bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstruction to left ventricular inflow secondary to combined mitral annular calcification and idiopathic hypertrophic subaortic stenosis
Authors: Hakki A‐Hamid , Iskandrian Abdulmassih S.
Published: March 2007

We present an elderly woman with idiopathic hypertrophic subaortic stenosis (IHSS) and obstruction to left ventricular inflow. The inflow obstruction is thought to be due to massive mitral annular calcification. The association of IHSS and inflow obstruction is rare and may be overlooked unless careful hemodynamic measurements are obtained.
Subaortic annular left ventricular aneurysm: An unusual cause of aortic regurgitation
Authors: Olowoyeye John O. , Thadani Udho , Charrette Edward J. P. , Salerno Tomas A. , Parker John O.
Published: March 2007

A subaortic left ventricular aneurysm in a 21‐year‐old white woman is described. The clinical features were those of moderately severe aortic regurgitation, and the chest x‐ray film showed cardiac enlargement with a bulge on the left heart border. Angiography confirmed the presence of gross aortic regurgitation and revealed an aneurysm behind the aortic root. At surgery, the aneurysm was found to be located below the aortic valve ring and communicated with the left ventricle through an ostium of 2.5 cm. Aortic valve replacement and closure of the aneurysmal ostium were carried out successfully.
Mechanism of nitroglycerin‐Induced hypoxemia
Authors: Weygandt Glenn R. , Kopman Ercument A. , Ludbrook Philip A.
Published: March 2007

We and others have previously demonstrated a consistent significant decline in arterial oxygen tension (PaO2) after sublingual nitroglycerin in premedicated and unpremedicated patients both with and without coronary artery disease and/or obstructive ventilatory disease. Thus, in our 19 patients, PaO2 fell by an average of 17% (12 mm Hg), mean systemic arterial pressure by 19% (17 mm Hg), pulmonary arterial pressure by 38% (6 mm Hg), pulmonary arterial occlusive pressure by 62% (5.3 mm Hg), and cardiac index by 16% (0.37 liter/min/m2) [P < 0.001 for each] after nitroglycerin. Previous experimental studies suggest that the mechanism for the reduction of PaO2 may be relief of hypoxic pulmonary vasoconstriction with an increase in perfusion to poorly ventilated or nonventilated regions of the lungs. To examine this possibility, pulmonary vasodilatation was precluded by administration of a pulmonary vasoconstrictor (phenylephrine) simultaneously with nitroglycerin in nine patients with coronary artery disease. No significant change was observed in systemic or pulmonary arterial pressure, pulmonary arterial occlusive pressure, or systemic and pulmonary vascular resistance, and PaO2 did not decline. In ten other patients with coronary artery disease, the intrapulmonary right‐to‐left shunt fraction was determined before and after sublingual nitroglycerin; only a minimal increase in shunt fraction of 1.4% was observed, quantitatively insufficient to account for the observed decline in PaO2, thus excluding a predominant effect of nitroglycerin on nonventilated alveoli as a cause of the hypoxemia. We conclude that the reduction of PaO2 after nitroglycerin administration is attributable to pulmonary vasodilatation with a relative increase in perfusion of poorly ventilated lung units.
Internal mammary arteriography: A new catheter technique by right brachial approach
Authors: Singh Ram N.
Published: March 2007

A technique for catheterization of both internal mammary arteries (IMAs) by right brachial approach is described. A special preformed catheter was used in 75 patients with coronary artery disease, including ten patients with direct IMA grafts. No complications occurred.

The IMAs were studied to examine the question of their usefulness in direct myocardial revascularization. There were individual variations in the size of IMAs with poor correlation to age (r=−0.432) and body surface area (r=0.517). Seventy percent of the women had adequate IMAs. The IMA diameter was equal to or larger than the left anterior descending coronary artery (LAD) in 72% and the right coronary artery (RCA) in 34% of comparisons.

Of the ten patients with direct IMA grafts, three instances of large side branches were seen. These branches appeared to carry large flows at the expense of the grafted coronary artery.

Preoperative internal mammary arteriography should be done if the use of this vessel is contemplated in direct myocardial revascularization to assure the use of an IMA of adequate caliber compared to the recipient coronary artery. The side branches should be meticulously ligated during the operation.
A simple device to reproduce the spatial orientations of the thorax and transducer for serial M‐mode and two‐dimensional echocardiograms
Authors: Wong Maylene , Shah Pravin M.
Published: March 2007

We have described a device consisting of three circular levels for locating the spatial orientations of the thorax and a transducer that can be used to reproduce the path of the sonic beam through the heart.
Coronary angiography post first myocardial infarction in the asymptomatic or mildly symptomatic patient: Clinical, angiographic, and prospective observations
Authors: Mautner Richard K. , Phillips John H.
Published: March 2007

The role of coronary arteriography In the asymptomatic or mildly symptomatic post first myocardlal infarction patient is controversial. Thirty‐one class 0–1 patients (Canadian Heart Association Grading System) underwent coronary arteriography within six months (mean 67 days) of their first myocardlal Infarction. Coronary arteriography revealed three‐vessel disease in nine (29%), two‐vessel disease in ten (32%), single‐vessel disease in ten (32%), and normal coronary arteries in two (6%). No pattern had left main disease, and two (6%) had teft main equivalent disease. In 12 patients with single‐vessel disease or normal coronary arteries there were no morbid events over a mean follow‐up period of 26 months. In the 19 with multivessel disease, eight (40%) developed a cardiac event during a mean follow‐up period of 11.4 months. These Included one who elected to undergo immediate aortocoronary bypass surgery, two with unstable angina, three acute myocardial infarctions, and two deaths. Based on these date and a review of the literature, a scheme Is proposed for the subsequent evaluation and treatment of this patient group.
Hemodynamic effects of disopyramide at rest and during exercise in normal subjects
Authors: Thadani Udho , Manyari Dante , Gregor Peter , Olowoyeye John , Leach Alan , West Roxroy O. , Parker John O.
Published: March 2007

The hemodynamlc effects of disopyramide phosphate, 2.0 mg/kg body weight, given intravenously over a period of five minutes were studied at rest and during exercise in ten patients without clinical or anglographlc evidence of heart disease.

