bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left heart catheterization and angiography via the percutaneous femoral approach using an arterial sheath
Authors: Barry William H. , Levin David C. , Green Laurence H. , Bettman Michael A. , Mudge Gilbert H. , Phillips David 
Published: March 2007

AbstractAn arterial sheath with a proximal hemostasis valve and a side‐arm extension tube was used in 562 consecutive patients undergoing cardiac catheterization and angiography via the femoral approach. Serious complications were rare. There was one death, one peripheral embolism, and one episode of delayed groin hemorrhage. The incidence of minor complications, including hematoma formation, in this series compares favorably with our own and the reported experience of others using the conventional percutaneous femoral approach. The sheath technique facilitated catheter exchanges and reduced patient discomfort. In addition, femoral artery pressure could be monitored via the side arm of the sheath during the catheterization. This proved helpful during retrograde catheterization of patients with aortic stenosis, as well as in detection of damping of coronary artery catheter tip pressure during coronary arteriography and hypotension following left ventriculography. Based upon this experience, use of an arterial sheath has become our standard practice when left heart catheterization is performed via the femoral approach, and the use of several different catheters is anticipated.
The provocation of coronary artery spasm
Authors: Chahine Robert A. 
Published: March 2007

AbstractOn the basis of the overall experience, the provocation of coronary artery spasm with ergonovine is thought to be a highly sensitive and specific test for coronary artery spasm in Prinzmetal's variant angina. In spite of occasional complications, in experienced hands the procedure is considered to be safe. The challenge remains to determine the value of this and other provocative interventions in assessing the role of spasm in other aspects of ischemic heart disease, particularly in patients with critical atherosclerotic lesions.
Quantitation of left ventricular wall motion in normal subjects: Comparison of various methods
Authors: Bhargava Valmik , Warren Sanford , Vieweg W. V. R. , Shabetai Ralph 
Published: March 2007

AbstractComputer‐assisted analysis of percent change in the square root of area in each of 12 consecutive 30‐degree, pie‐shaped ventricular segments was obtained in 48 normal subjects who underwent cardiac catheterization and left ventriculography. The information obtained permitted establishment of objective confidence limits for normal left ventricular regional wall motion. As an index of dynamic changes in segmental wall motion, the percent change in the square root of area method compared favorably with existing radius, area, hemichord, and chord methods. It also possessed a variety of theoretical advantages over these techniques: 1) large numbers of points were analyzed, 2) wall motion disorders in all areas except base were evaluated, 3) taking the square root of area's percent change provided both area information with least splay and an average measure of radius.
Cardiomyopathies characterized by evidence of resistance to left ventricular inflow
Authors: Maron Barry J. , Long Linda , Moller James H. , Edwards Jesse E. 
Published: March 2007

AbstractRestrictive cardiomyopathy characterized by evidence of left ventricular inflow obstruction was studied in four cases—one child and three adults. In three of the cases, including the child, there was pathologic evidence of hypertrophic cardiomyopathy with asymmetric septal hypertrophy. In the fourth case, no cardiac disease was identified as the anatomic basis for the inflow restriction. This latter case broadens the concept of restrictive cardiomyopathies.
Comparison of biplane and single plane left ventricular volumes in atrial septal defect
Authors: Fraker Theodore D. , Wise N. Kent , Harrell Frank E. , Behar Victor S. 
Published: March 2007

