摘要:

AbstractOver a 41 month period selective coronary arteriography was performed on all patients age 35 and under seen at our hospital with a documented myocardial infarction. In these 25 patients, 4 (16%) demonstrated no arteriographic evidence of coronary artery disease. One‐hundred and fifty‐two patients over age 35 with a documented myocardial infarction underwent selective coronary arteriography during the same period. In each of the 152 cases, obstructive coronary artery disease was demonstrated. The generally favorable prognosis of patients with myocardial infarction and normal coronary arteriograms has been previously documented. On the basis of our experience and a review of the literature, it is recommended that all patients age 35 and under sustaining a myocardial infarction should undergo selective coronary arteriography, in order to establish progno

ISSN:0098-6569    

DOI:10.1002/ccd.1810030102

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

年代:1977

数据来源: WILEY

摘要:

AbstractThe bilateral measurement of pulmonary artery wedge pressure is essential in the cardiac catheterization evaluation of all patients with pulmonary artery hypertension. Five cases of pulmonary venous obstruction are presented, 4 of whom had additional intracardiac defects. The pulmonary artery hypertension in these 4 patients was initially attributed to the associated cardiac anomalies and because the left atrium had been entered directly with the catheter in each case, pulmonary artery wedge to the left atrium pressure gradients were initially either not obtained or were discounted as being artificial. Pulmonary venous obstruction was recognized in all 5 cases on the basis of an elevated pulmonary artery wedge pressure, and the anatomic site of the obstruction was successfully documented. Unless bilateral pulmonary artery wedge pressures are measured in all patients with pulmonary artery hypertension regardless of the presence of additional cardiac anomalies, a surgically correctable cause of pulmonary hypertension may be overlooked.

ISSN:0098-6569    

DOI:10.1002/ccd.1810030103

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

年代:1977

数据来源: WILEY

摘要:

AbstractSeveral investigators have described close relationships between left ventricular wall motion and physiologic cardiac events. Using an improved wall motion tracking devide (Vidian) in studies of 30 patients, we have compared the dynamics of left ventricular wall motion, recorded noninvasively, with high fidelity left ventricular and aortic pressures, intracardiac phonocardiograms, apexcardiograms, and cyclic left ventricular volume curves obtained during cardiac catheterization. Wall motion tracking signals comprised: pre‐ejection outward deflection commencing with the first component of the first heart sound and coincident with the pre‐ejection phase of the left ventricular pressure and apexcardiogram; a sharp descent during ejection, commencing with the „E”︁ point of the apexcardiogram and with the onset of the upstroke of the aortic pressure; end ejection nadir, synchronous with the dicrotic notch of the aortic pressure; a nadir representing cessation of inward displacement, presumably reflecting slight inertial motion of the wall; a brief period of isovolumic relaxation which terminated synchronously with the „O”︁ point of the apexcardiogram; rapid, then slow filling waves, coincident with those of the apexcardiogram, and demarcated by a transitional angulation synchronous with the third heart sound; and „a”︁ wave, occurring simultaneously with that of the apexcardiogram. Ventricular wall motion tracking signals also corresponded to curves representing cyclic changes in left ventricular minor radius, and chamber volume derived from cineventriculograms. In 10 patients with abnormal contraction patterns detected by biplane cineventriculography, anomalous deflections were also recorded during ejection by the Vidian. Left ventricular wall motion tracking with the Vidian: 1) provides a sensitive index for timing of intracardiac events, 2) reflects cyclic changes in ventricular volumes and minor dimensions, 3) provides a convenient noninvasive technique for detection of regional asynergy involving the lateral left ventricular wall, and 4) by correlation with simultaneous ventricular pressure measurements, may provide useful information regarding left ventricular pressure/segmen

ISSN:0098-6569    

DOI:10.1002/ccd.1810030104

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

年代:1977

数据来源: WILEY

摘要:

AbstractExternal pressure counterpulsation (ECP) has been reported to improve the clinical status of patients with angina pectoris. To document the mechanisms for such an improvement left ventricular oxygen consumption and lactate metabolism, coronary sinus blood flow, and cardiac index were studied in 10 patients with angina pectoris 1) prior to and during ECP; and 2) during right atrial pacing before and after 4 consecutive 2‐hour sessions of ECP treatment. During ECP peak early and mean arterial diastolic pressures were significantly raised above control values by 32 and 13% respectively. However, coronary sinus blood flow, left ventricular oxygen consumption and left ventricular lactate extraction, mean systolic arterial pressure and cardiac index were not significantly altered by ECP. Right atrial pacing at 140 beats/min increased coronary sinus blood flow 70% over control values and induced angina and ischemic ST segment changes in 8 patients before and after 4 consecutive treatments of ECP. ECP treatment did not significantly modify the above metabolic and hemodynamic responses at rest or during atrial pacing. Although 5 patients reported improvement in angina symptoms the effect was transitory. No significant improvement over pre ECP‐treatment exercise angina threshold was observed immediately following or at 1 and 3 months post treatment. This method of noninvasive circulatory assistance appears to be of doubtful value in the management of patients with stable angina pecto

