bluuebunny/crossref_metadata_2025 huggingface dataset:
Proximal pancreatoduodenectomy for chronic pancreatitis
Authors: Stapleton G N , Williamson R C N
Published: March 2007

A personal series is reported of 52 patients who underwent proximal pancreatoduodenectomy for severe chronic pancreatitis between 1979 and 1994. There were 13 women and 39 men of median age 42·2 (range 12–70) years. Disease predominantly affected the head of pancreas, with calcification present in 37 patients. Indications for operation were chronic pain (47 patients), obstructive jaundice (19) and duodenal stenosis (six); cancer was suspected in 12. In addition, 14 patients had a pseudocyst, two pancreatic endocrine failure and 20 exocrine failure. Aetiology was chronic alcohol abuse in 34, recurrent acute pancreatitis in five and unknown in 13. Pylorus-preserving proximal pancreatoduodenectomy was performed in 45 patients, while the remaining seven had partial gastrectomy. Drainage of a dilated distal pancreatic duct by side-to-side pancreaticojejunal anastomosis was included in 15 patients. Mean operating time was 6·2 (range 4·5–9·5) h and mean blood loss was 2·7 (range 0·2–13·0) litres. There were no hospital deaths, but three patients required a second operation and five had percutaneous drainage of infected collections. During a median follow-up of 54 months, six patients required completion distal pancreatectomy for renewed pain and four others had persistent pain. Four patients required intervention for stricture at the biliary-enteric anastomosis. Ten patients have died from causes not directly related to chronic pancreatitis. Proximal pancreatoduodenectomy is a relatively safe procedure, effectively palliating pain in 80 per cent of patients with chronic pancreatitis.
Brush cytology for the diagnosis of rectal carcinoma
Authors: Farouk R , Edwards J , Thorne M , Young W , MacDonald A W , Monson J R T , Lee P W R
Published: March 2007

The use of brush cytology as an aid in the preoperative diagnosis of rectal cancer was prospectively assessed at 328 examinations in 289 consecutive patients with rectal lesions suspicious of carcinoma. Forty-five patients were reported as having benign polyps. There was 97 per cent agreement between conventional biopsy and cytology brushings for this group. Some 249 patients underwent a subsequent resection allowing comparison with formal histology. Forceps biopsy produced a true-positive diagnosis of cancer in 218 patients (89·7 per cent) and cytology in 222 (91 per cent). The sensitivity for forceps biopsy and cytology was 81 and 83 per cent respectively, with a combined sensitivity of 98 per cent. It is concluded that the addition of cytology to forceps biopsy increases the diagnostic yield in a single examination, and may be a complementary method of establishing the diagnosis of rectal lesions.
Effect of different infusion regimens on colonic motility and efficacy of colostomy irrigation
Authors: Gattuso J M , Kamm M A , Myers C , Saunders B , Roy A
Published: March 2007

The colonic motility response and short-term clinical effectiveness of colonic irrigation was studied in five patients with an end-colostomy, each of whom was studied on up to six occasions, using volumes of 500 and 1500 ml water infused under gravity and over a period of 2·5 and 5 min with a pump. The median baseline colonic luminal pressure was 14 cmH2O and rose to 42 cmH2O with a 500-ml infusion, and to 74 cmH2O with a 1500-ml infusion. Irrigation induced high-pressure (over 200 cmH2O) propagated waves which caused the efflux of colonic contents. These were more numerous after a 1500- than a 500-ml infusion (median 4·5 versus 2·0 respectively). There was no difference between the two volumes infused in the incidence of colostomy breakthrough before subsequent irrigation. Colostomy irrigation with 500–1500 ml water appears to produce intracolonic pressure rises that are safe. These volumes can be infused rapidly under gravity alone.
Strengths and weaknesses of laparoscopic and open mesh inguinal hernia repair: A randomized controlled experimental study
Authors: Morgan L F , Shelton J C , O'Riordan D C , Moore D P , Winslet M C , Davidson B R
Published: March 2007

There are no objective data available on the relative strengths of inguinal hernia repairs. The aim of this randomized controlled study was to measure the force required to disrupt laparoscopic and open mesh repairs in a porcine model. Eleven pigs had inguinal hernia repair following randomization to an open mesh group (n = 5) or a transabdominal preperitoneal laparoscopic group (n = 6). Four weeks after operation the pigs were killed and the pelvic girdles were mounted in a test jig on a mechanical testing machine. The applied disruption forces were measured and recorded. Mean(s.d.) force required to disrupt the normal inguinal canal (n = 11) was 68·6(30·1) N with no difference between groups. The open mesh repair required 110·3(41·4) N and the laparoscopic mesh 220·0(95·2) N. Both open and laparoscopic mesh repairs were stronger than the normal side (P<0·03). The laparoscopic mesh repair was stronger than the open mesh repair (P = 0·04). This model provides a standardized method for mechanically testing inguinal hernia repairs in pigs. It confirms that both open and laparoscopic mesh hernia repairs are stronger than the non-herniated normal side at 4 weeks after operation. Laparoscopic mesh repair is stronger than open mesh repair. The weakest points of the repairs correlate well with those identified in clinical reports.
Effects of vertical-banded gastroplasty on bone and mineral metabolism in obese patients
Authors: Cundy T , Evans M C , Kay R G , Dowman M , Wattie D , Reid I R
Published: March 2007

