[Visualization of the intra-stent lumen in the coronary arteries and detection of restenoses with 64-slices tomography scanners with cardiac synchronization: first experience]. / Visualisation de la lumière intrastent des artères coronaires et détection des resténoses au scanner 64 coupes avec synchronisation cardiaque: première experience.

PURPOSE: to assess the value of the new high spatial resolution 64-slice CT (0.4 mm collimation) technology for non-invasive visualization of coronary artery stent lumen and the characterization of significant in-stent restenosis. MATERIALS AND METHODS: a total of 100 stents were visualized in 50 consecutive patients. All CT examinations were performed with a 64-slice CT (sensation 64; Siemens), with a slice thickness of 0.75 mm at 0.5 mm intervals with retrospective gating. Images were evaluated by two readers and the quality of the in-stent lumen was classified on 5-point scale (1 = not visible; 5 = excellent visibility). Fifty-eight stents in 29 patients were also examined by conventional coronary angiography one week after CT examination. Attenuation values were measured in the vessel upstream from the stent and within the stent, using 1 mm2 regions of interest. The intra stent attenuation ratio (ISAR) was calculated as vessel enhancement/intra stent hypodense area. Interobserver agreement was evaluated by kappa statistics, RESULTS: the interobserver agreement was k= 0.82. The in-stent lumen was visible (score > or =3) in 88 stents (88%), with good visibility (> or = 4) in 54% of stents. Unsatisfactory in-stent lumen visibility was associated with heart rate > 65 beat/min (p < 0.001) and stent size < 3 mm (p < 0.0001). In-stent visibility was also lower in circumflex than other arteries (p= 0.02). Thirteen stenoses or occlusions were detected in 8 patients. In-stent restenosis was associated with hypodense areas within the stent. A ISAR>2 was an accurate criteria (2 false positives, 0 false negative) for detection of significant (> 50%) intra-stent restenosis. CONCLUSION: high resolution 64-slice CT allows reliable in-stent visualization for stents of 3 mm or more in diameter, if heart rate is below 65 bpm. Significant restenosis can be detected with a high sensitivity by determining the ISAR. Arch Mal

A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. STENTIM-2 Investigators.

OBJECTIVES: In a multicenter, randomized trial, systematic stenting using the Wiktor stent was compared to conventional balloon angioplasty with provisional stenting for the treatment of acute myocardial infarction (AMI). BACKGROUND: Primary angioplasty in AMI is limited by in-hospital recurrent ischemia and a high restenosis rate. METHODS: A total of 211 patients with AMI <12 h from symptom onset, with an occluded native coronary artery, were randomly assigned to systematic stenting (n = 101) or balloon angioplasty (n = 110). The primary end point was the binary six-month restenosis rate determined by core laboratory quantitative angiographic analysis. RESULTS: Angiographic success (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3 and residual diameter stenosis <50%) was achieved in 86% of the patients in the stent group and in 82.7% of those in the balloon angioplasty group (p = 0.5). Compared with the 3% cross-over in the stent group, cross-over to stenting was required in 36.4% of patients in the balloon angioplasty group (p = 0.0001). Six-month binary restenosis (> or = 50% residual stenosis) rates were 25.3% in the stent group and 39.6% in the balloon angioplasty group (p = 0.04). At six months, the event-free survival rates were 81.2% in the stent group and 72.7% in the balloon angioplasty group (p = 0.14), and the repeat revascularization rates were 16.8% and 26.4%, respectively (p = 0.1). At one year, the event-free survival rates were 80.2% in the stent group and 71.8% in the balloon angioplasty group (p = 0.16), and the repeat revascularization rates were 17.8% and 28.2%, respectively (p = 0.1). CONCLUSIONS: In the setting of primary angioplasty for AMI, as compared with a strategy of conventional balloon angioplasty, systematic stenting using the Wiktor stent results in lower rates of angiographic restenosis.

Feasibility, safety, cost-effectiveness and 1 year follow-up of coronary stenting without predilation: a matched comparison with the standard approach.

