Traumatic right coronary arterial-right atrial fistula.

A healthy 25 year old man presented with a machinery murmur and a history of a penetrating thoracic injury. Hemodynamic and angiographic evaluation demonstrated a fistula from the right coronary artery to the right atrium that was later successfully repaired. This case and similar reported cases indicate that fistula formation is a late complication of penetrating thoracic injuries. The onset of the murmur occurs with enlargement of the fistula and typically is delayed for several weeks to months after the initial injury.

A report of Uhl's disease in identical adult twins: evaluation of right ventricular dysfunction with echocardiography and nuclear angiography.

The first example of Uhl's disease affecting identical adult twins is reported, offering support for the contention that a congenital developmental defect or hereditable tendency is the responsible cause. In one case, echocardiography and nuclear angiography proved to be valuable in making the diagnosis. Uhl's disease in the adult should be suspected among cases of isolated right ventricular enlargement and failure complicated by ventricular dysrhythmias. The diagnosis may be made using a combination of noninvasive tests, obviating the need for cardiac catheterization.

Simultaneous measurement of aortic and left ventricular pressures in aortic stenosis using a double lumen pigtail catheter.

This technical note describes a double lumen pigtail catheter that can facilitate measurement of the aortic valve gradient in patients with aortic stenosis. The catheter is passed retrograde into the left ventricle with the aid of a flexible guide wire. In two patients the measured gradient was not significantly different from that obtained using two systemic arterial catheters.

Coronary artery surgery for recurrent ventricular arrhythmias in patients with variant angina.

Two patients with Prinzmetal's variant angina had recurrent episodes of resting chest pain, ST segment elevation, QRS widening, ventricular tachycardia, and ventricular fibrillation. These eqisodes were unresponsive to medical therapy including lidocaine, procaine amide, and quinidine sulfate. Coronary arteriography revealed severe obstructive coronary artery disease, involving more than one coronary artery, in both patients. Aorticocoronary saphenous vein grafts were utilized to bypass significant disease in each patient. In one patient blood flow through the grafts was measured at 90 and 65 ml per minute, respectively, at operation and patent grafts were demonstrated six months postoperatively. Neither patient has had recurrence of chest pain or evidence of ventricular tachycardia at one year or 2 1/2 years postoperatively. Postoperative resting and maximal exercise ECG's are normal. Coronary artery surgery may be an effective method of therapy for ischemic ventricular tachycardia when medical therapy fails.