AbstractThe close agreement between biplane (BP) and single‐plane (SP) angiographic estimates of left ventricular (LV) volumes results from the similarity of the minor axes measured in the right anterior oblique (RAO) and left anterior oblique (LAO) views. Disease states that alter LV geometry may change the length of one minor axis more than the other, producing a discrepancy between BP and SP volumes. To examine this hyposthesis, angiographically derived volumes in 21 patients with atrial septal defects (ASD) in which the LV appears to be compressed and flattened by an enlarged right ventricle, were compared to 100 normal control patients. In the control patients, the median SP estimate of end‐diastolic volume (EDV) was 7.6% larger than the BP determination, whereas in patients with ASD, the median SP EDV estimate was 16.7% larger than the BP EDV (P<0.0001). The SP end‐systolic volume (ESV) underestimated the BP value by 3.4% in controls but overestimated the BP ESV in patients with ASD by 4.3% (P<0.02). The overestimate of the SP EDV and SP ESV when compared to the BP volumes may be due to changes in either the minor axes or the appearance of the longest major axis in the LAO view. The longest major axis was found in the RAO view in 99% (99/100) of normals and 95% (20/21) of ASD patients (PNS). The median ratio of RAO to LAO end‐diastolic minor axes, however, was 1.07 in the normals and 1.17 for ASD patients. The median ratio of end‐systolic minor axes was 0.97 for controls and 1.04 for ASD patients.Compression of the LV in patients with ASD shortens the LAO minor axis, resulting in a significantly greater SP overestimation of LV volume than occurs in normals. The degree of SP volume overestimate was not predicted by the magnitude of the left‐to‐right shunt or pulmonary pressure. This source of error affects all SP methods for determining left ventricular volume, including radionuclide techniques using static images.
A simplified method for the calculation of left ventricular volume by equilibrium radionuclide angiography
Authors: Slutsky Robert , Battler Alexander , Gerber Kenneth , Gordon Donald , Phd John Verba , Peterson Kirk , Murray I. Provin , Ashburn William 
Published: March 2007

AbstractWe have recently reported on the relationship between left ventricular (LV) volume (V) determined by contrast ventriculography (CV) and corresponding volume units calculated from LV region‐of‐interest counts obtained from ECG gated equilibrium radionuclide angiographic (EQ) time‐activity curves. We corrected the absolute number of counts at end‐diastole (ED) and end‐systole (ES) for the number of processed cardiac cycles, acquisition time, and counts in plasma at the time of the data acquisition. To evaluate a simpler method, which merely involves correcting for counts in whole blood rather than plasma, we studied 15 patients prospectively prior to CV. Each patient underwent EQ using 15–20 mCi of 99mTc‐human serum albumin. Ten ml of blood were withdrawn at the midpoint of each study. Four ml were suspended above the scintillation camera detector to determine the “blood” radioactivity concentration. For comparison, the remaining 6 ml were centrifuged to yield 0.1 ml of plasma and counted separately in a well counter. ED and ES counts were obtained by using a standard commercial semi‐automatic computer program with a varying LV region‐of‐interest edge tracking algorithm. Radionuclide derived volume units by both methods were correlated with CV volume, yielding the following results: when counting plasma, for EDV, r = 0.94, and for ESV, r = 0.95; using the simpler blood counting method, for EDV, r = 0.93, and for ESV, r = 0.94. We conclude that LV volume can be calculated using count‐derived radionuclide volume units.
Left atrial electrograms recorded through the patent foramen ovale
Authors: Shapiro Jerome B. , Kaltman Alfred J. 
Published: March 2007

AbstractThe presence of a patent foramen ovale allows direct recording of a left atrial (LA) electrogram. Three patients are reported in whom simultaneous high right atrial (HRA), coronary sinus (CS), and direct LA electrograms were obtained. In two patients with normal surface ECG P waves the direct LA lead depolarized before the CS or low RA. The HRA to LRA and HRA to CS conduction times were similar to those reported previously. In a patient with a prolonged surface ECG P wave, the direct LA electrogram occurred late and after low RA depolarization.Recording LA electrograms through a patent foramen ovale is a useful technique, and these defects should be sought in all patients undergoing electrophysiological study.
Evaluation of a new catheter‐mounted electromagnetic velocity sensor during cardiac catheterization
Authors: Nichols Wilmer W. , Pepine Carl J. , Conti C. Richard , Christie Leonard G. , Feldman Robert L. 
Published: March 2007

AbstractPulsatile blood flow was measured with an electromagnetic catheter‐tip velocity transducer in the main pulmonary artery or ascending aorta of 37 patients. This catheter also contains micromanometers for high‐fidelity arterial and ventricular pressure measurements. We found that great vessel blood flow velocity patterns were similar to those obtained by other methods. Cardiac output, calculated from the product of mean flow velocity and vessel cross‐sectional area, was compared with output determined by dye dilution in 28 patients. The correlation coefficient was 0.93 and the regression equation y = 0.93 × + 0.26 liter/min (SEE = 0.8 liter/min). In the remaining nine patients, the flowmeter output was calibrated, in cm3/sec, by reference to simultaneous dye‐dilution cardiac output determination [5]. Output was then changed by exercise or β‐blockade and measured again by dye dilution. These values were compared to output simultaneously obtained by electromagnetic flowmeter (n = 19). In the patient subgroup of 19 subjects, the correlation coefficient was 0.94 and the regression equation y = 0.87 × + 0.49 liter/min (SEE = 0.72 liter/min). No complications were associated with the use of the catheter. These results suggest that the multisensor catheter offers a safe, reliable technique for obtaining high‐quality pulmonary artery and ascending aortic blood flow and pressure and ventricular pressure waveforms in conscious man.
Regional pressure differences in the left ventricle
Authors: Falsetti Herman L. , Verani Mario S. , Chen Ching‐Jen , Cramer James A. 
Published: March 2007