BACKGROUND: We evaluated the feasibility, safety, procedural cost-effectiveness, radiation dose and time and 1-year target vessel revascularization rate of direct unprotected mounted stenting without previous balloon dilatation (DS) in native coronary artery lesions. METHODS: DS was attempted in 119 patients; 39 had a recent myocardial infarction, 62 had unstable angina, and 18 had stable angina. The clinical follow-up was obtained at 14+/-5 months (range 6 to 24 months). These results were compared with those for a consecutive group of 160 patients matched for type and length of lesions and who had a stent only if the post-balloon residual stenosis was >30%. RESULTS: The feasibility of DS was 112/119 (94%). The number of inflations, the length of the stent/length of the lesion ratio, the time and the dose of radiation were dramatically lower in the DS group (P<0.001). DS conferred a slight reduction in procedure-related cost [$820+/-157 for DS vs. 894+/-427 for standard dilatation (SD) per patient]. The 1-year target vessel revascularization rate was similar in both groups [nine (8%) for DS vs. 17 (11%) patients for SD, ns]. CONCLUSIONS: DS is feasible and safe in selected coronary lesions. This method provides a low rate of repeat revascularization and reduces the time and the dose of radiation compared with the standard approach.

[Hemodynamic response to intracoronary injection of a vasodilator during coronary angiography. A randomized comparative study of trinitrin and linsidomin ]. / Réponse hémodynamique à l'injection intracoronarienne d'un vasodilatateur en cours de coronarographie. Etude comparée randomisée de la trinitrine et de la linsidomine.

Intracoronary injection of a vasodilator agent in an almost systematic practice during coronary angiography or angioplasty because of the dynamic information that it provides concerning the stenosis, the artery in the unstenosed segment and spastic phenomena. Nitroglycerin is the reference drug with, however, a significant dose-dependent hypotensive effect. The aim of this randomised open trial was to compare the effects of Linsidomine, the active metabolite of molsidomide with the reference product. Eighty patients aged 59.2 +/- 10.4 years received either 0.15 mg of nitroglycerin or 0.8 mg of linsidomine during coronary angiography. Aortic pressure and heart rate were monitored continuously over 3 minutes; at the 3rd minute and injection of contrast was performed under fluoroscopic control under the same conditions as the basal injection for an experienced coronary angiographist to judge semi-quantitatively the quality of vasodilation at the site of stenosis and in the whole artery. In the linsidomine group, the only significant change was a moderate fall in systolic pressure from the 1st to the 3rd minute. In the nitroglycerin group, all pressure parameters fell from the 30th second. The heart rate remained stable in both groups. The maximal pressure differences were significantly different in the two groups: -4 +/- 7.3 mmHg versus -11.3 +/- 9.2 mmHg (linsidomine versus nitroglycerin), p less than 0.001 for systolic pressure; -0.1 +/- 5 mmHg versus -3 +/- 5.4 mmHg respectively for diastolic pressure (p less than 0.05); and -1 +/- 6 mmHg versus -5.3 +/- 6.4 mmHg (p less than 0.01) for mean pressure. These pressure changes were not associated with any detectable untoward clinical effect in either group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Isolated anomalous origin of a septal artery from a third coronary ostium. Apropos of a case]. / Naissance anormale isolée d'une artère septale par un troisième ostia coronaire. A propos d'un cas.

The authors report the case of a patient undergoing coronary angiography for angina who had an anomalous origin of the septal perforator artery from a separate ostium. Anomalies of the coronary arteries may consist not only of anomalous trajectories and coronary fistulae but also of anomalous origins of the main coronary arteries. The anomalous origin of a septal artery from a separate ostium is very rare accounting for 0.5% of cases in the medical literature. In some cases, this artery provides a collateral circulation for occluded main coronary vessels, thereby preserving left ventricular contractility.

[Retrograde dissection of the common trunk of the left coronary vessel during angioplasty of left anterior descending coronary artery. Apropos of 2 cases]. / Dissection rétrograde du tronc commun coronaire gauche pendant une angioplastie coronaire de l'artère interventriculaire antérieure. A propos de 2 cas.

Acute dissection of the left main coronary artery during coronary angiography or angioplasty is a rare but well known complication; it is attributed to a mechanical trauma caused by the tip of the catheter guide wire. The authors present two cases of dissection at the site of coronary angioplasty with a retrograde extension to the left main stem requiring emergency coronary surgery.

[Clinical application of the alkalosis induction test for coronary artery spasm]. / Application clinique du test de provocation par l'alcalose du spasme artériel coronaire.

