摘要:

AbstractTo quantitatively analyze a coronary arterial segment from a cineangiogram, an enddiastolic or neighboring cineframe is usually selected, such that a possibly existing coronary lesion is visualized optimally, as judged by the cardiologist. However, different cardiologists may select different (although usually neighboring) frames, even when following the same selection criteria. It is also possible that the frames are selected from different cardiac cycles. In this study the effects of such phase shifts on the reproducibility of the quantitative measurements were studied.In a total of 38 consecutive patient films obtained at a filmspeed of 25 frames/sec, the frame O demonstrating the severity of a lesion optimally, as judged by a senior cardiologist, the three preceding frames, the three following frames and one frame exactly one cycle prior to or following frame O were selected; frame O was always chosen in the end‐diastolic phase of the cardiac cycle. In each film one coronary arterial segment with a focal lesion was analyzed quantitatively in these eight frames with the Cardiovascular Angiography Analysis System (CAAS).No significant differences were found in the mean difference and the standard deviations of the differences (variabilities) in the obstruction diameter, interpolated reference diameter, percent diameter stenosis, extent of the obstruction and area of atherosclerotic plaque obtained in the various frames with respect to frame O. Therefore, it may be concluded that the selection of a cineframe for quantitative analysis in the end‐diastolic phase of the cardiac cycle is not very critical; in other words, the obstruction measurements are not time‐dependent for frames in the end‐diastolic phase. It is argued that the quality of mixing of the contrast agent in the arterial segment is a major source of the observed variations; filling artefacts are potentially present in each of the selected

ISSN:0098-6569    

DOI:10.1002/ccd.1810140402

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY

摘要:

AbstractBetween February 1985 and May 1987, 72 patients with mitral stenosis (MS) underwent percutaneous transluminal mitral valvuloplasty (PTMV). The retrograde transarterial double‐balloon technique was used on 54/72 patients (75%); 16 males, 38 females; mean age: 39 ± 11 years. Transseptal catheterization was used to place two 0.035″, 350‐cm exchange wires into the ascending aorta in order to be snared, retrieved, and exteriorized, each through a femoral artery. Over these wires, the balloon dilation catheters were advanced through the femoral artery, retrogradely, across the mitral valve, for PTMV. The transmitral mean gradient fell [18 ± 4 to 9 ± 5 mmHg (P<0.001)]; the cardiac output increased [5.1 ± 0.8 6.1 ± 0.8 L/min (P<0.001)]; the hemodynamically calculated valve area increased [1.2 ± 0.2 to 2.3 ± 0.6 cm2(P<0.001)]; and the short axis two‐dimensional echocardiographic valve area increased [1.1 ± 0.3 to 2.2 ± 0.7 (P<0.001)]. PTMV was unsuccessful in two patients (4%), due to the inability to maintain the inflated balloons in the mitral position. Significant complications were encountered in two patients: two strokes (3.7%) and one mortality from the stroke (1.4%). Significant mitral regurgitation occurred in two patients (3.7%); no post‐PTMV hemodynamically significant atrial septal defects were detected. Follow‐up (mean time: 11 ± 6 months) of 43 patients showed a persistent improvement in echocardiographic findings in 27 (63%) and hemodynamically measured mitral valve area in the 16 patients in which cardiac catheterization was repeated. The retrograde, transarterial double‐balloon technique can successfully accomplish PTMV with good results and an acceptable low

ISSN:0098-6569    

DOI:10.1002/ccd.1810140403

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY

摘要:

AbstractA new catheter was used in an attempt to re‐establish coronary flow in six patients with acute occlusion after angioplasty and prior to emergency coronary artery bypass surgery. All patients suffered from severe chest pain, and the electrocardiogram showed signs of acute transmural ischemia. A reperfusion catheter manufactured by Advanced Cardiovascular Systems (ACS) has 36 side holes spirally arranged along the distal 10 cm. It is introduced over an exchange wire. After the catheter was positioned across the occlusion, five patients had complete relief of chest pain, and another patient had partial relief. The electrocardiogram normalized in all six patients (in one only initially). Two patients developed a limited myocardial infarction, but four did not. The time between introduction of the reperfusion catheter and aorta cross clamping varied between 1.5 and 6.5 hours, and there were no complications related to its use. We conclude that the ACS reperfusion catheter is useful in re‐establishing coronary blood flow after failed angioplasty and prior to emergency coronary artery bypass surg

ISSN:0098-6569    

DOI:10.1002/ccd.1810140404

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY

摘要:

AbstractProsthetic mitral valve regurgitation was evaluated by both pulsed Doppler ultrasound and left ventriculography. Pulsed Doppler ultrasound was found to have only a 20% sensitivity in detecting prosthetic mitral valve regurgitation documented by left ventriculography. Possible reasons for this poor sensitivity include 1) an eccentric jet not identified by the small pulsed Doppler sample volume; 2) prothesis interference with the Doppler signal in the apical four chamber view; and 3) the large angle of incidence between the pulsed Doppler signal and the regurgitant jet. Mitral insufficiency, especially when not severe, may be missed by this technique. Care must be taken in interpreting negative results from a pulsed Doppler ultrasound evaluation of a prosthetic mitral valve.