The surgical treatment of obesity can have adverse effects on bone, but there are few published data on the effects of vertical-banded gastroplasty. Serial measurements of bone mineral density at the lumbar spine and three upper femoral sites, using dual-energy X-ray absorptiometry, and also of biochemical indices of bone and mineral metabolism at intervals up to 2 years after operation were performed in 18 patients with morbid obesity who had vertical-banded gastroplasty. Bone mineral density measurements were also made in age- and sex-matched non-obese controls. Bone density before operation was significantly greater in the obese than in the controls (P<0·02 at all sites). The obese patients lost weight rapidly after vertical-banded gastroplasty (mean weight loss 29 kg at 1 year, P< 0·001). This was accompanied by a measurable loss of bone density from the trochanter and Ward's triangle sites in the upper femur (P<0·05), but not from the lumbar spine. Bone density values remained stable over 14 months in the controls. Hydroxyproline excretion increased significantly (P< 0·005), indicating an increase in bone resorption. Alkaline phosphatase levels decreased significantly (P< 0·001), but this probably represents the reversal of hepatic steatosis. There was no evidence of hyperparathyroidism or vitamin D deficiency. In conclusion, vertical-banded gastroplasty causes modest bone density loss from femoral sites, but not the lumbar spine. The difficulties of assessing bone density changes in the obese are discussed.
Desmoids in familial adenomatous polyposis
Authors: Clark S K , Phillips R K S
Published: March 2007

Clinical desmoid disease affects approximately 10 per cent of patients with familial adenomatous polyposis (FAP); the subclinical rate is unknown. Desmoids are probably neoplastic rather than regenerative in origin and may arise in association with germline or somatic mutations at or beyond codon 1444 of the APC gene. Intra-abdominal desmoids behave unpredictably but are an important cause of death in those with FAP. Signal intensity on magnetic resonance imaging reflects tumour cellularity, which in part determines progression, and this may help management. Surgical treatment of advanced desmoids is hazardous, but medical treatments have limited success. Chemotherapy with doxorubicin and dacarbazine is currently under evaluation.
Encapsulation of Hemoglobin in Mesoporous Silica (FSM)—Enhanced Thermal Stability and Resistance to Denaturants
Authors: Urabe Yoko , Shiomi Toru , Itoh Tetsuji , Kawai Akiko , Tsunoda Tatsuo , Mizukami Fujio , Sakaguchi Kengo
Published: March 2007

Hemoblogin (Hb), which is a typical oligomeric protein, was introduced into the pores of mesoporous silica (FSM: folded‐sheet mesoporous material) that had a diameter of 7.5 nm. Soret CD spectra of Hb–FSM‐7.5 conjugates showed a peak that was identical to that of free Hb. This suggests that Hb retained its highly ordered structure in the mesoporous silica. In addition, the UV‐visible absorption spectrum showed that Hb had an increased resistance to heat denaturation in the silica. Even after heat treatment at 85 °C, Hb–FSM‐7.5 retained its ligand‐binding activity. The stability of Hb–FSM‐7.5 was examined further by measuring its peroxidase‐like activity. Encapsulation of Hb resulted in the retention of activity in the presence of high NaCl or Gdn‐HCl levels. This suggests that encapsulation prevented dissociation and denaturing. Thus, it seems that the mesopores created a favorable environment for the oligomeric protein to perform its function, even under harsh conditions.
Cardiac catheterization experience in hospitals without cardiovascular surgery programs
Authors: Hansing Charles E. , Hammermeister Karl , Prindle Kirk , Twiss Richard , Schwindt R. Richard , Gowing Burton , Crecelaius Lyle , Robinson Wendell
Published: March 2007

In order to study the cardiac catheterization experience in hospitals without cardiovascular surgery programs, data was collected from all 8 Washington „satellite”︁ laboratories over a 5‐year period. There were 5 deaths (0.13%) during the 3878 coronary arteriography procedures. Of the 5,4 had severe left main coronary artery lesions. Of these patients, 2 died during the 24‐hour follow‐up period after an uncomplicated study. This mortality rate is remarkably good considering that the 5‐year period includes the early experience of 7 laboratories. There were 7 myocardial infarctions (0.18%) and 6 strokes (0.15%).

The average number of coronary arteriograms done per angiographer during 1976 was 65.

The experience of the Washington State „satellite”︁ cardiac catheterization laboratories proves that the immediate availability of cardiovascular surgery and large case loads per angiographer are not necessary in order to safely perform cardiac catheterization and coronary arteriographic studies. Additional studies should be undertaken to determine the appropriate distribution of cardiac diagnostic facilities.
Hypertrophic cardiomyopathy with midventricular obstruction associated with mitral stenosis: Partial relief of the obstruction by papillary muscle and trabecular resection
Authors: Falicov Raul E. , Karunaratne H. B. , Cahill Noel , Lamberti John J.
Published: March 2007

A patient is reported with hypertrophic cardiomyopathy where midventricular obstruction was found in association with mitral stenosis. Partial relief of the intraventricular obstruction was obtained by extensive papillary and trabecular muscle resection in the mid‐left ventricular area, in conjunction with mitral valve replacement with a porcine heterograft.
Clinical and angiographic implications of a depressed echocardiographic ejection fraction in coronary artery disease
Authors: Wharton Thomas P. , Cohn Peter F. , Sloss Laurence J. , Angoff Gerald H.
Published: March 2007