AbstractTheoretically, if blood is to have directional flow and different magnitudes of velocity, pressure should be distributed in the left ventricle (LV) as a function of both space and time. Thus, regional pressure differences (RPD) were examined in the LV of 20 open‐chested dogs. High‐fidelity transducers were implanted through stab wounds at three positions in the LV: the base (B), equator (EQ), and apex (APX). Simultaneous, high‐fidelity LV pressures were compared in each region under rest conditions and during graded infusions of isoproterenol and propranolol. In the baseline condition, there were slight but significant differences between the APX and B in end‐diastolic pressure (EDP), peak systolic pressure (PSP), peak dp/dt and Vmax. At rest, the largest RPD between the APX and B in PSP was 9 mm Hg (mean ± 1 SE = 2.1 ± 0.5), and the largest during diastole was 5.1 mm Hg (mean ± 1 SE = 1.2 ± 0.4); the largest difference in Vmax was 30.5% (mean ± 1 SE = 10.8 ± 2.4). During isoproterenol infusion the RPD in PSP were accentuated; the largest seen was 84 mm Hg between APX and B (mean ± 1 SE = 15.7 ± 4.5). The largest difference in Vmax between B and APX was 188% (mean ± 1 SE = 48.5 ± 9.4). Propranolol obliterated these RPD. These results indicate that there are significant RPD in the LV cavity; during systole the highest pressures decrease sequentially from the apex to the equator and to the base; during diastole these RPD are of lesser magnitude. These RPD affect all derived pressure indices, and these changes can be Increased or decreased by drug interventlon. These results are important for two reasons: 1) the position of catheters in the LV cavity is important when pressure dependent LV parameters are compared in different conditions; and 2) in any force balance analysis of the left ventricle it is important to note that force generation by the left ventricle is an active process that transmits regional pressure differences to the LV cavity.
Evaluation of pattern recognition rules for the apex of the heart
Authors: Brower R. W. 
Published: March 2007

AbstractThe observer variability and accuracy of rules for the automatic recognition of the left ventricular (LV) apex are reported. To form a data base for examining this problem 18 co‐workers were asked to independently identify the apex of 79 left ventriculograms (LVgrams) in the 30‐degree right anterior oblique projection at end‐disastole (ED) and end‐systole (ES), and to assign a confidence score from 0% to 100% for each apex. The group consisted of five clinical cardiologists (G1), six trained analysts (G2), and seven other experienced observers (G3). The LVgrams were selected to include those from 31 normal individuals and those from 48 patients with mixed akinesis/dykinesis as coded by conventional scoring techniques. There was no significant difference in the confidence for the ED vs ES apices. However, confidence of G1 was significantly lower than that of G2. The standard deviation in the observer‐detected apex correlated (r = −0.92) with the mean observer confidence, which suggests a basis for quantifying “confidence” in the automated apex detection. The apex determined with respect to the superior aspect of the aortic valve proved superior to all other tested methods. The concept of “peakedness index” is introduced and used to estimate observer variability.
Effects of coronary artery narrowing, collaterals, and left ventricular function on the pattern of myocardial perfusion
Authors: Iskandrian Abdulmassih S. , Segal Bernard L. , Haaz William , Kane Sally 
Published: March 2007

