Ann E. Kelly

Myocardial Toxicity of Contrast Agents Used in Angiography

Although reports on the general, neurological, and renal toxicity of the more widely used triiodinated compounds for cardiovascular contrast studies are not infrequent (1, 19, 20), relatively little (3, 8, 15, 16, 18, 21) has been published regarding their specific myocardial toxicity, especially with reference to the ever-growing application of selective injection technics. Our increasing interest in these methods (6, 13), particularly in coronary arteriography (10, 12), and the reportedly frequent occurrence of inadvertent intra-myocardial injection (14, 23) induced us to undertake an experimental investigation of the myocardial toxicity of commonly used radiopaque agents. We proposed to select the contrast medium combining the advantages of satisfactory opacity with the lowest possible degree of myocardial toxicity. With this goal in mind, we developed the concept and standardized the technic of occlusion retrograde coronary venous injection, a previously unreported method affording the opportunity of ...

Arteriographic demonstration of coronary artery spasm and its release after the use of a vasodilator in a case of angina pectoris and in the experimental animal.

From the Msgr. Toomey Cardiopulmonary Laboratory and Research Department of St. Joseph’s Hospital, Syracuse, New York. This study was supported, in part, by Research Grants of the American Heart Association (Grant No. 61 G 130) and the Heart Association of Onondaga County. Presented at the meeting of the American College of Angiology, June 1962, in Chicago, Illinois. * Diatrizoate methylglucamine, Squibb Laboratories. t Isordll~ (isosorbide dinitrate), Ives Laboratories, New York, N. Y. INTRODUCTION

Left ventricular end-diastolic pressure before and after coronary arteriography: The value of coronary arteriography as a stress test☆

Abstract A study of the left ventricular hemodynamics of 95 subjects in whom coronary cinearteriography was performed demonstrated statistical differences among the mean resting left ventricular end-diastolic pressure of normal subjects, patients with cardiomyopathy, patients with coronary artery disease and patients with coronary artery disease and aneurysm. These values were lowest in the normal subjects ( x = 8.1 mm Hg ) and in those with hypertrophic cardiomyopathy ( x = 9.7 mm Hg ), higher in the group with uncomplicated coronary artery disease ( x = 10.2 mm Hg ) and highest in patients with coronary artery disease and aneurysm ( x = 12 mm Hg ). The mean resting values appeared to be directly related to the degree of disease of the left ventricle. The largest increase of the left ventricular end-diastolic pressure after coronary arteriography, that is, up to 175 percent of the resting value, was recorded in patients with coronary artery disease ( x = 17.8 mm Hg ) and in the group with left ventricular aneurysm ( x = 18.6 mm Hg ). Lesser increments were detected in the control subjects ( x = 12.6 mm Hg ) and in patients with hypertrophic cardiomyopathy ( x = 11 mm Hg ). The correlation with left cineventriculography clearly indicates that the greatest increase in left ventricular end-diastolic pressure after selective coronary arteriography occurred in those patients who had the more extensive and severe degrees of left ventricular involvement. The behavior of the left ventricular end-diastolic pressure after selective coronary arteriography may be utilized as an additional and useful test in evaluating the functional state of the left ventricle.

Left ventricular aneurysm without coronary arterial obstruction or occlusion

Abstract The most common cause of left ventricular aneurysm is severe obstruction or occlusion of a major coronary artery. Among the last 2,500 patients studied in our laboratory with selective coronary cinearteriography and left ventriculography, we found 9 with unquestionable evidence of left ventricular aneurysm and no or minimal coronary arterial obstruction. Eight of the nine patients had a history of previous myocardial infarction and classic electrocardiographic changes. We believe that in these patients coronary arterial obstruction had led to the development of left ventricular aneurysm. Later, complete or partial regression of the coronary obstruction ensued, leaving a normal or a minimally compromised vascular lumen.

Cinefluorographic Control of Super Selective Coronary Occlusion in Experimental Animals

Experimental coronary occlusion formerly depended on either open chest techniques or dissemination of minute foreign particles in the blood stream. In the new method, a radio-opaque sphere is placed in the coronary artery of intact dogs, under cinefluorographic control. The occlusion of this vessel is performed under anesthesia by way of selective catheterization of the left coronary artery. Following a preliminary visualization, the catheter is removed and a sphere of the appropriate size is impaled on its tip. This instrument is then guided under image intensifier fluoroscopy into the coronary artery and lodged in place. Coronary arteriograms are performed immediately after the occlusion. This method has already demonstrated its value in studies of coronary vasomobility, in the serial observation of collateral development and is being utilized in detecting the influence of various surgical and/or medical therapy upon the natural history of acute coronary occlusion.