Following disopyramide, the resting cardiac index was lower (4.0 ± 0.6 vs 4.3 ± 0.6 iners/min/m2, mean ± 1 SO, P <0.05), while left ventricular end‐dlastollc pressure (16 ± 4 vs 11 ± 4 mm Hg, P <0.001), pulmonary arterial (PA) mean pressure (20 ± 5 vs 17 ± 5 mm Hg, P <0.05), and brachlal arterial (BA) mean pressure (105 ± 8 vs 96 ± 7 mm Hg, P <0.05) were higher than the pre‐infuslon resting values. During exercise, there was no change in left ventricular end‐diastollc pressure while cardiac index rose from 4.0 ± 0.6 to 6.5 ± 0.6 itters/mln/m2 (P <0.001) and left ventricular stroke work index increased from 62 ± 19 to 84 ± 22 gm/beat/m2 (P <0.001). The normal hemodynamlc response during exercise after disopyramide despite the apparent depression of left ventricular function at rest probably reflects the positive inotroplc effect of enhanced sympathoad‐renergic activity.
Cross‐sectional echocardiographic visualization of abnormal systolic motion of the left ventricle in mitral valve prolapse
Authors: D'Cruz Ivan A. , Shah Shirish , Hirsch Leroy J. , Goldbarg Alberto N.
Published: March 2007

In 11 of 34 patients with typical mitral valve prolapse on the M‐mode echocardlogram, cross‐sectional echocardiography in the apical four‐chamber view revealed a characteristic abnormality not previously described. In mid‐ to late‐systole the ventricular septum contracted vigorously, forming a bend or sharp convexity toward the left ventricle, while motion of the posterolateral basal left ventricle was diminished and delayed. This finding was not encountered In 35 other patients with innocent systolic murmurs, or in 15 patients with mitral regurgitation of etiologies other than mitral valve prolapse. This abnormal pattern of left ventricular contraction on cross‐sectional echocardiography occurred with equal frequency In patients with holoaystollc and late‐systolic prolapse; it was seen more frequently In patients with severe prolapse than In those with mild to moderate prolapse.
Evaluation of thallium‐201 imaging in nontransmural ischemia and infarction
Authors: Haider Bunyad , Oldewurtel Henry A. , Moschos Christos B. , Lee Won K. , Regan Timothy J.
Published: March 2007

To assess the validity of thallium‐201 myocardial imaging in the diagnosis of non‐transmural ischemia and infarction, the proximal left anterior descending coronary artery was partially occluded for 60 minutes with a balloon‐tip catheter in intact anesthetized dogs in a basal state or during atrial pacing. In vivo sclntigrams of myocardium were compared with those obtained in the isolated heart and in the incised ventricle spread flat. None of the animals with partial occlusion wtth or without pacing demonstrated abnormal scintiscans in vivo. Removal of background by isolating the heart increased positive images to 30%; positive images were associated wtth an isotope count ratio between ischemlc and normal muscle of less than 0.67. Removal of superimposed nonischemic muscle in the heart enface increased image detection after pacing to 11 of 15. Since animals with subendocardlal scar failed to demonstrate a “cold area” in vivo, unfavorable geometry as well as extent and degree of ischemia appear to be important Thus, thallium radioactivity in superimposed and adjacent myocardium, as well as background, may limit the detection of nontransmural ischemia and scar.
Cimetidine (Tagamet) combined with steroids and H1 antihistamines for the prevention of serious radiographic contrast material reactions
Authors: Myers Gene E. , Bloom Frederick L.
Published: March 2007

Cimetidine has recently proved useful in the prophylaxis of certain allergic and other hlstamlne‐medlated reactions [1–6, 25]. We have encountered a patient who had a serious cutaneous and respiratory reaction to Renografln‐76 during cardiac catheterizatlon. For the four days preceding his second catheterizatlon, the patient was treated with prednlsone, 30 mg daily, dlphenhydramlne, 25 mg orally, three times a day, intravenous dlphenhydramlne, 25 mg, three times a day, and Solu‐Cortef, 500 mg, intravenously, every six hours. Despite this preparation, he developed an intense reaction to Renografln‐76, which did not respond to further doses of Solu‐Cortef and dlphenhydramlne in the catheterlzation laboratory. Cimetidine, 300 mg, in 100 ml of D5W over 15 minutes, rapidly reversed the entire cutaneous and respiratory phenomenon.

