PTCA of complex atherosclerotic lesion at site of LAD myocardial bridging.

An 86-year-old patient with a history of chronic angina pectoris and a remote cerebrovascular accident presented to the hospital with an acute myocardial infarction complicated by a concomitant nonhemorrhagic cerebrovascular accident. Postmyocardial infarction angina pectoris, refractory to maximal medical therapy, led to coronary angiography. This demonstrated the "culprit" lesion to be a complex and critical atherosclerotic lesion at the distal-most extent of a long area of left anterior descending (LAD) myocardial bridging. This "culprit" lesion was successfully treated by balloon angioplasty. This is the second report in the recent literature of balloon angioplasty revascularization used in this fashion. Similarities and differences between our case report and the prior report in the literature are compared and contrasted.

Quantitative validation of cineangiographic axial oblique biplane left ventricular volume measurement.

Axial oblique left ventriculography allows unique visualization of acquired and congenital cardiac lesions. However, validation of the accuracy of left ventricular (LV) volume with axial oblique projections is limited and clouded by orthogonal violations between biplane projections. Biplane cineradiographic volume measurement of 17 LV casts employing the axial projection 35 degrees right anterior oblique/55 degrees left anterior oblique/30 degrees cranial (35 degrees RAO/55 degrees LAO/30 degrees Cr) was performed and compared to the conventional postero-anterior/lateral (PA/Lat) and 30 degrees right anterior oblique/60 degrees left anterior oblique (30 degrees RAO/60 degrees LAO) views. LV volume was calculated from biplane cineradiograms by area length and Simpson's rule method. True LV volume by water displacement was 33 +/- 28 (mean +/- S.D.), range 15 to 112 ml. LV cast volume calculated by the area length method from cineradiograms was overestimated (p less than 0.002) but no different by Simpson's rule method (pNS). The ideal correlation was best approximated by the 35 degrees RAO/55 degrees LAO/30 degrees Cr biplane view calculated by Simpson's rule, r = 0.99, y = 3.5 + 0.9x, and standard error of estimate (SEE) = 4.3 ml. Biplane LV angiography with the axial projection permitted accurate LV volume measurement, and Simpson's rule provided the best representation of true volume.