Alkalosis was used for stress testing for coronary artery spasm in 70 patients (average age: 56 years) with resting angina. A rapid intravenous infusion of an alkaline buffer (THAM) immediately followed by 5 minutes' maximal ventilation increased the arterial pH to 7.67 +/- 0.5. Anginal pain and ECG changes were observed in 24 Patients, with ST elevation in 10 cases and ST depression in 14 cases. The ischaemic changes occurred during hyperventilation in 16 cases and in the 3 minutes following the test in 8 cases. The heart rate increased from 66 +/- II to 71 +/- 14 bpm (p less than 0,01) but systolic blood pressure fell from 139 +/- 12 to 130 +/- 12 mm Hg during hyperventilation; there was no significant change in the rate-pressure product (1130 +/- 1750 to 8990 +/- 2690). In all cases, the angina and ischaemic changes regressed after intravenous Trinitrin. Coronary angiography was performed in 56 patients: in the 24 patients with positive responses (Group I) and in 30 of the 46 patients with negative responses (Group II). Significant coronary artery narrowing (greater than 70%) was observed in 21 patients of Group I: in the 3 patients without coronary lesions an intravenous injection of 0.4 mg methylergometrine provoked coronary spasm. In Group II, significant narrowing was demonstrated in 18 patients: in the 12 other patients, coronary spasm could not be induced by methylergometrine. Therefore, in the absence of organic coronary lesions, an excellent correlation has been shown between the alkalosis and methylergometrine tests. This stress test was repeated in 16 of the 24 patients in Group I one hour after administration of 20 mg of Nifedepine: the test was negative in all cases. We conclude that the alkalosis test could be useful in the coronary care unit as a stress test for coronary spasm to determine the antianginal treatment of choice and to evaluate its efficacity.

[Contribution of the exercise test to the diagnosis of sinus dysfunction. Correlation with endocavitary explorations]. / Apport de l'épreuve d'effort au diagnostic des dysfonctionnements sinusaux. Confrontation avec les explorations endocavitaires.

Standardised exercise electrocardiography was performed in 50 patients undergoing endocavitary electrophysiological investigation of sinus node function. There was no previous history of cardiac failure or coronary insufficiency, and the patients, who were not trained athletes, were investigated after interruption of any medication which could affect sinus node function. The endocavitary investigations comprised overdrive suppression with rapid atrial pacing (Mandel) premature extrastimulus method (Strauss) and stimulation at a relative constant prematurity of 50% (Normal values: A2 A3 - 2d - return cycle - sinoatrial conduction time - = 0,77 A1 A1 - spontaneous cycle - +345). A significant difference in the maximal heart rate on stress testing between normal subjects and patients with sinus node dysfunction was observed only when values obtained with the relative constant prematurity method was taken into consideration (24 cases) the relative constant prematurity method became more significant (p less than 0,001). This held true to a lesser degree for Mandel's method (p less than 0,02), but no significant difference was obtained with Strauss' method. The ratio of maximal heart rate to theoretical maximal heart rate for age gave similar results. The correlation between stress testing and the relative constant prematurity method is probably related to intra sinusal shift of the dominant pacemaker. Both investigations would seem to test the functional properties and the reserve of the sinus node, taking extrinsic factors such as vago sympathetic stimulation into account. Patients with functional sinus node dysfunction increase their heart rates normally on exercise (average maximum of 170 bpm); a maximal heart rate of less than 120 bpm is very suggestive of organic sinus node dysfunction.

[Diagnosis of acute myocardial infarction using multislice computed tomography in emergency room]. / TDM coronaire en urgence dans le diagnostic d'infarctus à la phase aiguë.

Managing chest pain in emergency remains a diagnostic challenge because of the speediness and the accuracy that request. The authors report the case of a 40 years old patient admitted for chest pain with suspected aortic dissection. Multislice computed tomography (sixteen-slice CT) was performed at the patient's admission, initial diagnosis was rapidly corrected, showing both and accurately show both antero-septal defect perfusion and an acute occlusion of the proximal left anterior descending artery. Angioplasty was performed in emergency within the 6 first hours after onset of the symptoms. Multislice computed tomography was able to identify accurately not only the chest pain etiology but also to show the culprit artery, leading to quick and oriented percutaneous coronary intervention.

