Myocardial accumulation of labeled phosphate in malignant pericardial effusion.

Recognition of the presence of a malignant pericardial effusion is important because of the insidious onset and life-threatening potential. This report presents data on three patients with metastasizing carcinoma of the breast, all admitted with a presumptive clinical diagnosis of malignant pericardial effusion. Two of the three revealed a diffuse concentration of Tc-99m PPi within the myocardium. In these cases the diagnosis was confirmed by identification of malignant cells in the pericardial fluid. We suggest that the use of labeled phosphate agents may allow early recognition of myocardial involvement in patients with disseminated neoplasm that results in malignant pericardial effusion.

Solitary interruption of the arch of the aorta. Clinicopathologic review of eight cases.

Patients with isolated total interruption of the arch of the aorta not accompanied by other cardiovascular anomalies may survive to advanced age. Their symptoms and course resemble those of patients with postductal coarctation of the aorta. However, there are basic differences in the pathologic findings in these two types of anomalies that may be of aid in the radiographic diagnosis.

Multiple aortic aneurysms in relapsing polychondritis.

A patient with relapsing polychondritis and thoracic and abdominal aortic aneurysms is described. The aortic changes were due to aortitis, which primarily involved the media, with increased vascularization, perviascular infiltration of mononuclear cells, increased amounts of collagen and decreased amounts of elastic tissue and sulfated acid mucopolysaccharides. Aortic aneurysms frequently occur in relapsing polychondritis; they are usually in the ascending aorta but may be multiple and involve the abdominal aorta; involvement of the ascending aorta results in aortic regurgitation and left ventricular failure, and involvement of the abdominal aorta may be clinically silent and result in fatal rupture.

Comparison of left ventricular ejection fraction and regional contractility fraction pre and post coronary angiography.

Thirty patients [four normals, eight with mild and 18 with severe coronary artery disease (CAD)] were studied to evaluate left ventricular function type and post coronary angiography. The end diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF) and the regional contractility fractions (RCF) of eight ventricular segments were evaluated by left ventriculography. The RCF's were analyzed, in addition to the EF's to ascertain the effect of contrast material upon normal and scarred or ischemic segments of the left ventricle, and to rule out spurious findings in the EF due to coexistent reciprocal changes in RCF's. There was good correlation (r = .45 to .97 and p less than .01 to less than .001) in the above parameters of left ventricular function in patients with and without CAD before and after angiography. Thus, although intraventricular and intracoronary injections of contrast material produce transient changes in myocardial contractility, in a clinical setting left ventriculography may be performed prior to or following coronary angiography without danger of spurious results in normals and in patients with CAD.

Regional ejection fractions in patients with patent and thrombosed grafts after coronary artery vein bypass surgery.

Twenty-six patients who had received 43 grafts were studied before and after coronary artery vein bypass surgery. Cine ventriculograms taken in the right anterior oblique projection were analyzed and regional ejection fractions calculated. Single and multiple grafts were considered separately as were thrombosed and patent grafts. Patients were also divided into those with regional ejection fractions below 50% and those with regional ejection fractions above 50%. No statistically significant improvement of the relevant segments was demonstrated in any group. However, those with a regional ejection fraction above 50%, whose grafts had thrombosed, deteriorated from a mean of .66 to .39. There is a significant trend here (p less than .05) and a t test significance at the 7% level.

An angiographic assessment of left ventricular function in isolated mitral valvular prolapse.

Angiographic studies demonstrating alterations in left ventricular contraction have been cited as evidence that isolated mitral valve prolapse (MVP) may be associated with a cardiomyopathy. We studied 17 patients with isolated MVP undergoing cardiac catheterization who had chest pain, palpitations, and/or a murmur of mitral regurgitation. Eleven of 13 patients (85%) with no or mild (Grade 1+) mitral regurgitation had normal left ventricular hemodynamic measurements, while three of four patients (75%) with moderate or marked (Grades 2+-4+) regurgitation had abnormal left ventricular hemodynamic measurements. An increased mean rate of circumferential fiber shortening (greater than 1.9 circumferences/sec) was observed in nine of 13 patients (70%). Systolic ventricular wall motion was analyzed from left ventriculograms by methods which quantitate percent shortening of ventricular areas, transverse chords, and radial axes. Marked variations in the number and location of alterations in ventricular contraction were obtained by the different methods used to analyze the ventriculograms, with segments of hypokinesis being detected in from 0-14 patients studied, depending upon the method used. Localization of alterations in contraction predominantly in the basal and mid-segments of the left ventricular and the association of hemodynamic abnormalities with mitral regurgitation suggest that changes in ventricular contraction are primarily related to an alteration of mitral valve function in this condition.

Effects of the intracoronary and intraventricular injections of a commonly available vs. a newly available contrast medium.

Two contrast media (Renografin 76 and Isopaque 370) were used in a double-blind study for coronary angiography and left ventriculography. Fifty-eight patients with presumed coronary artery disease were studied. The effects of the contrast media upon the myocardium and upon ventricular function of patients with and without coronary artery disease were assessed. Pre and post angiography myocardial enzymes were obtained. Cardiac output was determined before and after the angiograms. Hemodynamic and electrocardiographic changes were continuously monitored during the procedure. The study showed that both contrast media produced similar changes; however, the "maximum" decrease in T wave amplitude was more marked in the normal group when Renografin 76 (as compared with Isopaque 370) was injected (p = 0.05) on the right. Renografin 76 injection into the left coronary artery produced a higher median T wave amplitude in lead II relative to Isopaque 370 only in the abnormal group (p = 0.01). The heart rate dropped more severely in the normal patients when the left coronary artery was injected with Renografin 76 than with Isopaque 370 (p = 0.05).

A proposed mechanism for transient increases in arterial pressure and flow during angiographic injections.

In a series of animal experiments, we have confirmed the observation that arterial pressure and flow increase distal to the injection site during power injections through non-obstructing catheters. Our data suggest that the phenomenon is secondary to the transient production of turbulence. Thus, for a given injection rate, catheters with smaller end holes create more fluid velocity, which increases the Reynolds number and causes augmentation of downstream pressure and flow. The addition of side holes decreases the fluid velocity of the injectate and minimizes the hemodynamic effects. The discussion deals with factors contributing to the generation of local turbulence, the magnitude of pressure and flow changes caused by the injections, and the clinical implications of these artifacts.

Diagnosis and treatment of fluid-filled renal structures in children with ultrasonography and percutaneous puncture.

The application of ultrasonographic and percutaneous needle puncture techniques in the diagnosis of various fluid-filled renal anomalies has permitted rapid delineation of anatomic detail, more definitive physiologic evaluation, and drainage, when necessary, in a safe and cost-effective manner. Its usefulness in children is emphasized in 6 illustrated cases of male infants with minimally or nonopacified renal anomalies, one of the more difficult diagnostic problems in pediatric urology.

Permanent percutaneous antegrade ureteral stent placement without transurethral assistance.

A simple, one-step, permanent, percutaneous, antegrade insertion of a ureteral stent is described, utilizing a double, pigtail catheter. No transurethral assistance is necessary. The advantages of this simplified technique are presented, and the necessary prerequisites for its application are discussed.

Percutaneous transluminal carotid angioplasty in fibromuscular dysplasia. Case report.

A patient with fibromuscular dysplasia (FMD) of the internal carotid artery was treated by balloon percutaneous transluminal angioplasty (PTA). This is the sixth reported case of FMD stenotic disease which was dilated by PTA. All previous cases including the current example were treated successfully with resolution of symptoms. This procedure is associated with a relatively low morbidity and is an alternative method of treatment to operative endarterectomy for this disorder.