding those with thyroid pathology and previous thyroidectomies, was undertaken. The most superior point of the superior pole of the thyroid gland was identified and the shortest distance to the ELN was measured with a digital calliper (accuracy 0.01 mm). The metric study indicated a mean distance from the ELN to the superior pole of a normal sized thyroid gland of 5.76 mm (range: 2.00–11.26) on the right, and 6.17 mm (range: 2.78–13.48) on the left. From the literature, it is clear that the ELN may even be closer to the superior pole of an enlarged thyroid gland. The recommendation to stay on the substance of the superior pole of the thyroid gland when ligating the STA remains valid, as the nerve is extremely close in relation to the superior pole of the normal thyroid gland. Clin. Anat. 20:516–520, 2007. © 2007 Wiley‐Liss, Inc.
The pulmonary venous wedge pressure in pulmonary arterial hypertension
Authors: Waldman J. Deane , Lacorte Michael , Dick Macdonald , John Sarah A. , Miettinen Olli S. , LaFarge C. Grant
Published: March 2007

The comparability of the main pulmonary artery pressure (PAP) and the pulmonary venous wedge pressure (PVWP) was assessed during cardiac catheterization in 89 patients with pulmonary artery hypertension (PAH) and increased pulmonary blood flow. Preliminary evaluation revealed a wide disparity between the 2 determinations.

Fifty‐five pull‐back pressure recordings from branch‐to‐main pulmonary artery were analyzed. Twenty‐four percent (13/55) had systolic pressure gradients >20 mm Hg. between branch and main pulmonary artery. When PVWP and only ipsilateral branch PAP were compared (n=48), diastolic and mean (m), but not systolic PVWP, correlated closely with branch PAP (r=0.77, r=0.73 and r=0.59, respectively). In 46 of 48 patients the PVWPm was not significantly greater than the ipsilateral PAP. Twenty‐nine of 30 patients with PVWPm <30 mm Hg. had an ipsilateral PAPm <40 mm Hg. In 15 patients with PVWPm between 30 and 39 mm Hg, there was a wide range (30–59 mm Hg) of PAPm. Three patients with PVWPm >40 mm Hg. had severe PAH.

It is concluded that: 1) hemodynamically significant branch‐to‐main PAP gradients are present in some patients with PAH and may result in erroneously high pulmonary arteriolar vascular resistance when calculated from main PAP; 2) properly performed PVWP determination can define the lower limit of mean pressure in the ipsilateral branch pulmonary artery; 3) a PVWPm <30 mm Hg. usually indicates an ipsilateral PAPm <40 mm Hg; 4) a PVWPm >30 mm Hg. is compatible with either moderate or severe PAH; 5) correlation of PVWP with PAP is not related to pulmonary blood flow.
Unsuspected left‐to‐right shunt: Is routine use of hydrogen platinum electrode system indicated in shunt detection?
Authors: Iskandrian Abdulmassih S. , Kimbiris Demetrios , Bemis Charles E. , Carver Joseph
Published: March 2007

Unsuspected left‐to‐right shunt was found in 6 of 1,500 adult patients undergoing diagnostic cardiac catheterization.

In 3 patients were found unsuspected secundum atrial septal defects (1 associated with mitral stenosis and 2 with coronary artery disease). In 3 patients, unsuspected partial anomalous pulmonary venous drainage was found (1 associated with aortic valve disease and 2 with severe coronary artery disease).

It is concluded that the incidence of unsuspected left‐to‐right shunt diagnosed during routine cardiac catheterization is very low. Careful physical examination and the application of conventional techniques during cardiac catheterization should suggest the possibility of such a shunt. Hydrogen platinum electrode system (HPES) should be reserved for patients in whom the right heart catheter takes an abnormal course or when the pulmonary artery oxygen saturation is high and the arteriovenous oxygen difference is small.
Electrocardiographic correlates of ultrasonically increased septal, left ventricular posterior wall and left ventricular internal dimensions
Authors: Browne Patrick J. , Benchimol Alberto , Desser Kenneth B. , Sheasby Connie
Published: March 2007