In the future, strong consideration should be given to using Cimetidine, in its intravenous form, as a routine medication in angiographlc laboratories where radio‐graphic contrast materials (ROM) are used. It may be helpful as a pretreatment for recognized RCM reactive patients when catheterlzation Is essential.
Hypercontractile cardiac state mimicking hypertrophic subaortic stenosis
Authors: Erdin Robert A. , Abdulla Abdulla M. , Stefadouros Miltiadis A.
Published: March 2007

Idlopathic hypertrophic subaortte stenosis (IHSS) is a disease manifested as a spectrum of various clinical and laboratory findings. We present the case of a patient with classical clinical and hemodynamlc findings of IHSS who lacked all of the typical echocardlographlc features of the disease. The case emphasizes the need for diligent use of bedside physical examination and vasoactlve manipulation of systolic murmurs whenever functional left ventricular outflow tract obstruction is suspected, since it can occasionally be missed by echocardlography.
Preliminary experience with reversal of venoatrial flow in the diagnosis of tricuspid regurgitation
Authors: Midwall Jay , Untereker William , Richard Augusto , Gorlin Richard , Teichholz Louis Evan , Herman Michael V.
Published: March 2007

Present methods of assessing trlcuspld regurgttation are often unreliable. We present preliminary data concerning a new angiographic method for identification of tricuspid regurgttation which evaluates direction of flow of contrast media during right ventricular (RV) systole in the Inferior vena cava (IVC) and hepatic veins following right atrial or IVC angiography.

Group I consisted of 15 patients who had tricuspid regurgttation by conventional criteria. AIM 5 patients exhibited reversal of venoatrial flow by right atrial or inferior vena cava angiography. In a control group (group III) of 20 patients who do not have clinical tricuspid regurgttation, one patient demonstrated retrograde flow. Group II consisted of 11 patients wtth mttral valve disease and mild to moderate pulmonary hypertension. All 11 had no conventional evidence of tricuspid regurgttation; however, all 11 had the pathophysiologlc potential for tricuspid regurgttatlon. Five of 11 had reversal of venoatrial flow during RV systole, suggesting the presence of clinically inapparent tricuspid

In conclusion, preliminary data suggest that angiographic reversal of venoatrial flow may be both sensitive and specific for the presence of tricuspid regurgttation. Further investigation wtth comparison to RV angiography and real‐time echocardiography should be performed.
Clinical significance and characteristics of exercise‐induced ventricular tachycardia
Authors: Codini Michele A. , Sommerfeldt Lorraine , Eybel Carl E. , Messer Joseph V.
Published: March 2007

Forty‐seven patients (0.08%) from a total of 5,730 consecutive patients undergoing treadmill stress tests developed one or more episodes of ventricular tachycardia. Forty patients had heart disease, coronary artery disease being the leading cause. Rest ECG was normal in 12 patients and showed long QT (>440 msec) in 16 patients. Ventricular tachycardia was brief and self‐terminating, requiring D/C cardloverston In only one patient. “Exertional hypotension” preceded ventricular tachycardia In 16 of 34 patients. There was poor correlation (r=0.16) between the rate of ventricular tachycardia (VT) and the underlying heart rate. Only four episodes of VT were Initiated by R on T premature ventricular beats.

In summary, exercise‐Induced ventricular tachycardia 1) Is a rare complication of treadmill stress test and occurs In patients with heart disease; 2) is frequently preceded by “exertional hypotension;” and 3) Is not related to the R on T phenomenon. The high incidence of prolonged QT may indicate a role for the autonomic nervous system in its pathogenesis.
Effect of intraarterial injection of heparin on the complications of percutaneous arterial catheterization in infants and children
Authors: Rao P. Syamasundar , Thapar Mohinder K. , Rogers James H. , Strong William B. , Lutcher C. Larry , Nesbit Robert R. , Wray Charles H.
Published: March 2007

Thrombotto complications of percutaneous arterial Catheterization still remain a significant and serious problem in infants and children. Systemic heparlnlzation has been recommended for prevention of these complications. The purpose of this study was to evaluate the effect of Intraarterial injection of heparin In reducing thrombotic complications following percutaneous femoral artery Catheterization. One hundred sixteen consecutive patients (ages four months to 20 years) studied by the Desllets‐Hoffman modification of Seldlnger's technique of femoral artery Catheterization were randomly allocated to the control or heparin groups using a double‐blind technique. At the completion of the Catheterization, 0.1 ml/kg of placebo or heparin (1,000 units/ml) was injected into the common iliac artery prior to removal of the catheter and sheath. Segmental plethysmography was performed in both lower extremities prior to and after the Catheterization, and a plethysmography index (PI) was calculated.