[Cardiology in general hospitals. A cooperative survey on medical teams, technical means and activity]. / La cardiologie en hôpital général. Enquête coopérative sur les équipes médicales, les moyens techniques et l'activité.

A national enquiry carried out in 1990 in the departments of cardiology of general and private non-profit making hospitals established the status of these departments and the evolution of their personnel and equipment since their creation. The enquiry involved two thirds of the cardiology departments of the general hospitals (119/180) and showed that most (66%) were established between 1974 and 1988. Implanted in fairly important cities with catchment areas of 100,000 to 400,000 people, they have an average of 32 beds (range 11 to 100) and 7.25 coronary care beds (range 4 to 19); 347 doctors work full (211) or part time (136) in these departments. These two types of work are allowed in the majority of these units (64/119). Specialist certified cardiologists practice in 62 departments (56%). The usual technical equipment is available in 80% of the units (Doppler echocardiography, exercise stress testing, Holter monitoring, right heart catheterisation). Permanent pacing is performed in 65% of these hospitals, more so in the provinces than in the Paris region. Coronary angiography is only available in 21%, radioisotopic investigations in 15% and coronary angioplasty in 12% of these centres. A prospective study performed in 1990 concerning 110 hospitals recruited 1,030 myocardial infarctions, which enabled the total number of infarcts hospitalised in the coronary care units of the general hospitals to be estimated at about 21,000 (60% of French myocardial infarctions).

[Transposition of great vessels with pulmonary stenosis and interventricular communication. Anatomic and surgical aspects. Apropos of 10 cases]. / Transposition des gros vaisseaux avec sténose pulmonaire et communication interventriculaire. Aspect anatomique et chirurgical. A propos de 10 observations

10 cases of anomalous position of the great vessels are reported. They include 8 cases of d-transpositions, 1 of 1-transposition and 1 anatomically corrected malposition. These cases have in common the combination of a ventricular septal defect with a pulmonary stenosis. The anatomical study (6 of 10 cases) made it possible to describe the type of the VSD (related to a defect of development and/or alinement of parietal on the septal band) and of the pulmonary pathway stenosis. Blalock's anastomosis has made it possible to obtain an improvement in 6 patients. 4 operations of complete cure were undertaken in d-transpositions: 2 Mustard's operations ending in death. 2 operations according to Rastelli's principles with one death and one good result. The case of anatomically corrected malposition died after an attempt at complete cure, in view of a left ventricular hypoplasia. The indication for the type of complete cure was discussed in relation with the anatomical data.

[Left juxtaposition of the atria. Apropos of a case with dextroversion, transposition of great vessels, bilateral conus, interventricular communication and pulmonary atresia]. / Juxtaposition gauche des auricules. A propos d'une observation avec dextroversion, transposition des gros vaisseaux, conus bilatéral, communication interventriculaire et atrésie pulmonaire

Report of one case of a woman aged 29 years with a severe cyanotic congenital heart disease complicated by brain abscess. The diagnosis of left juxtaposition of the atria combined with dextroversion, a d-transposition of the large vessels and a vestricular septal defect was done pre-operatively. An attempt at a Rastelli's operation was followed by immediate death. The post-mortem examination confirmed the pre-operative diagnosis and demonstrated besides a double conus and a pulmonary atresia. The juxtaposition of the atria was underlined.

[Simultaneous measurement of cardiac output by indium 113 m detected externally and by dye dilution of indocyanine green]. / Mesure simultanée du débit cardiaque par l'indium 113m en détection externe et par la dilution de vert d'indocyanine.

The cardiac output of 11 patients was measured by a method of dilution of a short-life radio-isotope, and compared with measurements obtained simultaneously by a dye dilution technique. After sudden intravenous injection of siderophilin (transferrin) labelled by Indium 113 m, the precoridal radioactivity was measured by a single panel detector probe. In 9 patients these measurements were carried out twice with a 15 minute interval. The correlation coefficient between the two methods was 0.884 for 20 measurements, and 0.939 for the first 11 measurements. The reproducibility of these measurements was comparable for the two techniques. The radio-isotope method of measuring cardiac output, which can be carried out at the bedside, is a simple, reliable and reproducible technique.

[Value of the exercise test after aortocoronary bypass]. / Valeur de l'épreuve d'effort aprés pontage aorto-coronaire. A propos de 100 cas.