The electrocardiograms (ECG) of 64 subjects who exhibited an echocardiographically demonstrable increase in thickness of the interventricular septum and left ventricular posterior wall (Group 1,22 patients), isolated left ventricular internal dimension (Group 2, 26 patients), combined wall thickness and chamber diameter (Group 3, 2 patients), and septal thickness, (Group 4, asymmetric septal hypertrophy, 14 patients) were reviewed in order to determine sensitivity of ECG criteria for the diagnosis of left ventricular hypertrophy (LVH) proposed in 1949 by Sokolow and Lyon (13), in 1968 by Romhilt and Estes (14), and in 1973 the New York Heart Association (15). Relative sensitivity of the three methods was as follows: Total group, NYHA (77%) > Sokolow and Lyon (67%) > Romhilt and Estes (58%); Group 1, NYHA (91%) > Sokolow and Lyon (73%) > Romhilt and Estes (54%); Group 2, NYHA and Sokolow and Lyon (65%) > Romhilt and Estes (61%); Group 4, NYHA (79%) > Sokolow and Lyon (64%) > Romhilt and Estes (57%). We conclude that (1) ECG criteria of the NYHA for the diagnosis of LVH correlate best with an increase of ultrasonically determined septal, left ventricular posterior wall or left ventricular internal dimensions when compared with voltage criteria of Sokolow and Lyon and the point score system of Romhilt and Estes; and (2) isolated increase of left ventricular internal dimension, in the absence of thickened septum or posterior left ventricular wall, frequently results in ECG criteria compatible with the diagnosis of LVH.
Loss of indicator in the thermodilution technique
Authors: Wong Maylene , Skulsky Albert , Moon Easter
Published: March 2007

The use of a second thermistor for detecting the injectate temperature in the extravascular segment of a standard right heart thermodilution catheter is described. Experiments with chilled (0°C) indicator show that the temperature of the injectate as it enters the catheter is always greater than zero and that it depends on time and the gradient between indicator and surroundings; that serial injections made 30 to 60 seconds apart are successively cooler and do not plateau until the third injection. These variables amount to an overestimation in the cardiac output of 3 to 12%.
Elevated ejection fractions in patients with the anginal syndrome and normal coronary arteriograms
Authors: Boden William E. , Smulyan Harold , Potts James , Johnson Lewis W. , Obeid Anis I. , Eich Robert H.
Published: March 2007

The etiology of chest pain in patients with the anginal syndrome and normal coronary arteriograms has not been established. There has been no explanation for the association of electrocardiographic, hemodynamic, and myocardial metabolic abnormalities consistent with myocardial ischemia observed in some patients with this disorder. Historical, clinical, laboratory, and hemodynamic data of 45 patients (24 females, 21 males), mean age 47.5 years, with chest pain and normal coronary arteriograms are reviewed. Left ventriculograms were analyzed utilizing the single‐plane cineangiographic measurement of left ventricular volume. Systolic ejection fractions for the 45 patients ranged from 0.66 to 0.91 (mean 0.80 ± 0.01 SEM). Ventricular volumes determined angiographically revealed mean end‐diastolic and end‐systolic volumes of 83 ± 5 ml and 18 ± 2 ml, respectively. The mean changes in longitudinal and transverse segmental axis shortening that occurred during ventricular systole were 28.8% and 50.7%, respectively.

These elevated values for ejection fraction, and reduced measurements of ventricular volumes, indicate that some patients with chest pain and normal coronary arteriograms may have small hearts with hyperdynamic ventricular contraction. These findings suggest that hyperdynamic ventricular contraction may play a causative role in the development of transient, angina‐like chest pain in these patients. The etiology of the proposed hyperdynamic ventricle is unknown, but it may be attributable to increased beta‐sympathetic stimulation of the myocardium.
New preformed catheter and method for retrograde left atrial or complete left heart catheterization
Authors: Freeman D. Joe
Published: March 2007