The age and sex distribution, diagnoses, number, type, and site of previous Catheterization, hemoglobin, platelet count, the amount of flush solution and the heparin contained therein, size of the catheter and sheath used, number of arterial punctures, and the length of the time in the artery were similar In the two groups (P > 0.1). Thrombln time and activated partial thromboplastin time were measured prior to the use of flush solution and prior to angtography, and these remained essentially unchanged In the two groups. The PI in the control group (97.5 ± 32) was not significantly different (P > 0.1) from that of the heparin group (97.7 ± 32). Similarly, the six to 24 month postcatheterlzatlon plethysmography data show no differences (P > 0.1). The number of patients with reduced Ipsilateral posterior tlbial and dorsalls pedls pulses was also similar (P > 0.1). None of the patients in either group required thrombectomy. The low incidence of arterial complications in our patients when compared with other studies may be related in part to use of a sheath, which is not called for in original Seldinger technique. The data suggest that full‐dose heparin administration does not significantly alter arterial complications following percutaneous femoral artery catheterization, especially in childern over five years of age.
Treatment of unstable angina pectoris with percutaneous transluminal coronary angioplasty (ptca)
Authors: Meyer Jürgen , Schmitz H. , Erbel R. , Kiesslich T. , Böcker‐Josephs B. , Krebs W. , Braun P. C. , Bardos P. , Minale C. , Messmer B. J. , Effert S.
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 40 patients (34 male, 6 female; 51.0 ± 8.5 years) with the typical clinical picture of unstable angina. All had a short history of pain (2.9 ± 2.0 months), angina at rest, transient ST and/or T wave changes during this period, and little or no enzyme elevations. The patients had a total of 41 stenoses (39 single, one double; one main‐stem, 26 left anterior descending, 14 right coronary artery). The degree of the stenoses was 95.5 ± 4.9% (area method) and 81.8 ± 10.7% (diameter method). PTCA was successfully performed in 26 cases (63%), reducing the stenoses to 61.5 ± 12.4% (area method) and 39.1 ± 10.0% (diameter method). One patient (2.5%) received an immediate bypass operation because of an acute vessel occlusion. Eleven of the 14 not successfully treated patients received an aortocoronary bypass within the next three to 35 days. All still had symptoms of unstable angina. Three patients refused operation. Their treatment consisted of nitroglycerin, beta‐blockers and nifedipin.

Seventeen of the 26 successfully treated patients were restudied after 4.9 ± 1.7 months. The degree of stenosis had risen to 69.2 ± 17.4% (area method). While the stenoses in 12 patients were equal or less than before PTCA, stenosis recurred in five cases. Two patients were successfully retreated.

PTCA can be performed with a good early success rate and a low complication rate in patients with unstable angina. Relief of pain and improvement of blood supply to the jeopardized myocardium can be provided immediately and with a limited amount of expense. The method can therefore be regarded as appropriate first‐stage treatment in such patients.
Right ventriculography as a valid method for the diagnosis of tricuspid insufficiency
Authors: Ubago José L. , Figueroa Alvaro , Colman Thierry , Ochoteco Alberto , Rodriguez Miguel , Durán Carlos MG
Published: March 2007

The value of right ventriculography in the diagnosis of tricuspid insufficiency (Tl) is often questioned because of (1) the high incidence of premature ventricular contractions (PVCs) during injection and (2) interference of the catheter in the valve closure mechanism. In 168 patients a commercially available, not preshaped, balloon‐tipped catheter was used for right ventriculography. To avoid the induction of PVCs, the catheter tip was placed in the middle third of the diafragmatic wall of the right ventricle, and the balloon was inflated, becoming trapped by the trabeculae. In this position the catheter's side holes should be located in the inflow chamber. To ensure this correct position, and therefore lack of ectopic beats during angiography, a saline test injection was performed previously in every case. With this technique the incidence of PVCs during ventriculography was only 7.7%. In all but one case, such beats were isolated. The 168 patients were divided into three groups according to their likelihood of experiencing tricuspid interference by the catheter group 1 included 41 patients with a normal heart or with coronary artery disease. No one from this group had Tl. Of group II, 28 patients with right ventricular pressure or volume overload or cardiomyopathy, only 2 had Tl, both with a previous clinical diagnosis of regurgitation. Group III contained 99 patients with rheumatic heart disease. Thirty‐five of them showed angiographic Tl, and 24 of these had this diagnosis confirmed either clinically or at surgery. It is felt that this technique of right ventriculography, with its low incidence of PVCs and slight interference with tricuspid closure, is a valid method for the objective study of the tricuspid valve.
Anomalous origin of the right coronary artery from the left anterior descending: Angiographic diagnosis in a patient with coronary artery disease
Authors: Simkoff William L. , Murphy Edward S. , Demots Henry , Khonsari Siavosh , Abbruzzese Pietro
Published: March 2007

The coronary angiographic findings of an individual whose right coronary artery originates from the proximal left anterior descending coronary artery are described.
Anomalous origin of the left coronary artery from the right pulmonary artery associated with complex congenital heart disease
Authors: Driscoll David J. , Garson Arthur , McNamara Dan G.
Published: March 2007

The rare coexistence of anomalous origin of the left coronary artery from the main pulmonary artery with other cardiac malformations prompts us to report an unusual case of anomalous origin of the left coronary artery from the right pulmonary artery associated with complete atrioventricular canal, patent ductus arteriosus, and coarctation of the aorta. It is important to recognize the presence of an anomalous origin of the left coronary artery in complex congenital heart disease since the coronary artery anomaly will increase the morbidity of the associated congenital cardiac malformation. Conversely, correction of the associated congenital cardiac defect may decrease the pulmonary artery pressure resulting in reduced left coronary artery flow, myocardial ischemia, and death.
Angled views in the evaluation of the right coronary artery
Authors: Gomes Antoinette S. , Esposito Vincent A. , Grollman Julius H. , O'Reilly Ronald J.
Published: March 2007

The use of cranial and caudal angulated views in the angiographic evaluation of the right coronary artery (RCA) was assessed in 61 patients. Each patient had a standard LAO and RAO view, followed by one or more angled views. The standard LAO view showed the area about the origin of the posterior descending artery (PD0) adequately in 33 of 46 patients (72% ), and the mid and distal portions of the posterior descending artery (PDm&d) adequately in 26/46 (56% ). The standard RAO view showed the PD0 adequately in only 17/46 (37% ) and the PDm&d adequately in 41/46 (89% ).

With the LAO cranial view, however, the PD0 was seen well in 45/46 (98% ), and PDm&d was seen well in 44/46 (96% ). The RAO angled views, although of more limited utility, also afforded improved visualization of the distal segments of the RCA.