AbstractWe evaluated effects of the degree of diameter narrowing of the coronary arteries (50–69%, 70–89%, ≥90%); extent of coronary disease [one‐vessel disease (1VD), two‐vessel (2VD), three‐vessel (3VD)]; collaterals; and left ventricular function on the pattern of exercise thallium‐201 perfusion in 121 patients; 30 patients with normal coronary angiograms, 37 with 1VD, 24 with 2VD, and 30 with 3VD. Fifteen patients had Q waves on ECG, 29 patients had akinetic segments on the left ventriculogram, and 46 patients had collaterals. The results suggest the following: 1) Patients with 59–69% narrowing of one vessel have normal exercise perfusion. 2) All patients with 1VD have abnormal exercise perfusion if the degree of narrowing is ≥90%, unless the right coronary artery (RCA) is the vessel involved. 3) Patients with 2VD and 3VD generally have abnormal exercise perfusion unless all the narrowings are <90%, or the RCA is the only vessel with ≥90% narrowing, or the stress is submaximal. 4) Collaterals do not protect against development of abnormal exercise perfusion; they feed the most severely narrowed vessel, and perfusion abnormalities are ordinarily seen in the distribution of such severely narrowed vessels. 5) Neither the presence of Q waves on the ECG nor an akinetic segment on the left ventriculogram correlates with defects in the redistribution images; residual defects may be seen in the delayed images despite the absence of prior myocardial infarction, and normal images may be seen despite the presence of akinetic segments in the left ventriculogram.
Myocardial infarction following acute aortic dissection
Authors: Khan Rahman , Amaram Sudhir , Gomes Joseph A. , Kelen George J. , Lynfield Joshua , El‐Sherif Nabil 
Published: March 2007

AbstractAcute aortic dissection may present a clinical picture simulating myocardial infarction, including electrocardiographic changes. The mechanism underlying this mode of presentation has not heretofore been documented during life. We present here for the first time, a patient with acute aortic dissection and the clinical picture of acute myocardial infarction, where the mechanism of infarction has been demonstrated, by preoperative angiographic studies, probably to be due to compression of the extramural portion of the right coronary artery by the false channel of the dissecting hematoma.
Normal left ventricular function with total occlusion of right and left main coronary arteries
Authors: Goldberger Ary L. , Costello Dennis L. , Moores William Y. 
Published: March 2007

AbstractThis report describes a unique case of normal left ventricular function in a patient with total proximal occlusion of the entire native coronary circulation in addition to an occluded left anterior descending bypass graft. Coronary flow was maintained by a sequential saphenous vein graft to the obtuse marginal and posterior descending arteries, with collateral filling of the left anterior descending vessel. Myocardial function was preserved, presumably because of the relatively gradual process of native coronary occlusion, allowing time for development of adequate collateral perfusion.
Pressurized contrast delivery for coronary arteriography
Authors: Sosa Julio A. , Cameron Stephen 
Published: March 2007

AbstractA system is described for eliminating negative pressure source of air bubbles within a closed‐circuit arrangement for dye delivery in coronary angiography. Replacing the usual manual pressure created by an aspirating syringe, this system pressurizes the reservoir bottle by means of a cuffed bag, double‐lumen, one‐way piercing spike and a 0.2 μm filter.
The clinical and hemodynamic significance of mitral regurgitation in coronary artery disease
Authors: Zeldis Steven M. , Hamby Robert I. , Aintablian Agop 
Published: March 2007

AbstractTo evaluate the significance of mitral regurgitation in coronary artery disease (CAD), clinical, electrocardiographic, and angiographic data in 100 coronary artery disease patients with mitral regurgitation were compared to data in 100 coronary artery disease patients without mitral regurgitation. Mitral regurgitation was mild (1+) to moderate (2+) in 94 patients. Heart failure, cardiomegaly, and anterior myocardial infarction were more common in mitral regurgitation patients than in controls (33 vs 4; 47 vs 8; 22 vs 5, respectively, P <0.001). The frequency of inferior myocardial infarction was equal in both groups. Significant left anterior descending and circumflex disease was equally frequent; however, right coronary disease was more frequent in patients with mitral regurgitation (87 vs 68, P <0.001). Total vessel occlusions and triple‐vessel disease were more frequent in patients with mitral regurgitation (113 vs 78, P <0.01; 60 vs 40, P <0.001, respectively). No localized area of asynergy was more common in patients or controls, but left ventricular aneurysms and generalized hypokinesis were more common in patients with mitral regurgitation (6 vs 0; 23 vs 2; P <0.001).These data suggest that mitral regurgitation is most often mild, but is associated with significant left ventricular dysfunction and advanced CAD.
Hemodynamic assessment of the lonescu‐shiley pericardial xenograft in the mitral position
Authors: Febres‐Roman P. R. , Haas J. M. , Cowen G. D. 
Published: March 2007