Employing a new catheter and technique complete retrograde left heart catheterization was accomplished in 96 of 100 consecutive patients. These 96 patients included 37 with ischemic heart disease, 13 of 17 with isolated aortic valve deformities, 11 with isolated rheumatic mitral valve deformities, 10 with combined rheumatic aortic and mitral valve deformities, and 25 with other problems. The only failures were in 4 (of 27) patients with aortic valve deformities. No untoward complications occurred. The retrograde catheterization fluoroscopy time was usually less than 2 minutes. The shortest time was 44 seconds, the longest, 6 minutes and 2 seconds. These data indicate that this new catheterization method achieves safe, reliable (when the aortic valve is not deformed), simple, and rapid complete left heart catheterization. They further indicate it may be useful in assessing patients with mitral stenosis, pulmonary hypertension, hypertrophic obstructive cardiomyopathy, and left‐to‐right shunt problems.
A new technique: Right ventriculography using a preshaped catheter
Authors: Cha Se Do , Maranhao Vladir , Lingamneni Ramesh , Goldberg Harry
Published: March 2007

Right ventriculography with a preshaped catheter (J‐ or L‐shaped) was evaluated in make the diagnosis of tricuspid regurgitation. Thirty normal subjects who did not have valvular disease showed no evidence of tricuspid regurgitation or premature ventricular contractions during injection except in one case. On the other hand, 24 patients with combined aortic and mitral valve disease showed mild to moderate tricuspid regurgitation in 11 patients and severe tricuspid regurgitation in eight patients. Only two patients developed frequent run of premature ventricular contraction during injection. Seven patients with severe tricuspid regurgitation were found to have severe tricuspid regurgitation during surgery. No evidence of tricuspid regurgitation was found In all six patients with isolated aortic valve disease.

We can conclude that right ventriculography by the preshaped catheter improves the diagnostic accuracy of tricuspid regurgitation and a grading system of tricuspid regurgitation by angiography is proposed.
Origin and length of left main coronary artery: Its relation to height, weight, sex, age, pattern of coronary distribution, and presence or absence of coronary artery disease
Authors: Abedin Zainul , Goldberg Judith
Published: March 2007

The distance from the base of the left coronary sinus to the origin of the left main coronary artery was measured in 54 patients. The length of the left main coronary artery and the pattern of arterial dominance were determined in the last 37 patients. These variables were correlated with height, weight, age, sex, and presence or absence of coronary artery disease. Average distance from the base of the left coronary sinus to the origin of the left main coronary artery was 19.4 ± 2.7 mm. Average length of the left main coronary artery was 9.7 ± 4.3 mm. There was a large inherent variability between distance from the base of left coronary sinus to the origin of the left main coronary artery and height of the subjects. Other variables did not show positive correlation. Similar large variability was noticed between length of the left main coronary artery and height of the subjects.

Thus, from these observations it was not possible to predict the distance from the base of the left coronary sinus to the origin of the left main coronary artery or the length of the left main coronary artery using height or any other variable. The importance of these findings in relation to coronary angiography is discussed.
Problems in the detection of acute severe mitral insufficiency using flow‐directed catheters
Authors: Moore Thomas B. , Holmes David R. , Corcoran Francis H. , Baker William P.
Published: March 2007

A case of acute severe mitral insufficiency is described wherein bedside Swan‐Ganz right heart catheterization failed to establish the diagnosis. Emphasis is given to problems inherent in recording the diagnostic large dominant V‐waves with this technique, and to the necessity of resolving conflicting measurements with conventional cardiac catheterization.
The differential diagnosis of paracardiac lesions: Pericardial cysts
Authors: Unverferth Donald V. , Wooley Charles F.
Published: March 2007

The differential diagnosis of paracardiac lesions includes pericardial cysts (PC), which are benign, developmental lesions. Patients with PC are usually asymptomatic, although chest pain or dyspnea may occur. The diagnosis may be established by chest roentgenogram (radiographic contour and location), fluoroscopy (changes in shape with respiration or positioning the patient), and echography (smooth, cystic contour and characteristic location).

