摘要:

AbstractThe occurrence of visual disturbances following cardiac catheterization with angiographies was studied in a prospective study of 2,006 consecutive adult patients. The overall incidence of visual disturbances was 1.0% and of complete blindness 0.2%. Women had higher incidence than men (2.0 versus 0.6%, p<0.01) and patients with a history of angina pectoris with normal coronary arteries had higher incidence than those with coronary artery stenosis (3.7 versus 0.8%, p<0.02). Thirteen of twenty patients also had signs of mental confusion. An abnormal electroencephalogram was found in 8 of 13 patients studied. Other neurological findings were observed in one patient only. All patients had complete recovery within 24 hours. Thus, the incidence of visual disturbances is found to be higher than earlier reported, but the visual loss is transient with a benign course.

ISSN:0098-6569    

DOI:10.1002/ccd.1810120102

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

年代:1986

数据来源: WILEY

摘要:

AbstractRight anterior oblique intravenous digital subtraction ventriculograms and selective coronary angiograms were performed on 71 consecutive patients. The intravenous ventriculograms were reviewed by two blinded observers with close examination of the right and left anterior descending coronary arteries. These were considered abnormal if they failed to opacify or if luminal irregularities suggested>50% obstruction. Significant (<50% obstruction) occlusions of the right coronary artery were found in 16 patients according to a blinded reading of the selective angiograms. The observers correctly identified 13 of these on the digital subtraction ventriculograms (sensitivity 81%(. Of the 55 nondiseased right coronary arteries, correct identification was made in 47 (specificity 85%). Likewise, 17 patients had angiographically significant obstructions of the left anterior descending coronary artery and 15 were correctly identified by digital subtraction ventriculography (sensitivity 88%). However, only 20 of the 54 nondiseased left anterior descending coronary arteries were correctly identified (specificity 37%). Nonopacification or visualization of a severe obstruction of the right coronary artery is a useful finding and should be sought during examination of routine intravenous digital subtraction ventriculograms. This technique is not adequate at the present time to replace selective coronary arteriography in the assessment of coronary anatomy.

ISSN:0098-6569    

DOI:10.1002/ccd.1810120103

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

年代:1986

数据来源: WILEY

摘要:

AbstractDoppler ultrasound has been used to determine the pressure gradient P1P2across the valve in patients with aortic stenosis (AS), but since the gradient varies over time and may be deceptively low in patients with impaired cardiac output, the key parameter to obtain is the orifice area (A)By calculating stroke volume (SV) from the modal flow velocity [vmode(t)] over the systolic ejection period (sep) or diastolic filling period (dfp(, wherever laminar flow exists in the heart across an area of known diameter D, (pulmonary artery or atrioventricular valves), and by substituting P1−P2= 4Vmax2, (Vmax= peak velocity in the aortic jet), the Gorlin formula becomes:\documentclass{article}\pagestyle{empty}\begin{document}$${\rm A = }\frac{{{\rm 0}{\rm .89 D}^{\rm 2} {\rm f}_{\rm o}^{{\rm sepordfp}} {\rm v}_{{\rm mode}} {\rm (t)}}}{{{\rm sep V}_{{\rm max}} \cos {\rm \theta }}}{\rm dt}$$\end{document}where θ = flow intercept angle at D.This approach was applied in nine adult patients with AS (age 64 ± 8 yearsrpar; in whom recent catheterization data was available for comparison. Close correlation was found between the calculated areas: A(Doppler) = 0.82 A(Cath) + 0.17 (r = 0.94, p<0.001). Two patients with Doppler gradients of<40 mmHg were shown by this Doppler method nevertheless to have severely narrowed orifice areas of<0g.78 cm2.Although there is a tendency to overestimate slightly the valve area, Doppler ultrasound assessment using this technique adds valuable noninvasive information concerning the degree of aortic valve dise

ISSN:0098-6569    

DOI:10.1002/ccd.1810120104

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

年代:1986

数据来源: WILEY

摘要:

AbstractIntraaortic balloon (IAB) Counterpulsation is a proven treatment for patients with refractory ischemia or cardiogenic shock; however its use has been largely limited to tertiary centers due to the difficulties and risks encountered in transporting patients with this device in place. We report our initial experience with 11 patients who underwent IAB Counterpulsation at a community hospital utilizing a portable transport IAB system. All 11 patients had successful IAB insertion, resulting in prompt stabilization. Immediate transportation during uninterrupted IAB Counterpulsation was successfully accomplished in each case using routine ambulance vehicles, allowing for the prompt initiation of further tertiary care. The role of portable IAB Counterpulsation in the community hospital and guidelines for the implementation of this portable IAB system are outlined.