The 100 patients who underwent an exercise test and a follow-up coronary arteriogram at a mean interval of 10.1 months after an aorto-coronary bypass had suffered preoperatively from incapacitating angina 50%), a threatened infarction syndrome (35%), or Prinzmetal's angina (15%). The majority had a single bypass graft (72%), but 28% had two or three grafts. The exercise test was positive 39 times, negative 51 times, and indeterminate in 10. Correlation with the clinical picture shows that 27% of the patients in functional category I had a positive exercise test. Correlation with coronary arteriography shows that a positive test is reliable evidence for a defect or occlusion of the graft. On the other hand, a negative exercise test is a less reliable indicator of a good result. No instances of positive exercise tests were found when there was complete alleviation of the coronary condition.

[Valve replacement in case of a partial atrioventricular canal. A propos of 17 cases]. / Remplacement valvulaire en cas de canal atrio-ventriculaire partiel. A propos de 17 cas.

In 17 patients with a partial form of atrioventricular canal, at least one valve was replaced. The mitral valve was the most commonly affected (16 cases), sometimes in association with the tricuspid valve (5 cases) or the aortic valve (1 case); the tricuspid valve alone was replaced in one case. 7 cases were ranked as operative deaths, and the longer term mortality was of 4 cases. The factors leading to this high mortality figure are discussed. The future treatment policy for this condition is discussed.

[Anomalies in myocardial contrast uptake revealed by multislice cardiac CT during acute myocarditis]. / Anomalies de la prise de contraste myocardique mises en évidence par le scanner cardiaque multicoupes au cours de myocardites aiguës. A propos de 2 cas.

Acute myocarditis can display many various clinical appearances. Endomyocardial biopsy is an invasive investigation for which the sensibility is insufficient in mild cases and when it is performed too early. Multislice cardiac CT with ECG synchronisation and injection of contrast medium allows visualisation of the coronary arteries and the study of myocardial contrast uptake. We report the cases of two patients with a mild myocarditis where multislice CT performed early showed multiple areas of increased myocardial contrast uptake consistent with a diffuse inflammatory disorder. Coronary angiography was normal in these two patients. Multislice cardiac CT could be a useful non-invasive investigation for the early diagnosis of this disease.

[Visualization of coronary tree and detection of coronary artery stenosis using 16-slice, sub-millimeter computed tomography: preliminary experience]. / Visualisation des artères coronaires et détection des sténoses significatives au scanner 16 coupes avec synchronisation cardiaque: première expérience.

PURPOSE: multislice CT has been shown as a promising tool for coronary artery imaging. Our goal was to investigate the value of the new sixteen-slice, CT technology for non-invasive visualization of coronary arteries and assessment of coronary stenosis. MATERIALS AND METHODS: we assessed coronary artery visualization in 30 consecutive patients using 16-slice CT and compared the findings with conventional coronary angiography. The whole heart was scanned using 0.75 millimeter slices after injection of contrast medium. Retrospective ECG-gated reconstructions were performed and images were analyzed using axial CT, maximum intensity projection and 3D images, blind to the conventional angiography findings. Seventeen main coronary segments of more than 1.5 mm were analyzed and stenosis was graded on a four-point scale. RESULTS: CT angiography attained diagnostic quality for the whole coronary artery tree in 90% (27/30) of patients. Sixteen of 493 segments (4%) were not interpreted because of substantial motion artifacts (n=12) or heavy calcifications or stenting (n=4). Thirty seven of the 43 cases of significant stenosis (>50%) identified on coronary angiograms were correctly identified with multislice CT. All 6 false negatives involved stenosis of the circumflex artery or branches. Five false positive stenoses were found in 432 non stenotic segments. The sensitivity was thus 86%, specificity 99% for stenosis of more than 50%. CONCLUSION: 16-slice CT provides an excellent visualization of the coronary tree in most patients, allowing accurate non-invasive detection of significant coronary stenosis. Stenoses of the left circumflex artery remain more difficult to detect.

[Role of the renin-angiotensin system in arterial hypertension with aortic coarctation in young adults]. / Rôle du système rénine--angiotensine dans l'hypertension artérielle de la coarctation aortique de l'adulte jeune.