We present the diagnostic approach to patients with PC, and a review of the case histories of 12 patients with PC. Two symptomatic patients with PC were treated with surgical excision. Cyst aspiration in two patients yielded clear fluid and was initially considered therapeutic, but was followed by gradual reaccumulation of fluid.

Six of ten asymptomatic patients followed for three to ten years did not develop symptoms, nor was there radiographic evidence of progressive PC enlargement. Three of ten died from unrelated causes during the follow‐up period. Although symptomatic patients with PC may require surgical excision, asymptomatic patients with PC should be managed conservatively.
Iliac venous thrombosis in infants and children after cardiac catheterization
Authors: Mathews Robert A. , Park Sang C. , Neches William H. , Fricker Frederick J. , Lenox Cora C. , Zuberbuhler J. R.
Published: March 2007

Twenty‐two patients developed thrombosis of the lower abdominal portion of the inferior vena cava, iliac or femoral vein (IVT) after cardiac catheterization. All patients had at least one previous study from 1 day to 11 months of age (mean, 2 months) and seven had two catheterizations before discovery of IVT. Transposition of the great arteries was the most common defect associated with IVT (12/22, 55%).

From one to seven catheter changes were made during the time of venous cannulation (mean, 105 minutes). No clinical evidence of IVT was present immediately after the preceding cardiac catheterization. The discovery of significant IVT usually necessitated the use of a vein from the upper extremity to complete the cardiac catheterization. IVT was associated with previous BAlloon atrial septostomy using either a Fogarty or Rashkind septostomy catheter in 13/22 patients (59%). In addition, 86% of the patients had either of these BAlloon catheters or a Swan‐Ganz catheter used during a previous study.

The potential development of IVT should be considered especially in cyanotic infants and small children in whom balloon catheters are used.
Indicator dilution curves in the diagnosis of D‐transposition of the great arteries in infancy
Authors: Gingell Robert L. , Freedom Robert M. , Hawker Richard E. , Krovetz L. Jerome , Rowe Richard D.
Published: March 2007

Paired right and left atrial indicator dilution curves performed in a series of 17 patients with D‐transposition of the great arteries (D‐TGA) were reviewed. Taken together, the patterns obtained from patients who had trivial mixing between the pulmonary and systemic circulations were distinctive and easily recognizable. In the presence of substantial degrees of intracardiac mixing, however, the paired curves recorded become virtually identical and cannot be distinguished from curves recorded from patients with other forms of cyanotic congenital heart disease characterized by obligatory admixture. Thus paired atrial dye curves demonstrate a high degree of diagnostic specificity for the infant with D‐TGA at greatest risk, normally those with a small intracardiac shunt. Such a procedure should facilitate early balloon atrial septostomy and obviate deterioration in the infant's condition due to prolonged catheter manipulation and/or angiography.
Survival with total occlusion of the left main coronary artery. Significance of the collateral circulation
Authors: Valle M. , Virtanen K. , Hekali P. , Frick M. H.
Published: March 2007

Four patients with total occlusion of the left main coronary artery are described. Angina pectoris was severe (NYHA class 3‐4) and had lasted 20 months to seven years. Three patients had experienced a myocardial infarction. All displayed large collaterals arising from a nearly normal right coronary artery and feeding both the left anterior descending and the left circumflex arteries. The left ventricular ejection fractions ranged from 20% to 65%, and all patients had varying degrees of left ventricular asynergy. Coronary artery bypass surgery resulted in a marked improvement in three patients; one patient who underwent an aneurysmectomy died two months after the operation.

The data show that total occlusion of the left main coronary artery is compatible with survival if adequate collateral supply develops from the right coronary artery. In this rare angiographic subset collateral circulation is clearly functionally significant.
Comparison of digital boundary detection and semi‐automated analysis of left ventricular cine angiograms
Authors: Smalling Richard , Cole James S. , Skolnick Malcolm H.
Published: March 2007

A technique has been developed to analyze automatically 35 mm left ventricular cine angiograms with an image dissector and digital computer. The analysis procedure detected the ventricular boundary and aortic valve position, then calculated the projected left ventricular area and estimated volume, and performed a polar wall motion analysis as a function of time. The automated method was compared to a semi‐automated method using a technician‐operated electronic cursor linked to a minicomputer.