To evaluate the clinical and angiographic implications of a depressed echocardiographic ejection fraction (EF) in coronary artery disease, 45 patients with an echocardiographic EF < 0.50 were studied with complete cardiac catheterizations. Most of the patients had clinical evidence of a prior myocardial infarction, cardiomegaly, and/or congestive heart failure. All had coronary arteriographic evidence of multivessel disease and either reduced cardiac output, elevated left ventricular end‐diastolic pressure, or both. Reduction in percentage of echocardiographic dimensional shortening closely paralleled reduction in echocardiographic EF. Forty of the 45 patients (89%) had an angiographic EF less than 0.50. There was considerable scatter of angiographic EF's with echocardiographic EF's between 0.40 and 0.50, limiting the usefulness of these latter values. However, 23 of the 24 patients (96%) with an echocardiographic EF less than 0.40 had an angiographic EF less than 0.40, and there was a linear relationship between these echocardiographic and angiographic values with a correlation coefficient (r) = 0.54 (SEE = ±0.15, p<0.05). All of the 12 patients with both reduced septal and reduced posterior wall excursion on the echocardiogram had both abnormal echocardiographic and angiographic ejection fractions, and 10 of the 12 had EF < 0.40 by both techniques. Our study suggests that coronary artery disease patients with extensive left ventricular dysfunction can be identified noninvasively, and the echocardiographic EF may be useful in deciding whether such patients may require special cardiac catheterization procedures to evaluate contractile reserve if cardiac surgery is being considered.
Mechanism of electrical alternans in patients with pericardial effusion
Authors: Rinkenberger Robert L. , Polumbo Ralph A. , Bolton Merle R. , Dunn Marvin
Published: March 2007

Electrical alternans concomitant with pericardial effusion has been considered a pathognomonic sign suggestive of a large effusion with cardiac tamponade, particularly if there is P wave alternans as well as QRS alternans. However, the mechanism of this phenomenon remains controversial. A patient with pericardial effusion secondary to adenocarcinoma of the lung with metastases, pericardial effusion, electrical alternans, and cardiac tamponade was studied by echocardiography, right and left heart catheterization, and pericardiocentesis. Hemodynamic data were consistent with cardiac tamponade. The echocardiogram demonstrated a large anterior and posterior pericardial effusion. Noncongruous motion of the septum and posterior wall was recorded at a rate equal to the heart rate. In addition, congruous motion of the septum and posterior wall was recorded at a rate that was half the heart rate and corresponded to the electrical alternans. The congruous movement disappeared after pericardiocentesis, as did the electrical alternans. The electrical alternans is synchronous with and due to the pendulous movement of the heart within the pericardial sac, as demonstrated by echocardiogram and cineangiograms.
Relief of coronary artery spasm by nitroglycerin: Time‐dependent variability in drug action
Authors: Fallen Ernest L. , Cairns John A. , Stolberg Harold O. , Tanser Paul H.
Published: March 2007

The arteriographic distinction between a fixed atheromatous obstruction and localized vasospasm in the coronary artery is often decided by the response of the lesion to nitroglycerin. We studied the time course of nitroglycerin in four patients with coronary artery spasm as revealed by selective angiography. Following complete dissolution of a 0.6 mg tablet of nitroglycerin sublingually, a slight increase in heart rate occurred as early as two minutes, variable changes in overall vessel diameter were observed within four minutes, but the localized spasm remained fixed. It was not until six minutes had elasped that reinjection showed disappearance of spasm and uniform patency of the vessel in all cases. These observations stress the importance of waiting an appropriate period of time (at least six minutes) following complete absorption of sublingual nitroglycerin before any conclusion can be rationally drawn regarding the nature of a stenotic lesion as seen angiographically.
Ergonovine testing for coronary artery spasm in patients with angiographic mitral valve prolapse
Authors: Sabom Michael B. , Curry R. Charles , Pepine Carl J. , Christie Leonard G. , Conti C. Richard
Published: March 2007

Coronary artery spasm (CAS) has been postulated to be a pathophysiologic mechanism in the production of ischemic‐like chest pain and ECG changes in patients with idiopathic mitral valve prolapse syndrome. To evaluate the possible role of symptomatic CAS evoked by ergonovine maleate, this agent was administered (0.05 to 0.4 mg IV) to 24 patients with chest pain and mitral valve prolapse who had no significant (<50%) coronary artery obstruction.

Symptoms, ECG and blood pressure changes were monitored in all patients following ergonovine administration. No significant changes were observed in heart rate, systolic blood pressure, or double product. Six patients developed their typical chest pain. In two of these six with chest pain, ST segment shifts >1 mm were seen.

Post‐ergonovine left ventricular end‐diastolic pressure (LVEDP) and coronary angiographic changes were also studied in a subgroup of 12 of these patients, including five of the six chest pain responders. In the five chest pain responders, pain was associated with a significant rise in LVEDP, whereas no significant change occurred in those patients not experiencing chest pain (p<0.01). Chest pain was also associated with significant CAS (>50% lumen reduction) in two patients, each with ST segment shifts >1 mm.