We recommend the use of angled views in the evaluation of the right coronary artery, as these views, particularly the LAO cranial view, afford improved visualization of the distal segments of the RCA.
A mechanical arm for spatial registration of two‐dimensional echocardiographic sections
Authors: Geiser Edward A. , Christie Leonard G. , Conetta Donald A. , Conti C. Richard , Gossman, Gary S.
Published: March 2007

The accurate calculation of left ventricular (LV) wall motion from two‐dimensional echocardiographs will require the accurate registration of the position from which each two‐dimensional (2‐D) view was obtained. This paper describes a mechanical arm with five degrees of freedom that was developed so that the position and orientation of 2‐D echo sections could be calculated in three‐dimensional space. High precision potentiometers, direct or gear driven, permit calibration and measurement of each of the five movements. Using the length of the arm and the angles measured by these potentiometers, the position of a 2‐D section can be calculated with respect to a fixed reference point outside the body. The measurement arm was extensively retested after six months of clinical use. In patient studies, 95% confidence interval for positioning a cross‐section of the long axis is ± 6 mm. This error is similar to the cross‐plane resolution of most contemporary two‐dimensional transducers. On the basis of an extensive analysis of variance, recommendations are made to improve the accuracy of the arm.
Cardiac perforation with tamponade during cardiac catheterization
Authors: Gehl Leonard , Iskandrian Abdulmassih S. , Goel Inder , Mintz Gary S. , Kimbiris Demetrios , Bemis Charles E. , Mundth Eldred D. , Segal Bernard L
Published: March 2007

Among 6,675 adult patients undergoing cardiac catheterization in our institution, three patients developed cardiac perforation and tamponade (incidence 0.04%). Two perforations involved the left atrium, and one the right atrium. Tamponade developed in the three patients. Hemodynamic confirmation of tamponade was available in two patients. Pericardiocentesis was performed in all three patients. Two patients required emergency surgery. All patients recovered.
New technique for retrograde left heart catheterization in aortic stenosis
Authors: Baur Hans R. , Mruz Gerald L. , Erickson David L. , Vantassel Robert L.
Published: March 2007

Retrograde catheterization of the left ventricle in patients with aortic stenosis is frequently difficult and occasionally impossible. We have developed a new technique to facilitate this problem.

A standard #8 “pigtail” catheter is preformed with a 145° angle 7 cm from the catheter tip. With this catheter in the ascending aorta, the preformed angle lifts the catheter tip leftward and superiorly, allowing a straight guidewire a direct approach to the orifice of the stenotic aortic valve. Utilizing this technique, we were able to cross the stenotic aortic valve in 26‐29 consecutive patients with isolated aortic stenosis (mean gradient ± 0.22 cm2, mean fluoroscopy time for crossing: 32 ± 40 seconds). The 145° angle also lifts the catheter off the posterior wall of the left ventricle and allows a more parallel alignment of the catheter with the long axis of the left ventricle, leading to a more stable position with less ventricular dysrhythmias during angiography. Thus a preformed angle in the “pigtail” catheter facilitates crossing of the stenotic aortic valve and produces a more stable position in the left ventricle.
Rapid assessment of ventricular function in acute volume overload using opaque myocardial markers
Authors: Santamore William P. , Bove Alfred A. , Philips Charles M. , Monster Vim
Published: March 2007

Radiopaque markers, implanted in the myocardium, have been used to analyze ventricular function. However, the inordinate time involved in measuring marker motion limited widespread use. This work describes the application of a marker recognition system, which provides automatic recording and storage of marker locations. Use of the system was demonstrated by repeated measurements of ventricular performance in a canine model of acute volume overload.
Fixed vs nonfixed coronary stenosis: The response to a fall in coronary pressure in a canine model
Authors: Schwartz Jeffrey S.
Published: March 2007

The resistance of a coronary stenosis capable of passive vasomotion may change in response to alterations in intraluminal pressure. We studied the effects of a fall in perfusion pressure on the hemodynamics of two types of coronary stenosis in 12 open chest dogs: (1) a stenosis produced by placing a soft wire snare around the artery, and (2) a stenosis that was fixed in severity, produced by introducing and tying a short section of hollow plastic tubing into the coronary artery. Aortic pressure, coronary pressure proximal and distal to the stenosis, and coronary flow were measured. Pressure in the stenotic artery was lowered by tightening a snare placed very proximally on the artery. In arteries with a snare stenosis, lowering proximal coronary pressure by a mean of 31 mm Hg caused a rise in stenosis resistance from 0.86 ± 0.06 to 1.38 ± 0.14 units (p < 0.001). However, in arteries with a fixed plastic stenosis, lowering the proximal coronary pressure by a mean of 30 mm Hg caused a fall in stenosis resistance from 0.36 ± 0.04 to 0.21 ± 0.03 units (p < 0.001). The increase in resistance of the snare stenoses as pressure was lowered may be attributed to passive narrowing of the stenotic segment, suggesting that these stenoses were not fixed in severity. However, the fixed plastic stenoses did not show an increase in resistance as pressure fell because the tubing was not capable of passively narrowing. Therefore, the hemodynamics of a coronary stenosis depend importantly on the type of stenosis that is present and whether it is capable of vasomotion.
The myocardial oxygen supply/demand ratio in patients with and without coronary artery disease
Authors: Dehmer Gregory J. , Winniford Michael D. , Hillis L. David , Markham Roy V. , Firth Brian G.
Published: March 2007