The two methods were used to analyze a set of idealized ventricular models as well as normal and abnormal angiographic data. The volumetric and wall motion data for the idealized models calculated by the two methods were equivalent (r > 0.99). Volumetric analysis of the patients' ventriculograms produced correlation coefficients of 0.88‐0.99. Corresponding wall motion data produced correlation coefficients of 0.72‐0.94. The time necessary to analyze 30 frames of a cine ventriculogram was approximately 30 minutes for each method.
Cardiac rhabdomyoma simulating pulmonic stenosis
Authors: Mahoney Larry , Schieken Richard M. , Doty Donald
Published: March 2007

The angiographic and echocardiographic findings of a right ventricular pedunculated rhabdomyoma prolapsing through the pulmonic valve which mimicked the hypoxic spells of tetralogy of Fallot are presented. A dense mass of echoes was seen within the pulmonic valve during systole. The presence of a right ventricular tumor was confirmed by angiography and surgery. The abnormal echoes were no longer seen following surgical excision of the tumor.
Transseptal and retrograde left ventricular catheterization in patients with the stent‐mounted porcine xenograft valve prosthesis in the aortic position
Authors: Handler Jeffrey B. , Thompson Stanley I. , Vieweg W. V. R. , Johnson Allen D.
Published: March 2007

Cardiac catheterization techniques for measuring the systolic pressure gradient across the stent‐mounted porcine xenograft in the aortic position and accomplishing left ventriculography are described. The transseptal technique is a rapid and predictable means of entering the left ventricle but requires a highly skilled operator. Retrograde left ventricular catheterization via the femoral artery is a technique familiar to all invasive cardiologists. Usually, a pigtail catheter is used. In patients with the stent‐mounted porcine xenograft in the aortic position, we have found the A2 Multipurpose catheter to be the fastest and most predictable means of entering the left ventricle from the groin. Potential complications of retrograde left ventricular catheterization in patients with aortic valve prostheses are discussed.
Myocardial ischemia after left ventriculography: Pathophysiology and clinical significance
Authors: Iskandrian Abdulmassih S. , Lichtenberg Richard , Segal Bernard L. , Kimbiris Demetrios , Bemis Charles E. , Mintz Gary S.
Published: March 2007

The effects of contrast material on the left ventricular end‐diastolic pressure (LVEDP) were evaluated in three groups of patients. Twenty patients (group I) with severe coronary artery disease (CAD) were found to have a change in LVEDP ≥ 20 mm Hg; 15 patients (group II) with severe CAD had elevation of LVEDP <20 mm Hg; ten patients (group III) with normal coronary angiograms had a rise in LVEDP <20 mm Hg. The change in LVEDP was higher in group I than in groups II and III (P <0.005). Nineteen patients (95%) in group I complained of angina pectoris or had ST segment depression (or both) after ventriculography in association with the sharp increment in LVEDP. Angina or ST depression were seen in only two patients (13%) in group II and none in group III. We conclude that 1) elevation of LVEDP of 20 mm Hg or more after ventriculography may be seen in patients with severe CAD (most likely secondary to direct depressant effect of the contrast material on the myocardium) and 2) the abrupt and marked rise in LVEDP may produce myocardial ischemia due to reduction of coronary blood flow, especially to the subendocardial layer.
The effect of acute aortic regurgitation on the transthoracic impedance cardiogram
Authors: Schieken Richard M. , Patel Mahendra R. , Falsetti Herman L.
Published: March 2007