In summary, ergonovine stimulation failed to evoke symptoms, ECG or blood pressure changes in three quarters of mitral valve prolapse patients studied. Six patients developed chest pain. Chest pain was associated with ECG changes characteristic of CAS in two of these patients, each with angiographic CAS. Thus, symptomatic CAS induced by ergonovine was absent in the majority of these 24 patients with idiopathic mitral valve prolapse syndrome.
Echocardiography in the diagnosis of lutembacher syndrome
Authors: Garcia Jorge A. , Krajcer Zvonimir , Pechacek Leonard W. , Leachman Robert D.
Published: March 2007

In two patients with Lutembacher syndrome cardiac catheterization demonstrated a large atrial septal defect but no diastolic gradient across the mitral valve. Echocardiography was compatible with right ventricular volume overload and mitral stenosis. Surgical exploration of the mitral valve at the time of atrial septal defect correction is warranted when the echocardiogram is suggestive of mitral stenosis.
Restrictive cardiomyopathy in an infant with massive biatrial enlargement and normal ventricular size and pump function
Authors: Erath Harold G. , Graham Thomas P. , Smith Clyde W. , Boucek Robert J.
Published: March 2007

Restrictive cardiomyopathy in an infant with massive biatrial enlargement and normal ventricular size has been reported only once previously [3]. We now present a 13‐month‐old patient with severe and progressive congestive heart failure who demonstrated normal ventricular cavity size with biatrial enlargement. Ejection fraction and echocardiographic ventricular function studies were normal.
Anomalous origin of the right coronary artery above the left sinus of valsalva
Authors: Yans Javad , Kumar Samuel P. , Kwatra Manmohanlal
Published: March 2007

Various anomalies of coronary arterial origin have been described. These anatomical variations are discovered either by coronary angiography or at autopsy. We are reporting a case of anomalous origin of the right coronary artery above the left sinus of Valsalva. To our knowledge, this anomaly has not been described before. A technique for selectively catheterizing such an aberrant coronary artery is described.
Anomalous origin of the left coronary artery from the right sinus of valsalva
Authors: Sher Ronald F. , Iskandrian Abdulmassih S. , Kimbiris Demetrios , Bemis Charles E.
Published: March 2007

We present the clinical, angiographic and surgical findings in a 63‐year‐old man with anomalous origin of the left main coronary artery from the right sinus of valsalva. The course of the left main artery was abnormal in that it passed between the aorta and the pulmonary artery; in addition, there was obstructive disease involving the left main coronary artery. The association of these two entities in this age group is unusual.
Sudden death in severe aortic stenosis following cardiac catheterization
Authors: Iskandrian Abdulmassih S. , Segal Bernard L. , Wasserman Louis , Kimbiris Demetrios , Bemis Charles E.
Published: March 2007

Five patients with critical aortic stenosis (aortic valve area 0.6 cm2 or less) died 2 days to 21 days following cardiac catheterization performed in anticipation of cardiac surgery. A sixth patient was successfully resuscitated for spontaneous ventricular fibrillation, and successful aortic valve replacement was accomplished. Two patients had prior history of syncope; one patient, of ventricular tachycardia; three patients, of pulmonary edema; and three patients, of crescendo angina. One patient had severe hypotension during maintenance hemodialysis for chronic renal failure. The mode of death was sudden but not witnessed in two patients. The terminal cardiac rhythms were slow junctional in one patient, idioventricular in one, ventricular tachycardia in one, and ventricular fibrillation in the fourth patient. We conclude that symptomatic patients with critical aortic stenosis should be monitored after cardiac catheterization, and surgery should be performed as soon as possible since sudden death is not unusual.
Patency of the interatrial septum in children undergoing cardiac catheterization
Authors: Waldman J. D. , Rose G. , Turner S. W. , Pappelbaum S. J.
Published: March 2007

Catheter passage into the left atrium from the right atrium greatly facilitates invasive cardiovascular evaluation and reduces the risks attendant on cardiac catheterization studies. We reviewed 371 consecutive cardiac catheterizations to establish the presence of natural interatrial communications. Catheter course, pressure equalization, and left‐to‐right atrial shunt on recirculation angiography were considered to determine intact interatrial septum (IIS), patent foramen ovale (PFO) or atrial septal defect (ASD).

During the first year of life, 88% of infants had PFO or ASD; in 12%, the interatrial septum was intact. In children 1–10 years old, 49% had IIS, 27% had PFO, and 24% had ASD. In children 10–21 years old, 24% had PFO, or ASD. Though there seems to be a greater likelihood of ISS in those with left heart obstruction, hemodynamic factors did not completely explain the timing of closure of the foramen ovale.

Presence of an interatrial communication allows catheter entrance into all left heart structures including the aorta; therefore, in patients with PFO or ASD, retrograde arterial procedure or transseptal puncture technique can be avoided when performing left heart catheterization. This appears possible in 88% of those under 1 year of age, in 51% of those 1–10 years old, and in 24% of children 10–21 years old.
Tricuspid regurgitation: Clinical and angiographic assessment
Authors: Lingamneni Ramesh , Do Cha Se , Maranhao Vladir , Gooch Alden S. , Goldberg Harry
Published: March 2007