This study was performed to assess the relationship between coronary sinus blood flow (by thermodilution) and myocardial oxygen demand (heart rate‐systolic arterial pressure double product) during atrial pacing in patients with and without coronary artery disease. In 11 individuals with coronary artery disease, pacing was performed to ischemia, as reflected by electrocardiographic changes or lactate production; 8 patients without coronary artery disease served as controls. Coronary sinus blood flow (in ml/min) was similar for the two groups at rest. However, the increase in coronary blood flow from rest to peak pacing was less (P = 0.025) in those with coronary artery disease (50 ± 26 ml/min) than in controls (79 ± 26 ml/min). The ratio of coronary sinus blood flow to double product was the same at rest in both groups (11.1 ± 2.2 × 10−3 controls, 11.6 ± 2.7 × 10−3 coronary artery disease; NS). At peak pacing, it was unchanged in the controls (10.4 ± 2.0 × 10−3) but fell in those with coronary artery disease (9.0 ± 2.5 × 10−3; P = 0.002). The aortic‐coronary sinus oxygen content difference was similar at rest in both groups and did not change in response to pacing in either group. Thus, in response to augmented myocardial oxygen demand, patients without coronary artery disease have an appropriate increase in coronary blood flow and myocardial oxygen supply, while in those with coronary artery disease who develop ischemia the increment in myocardial blood flow (and oxygen supply) is inappropriately low.
Thrombolysis in an aortocoronary saphenous vein graft
Authors: Smuckler Alan L. , Rufty Alfred J. , Headley Robert N. , Welbourne Rebecca
Published: March 2007

Selective intracoronary infusion of streptokinase during the acute phase of myocar‐dial infarction may reduce myocardial necrosis. Thrombolytic therapy of acute myocardial infarction has been primarily applied to the native coronary circulation. We are reporting successful thrombolysis in an aortocoronary saphenous vein graft 39 months after bypass surgery. Thrombosis may have developed as a complication of catheterization, and streptokinase may also prove useful in the reversal of thrombosis in this setting.
Transluminal coronary angioplasty of the right coronary artery brachial cutdown approach
Authors: Krajcer Zvonimir , Boskovic Dejan , Angelini Paolo , Leatherman Louis L. , Springer Arthur , Leachman Robert D.
Published: March 2007

Transluminal coronary angioplasty (TCA) of the right coronary artery (RCA) was performed by brachial cut‐down approach in 33 patients during a period of 16 months. Flexible‐tip guiding catheters were used in all cases. TCA was successful in 27 of 33 patients (81%). The stenosis was reduced in successful cases from a mean of 89% predilatation to 26% postdilatation (P < 0.001). The systolic pressure gradient across the lesion was reduced from a mean of 49 mm Hg to 4 mm Hg (P < 0.001). Following successful TCA, patients experienced marked improvement in clinical status, functional capacity, and relief of angina. The complication rate In this study was low. There was no early or late mortality. The most common complication was dissection of the coronary artery occurring in four cases (12%). One patient sustained an acute inferior myocardial infarction. Only one patient required emergency coronary artery bypass surgery. The late follow‐up (mean 6 months) anglography was obtained in 17 patients. The stenosis recurred in late follow‐up in three cases (18%). Our initial experience revealed that the use of softer guiding catheters by brachial technique offers more selective approach for TCA of RCA lesions and provides better results than percutaneous femoral approach with fixed‐tip catheters. Our success rate of 81% for dilatation of RCA is significantly higher than previously reported.
Clinical significance of the double silhouette in the septal side in left anterior oblique cine left ventriculograms
Authors: Takatsu Fumimaro , Osugi Junichi , Nagaya Teruo
Published: March 2007

The clinical significance of a line often visible in left ventriculograms performed in the left anterior oblique position was analyzed. This line runs inside the free border of the septal silhouette, and occasionally displays a movement completely different from that of the border. Analysis of ventricuiograms of 189 patients with single‐vessel disease suggested that the movement of this line reflects the contractile state of the left ventricular myocardium near the posterior interventricular groove, supplied by the right coronary or circumflex artery. Evaluation of this line may be useful for a more complete assessment of left ventricular function in patients with ischemic heart disease.
Cardiac amyloidosis masquerading as constrictive pericarditis
Authors: Kern Morton J. , Lorell Beverly H. , Grossman William
Published: March 2007

Cardiac amyloidosis cannot always be differentiated from constrictive pericarditis even after careful review of the clinical, laboratory, and hemodynamic data prior to pericardial exploration. This case report underscores the necessity of precise histologic examination for cardiac amyloidosis in all suspected cases of constrictive pericarditis at the time of pericardiectomy.
Method for computation of cardiac output in mitral stenosis independent of left ventricular dimensions and kinetic state: Correlation with cardiac catheterization via the fick method
Authors: Seitz W. , Spiel M. , Edmiston W. , Miller F.
Published: March 2007