In nine anesthetized dogs, recordings of the first derivative of the transthoracic impedance cardiogram (ICG) were made during varying grades of acute aortic regurgitation. Acute aortic regurgitation was induced using a specially designed umbrella catheter, passed retrograde across the aortic valve into the left ventricle. The RFA (representing the fraction of the aortic reverse flow to the aortic forward flow) was computed using an electromagnetic flow probe implanted around the ascending aorta. Both the peak of the scalar ICG, dz/dtmax, which occurs at peak systolic ejection, and the nadir of the scalar ICG, X, which marks the closing of the aortic valve, increased with aortic regurgitation. The planimetered areas of the ICG during systole (S̄), and in early‐diastole (X̄) increased during aortic regurgitation. These areas, S̄ and X̄, correlated with the electromagnetic normalized aortic stroke volume (r = 0.90) and the regurgitant volume (r = 0.78), respectively. The ICG ratio X̄/S̄ was correlated directly with the electromagnetic aortic regurgitant fraction (r = 0.86). This study demonstrates that the ICG waveform is consistently modified by experimental aortic regurgitation. Furthermore, these changes can be quantitatively related to the degree of aortic regurgitation.
Truncus arteriosus communis, an unusual anatomical variant of type I
Authors: Zamora Carlos , Jain Suresh Chand , Muñoz‐Castellanos Luis , Testelli Mario
Published: March 2007

We present a case of type I truncus arteriosus communis characterized by the horizontal origin of the main pulmonary artery from the common trunk and by a winding course up to a total length of 11.5 cm to the point of bifurcation of the pulmonary artery. Other than cyanosis the patient had a normal clinical history, which was followed for 20 years. The length of the main pulmonary artery could be related to the lower site of the incomplete septation of the common trunk, and it seems that hemodynamic factors contributed to this unusual configuration.
Coronary artery—left ventricular communications
Authors: Grollman J. H.
Published: March 2007

Vogelbach et al, in their recent article in Catheterization and Cardiovascular Diagnosis, describe two patients with small communications between the major branches of the coronary arteries and the left ventricle with associated chest pain [1]. Although they described this as a rare entity, I, among many others in the Southern California area, have noted several similar cases over the years, which raises the possibility that the finding is a normal variant that might also be found in individuals without chest pain.
Orifice‐view aortography in patients with congenitally deformed aortic valves: Determination of aortic valve area
Authors: Folger Gordon M. , Sabbah Hani N. , Anbe Daniel T. , Stein Paul D.
Published: March 2007

Orifice‐view aortography is a contrast cineaortographic technique that allows en face viewing of the aortic valve. In this projection the anatomic configuration of the aortic valve is identified, and it is possible to planimeterize the visualized aortic valve opening and accurately determine the orifice area. Fifteen individuals with congenitally deformed aortic valves with gradients ranging from trivial (<10 mm Hg) to surgically significant (> 60 mm Hg) were subjected to aortic orifice area measurement by orifice‐view aortography, and the area was compared with the peak systolic gradient and valve area. The results yielded a close correlation with the aortic valve area index as measured hydraulically or, as in three instances, directly from the surgically excised specimen (r = 0.94). A satisfactory correlation was also shown with the valve area index and the peak aortic valve gradient (r = 0.85). These observations indicate that orifice‐view aortography is an accurate method for the measurement of the aortic valve orifice and may be particularly useful when hydraulic measurements are unattainable or invalid.
Myocardial bridging of the left anterior descending artery: Evaluation using exercise thallium‐201 myocardial scintigraphy
Authors: Greenspan Mitchell , Iskandrian Abdulmassih S. , Catherwood Edward , Kimbiris Demetrios , Bemis Charles E. , Segal Bernard L.
Published: March 2007

Seven patients with myocardial bridging of the left anterior descending coronary artery were evaluated by means of thallium‐201 exercise scintigraphy. The degree of systolic narrowing was 60–70% in five patients and 75–80% in two patients. All patients had presented with chest pain. The resting electrocardiogram was normal in six patients; there were ST segment and T‐wave abnormalities in one patient. No patient complained of chest pain during exercise. The exercise electrocardiogram was negative in six patients and inconclusive in one patient. Exercise myocardial scans were negative in all seven patients. We conclude that no evidence of ischemia was demonstrated in patients with myocardial bridging of the left anterior descending coronary artery as determined by exercise electrocardiography and stress thallium‐201 scintigraphy.