Because previous attempts to diagnose and quantitate tricuspid regurgitation (TR) by angiography have been unreliable, 60 patients with mitral or combined mitral and aortic valve disease had right ventriculography using a special preshaped catheter. A clinical diagnosis of TR was confirmed in 45% of the patients with moderate and severe TR. A pansystolic murmur increasing in intensity with inspiration, a pulsatile liver, and a prominent CV wave in the jugular veins when present together were specific for severe TR but were seen in only 30% of the patients with severe TR (3+ or 4+). Ventricularization of the right atrial pressure contour was specific for severe TR but was seen in only 40% of the patients with severe TR. A normal right atrial mean pressure (RAP) did not exclude TR, but a rise in RAP or an unchanged RAP with deep inspiration was seen in all patients with TR. Similar findings were observed in two patients with severe pulmonary hypertension who had no TR. There was no relation between the magnitude of this rise in RAP, the degree of pulmonary hypertension, and the severity of TR. The use of a special preshaped catheter tends to avoid the induction of premature beats, and right ventriculograms with a preshaped catheter may be useful in diagnosing TR.
The sensitivity of contrast echocardiography in detecting intracardiac shunts
Authors: Pieroni Daniel R. , Varghese P. Jacob , Freedom Robert M. , Rowe Richard D.
Published: March 2007

While contrast echocardiography has been shown to delineate intracardiac shunts, no information is available concerning the sensitivity of the method. This study establishes the relative sensitivity of the technique in detecting and localizing shunts by comparing the contrast echocardiograms with the simultaneously recorded cardiogreen dye curves in 26 children during cardiac catheterization. The echocardiograms substantiated isolated intracardiac shunting as small as 5%. There were no false‐positive or false‐negative echocardiograms in patients with or without shunt defects.

This report demonstrates the contrast echocardiographic technique to be extremely sensitive in detecting intracardiac communications. It reviews the diagnostic patterns necessary for diagnosis and proposes the technique as a sensitive, safe, and accurate alternate method of study in the cardiac catheterization laboratory.
Atrial pacing induced left ventricular dysfunction: Reversibility after aortocoronary bypass surgery
Authors: Hamby Robert I. , Aintablian Agop , Wisoff B. George
Published: March 2007

Three patients with angina pectoris were studied before and after aortocoronary bypass surgery. Angiographic studies were performed with and without atrial pacing. Preoperative atrial pacing in all three patients resulted in angina and/or ST segment changes accompanied by regional left ventricular contractile abnormalities, decreased ejection fraction, as well as decreased left ventricular end‐diastolic and stroke volumes. After surgery with all grafts patent, atrial pacing at similar heart rates did not produce an ischemic response. Left ventricular contractile pattern remained normal, and there was no change in ejection fraction, though end‐diastolic and stroke volumes decreased. These studies demonstrate that aortocoronary bypass surgery can abolish both the ischemic response and left ventricular dysfunction that accompany atrial pacing.
The noninvasive assessment of anomalous origin of the left coronary artery from the pulmonary artery
Authors: Wasserman Louis A. , Eshaghpour Eshagh , Takahashi Osahiro , Iskandrian Abdulmassih , Kotler Morris N.
Published: March 2007

We present a patient with anomalous origin of the left main coronary artery from the pulmonary artery. We correlate the findings of echocardiography and myocardial imaging with angiography, and discuss the value of the noninvasive techniques in the diagnosis and in the followup of such patients.
A simple, new system for maintaining measured quantities of saline cold and sterile for thermodilution cardiac output measurement
Authors: Hammermeister K. E. , Vandamme John
Published: March 2007

A new, simple system for cooling and maintaining prefilled syringes of injectate in a dry, sterile environment for thermodilution cardiac output using a thermoelectric cold plate is described. Rates and uniformity of cooling were studied. Uniform cooling is achieved in about 60 minutes if refrigerated injectate is used.
Coronary artery‐left ventricular communications: A report of two cases and review of the literature
Authors: Vogelbach Karl‐Heinrich , Allan W. Edmiston , Stenson Robert E.
Published: March 2007

Two patients with chest pain had angiographically‐demonstrated communications between the three coronary arteries and the left ventricular chamber. Communications between coronary arteries and the left ventricle are unusual and communications between all three coronary arteries and the left ventricle are rare. These anomalies are, however, commonly associated with symptoms of chest pain. The presence of left ventricular hypertrophy and a widened pulse pressure may suggest a greater hemo‐dynamic effect of the shunt flow than often suspected angiographically.
Percutaneous cannulation of large pericardial effusions
Authors: Singham K. T.
Published: March 2007

A rapid, easy, and safe method of introducing a large cannula into the pericardial space for drainage of large pericardial effusions using conventional catheter introducers and catheters is described. Confirmation of the presence of a sizeable pericardial effusion is essential before insertion of a percutaneous cannula.
Cine‐densitometric measurement of coronary arterial stenoses
Authors: Sandor Tamas , Als Ann V. , Paulin Sven
Published: March 2007

Computer‐aided operator‐interactive densitometry has been developed and applied to determine the percent stenosis for obstructive lesions in the coronary arterial tree. Phantom experiments performed to assess system linearity, accuracy of densitometric measurements, nonuniformity in image amplifier response, and the interference of structure noise in measuring precision have been described. Three observers assessed the reproducibility of the method by repeating analyses on 20 stenoses in man recorded on 35‐mm cine angiograms. Calculation of the intra‐ and interobserver errors found that their values significantly decrease with increasing percent stenosis. The reproducibility of the technique was also tested on stenoses that were exposed at multiple angles. The results agreed with those found for the intra‐ and interoperator errors. Limitations of the densitometric approach and desirability of further automation of the measurements are also discussed.
Pulmonary atresia and suprasternal echocardiography
Authors: Sassé; Lewis , Froelich Carla R. , Danielson Gordon K.
Published: March 2007