An hydraulic orifice formula offering the possibility of quantifying cardiac output in conditions of mitral stenosis is tested using potentially noninvasive portions of catheterization data from patients evaluated for obstructive mitral valve disease. The equation studied is V = (1/21) R A T2, where V is the cardiac output (mi/min), R is the heart frequency, A is the mitral valve area (cm2), and T is the diastolic filling interval (sec/min). The mitral valve area was determined by the Gorlin formula, and R and T were measured from the pressure tracings recorded at cardiac catheterization. The degree of correspondence between the equation tested and the measured cardiac output as determined by the Fick principle technique is characterized by r = 0.87, SE = 450 mi/min, N = 10. The results suggest that the new formulation may offer a noninvasive method for estimating the cardiac output status of patients with mitral valve disease once mitral valve area is measured either at catheterization or by two‐dimensional echocardiography.
Noninvasive evaluation of a left ventricular pseudoaneurysm: Complementary role of echocardiographic and nuclear techniques
Authors: Ptacin Michael J. , Bamrah Virinderjit S. , Wann Lee S. , Olinger Gordon N. , Singh Rajinder
Published: March 2007

This 45‐year‐old white male was evaluated for congestive heart failure initially ascribed to a rapidly progressive cardiomyopathy. Both radionuclide ventriculography and echocardiography correctly identified a left ventricular pseudoaneurysm as the cause for heart failure. Thallium‐201 scintigraphy, by demonstrating a large perfusion defect, suggested a large ostium of the pseudoaneurysm. Following resection of the false aneurysm, a Dacron prosthesis was required to close a large posterior wall defect. We conclude that both radionuclide ventriculography and echocardiography can independently demonstrate a left ventricular pseudoaneurysm. The combined noninvasive approach is able to delineate various anatomical aspects of the pseudoaneurysm and help in planning adequate surgical intervention.
Nonpenetrating traumatic complete heart block and myocardial infarction with normal coronaries: A case report with review of the literature
Authors: Kennedy Willard J. , Sridharan Marandapalli R. , Flowers Nancy C.
Published: March 2007

A case of transient complete heart block and lateral wall myocardial infarction secondary to nonpenetrating chest trauma is presented. Lack of any associated cardiac lesions is an interesting feature of this case report. Proposed criteria for heart block secondary to trauma and difficulty in making the diagnosis of myocardial infarction secondary to trauma due to lack of appropriate “gold standard” are discussed.
Consumptive coagulopathy secondary to a groin hematoma: An unusual complication of percutaneous transfemoral catheterization
Authors: Murdaco Francis , Auerbach Michael , Berdoff Russell L. , Goldberg Emanuel
Published: March 2007

An unusual case of consumptive coagulopathy due to hematoma formation, which occurred as a local complication of percutaneous transfemoral coronary arteriography, is reported. To our knowledge, this entity has not been reported in previous series. Prompt recognition of the syndrome through appropriate laboratory tests and early surgical intervention is indicated.
New method: Calculation of magnification factor from an intracardiac marker
Authors: Cha Se Do , Incarvito John , Maranhao Vladir
Published: March 2007

In order to calculate a magnification factor (MF), an intracardiac marker (pigtail catheter with markers) was evaluated using a new formula and correlated with the conventional grid method. By applying the Pythagorean theorem and trigonometry, a new formula was developed, which is

In an experimental study, MF by the intracardiac markers was 0.71 ± 0.15 (M ± SD) and one by the grid method was 0.72 ± 0.15, with a correlation coefficient of 0.96. In patients study, MF by the intracardiac markers was 0.77 ± 0.06 and one by the grid method was 0.77 ± 0.05. We conclude that this new method is simple and the results were comparable to the conventional grid method at mid‐chest level.
Left ventricular and aortic catheterization and angiography via a patent ductus arteriosus: A new technique
Authors: Mardini Mohamed K. , Rao P. Syamasundar
Published: March 2007

A new “transductal” technique of aortic arch and left ventricular angiography in patients with patent ductus arteriosus (PDA) is described by introducing the catheter to the aortic arch from the pulmonary artery via the PDA. Over a 4‐year period, 44 infants and children with complicated PDA underwent cardiac catheterization with this technique at our institution. Twenty‐five of the 30 in the group with PDA alone and 12 of 14 in the group with associated cardiac defects had successful aortic arch catheterization and angiography, an 84% success rate. No complications were encountered during the procedure. The technique offers a safe alternative to retrograde arterial catheterization in patients with PDA who have other associated lesions.
Percutaneous transluminal angioplasty of a large septal artery
Authors: Comazzi James L. , Jang Geun C. , Marsa Robert J. , Willis William H. , Anderson Donald L. , Wareham Ellsworth E.
Published: March 2007

A severely stenotic, large‐caliber, first septal artery was successfully dilated in a patient with refractory angina and nonsurgical, multivessel coronary artery disease. The success of this dilatation was related to favorable coronary anatomy and to the availability of a guidewire‐directed dilatation catheter. Septal artery stenosis with or without surgically accessible stenoses in other coronary vessels represents a potential indication for percutaneous transluminal coronary angioplasty.
Angiographic identification of primary coronary anomalies causing impaired myocardial perfusion
Authors: Donaldson R. M. , Raphael M. , Radley‐Smith R. , Yacoub M. H. , Ross D. N.
Published: March 2007