ISSN:0098-6569    

DOI:10.1002/ccd.1810030105

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

年代:1977

数据来源: WILEY

摘要:

AbstractTo clarify the influence of propranolol—and particularly its heart‐rate effects—on myocardial ischemia, coronary hemodynamics and metabolism were studied in 15 patients utilizing a protocol to control heart rate. Ten patients had significant coronary narrowing (CAD) and 5 were normal. Systemic pressure, coronary sinus blood flow (CSBF), left ventricular oxygen utilization (LVV̇O2), ST Segment depression, and myocardial lactate extraction were measured before and after propranolol (10 mg IV), at rest, and during pacing‐induced tachycardia stress. Propranolol‐related reduction in CSBF and LVV̇O2at rest was reversed when heart rate was controlled in both patient groups. Propranolol failed to alter heart‐rate threshold, tension‐time index (TTI), CSBF, or LVV̇O2at angina in the CAD patients. Likewise, ischemic‐type ST depression, decreases in lactate extraction, and coronary resistance were unchanged compared to values observed during tachycardia stress before propranolol. In normal coronary patients, propranolol also produced no significant change in LVV̇O2or coronary resistance when its heart rate effects were controlled.These data imply that a major coronary and metabolic influence of propranolol relates to changes occurring secondary to its influence on heart rate. Furthermore, this agent's anti‐ischemic effect is not prominent during tachycardia stress suggesting that this stress test may be clinically useful in patien

ISSN:0098-6569    

DOI:10.1002/ccd.1810030106

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

年代:1977

数据来源: WILEY

摘要:

AbstractLittle is known of the clinical significance of myocardial bridges, which may be recognized angiographically as systolic coronary artery narrowing (SCAN). A retrospective review of a 1 year's experience (313 consecutive coronary arteriograms) revealed 5 patients with SCAN, an incidence of 1.6%. SCAN involved the proximal and/or middle segments of the left anterior descending coronary artery in all patients. It is of particular note that the administration of nitroglycerin noticeably accentuated the SCAN phenomenon in each of 3 patients to whom it was administered.Four of the 5 patients had left ventricular hypertrophy due to hypertrophic car‐diomyopathy (2), aortic stenosis (1), and hypertension (1). All 5 patients with the SCAN phenomenon had anginal chest pains, and critical obstructive coronary atherosclerosis was observed in only 2 cases. The other 3 patients showed, otherwise, normal coronary arteriograms.Thus, myocardial bridges appear to be angiographically manifest predominantly in patients with cardiac hypertrophy. Nitroglycerin, which accentuates SCAN, might be useful as a provocative test to enhance the angiographic recognition of this phenomenon. The possible role of myocardial bridges in the production of myocardial ischemia warrants further investigatio

ISSN:0098-6569    

DOI:10.1002/ccd.1810030107

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

年代:1977

数据来源: WILEY

摘要:

AbstractAn unusual case of a single left pulmonary vein draining the left lung and joining the left atrium without venous obstruction is reported. This anomaly occurred in association with partial anomalous pulmonary venous return from the upper lobe of the right lung to the superior vena cava. A similar case has been previously reported from our laboratory. The diagnosis of a single left pulmonary vein can be made by routine chest roentgenography because of the charácteristic radiologic appearance of this anomaly. It is important to distinguish this benign entity from more ominous pulmonary radiodensities

ISSN:0098-6569    

DOI:10.1002/ccd.1810030108

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

年代:1977

数据来源: WILEY

摘要:

AbstractAtresia of the aortic arch is distinguished from complete interruption of the aorta by the presence of a fibrotic strand bridging the 2 discontinuous segments of aorta. Most patients with aortic arch atresia have associated intracardiac defects. There is a high neonatal mortality in this condition, with 95% of the patients dying in the first year of life. The case described herein is the first long‐term survivor with atresia of the aortic arch, a patent ductus arteriosus, and an atrial septal defect to reach adulthood.In this patient an extensive collateral network existed in spite of the presence of a patent ductus arteriosu

ISSN:0098-6569    

DOI:10.1002/ccd.1810030109

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

年代:1977

数据来源: WILEY

摘要:

AbstractA 64‐year‐old woman presented with acute congestive heart failure and atrial fibrillation, with good response to medical management. Selective coronary and left ventricular cineangiography demonstrated multiple arteriosystemic connections arising from both left and right coronary arteries, but normal (although tortuous) coronary vessels and ventricular contraction pattern. Determination of the magnitude of the shunt flow and concommitant measurement of myocardial lactate extraction suggested that this type of coronary vascular abnormality was an angiographic curiosity without discernible clinical import; however, the etiology of the patient's heart disease remains an eni

ISSN:0098-6569    

DOI:10.1002/ccd.1810030110

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

年代:1977

数据来源: WILEY

摘要:

AbstractPresented are the results of the use of the transfemoral approach for coronary arteriography, as a safe alternative to the brachial approach, in evaluating patients in cardiogenic shock. Five patients, each with an intraaortic balloon pump device in operation, were evaluated. No complications were encountered using the transfemoral approach.

ISSN:0098-6569    

DOI:10.1002/ccd.1810030111

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

年代:1977

数据来源: WILEY