A 54‐year‐old housewife with pulmonary atresia and ventricular septal defect developed increasing cyanosis, dyspnea, weakness, and myocardial ischemia. Initial cardiac catheterizations with angiography, including subtraction techniques, did not definitely indicate main pulmonary artery or right or left pulmonary arteries that would make her amenable to currently available surgical correction. Single‐crystal suprasternal notch echocardiography indicated the presence of a small but definite right pulmonary artery. She subsequently underwent first‐stage surgical correction after angiography and selective catheterization of aortopulmonary shunt vessels, which also revealed the presence of small proximal pulmonary arteries.
Chronic oral vasodilator therapy to control heart failure in postinfarction ventricular septal defect
Authors: Phaneuf Denis C. , Waters David D. , Thé;Roux Pierre , Pelletier Guy , Mizgala Henry F.
Published: March 2007

This report describes a 70‐year‐old woman with biventricular failure following an anteroseptal infarction complicated by interventricular septal rupture. Treatment with nitroprusside followed by oral hydralazine eliminated the failure and reduced the shunt from 2.75 to 1 to 1.7 to 1. She is asymptomatic post‐discharge. Chronic medical therapy including oral vasodilators may be an acceptable alternative to surgery in a small minority of patients with this complication of myocardial infarction.
Congestive cardiomyopathy with segmental wall motion abnormalities and a non‐uniform pattern of fibrosis
Authors: Ritchie James L. , Clarke L. John , Reichenbach Dennis
Published: March 2007

A case of congestive cardiomyopathy in a 46‐year‐old smoker with single‐vessel right coronary artery disease is presented. Segmental contraction abnormalities were present in the anterior wall. Pathologic analysis showed diffuse fibrosis consistent with a cardiomyopathy in areas of abnormal contraction and normal muscle in areas of normal contractility. Segmental wall motion abnormalities have been reported but none with microscopic studies of areas of both abnormal and normal contractility.
The risk of sudden death in sickle cell trait: Noninvasive assessment of cardiac response to exercise
Authors: Francis Charles K. , Bleakley Dennis W.
Published: March 2007

The effect of symptom‐limited maximal treadmill exercise was evaluated in 34 patients with sickle cell trait (SCT) and 43 controls. Systolic time intervals were measured before and after exercise in 15 of the sickle cell trait subjects, and in 11 controls. Rate pressure product, degree of ST segment depression and incidence of ventricular arrhythmias in subjects with SCT were not significantly different from similar measurements in the control group. No significant difference in electromechanical systole QS2, left ventricular ejection time (LVET), pre‐ejection period (PEP)/LVET or ejection fraction (EF) were found between the groups. These data indicate that healthy subjects with SCT do not have an increased incidence of exercise‐induced ventricular arrhythmias, myocardial ischemia, or diminished ventricular function compared to normals. Further studies are indicated to elucidate factors that may be operative in the sudden death syndrome.
Percutaneous sheath brachial vein cardiac catheterization in children
Authors: Hesslein Peter S. , Mullins Charles E. , Kugler John D. , Gillette Paul C.
Published: March 2007

During the past ten years we have performed certain phases of cardiac catheterization on 48 children using a modified percutaneous sheath technique to enter a superficial arm vein. Our patients ranged in age from 15 months to 21 years, with a mean age of 10.0 years. The indications for a superior approach most commonly have included electrophysiologic investigations, femoral vein occlusions, and proximal obstructions of the inferior vena cava. The advantages of a percutaneous sheath technique in the superficial brachial veins include the ease of changing catheters frequently during a case and the preservation of the vessel for possible repeat studies. It is not always possible to enter the heart with this technique, owing to sharp angulation of deep venous confluences in the axilla and occasional venous spasm. When successful, this mode of approach is attended by a very low prevalence of complications. There were no deaths, heart or vein perforations, or systemic infections. One patient developed a superficial phlebitis; this was mild and temporally limited. We have not encountered any case of clinically apparent venous thrombosis. When a superior approach for prograde heart catheterization in children is indicated, we have found that our modified percutaneous sheath technique is a simple, safe, and frequently successful alternative to a cutdown approach.
Anomalous origin of the left coronary artery from the pulmonary artery: A case report with remarkable improvement of myocardial function following subclavian artery—Coronary artery anastomosis
Authors: Yoshida Yoshiro , Emmanouilides Geroge C. , Nelson Ronald J. , Baylen Barry G. , Criley J. Michael
Published: March 2007

A 3 2/12‐year‐old boy with anomalous origin of the left coronary artery from the pulmonary artery was successfully treated by anastomosis of the left subclavian artery to the anomalous vessel. A remarkable improvement in left ventricular function and electrocardiogram has occurred postoperatively. This case report supports the postulation that chronically hypoperfused, electrically silent, and minimally contractile myocardial tissue may acquire its electrical activity and function with the establishment of adequate coronary perfusion.
Mid‐Systolic closure of the aortic valve in hypertrophic obstructive cardiomyopathy: A pressure‐Related phenomenon induced by turbulent blood flow
Authors: Sabbah Hani N. , Alam Mohsin , Anbe Daniel T. , Stein Paul D.
Published: March 2007