The origin and early branching of the coronary arteries is fairly constant. Anomalous origin of the coronary arteries, which produced significant abnormalities of myocardial perfusion, were documented in 13 adult patients undergoing investigation because of chest pain. All underwent surgical treatment with relief of the presenting symptoms. They can be divided into four groups: (1) Origin of the left anterior descending branch of the left coronary artery (LCA) from the pulmonary artery (PA) (three cases); (2) origin of the LCA from the anterior sinus. Acute angulation of the ostium and compression of the intramural segment of this coronary produced severe myocardial ischaemia in three patients. (3) Origin of the LCA from the right coronary artery with its proximal segment closely related to the noncoronary sinus (one patient) in whom relief of symptoms was obtained by surgery. (4) Origin of the LCA from the PA with reversal of coronary flow and left to right shunting (six patients). It is concluded that anomalies of the origin of the coronary arteries are rare, but can produce specific clinicopathological entities that can be diagnosed with confidence and corrected surgically. Moreover, the study emphasises the need for angiographic awareness of these coronary anomalies, even in adult patients in whom atherosclerotic disease would be the most likely finding at cardiac catheterisation.
Provocative ergonovine testing in patients without obstructive coronary disease
Authors: Carabello Blase A. , Gash Arnold K.
Published: March 2007

Ergonovine administration during coronary angiography is frequently used to rule out coronary spasm as a cause of chest pain. We performed this study to determine which electrocardiographic variables (other than ST segment elevation with pain) and which chest pain characteristics might be predictive of ergonovine test outcome in patients without obstructive coronary disease.

Thirty‐one patients had an electrocardiogram recorded during chest pain. Three of four patients (75%) who had an ischemic electrocardiogram with pain had a positive ergonovine test while only 1 of 27 (4%) patients who had a nonischemic electrocardiogram during chest pain had a positive ergonovine test (p < 0.001)

Pain that occurred predominantly at rest was present in five of five patients with positive ergonovine tests but pain occurring predominantly at rest was also present in 76% of patients with negative ergonovine tests (85%). Prompt relief of pain with nitroglycerine was also present in all patients with a positive ergonovine test but was also seen in 58% of patients with a negative test (NS). Association of chest pain with nausea, vomiting, diaphoresis, or radiation to left arm, jaw or neck were similarly poor predictors of ergonovine test outcome.

We conclude that ergonovine testing in patients without obstructive coronary disease is of low yield if an electrocardiogram recorded during pain does not show evidence of ischemia. Historical features of the chest pain are not good predictors of test outcome.
Noninvasive ergonovine maleate provocative testing for coronary artery spasm: The need for routine thallium‐201 imaging
Authors: Shanes Jeffrey G. , Krone Ronald J. , Fisher Keith , Shah Bharat , Eisenkramer Gail , Humphrey Jane R.
Published: March 2007

We administered ergonovine and used both electrocardiographic monitoring and thallium‐201 [201TI] imaging to detect reversible ischemia in 100 patients. Patients already established as having coronary artery spasm and those with nonbypassed, proximal, high‐grade coronary artery stenosis were excluded. No complication occurred in any patient. The use of thallium imaging in addition to electrocardiographic monitoring resulted in a higher degree of sensitivity than did ECG monitoring alone. Fourteen patients demonstrated evidence of coronary artery spasm as documented by 201TI imaging but of the 14, significant ECG changes occurred in only 50%, and classic ST segment elevation in 21%. Thus, in carefully selected patients the noninvasive provocation of coronary spasm can be accomplished safely, but ECG monitoring must be combined with thallium‐201 imaging to achieve an acceptable degree of sensitivity.
Cardiac rupture following intracoronary streptokinase
Authors: Vasilomanolakis Emmanuel C. , Famularo Michael A. , Kozlowski Jay , Schrager Bernard , Licht James R. , Ellestad Myrvin H.
Published: March 2007

Thrombolytic dissolution of coronary artery thrombus has added new dimensions to early myocardial infarction treatment. Reperfusion via streptokinase infusion has been shown to be beneficial; however, adverse effects are being noted. We present the case of a patient so treated who subsequently developed left ventricular free wall rupture.
Pulmonary arteriography through patent ductus arteriosus with preformed catheters
Authors: Momma Kazuo , Nakazawa Makoto , Satomi Gengi , Chon Yong , Takao Atsuyoshi
Published: March 2007

Selective pulmonary arteriography was performed successfully with new preformed catheters in eight consecutive patients with pulmonary atresia or severe stenosis and patent ductus arteriosus. The catheters were inserted percutaneously into the femoral artery and passed into the patent ductus arteriosus very easily within a few minutes. Pulmonary arteriography was performed with biplane cineangiography. All eight patients showed either stenosis or secondary atresia in the central pulmonary artery. The obstructive lesions occurred at the junction of either a patent ductus arteriosus or a surgically anastomosed subclavian artery.
Coexistent mitral stenosis and dynamic left ventricular outflow obstruction
Authors: Gash Arnold K. , Ferri Donald P. , Kolff Jacob , Carabello Blase A. , Spann James F.
Published: March 2007

A 66‐year‐old female with known mitral stenosis presented with symptoms of progressive pulmonary congestion. Concomitantly, subvalvular left ventricular outflow obstruction was suspected clinically and both lesions were confirmed at cardiac catheterization. At operation, marked septal hypertrophy and rheumatic mitral stenosis were observed, the mitral valve was replaced, and a septal myomectomy was performed.
Anomalous origin of the left anterior descending coronary artery from the pulmonary artery: Surgical correction in an adult
Authors: Singh Ram N. , Taylor Paul C.
Published: March 2007

A 45‐year‐old female with severe anginal symptoms was found to have anomalous origin of the anterior descending branch of the left coronary artery (LCA) from the pulmonary artery. Proximal ligation and anastomosis with aortocoronary saphenous vein graft (SVG) were performed. There was complete relief of symptoms. Two‐year postoperative angiography revealed a patent SVG with excellent flow, normalization of the caliber of the right and left circumflex coronary arteries with complete regression of collaterals, and improved left ventricular function.