ISSN:0098-6569    

DOI:10.1002/ccd.1810120105

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

年代:1986

数据来源: WILEY

摘要:

AbstractA patient presented with an acute inferior myocardial infarction. Coronary angiography in the acute stage revealed total occlusion of the right coronary artery. Reperfusion was obtained after intracoronary infusion of 250,000 units of streptokinase. Angioplasty was subsequently performed because of a high grade residual stenosis. An 8‐French right Judkins guiding catheter with a single side hole (USCI), a 3.0 mm balloon dilatation catheter (ACS), and a 0.018 high torque floppy guide wire (ACS) were used. After successful angioplasty angiography was repeated with the guide wire in the RCA, but the balloon was withdrawn into the guiding catheter. After injection of contrast, it was impossible to withdrawn the balloon catheter out of the guiding catheter. Fluoroscopy revealed extrusion of the balloon through the side hole in the guiding cathete

ISSN:0098-6569    

DOI:10.1002/ccd.1810120106

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

年代:1986

数据来源: WILEY

摘要:

AbstractDigital subtraction intravenous angiography (DSIVA) represents an important technical advance in angiographic diagnosis. Herein we present three patients with left atrial myxoma assessed by DSIVA. We review the role of DSIVA in evaluation of patients with suspected cardiac tumors and the importance of careful atrial‐phase scrutiny in examinations obtained for other purposes (ie, pulmonary angiography and assessment of ventricular function

ISSN:0098-6569    

DOI:10.1002/ccd.1810120107

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

年代:1986

数据来源: WILEY

摘要:

AbstractWe have examined 5 patients with typical angina pectoris and found them to have left coronary ostial stenosis without evidence of any other coronary arterial disease and without evidence of aortic disease (Takayasu aortitis, syphilitic aortitis, or familial hypercholesterolaemia). All five patients were female aged between 38 and 53 years, a striking difference from the normal 7:1 male:female ratio for atherosclerotic coronary artery disease. It may be that these patients represent a rare but distinct syndrome. The angiographic diagnosis can be difficult but a pressure drop as the catheter tip engages the ostium and lack of spill‐over of contrast into the sinus of Valsalva are findings that should lead the angiographer to suspect ostial stenosi

ISSN:0098-6569    

DOI:10.1002/ccd.1810120108

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

年代:1986

数据来源: WILEY

摘要:

AbstractLate (greater than 1 year) postoperative angiographic studies in five patients revealed evidence of flow disturbance at the distal valve, when two valves were present in the body of a saphenous vein graft (SVG(. This was associated with delayed clearance of radiopaque dye due to reduced velocity of flow. On follow‐up, occlusion, thrombus formation, or development of atherosclerosis seemed to have occurred in anatomic relation to these valves. All five patients had one additional graft in a good state of preservation; three internal mammary artery (IMA) grafts, and 2 SVGs. The latter had only one venous valve, and the velocity of flow was good.It appears that good velocity of flow is essential to the integrity of coronary bypass grafts. The presence of more than one venous valve in a graft appears to cause flow disturbance and sluggish velocity, factors adversely affecting their integrit

ISSN:0098-6569    

DOI:10.1002/ccd.1810120109

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

年代:1986

数据来源: WILEY

摘要:

AbstractFour unusual cases of phasic (occurring only in systole or only in diastole) coronary artery narrowing are reported. In two cases, diastolic compression of the left anterior descending coronary artery was due to tight pericardial adhesions in patients with aortic insufficiency; in the third case, systolic compression of two right ventricular coronary branches was associated with hypertrophic cardiomyopathy and a normotensive right ventricle; and in the fourth case, a large aneurysm of the inferior wall of the left ventricle caused systolic compression of the posterior descending coronary artery, which was epicardial. The diagnostic and pathophysiologic characteristics of each case are discussed.

ISSN:0098-6569    

DOI:10.1002/ccd.1810120110

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

年代:1986

数据来源: WILEY

摘要:

AbstractA case of catheter‐induced spasm in a 40‐year‐old male one year after orthotopic cardiac transplantation is presented. The fact that spasm can occur in this setting of total cardiac denervation demonstrates that other factors can play an important part in modifying the status of coronary artery pa

ISSN:0098-6569    

DOI:10.1002/ccd.1810120111

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

年代:1986

数据来源: WILEY