The purpose of this study was to determine whether mid‐systolic closure and opening of the aortic valve in patients with hypertrophic obstructive cardiomyopathy (HOCM) may reflect dynamic changes of pressure induced by turbulent blood flow in the aorta and left ventricular outflow tract. Five patients with HOCM who had echocardiographic evidence of mid‐systolic closure of the aortic valve and two patients with HOCM who did not have transient mid‐systolic closure of the aortic valve were studied. In patients in whom mid‐systolic closure was present, a transient mid‐systolic drop of pressure was present in the left ventricular outflow tract, distal to the dynamic intraventricular obstruction, 17 ± 3 mm Hg (mean ± SEM) and in the root of the aorta, 16 ± 4 mm Hg. In these patients the mid‐systolic drop of pressure was consistently associated with a high‐intensity intracardiac murmur indicative of turbulence. In the two patients in whom mid‐systolic closure of the aortic valve was absent, the transient mid‐systolic drop of pressure during systole was minimal (average, 3 mm Hg). The transient mid‐systolic drop of pressure distal to the intraventricular obstruction can be explained on the basis of decreased pressure energy of the blood due to turbulence. Since total energy is conserved, increased kinetic energy due to turbulence occurs at the expense of a loss in pressure energy. The transient mid‐systolic reduction of pressure in the turbulent zone during systole may cause a pressure differential across the open valvular leaflets resulting in a transient closure of the aortic valve.
An improved snare system for the nonsurgical retrieval of intravascular foreign bodies
Authors: Hubert John W. , Krone Ronald J. , Shatz Burton A. , Susman Noah
Published: March 2007

We have modified a snare technique originally described for transcolonoscopic removal of colonic polyps for the retrieval of intravascular foreign bodies. The key difference from other snare techniques is the employment of a wire snare with a crimp in its midportion that enables the formation of a loop in a plane perpendicular to the axial direction of the guiding catheter. With this technique we have quickly removed a variety of objects from the right heart and pulmonary arteries in four patients.
Left ventricular outflow obstruction at multiple levels: Occurrence in a single patient
Authors: Morton Brian C. , Troup Wallace J. , Baird Michael G. , Keon Wilbert J.
Published: March 2007

Combined forms of left ventricular outflow obstruction are being recognized with increasing frequency. A patient who had coarctation of the aorta, valvular aortic stenosis, and fixed and dynamic subvalvular obstruction is described. The importance of recognizing multiple levels of obstruction in such patients is emphasized.
Cardiac dimensional analysis by use of biplane cineradiography: Description and validation of method
Authors: Lipscomb Kirk
Published: March 2007

Biplane cineradiography is a potentially powerful tool for precise measurement of intracardiac dimensions. The most systematic approach to these measurements is the creation of a three‐dimensional coordinate system within the x‐ray field. Using this system, interpoint distances, such as between radiopaque clips or coronary artery bifurcations, can be calculated by use of the Pythagoras theorem. Alternatively, calibration factors can be calculated in order to determine the absolute dimensions of a structure, such as a ventricle or coronary artery. However, cineradiography has two problems that have precluded widespread use of the system. These problems are pincushion distortion and variable image magnification. In this paper, methodology to quantitate and compensate for these variables is presented. The method uses radiopaque beads permanently mounted in the x‐ray field. The position of the bead images on the x‐ray film determine the compensation factors. Using this system, measurements are made with a standard deviation of approximately 1% of the true value.
Comparison of coronary arteriographic and left ventriculographic findings in patients with single, double, and triple vessel disease and angina pectoris
Authors: Vieweg W. V. R. , Warren S. E. , Alpert Joseph S. , Hagan A. D.
Published: March 2007

The distribution and severity of coronary artery disease and degree of left ventricular dysfunction are described in 500 patients with single (103), double (119), and triple (278) vessel disease and angina pectoris. The coronary arterial patterns were divided into right (360), mixed (89), and left (51) systems, depending upon the blood supply to the inferior surface of the left ventricle. The following relationships were noted:

Coronary arterial patterns of right, mixed, and left systems do not influence the presence, distribution, or severity of coronary arterial lesions among patients with single, double, and triple vessel disease and angina pectoris.

Analysis of the distribution of lesions among patients with single and double vessel disease reveals that the circumflex/obtuse marginal arteries contribute least of the three major coronary arteries to angina pectoris.

Lesions of 70–90% reduction in coronary arterial luminal diameter are the most common, and 90–99% lesions are the least common. The latter are least stable among patients with both coronary artery disease and angina pectoris.