The renin-angiotensin system (RAS) was evaluated in 7 hypertensives with pure isthmic coarctation of the aorta. RAS was studied under basal conditions, standing, after saralasine (a specific angiotensin II antagonist) and after acebutolol (a cardioselective beta-blocker and an inhibitor of renin secretion). Plasma volume was measured by radio isotopic methods and cardiac catheterisation was performed to assess the pressure gradient across the coarctation. On a normal salt diet on orthostatism, plasma renin activity (PRA) was increased in 5 patients and normal in the other 2. After moderate salt depletion, saralasine injection caused a significant fall in diastolic blood pressure (89,2 +/- 4,4 to 77,3 +/- 6,6 mmHg; p < 0,02) with an associated rise in PRA (5,7 +/- 4,4 to 17,1 +/- 9,1; p < 0,01). There was no correlation between these two parameters or their variations. The test was negative in two patients. The antihypertensive effect of acebutolol was moderate due partly to the absence of salt depletion. Inhibition of renin secretion by acebutolol was significant (4,7 to 1,95 +/- 1,10 ng AI/ml/h; p < 0,02) but did not correlate with variations of arterial blood pressure. There was no correlation between the antihypertensive effect of saralasine and acebutolol (R = 0,51). Plasma volume (n = 5) was almost always increased (47,15 +/- 5,4 ml/kg). No correlations were observed between the different levels of PRA, plasma volume, and the systolic and/or diastolic gradient. In conclusion, this study underlines the limitations of isolated peripheral assessment of PRA and the acebutolol test. On the other hand, the effectiveness of saralasine, a specific RAS antagonist, and the demonstration of the effective participation of this system associated with the usual increase in plasma volume, seems to liken coarctation of the aorta to the single kidney Goldblatt experimental model.

[Is plasma lipoprotein (a) level a reliable indicator predicting restenosis after angioplasty?]. / Le taux plasmatique de lipoprotéine (a) permet-il de prédire la resténose après angioplastie?

Lipoprotein (a) [Lp(a)] is an independent genetically determined marker of coronary artery disease. It is present in the atheromatous plaque with a molecular structure similar to that of plasminogen. Its role in postangioplasty restenosis is a possibility but is controversial. A population of 103 coronary patients underwent angioplasty with control coronary angiography before the 6th month; there were 53 good results and 50 cases of restenosis. The Lp(a) was measured by immunonephelemetry (threshold value of 250 mg/l). A subgroup with Lp(a) concentrations > 250 mg/l was identified. The average concentrations of Lp(a) in the two groups without restenosis (368 +/- 350 mg/l) and with restenosis (418 +/- 434 mg/l) were not statisticaly different (p = 0.2). When cases with Lp(a) > 250 mg/l were considered alone, the tendency to higher average concentrations of Lp(a) in the group with restenosis (777 +/- 424 mg/l) compared with the group without restenosis (656 +/- 340 mg/l) was more clear-cut but did not achieve statistical significance (p = 0.08). The individual scatter of Lp(a) being very wide (83 to 1,450 mg/l in the group without restenosis and 90 to 1,740 mg/l in the group with restenosis), it is impossible to predict restenosis from this parameter in a given individual. No correlations were observed between the different lipid fractions and restenosis. The extension of the lesions and the angioplasty site did not correlate with restenosis in this study. The authors conclude: 1) that the Lp(a) concentration has no individual predictive value for restenosis; 2) individuals with Lp(a) concentrations > 250 mg/l have an increased risk of restenosis (NS); 3) these results confirm other recent publications; and 4) further research into the isoforms of Lp(a) in each group could provide interesting data.

[Non-invasive study of the patency of aortocoronary bypass with pulsed Doppler technic. Preliminary studies]. / L'exploration non sanglante de la perméabilité des pontages aorto-coronaires par Doppler pulsé. Etude préliminaire.

The pulsed Doppler effect is a non-invasive investigation technique based on the fact that the blood cells moving in a vessel on which ultrasound is incident cause a rebound of different frequency, according to their rate. This technique allows us to measure flow in a "measuring volume", whose size and depth are regulable. It is also possible to collect the signal from one or several aorto-coronary grafts, and to distinguish these from the sorrounding vasculature by their diastolic perfusion. This preliminary study (11 cases) is an attempt to formulate strict procedural criteria by comparison with follow-up arteriography of the grafts. The ease of performance of this investigation should, eventually, make it unnecessary to have to carry out repeated arteriography.