AbstractWhile the very low thrombogenicity without anticoagulant therapy and generally good durability of the lonescu‐Shiley bioprosthesis has been demonstrated, further hemodynamic assessment is necessary. The present study assessed cardiac function and heterograft performance during right and left heart catheterization at rest and exercise (three to six months postoperation) of eight patients with severe mitral stenosis and/or regurgitation prior to surgery. We found, comparing pre‐ and postoperative resting values, that mean pulmonary artery pressure decreased (32 ± 2.7 to 22 ± 3.5 mm Hg; P < 0.02), cardiac index increased (2.1 ± 0.09 to 2.5 ± 0.13 liters/min/m2; P < 0.01), pulmonary wedge pressure decreased (21 ± 2.3 to 13 ± 1.8 mm Hg; P < 0.01), and the clinical status (NYHA) improved markedly. Mean diastolic gradient across the pericardial xenograft was 6.1 ± 1.1 mm Hg at rest and 14.6 ± 2.3 mm Hg on exercise. The calculated xenograft surface area was 1.7 cm2 at rest and 2.0 cm2 during exercise. No regurgitation was detected in seven of eight patients. Thus, mitral lonescu‐Shiley bioprosthesis provide excellent heterograft function.
Pulsed doppler echocardiographic findings in total anomalous pulmonary venous drainage to the coronary sinus
Authors: Pickoff Arthur S. , Sequeira Rafael , Ferrer Pedro L. , Tamer Dolores , Bennett Vicki , Fojaco Rita , Gelband Henry 
Published: March 2007

AbstractThe pulsed Doppler echocardiographic (PDE) findings in a premature cyanotic infant with total anomalous pulmonary venous return to the coronary sinus are reported. Features that suggested the diagnosis of total anomalous pulmonary venous return were 1) an area of systolic‐diastolic turbulent flow posterior to the apparent left atrial border, which was interpreted as representing the convergence of pulmonary venous return to a common pulmonary vein, and 2) systolic and diastolic turbulent flow within the right atrium suggesting pulmonary venous return through the coronary sinus. We suggest that PDE should be included as part of the evaluation of cyanotic infants in whom the diagnosis of total anomalous pulmonary venous return is considered.
Pulsed doppler echocardiographic diagnosis of patent ductus arteriosus: Sensitivity, specificity, limitations, and technical features
Authors: Stevenson James Geoffrey , Kawabori Isamu , Guntheroth Warren G. 
Published: March 2007

AbstractTo determine the diagnostic features, sensitivity, and specificity of pulsed Doppler echocardiographic (PDE) diagnosis of patent ductus arteriosus (PDA), 110 infants with heart disease were examined by PDE from the precordial and suprastenal notch approaches. On precordial examination, PDA was diagnosed upon recording of diastolic ductal flow into the pulmonary artery. From the suprasternal approach, PDA was suspected upon recording of continuous turbulent flow in the right pulmonary artery. A PDA was proved by invasive means in 45 of 110 cases. Precordial PDE had diagnosed PDA in 43 of 45 cases. In eight of 110, continuous turbulent flow was present in the pulmonary artery from the precordial approach, but no PDA jet was recorded. In two of eight, PDA was present, and in six of eight others systemic‐to‐pulmonic communications were present. Precordial PDE diagnosis of PDA had a sensitivity of 96%, specificity of 100%, positive predictive index of 100%, and negative predictive index of 97%. From the suprastenal notch approach, PDA was suspected in 51 cases, with six false‐positive diagnoses, yielding a sensitivity of 100%, specificity of 91%, positive predictive index of 88%, and negative predictive index of 100%. Since the diastolic ductal jet flowing into the pulmonary artery was specific for PDA in all patients in whom it was recorded from a precordial approach, that approach and diagnostic feature, with sensitivity and positive predictive index of 100%, would seem preferred for PDE diagnosis of PDA. This would be especially important if the PDE diagnosis of PDA were to be used in place of invasive documentation of PDA, and in the differential diagnosis of PDA and other systemic‐to‐pulmonic communications. The suprastenal approach, while not specific for PDA, may have the advantage of sensitive detection or exclusion of a variety of systemic‐to‐pulmonic communications.