Quantitatively there is progression of both coronary artery disease and left ventricular dysfunction as one moves from single to double and then to triple vessel disease. However, the pattern of coronary arterial lesions (50–70%, 70–90%, 90–99%, and 100% reduction of luminal diameter) and the pattern of left ventricular dyssynergy (hypokinesis, akinesis, and dyskinesis) are similar among the patients with single, double, and triple vessel disease and angina pectoris.
Prevention of contrast‐induced bradycardia during coronary angiography
Authors: Richards Kent L. , Browning J. D. , Hoekenga David E.
Published: March 2007

A double‐blind study of 90 patients undergoing coronary angiography was performed to determine the safety and efficacy of 0.6 mg atropine sulfate in preventing contrastinduced bradycardia. Coronary angiography performed using the Sones technique resulted in ventricular pauses of greater than 2 seconds in 3 of 49 patients (6%) who received prophylactic atropine and 20 of 41 patients (49%) receiving placebo. Though the pauses were usually due to atrial asystole, 26% of those with greater than 2 second pauses did so because of transient complete heart block. Prophylactic atropine did increase resting heart rate but did not cause other arrhythmias or increase the frequency of angina pectoris despite the presence of severe coronary disease. Our data indicate that contrast‐induced asystole is very common, cannot be predicted by consideration of “precatheterization data,” and can be prevented effectively and safely by use of prophylactic atropine sulfate.
Delayed post‐cardiac‐surgery tamponade producing localized right atrial compression
Authors: Marx Peter , Jaffe Carl , Laks Hillel , Son Steven Wolf
Published: March 2007

A patient with dyspnea and lethargy 19 days after aortic valve replacement was admitted to the hospital with physical signs suggesting cardiac tamponade. Initial echocardiogram was unhelpful, but Swan‐Ganz catheterizatlon showed a gradient in diastole between the right atrium and ventricle. Anglography and repeat echocardlography then showed a mass compressing the right atrium, which was confirmed at surgery.
Outpatient cardiac catheterization and coronary angiography
Authors: Mahrer Peter R. , Eshoo Norman
Published: March 2007

The cost of and hospitalization required for cardiac catheterization led us to evaluate this procedure in 308 adult outpatients. Patients were scheduled on the basis of stability of symptoms. Two hundred eighty‐eight underwent left heart catheterizations and coronary arteriography. Ninety‐five percent of the procedures were performed by the percutaneous technique. Fifty patients had normal studies and 30 patients had congenital or valvular disease. Two hundred twenty‐eight patients had significant coronary artery disease, 85 patients had triple vessel disease, and 45 patients had left main coronary artery disease. There were six significant complications: one death; two myocardial infarctions; one air embolism, and two patients with hematomas. Three of the complications were in patients with left main disease. Only two of the complications can be ascribed to the outpatient nature of the procedure. The complication rate is comparable to that reported in the literature. Fifteen hundred subsequent cases were studied as outpatients, with a very low mortality and morbidity. It is concluded that cardiac catheterization can be performed on an outpatient basis with safety comparable to inpatient studies, and at a great economic savings.
Atrial fibrillation in congestive cardiomyopathy: Echocardiographic and hemodynamic correlates
Authors: Mann Bruce , Ray Richard , Goldberger Ary L. , Shabetai Ralph , Green Curtis , Kelley Michael
Published: March 2007

Previous studies have suggested an unexpectedly low incidence of atrial fibrillation in patients with congestive cardiomyopathy. To further investigate the incidence of chronic atrial fibrillation in these patients and its relationship to left atrial dimension and pressure, we retrospectively examined M‐mode echocardiographic and cardiac catheterization data from 54 patients with idiopathic (n = 29) and ischemic (n = 25) congestive cardiomyopathy. The incidence of atrial fibrillation (17%) was surprisingly low given the degree of left atrial enlargement (51 ± 5 mm; mean ± SD) and left atrial hypertension (19 ± 8 mm Hg). In addition, there were no significant differences in left atrial pressure or left atrial dimension between those congestive cardiomyopathy patients in sinus rhythm and those in atrial fibrillation, nor was there a higher incidence of secondary mitral regurgitation in patients in atrial fibrillation.

Comparisons were also made between congestive cardiomyopathy patients and 21 patients with primary mitral valve disease and atrial fibrillation. Left atrial pressure was not significantly different between these groups. However, the mean left atrial dimension of the patients with mitral valve disease (56 ± 8 mm) was greater (P < 0.01) than that of patients with idiopathic (51 ± 6 mm) or ischemic (50 ± 4 mm) cardiomyopathy in sinus rhythm and also greater (P = 0.07) than left atrial dimension (51 ± 6 mm) of congestive cardiomyopathy patients in atrial fibrillation. Furthermore, massive enlargement of the left atrium (greater than 60 mm) was a common feature of mitral valve disease (33% incidence) but occurred only rarely in congestive car‐diomyopathy (5% incidence).

We conclude that while left atrial volume and pressure loads may be important contributors to the pathogenesis of atrial fibrillation, these factors are not sufficient to produce the arrhythmia in most patients with congestive cardiomyopathy. Other variables such as disease duration or the degree of atrial fibrosis or inflammation may also be important in determining which patients with left atrial enlargement will develop atrial fibrillation. Furthermore, massive left atrial enlargement (left atrial dimension > 60 mm) is rarely associated with ischemic or idiopathic congestive car‐diomyopathy and suggests underlying primary mitral valve disease.
En face demonstration of a prosthetic mitral valve orifice during left ventriculography
Authors: Smuckler Alan L. , Kahl Frederic R.
Published: March 2007

Direct demonstration of the orifice of a prosthetic mitral valve was obtained using an en face projection of the mitral valve during left ventriculography. With a dimensional reference and planimetry, the mitral valve area was directly measured. The value for the mitral valve area derived from en face demonstration of the mitral valve during left ventriculography agreed well with valve area estimates obtained by the Gorlin and Gorlin formula and by direct examination of the surgical specimen.