Goffredo G. Gensini

The coronary collateral circulation in living man

Abstract The coronary arteriograms of 100 patients studied in our laboratory were reviewed and searched for the presence or absence of coronary collaterals. Fiftythree had either normal coronary arteriograms or less than 50 per cent lumen reduction. We found no collaterals in this group. The remaining 47 patients had more than 50 per cent lumen reduction of one or more of the main trunks or major branches. There was collateral circulation in 37 cases. Five had normal electrocardiograms. In 13, the existence of collaterals was inferred by visualization of an artery distal to a complete occlusion or from its opacification after injection of contrast agent into the heterolateral artery. In the remaining 24, continuity could be traced from the feeding artery through the collateral vessel into the recipient vessel. We describe several patterns of anastomotic pathways. The presence of coronary collaterals is a reliable indication of severe coronary artery disease and may account for a normal resting electrocardiogram even in patients with major arterial occlusion.

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

Effect of lipid-lowering therapy on the progression of coronary atherosclerosis assessed by scheduled repetitive coronary arteriography *

We studied 42 subjects, each of whom demonstrated significant (greater than or equal to 50%) narrowing of a non-grafted coronary artery and a baseline cholesterol level greater than 250 mg%. All patients underwent repeat scheduled coronary arteriography after 2 years on the study. Twenty-five colestipol responders (cholesterol levels reduced at least 15% within 1 month of therapy) were compared to 17 non-responders who were given 23 months of placebo after a 1 month exposure to colestipol. Baseline risk factors and demographic characteristics were similar for the two groups. In comparison to baseline arteriography, only 3 of the 25 drug-treated patients showed progression, while 8 of 17 placebo treated patients demonstrated progression (P = 0.011). Drug-treated patients demonstrated a 20% decrease in cholesterol levels, while placebo patients did not experience a significant reduction in cholesterol levels. Our study suggests that significant reduction in serum cholesterol levels is associated with a reduced likelihood of progression of coronary atherosclerotic lesions assessed by scheduled repetitive coronary arteriography in hyperlipidemic subjects demonstrating significant coronary artery narrowing on their initial arteriograms.

The Erysichthon syndrome. Progression of coronary atherosclerosis and dietary hyperlipidemia.

One hundred nineteen patients with coronary artery disease confirmed by coronary arteriograms were studied. Cine coronary arteriography confirmed progression of atherosclerosis in 106 (89%) patients (mean age 50.9 yr) and nonprogression in 13 (11%) patients (mean age 50.3 yr). Progression was defined as follows: any increase to 50% stenosis, 50% to 75% narrowing, 75% to 90%, 90% to 99%, 99% to total occlusion. Only one patient of the 106 who progressed (less than 1%) had ideal values for both cholesterol and triglyceride. Three of 13 patients (23%) who did not progress had ideal lipid values (P < 0.005). Fifty four of 106 patients who progressed had cholesterol levels 2 250 mg%; none of 13 patients who did not progress had suchlevels (P < 0.005). Thirty-nine of 98 (40%) patients who progressed had hypertension; only one (8%) who did not progress had hypertension (P < 0.025).Seventy-four of 96 patients who progressed were smokers (77%); two of 13 nonprogression patients smoked (15%) (P < 0.005).

Normal electrocardiogram in the presence of severe coronary artery disease

In 480 consecutive coronary arteriograms, we found 21 cases with normal resting electrocardiograms associated with complete or nearly complete occlusion of one or more of the three major coronary branches. Significant collateral circulation was demonstrated in 19 cases. In the other 2 there was evidence of good flow of contrast agent past the narrowed segment. All the patients had angina and 6 had clinical evidence of myocardial infarction six months or more before the arteriogram. No electrocardiographic evidence of necrosis was detected at the time of arteriography in these 6 patients. We believe that the absence of electrocardiographic abnormalities is related to the development of collateral vessels. This collateral network must be capable of either (1) supplying all or most of the affected tissue with blood flow in amounts sufficient to meet their minimal metabolic demands or (2) inducing the shrinkage of the necrotic area and its envelopment by viable myocardium.

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.

Fistula from Circumflex Coronary Artery to Superior Vena Cava

ANEURYSMS of the left coronary artery draining into the superior vena cava have not previously been recorded. Such an anomaly, however, may exist, as demonstrated by this report, and may easily be confused with patent ductus arteriosus, aortopulmonary window, sinus of Valsalva aneurysm, pulmonary arteriovenous fistula, and even rheumatic valvular disease. Aortography, or better yet selective coronary arteriography, correctly outlines this anomaly which is amenable to surgical correction.

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.

New Approaches To Coronary Arteriographya

are at present enjoying various degrees of success and are currently applied by several investigators in selected series of clinical cases.6-8 However, a number of these methods carry a high risk. Others have, so far, been successful only in the skilled hands of the originator7 and therefore may not be readily applicable on a routine basis. The main purpose of this work is to report our search for a safe, accurate, reproducible method of coronary arteriography and to describe in detail