ISSN:0098-6569    

DOI:10.1002/ccd.1810140405

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY

摘要:

AbstractContrast‐enhanced ultrafast computed tomography (CT) of the left ventricle was done in the long axis and short axis within one day of cardiac catheterization in 14 males with ischemic heart disease and a mean age of 58 years. Imaging was R wave‐triggered at 58‐msec intervals (13/level). Left ventriculography was performed in 30° right anterior oblique (RAO) and 60° left anterior oblique (LAO) caudal 12°. CT left ventricular ejection fraction was measured using a modified Simpson's reconstruction of end‐systolic and end‐diastolic slices. Catheterization left ventricular ejection fraction was measured by area‐length method. Six left ventricular segments (septal, apex, anterior, lateral, inferior, and posterior) were scored by different paired observers as follows: dyskinesis (−1), akinesis (0), moderate‐severe hypokinesis (1), mild hypokinesis (2), and normal (3). Correlations of left ventricular ejection fraction for catheterization vs. long‐axis CT and short‐axis CT were r =.83 and r =.86, respectively. Seven of eight patients with transmural myocardial infarction were identified on CT by akinetic/dyskinetic segments. Eighty‐four segments were scored. There was agreement (normal vs. abnormal) in 76 (90%). CT detected 47 normal segments vs. 51 by catheterization (92%), 11 akinetic/dyskinetic segments (92%), and 14 hypokinetic segments vs. 21 (67%). Wall motion scores between CT and catheterization differed by>1 in 6 of 84 segments (7%). Therefore, ultrafast CT can accurately assess global and regional l

ISSN:0098-6569    

DOI:10.1002/ccd.1810140406

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY

摘要:

AbstractThis report presents a case in which an angioplasty balloon catheter became entrapped within the lumen of a coronary artery after rupture during percutaneous transluminal coronary angioplasty (PTCA). Prior to this report, balloon rupture had been considered a relatively benign occurrence. However, this case demonstrates that balloon rupture may lead to serious complications.

ISSN:0098-6569    

DOI:10.1002/ccd.1810140407

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY

摘要:

AbstractThree cases (one fatal) of a rare angioplasty complication, vein graft rupture, are presented with a review of the literature. Caution is suggested when oversizing balloons for vein graft dilatation.

ISSN:0098-6569    

DOI:10.1002/ccd.1810140408

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY

摘要:

AbstractHemodialysis fistulas are a cause of high‐output congestive heart failure (CHF). A case is reviewed of a patient in whom surgical correction of an excessively high fistula flow led to resolution of CHF. Bradycardia induced by fistula occlusion (Nicaladoni‐Branham sign) was not present, but transient occlusion did produce a marked decrease in cardiac out

ISSN:0098-6569    

DOI:10.1002/ccd.1810140409

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY

摘要:

AbstractIn a patient who died of complications of severe pulmonary hypertension, right ventricular failure, and sepsis, antemortem two‐dimensional (2‐D) echocardiography and magnetic resonance imaging (MRI) studies demonstrated a right ventricular mass which at autopsy proved to be thrombus. The diagnostic features of this mass as imaged by these two methods are compared. This case was complicated in that the patient had a history of right atrial myxoma that had been successfully removed three years previously, and a history of several prior pulmonary emboli. Gated MRI depicted the size, shape, and surface characteristics of the mass more clearly than 2‐D echocardiography because MRI provided better contrast and spatial resolution. Both techniques were useful in localizing the mass and showing if it was fixed or mobile. Depiction of tumor attachment was unclear with echocardiography but very clear with MRI. MRI also showed a left pulmonary artery thrombus that was not visualized by 2‐D echocardiography. Both techniques provided chamber dimension measurements showing enlargement of the right atrium and ventricle. This case demonstrates that gated MRI provides high‐quality images of cardiac anatomy and masses. Gated cardiac MRI should be considered at least complementary and potentially superior to two‐dimensional echocardiography in the evaluation of intracardiac masses in certa

ISSN:0098-6569    

DOI:10.1002/ccd.1810140410

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810140411

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1988

数据来源: WILEY