ISSN:0098-6569    

DOI:10.1002/ccd.1810110202

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

年代:1985

数据来源: WILEY

摘要:

AbstractMitral area is the parameter used for quantitating mitral stenosis (MS) severity. When mitral gradient (MG) is low and reduction of mitral valve area (MVA) might be critical, interventions presumably increasing mitral valve flow (MVF), such as stress or atrial pacing, have been carried out. The purpose of this study was to analyze in 28 patients the combined effect of left ventriculography (LVG) and intravenous atropine (ATR) in the hemodynamic evaluation of MS. The rationale for combining these two interventions is to add up the ATR‐positive chronotropic effect to the LVG potentiation of cardiac output. The LVG plus ATR markedly accelerated heart rate (from 80 ± 14 to 104 ± 18 bts/min, P<0.001), mildly increased cardiac index (from 2.6 ± 0.6 to 2.9 ± 0.6 1/min/m2, P<0.05), and importantly increased MVF (from 136 ± 30 to 172 ± 46 ml/bt, P<0.001). Pulmonary wedge pressure increased (from 14 ± 5 to 21 ± 5 mmHg, P<0.001). because of an important increment of MG (from 12± 6 to 18 ± 7 mmHg, P12 mmHg. The remaining case with severe MS and the two cases (out of 12) with moderate MS having MG after LVG plus ATR ± 12 mmHg had, at surgical evaluation, noncriticall

ISSN:0098-6569    

DOI:10.1002/ccd.1810110203

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

年代:1985

数据来源: WILEY

摘要:

AbstractSince the introduction by Gorlin and Gorlin [1] of the hydraulic formulae for calculating valve area, it has become the best parameter for quantitating valve stenosis. Recently Hakki et al [3]proposed a simplified formula for valve area calculation that does not take into account either heart rate (HR) or left ventricular filling or ejection time. The purpose of this study was to analyze the validity of Hakki's formulae under different physiological conditions and to propose an easy correction to improve its accuracy. Our study suggests: (1) that an easy correction for heart rate in certain cases, dividing by 1.35 when HR90 beats per min in aortic stenosis, significantly improves the accuracy and validity of Hakki's formulae (p<0.02 and p<0.05); (2) the instantaneous valve gradients (peak gradient for aortic stenosis and average of instantaneous early, middle, and late diastolic gradients for mitral stenosis) are as valid as mean planimetric gradients for valve area calculation. Thus the simplified formulae proposed in this study allow mitral and aortic valve area calculations by means of instantaneous gradients, cardiac output, and heart rate.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110204

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

年代:1985

数据来源: WILEY

摘要:

AbstractThe hemodynamic and angiographic data of 147 individuals were analyzed in an attempt to assess the value of three techniques used in the diagnosis of mitral incompetence. One hundred patients had clinical evidence of mitral incompetence (group A) and 47 had normal hemodynamics (group B). The degree of mitral incompetence was assessed in all 147 individuals by two methods: determination of a regurgitant index (RI) using indicator dilution curves and determination of a regurgitant fraction (RF) using left ventricular volumes. In 26 patients of group A and 26 individuals in group B mitral incompetence was also assessed by cineangiocardiography. Each of these methods was compared with the clinical and hemodynamic evidence of mitral valvular incompetence. Both the determination of RI by dye dilution curves and RF by angiocardiography were found to be useful in separating normal individuals from patients with mitral valvular incompetence. Severe mitral incompetence is associated with an RI>35% and with an RF>55%. The degree of incompetence by either method was not well correlated with any independent hemodynamic variable. The use of cine angiocardiography to quantify the degree of mitral incompetence was found to be too subjective, depending on the observer, and thus less useful.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110205

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

年代:1985

数据来源: WILEY

摘要:

AbstractThe intracoronary injection of contrast media during coronary angiography occasionally results in ventricular fibrillation. Experimental studies have implicated the calcium sequestering agents, sodium citrate and EDTA in Renografin 76 (RG76), as contributing to this complication. Angiovist 370 (AV370) is a contrast medium similar to RG76 except that it contains disodium calcium EDTA instead of EDTA and sodium citrate. To determine if contrast media lacking sodium citrate and EDTA will result in a lower incidence of ventricular fibrillation in man, this investigation compared the incidence of contrast media‐induced ventricular fibrillation in patients undergoing coronary angiography with RG76 to that with AV370. Group A consisted of 2,500 consecutive patients undergoing coronary angiography with RG76 and group B consisted of 2,000 subsequent consecutive patients in whom AV370 was employed as the contrast medium. There was no significant difference between groups A and B with respect to the volume of contrast media used per patient (153 ± 49 ml vs 154 ± 45ml), age (58.4 ± 10 vs 58.6 ± 10 years), sex (70% male vs 70% male), ejection fraction (59 ± 17 vs 60 ± 20), history of mitral valve disease (5.8% vs 7.1%), history of aortic valve disease (6.7% vs 6.5%), prior coronary artery bypass graft surgery (6.6% vs 7.3%), or extent of coronary artery disease.Fifteen episodes of contrast media‐induced ventricular fibrillation occurred in group A (incidence 0.6%) whereas two episodes occurred in group B (incidence 0.1%) (p<0.02). Each patient was successfully defibrillated and no adverse sequelae resulted. Thus the present investigation suggests that the incidence of ventricular fibrillation during coronary angiography can be significantly decreased by using contrast media lacking sodium citrate

ISSN:0098-6569    

DOI:10.1002/ccd.1810110206

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

年代:1985

数据来源: WILEY

摘要:

AbstractPercutaneous balloon valvuloplasty (BV) for pulmonic valve stenosis (PS) is increasingly becoming a nonsurgical alternative in patient management [1–3]. However, the mechanism by which BV dilates the obstructive lesion has not been firmly established [4]. We have had the opportunity to examine the effects of BV in the setting of PS and present two illustrative cases documenting the morphology after BV of the stenotic bicuspid and tricuspid pulmonary valv

ISSN:0098-6569    

DOI:10.1002/ccd.1810110207

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

年代:1985

数据来源: WILEY

摘要:

AbstractWe recently observed the unusual origin of the posterior descending from the left anterior descending coronary artery in three patients undergoing coronary angiography. These three cases are presented and the clinical implications of this variation are discussed.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110208

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

年代:1985

数据来源: WILEY

摘要:

AbstractDiaphragmatic coronary stenosis is a rare coronary angiographic finding. It gives rise to an appearance of relatively severe obstruction and can lead to unnecessary surgical intervention or PTCA. We described four patients with this type of stenosis in whom the lesions proved to be hemodynamically insignificant as judged by the presence of only minor pressure gradients across them.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110209

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

年代:1985

数据来源: WILEY

摘要:

AbstractSevere pulmonary hypertension is rare in patients with aortic stenosis. When present, it usually implies either associated mitral valve disease, poor left ventricular function, or pulmonary disease. In this case report, severe pulmonary hypertension was present in a patient with isolated aortic stenosis and normal left ventricular systolic function. Pulmonary hypertension was probably related to left ventricular diastolic dysfunction. Following successful aortic valve replacement, pulmonary pressures declined but symptoms of shortness of breath persisted and the patient still required daily diuretics.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110210

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

年代:1985

数据来源: WILEY

摘要:

AbstractA deformable soft‐tipped angiographic catheter has been designed and developed to reduce vascular trauma during coronary arteriography. In order to test the ability of the catheter tip to glide over vascular endothelium, the coefficient of resistance was tested using fresh human aortic tissue. The mean frictional coefficients of resistance (FRc) for the soft‐tipped catheter, as compared with two commonly used catheters (N = 10/group), were .78 ±.08 units for the soft‐tipped catheter and 1.10 ± .10 (p<.006) and .98 ± .10 (p<.034) for the conventional catheters. This demonstrates a significant 23% reduction in FRc with the soft‐tipped catheter. The ease of penetration into a wax media was also measured using the soft‐tipped catheter and compared with the same two conventional catheters. The indentation depths for the soft‐tipped catheter and the two other catheter groups (N = 7/group) were 140 ± 18 m̈m, 246 ± 15 m̈m and 318 ± 20 m̈m, respectively. This represents a 56% decrease in indentation depth with the soft‐tipped catheter.Histologic studies in canines have demonstrated considerably less endothelial damage and subsequent intimal proliferation in the aorta and coronary ostia with the soft‐tipped catheters compared with control catheters.It is concluded that a soft‐tipped angiographic catheter is less traumatic to vascular tissue and may offer a safer approac

ISSN:0098-6569    

DOI:10.1002/ccd.1810110211

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

年代:1985

数据来源: WILEY