Assessment of thallium scintigraphy and echocardiography during dobutamine infusion for the detection of coronary artery disease.

Dobutamine infusion was performed in 16 patients following cardiac catheterization, and non-invasive assessment was performed with thallium SPECT and echocardiography. Dobutamine thallium scintigraphy was abnormal in 93% of patients with significant coronary artery disease. In addition, individual epicardial vessel involvement was identified by a corresponding perfusion defect with 88% sensitivity and 93% specificity. Dobutamine echocardiography revealed segmental wall motion abnormalities in 62% of patients with significant coronary disease. However, in six patients baseline segmental wall motion abnormalities on echocardiography improved during dobutamine infusion. Dobutamine thallium SPECT is a safe and useful test for the detection and localization of coronary artery disease. Dobutamine echocardiography is less useful in screening for coronary disease, but may detect areas of abnormally functioning myocardium having retained viability.

Complete left main coronary artery occlusion: angiographic evaluation of collateral vessel patterns and assessment of hemodynamic correlates.

An angiographic study of eight patients with total occlusion of the left main coronary artery identified six patients with chronic occlusion and two with acute complete occlusion. In each of six patients, there were two to six different intercoronary collateral pathways. Altogether, a total of 13 specific collateral channels were recognized. One patient had evidence of unique homocollaterals represented by enlarged vasa vasorum, which created a vascular cuff that surrounded a totally obstructed left main artery. The ventricular function and hemodynamic parameters in these patients not only depend on the collateral vessels but may also be affected by the severity of coronary artery disease in the artery that supplies collaterals.

Simultaneous left ventricular and ascending aortic pressure measurements via single artery access for assessment of aortic stenosis.

In order to determine the reliability of a single arterial access technique for hemodynamic assessment of aortic stenosis, data obtained from this method was compared with that from dual arterial access in 13 patients. A 59 cm long, 8 Fr. Mullins Transseptal Sheath (MTS) was placed in the ascending aorta (AA) and a 5 Fr. pigtail catheter advanced through the MTS (using a hemostatic "Y" adapter) into the left ventricle for simultaneous pressure recordings. Another 5 Fr. pigtail catheter (PTC) was advanced in the AA from the contralateral femoral artery. Peak pressures, AA pressure-tracing characteristics, mean gradients, and the aortic valve area using tracings from the MTS and the PTC were compared. Peak pressures 120 +/- 8 vs. 119 +/- 8 mmHg (r = .998), "T" time .16 +/- .01 vs. .15 +/- .01 sec. (r = .913), "U" time .36 +/- .02 vs. .36 +/- .02 sec. (r = .983), mean gradients 38.4 +/- 6.1 vs. 39.6 +/- 6.9 mmHg (r = .990) and the AV area .78 +/- .08 vs. 79 +/- .08 cm2 (r = .994) were similar. Therefore, this single arterial technique provides data comparable to the traditional dual access system for hemodynamic assessment of aortic stenosis.

The usefulness of the lateral projection in the assessment of the right coronary artery during percutaneous transluminal coronary angioplasty.

Optimum coronary angiographic definition of lesion morphology and side branch orientation is important during percutaneous transluminal coronary angioplasty (PTCA) to enhance the ease and safety of guidewire passage. This study was performed to compare the efficacy of the lateral (LAT) projection to conventional angiographic views for right coronary artery (RCA) evaluation pre- and post-PTCA. In 45 consecutive patients undergoing PTCA of 56 RCA lesions, the LAT was available to evaluate 40 lesions pre- and 44 lesions post-PTCA. Angiographic comparison of the LAT versus standard LAO, LAO cranial, and RAO views were performed by two experienced angiographers with consensus reading. The LAT was the best projection for assessing lesion morphology pre-PTCA in 19/40 (48%) and in 19/44 (43%) post-PTCA, while the LAT was significantly better (P less than or equal to 0.01) than standard views for assessing side branch orientation (48/56, 86%) and post-PTCA intimal disruption (18/33, 55%). In addition, LAT was the best view for assessing mid RCA lesions 13/21 (62%) pre-PTCA and 12/27 (44%) post-PTCA, while post-PTCA intimal disruption was best detected by LAT in 14/24 (58%). Lesions only recognized in the LAT view occurred in five instances, four involving right ventricular branch ostia and one involving the proximal posterior descending. Thus, the LAT projection appears helpful during PTCA to assess lesion morphology, eccentricity, side branch orientation, and intimal disruption pre- and post-PTCA as an adjunct to conventional views.