Gunnar Helmius

Complications of Percutaneous Pericardiocentesis under Fluoroscopic Guidance

Complications in 352 cases of fluoroscopy-guided percutaneous pericardiocentesis accomplished through an indwelling catheter were reviewed following surgery and non-surgery. Thirteen major complications were found, namely 3 cardiac perforations, 2 cardiac arrhythmias, 4 cases of arterial bleeding, 2 cases of pneumothorax in children, one infection, and one major vagal reaction. No significant difference in complications was found between pericardiocenteses for pericardial effusions after cardiac surgery (n = 208) and those for effusions of non-surgical (n = 144) origin. Fluoroscopy-guided pericardiocentesis by the subxiphoid approach with placement of an indwelling catheter is a safe method for achieving pericardial drainage in both surgical and non-surgical effusions. Accidental cardiac perforation with a fine needle is a minor complication as long as the needle is directed towards the anterior diaphragmatic border of the right ventricle and drainage is achieved with a reliable indwelling catheter.

Repeat Femoral Arteriography in Hyperlipidemic Patients: A Study of Progression and Regression of Atherosclerosis

Femoral arteriography was performed in 62 patients with significant hyperlipidemia. Sixty were asymptomatic and two had intermittent claudication. The patients participated in a study aiming to demonstrate whether serum lipid lowering by drugs could influence the development of femoral artery atheromatous disease. Half of the patients were treated with fenofibrate and nicotinic acid and the other half served as a control group. At the first arteriography atherosclerotic lesions were found in 46 of the 62 patients (74%). Arteriography was repeated up to three times without complications. Visual analysis of angiograms revealed considerable inter-observer variation. An attempt was made to assess the angiograms by a computerized method which, however, still needs improvement and a computer designed for image analysis. Most patients had small or moderate atheromatous deposits in the femoral artery at the initial examination, in most cases showing no change during the study period of 18 months. Regression was found in five patients of the treated group, but in none of the control patients as judged by visual gradation (p<0.001).

Repeat femoral arteriography in hyperlipidemic patients

Femoral arteriography was performed in 62 patients with significant hyperlipidemia. Sixty were asymptomatic and two had intermittent claudication. the patients participated in a study aiming to demonstrate whether serum lipid lowering by drugs could influence the development of femoral artery atheromatous disease. Half of the patients were treated with fenofibrate and nicotinic acid and the other half served as a control group. at the first arteriography atherosclerotic lesions were found in 46 of the 62 patients (74%). Arteriography was repeated up to three times without complications. Visual analysis of angiograms revealed considerable inter-observer variation. an attempt was made to assess the angiograms by a computerized method which, however, still needs improvement and a computer designed for image analysis. Most patients had small or moderate atheromatous deposits in the femoral artery at the initial examination, in most cases showing no change during the study period of 18 months. Regression was f...

Regression of Femoral Atherosclerosis in Humans: Methodological and Clinical Problems Associated with Studies of Femoral Atherosclerosis Development as Assessed by Angiograms

Ischemic heart disease is the most prevalent clinical consequence of atherosclerosis.1 Atherosclerotic peripheral artery disease is, however, one of the most frequent causes of disability in the middle-aged and elderly.2

Effects of Exogenous Adenosine in a Patient with Transplanted Heart. Evidence for Adenosine as a Messenger in Angina Pectoris

In this pilot study some cardiac effects of exogenous adenosine on the denervated heart were studied in a patient with transplanted heart since 3 years. He was instrumented with catheters into the left coronary artery, the coronary sinus and the right ventricle. Adenosine was given in increasing doses intracoronarily, into the aorta at the diaphragmal level and into a peripheral vein. When given into the aorta pain was provoked dose-dependently and not different from a reference group. When given intracoronarily no pain was provoked except at the highest dose when a slight discomfort of the chest was provoked. After intravenous injection no pain was provoked in the chest or in adjacent structures. Coronary sinus flow increased dose-dependently and not different from the reference group. No increased heart rate response occurred after intravenous or intracoronary injections. Extensive degrees of sinus and AV nodal blockade occurred. In conclusion, the results are in keeping with a role for adenosine as a messenger between myocardial ischaemia and angina pectoris and cardiac sympathetic pressure response. The importance of innervation for proper sinus and AV nodal function was also illustrated.

Myocardial Infarction without Coronary Occlusion: A morphologic study in sheep

The macroscopic, histologic and enzyme-histochemical characteristics of the myocardial lesion obtained after heating of a thermoprobe in a branch of the left coronary artery in sheep is reported. In 13 sheep such myocardial lesions were produced distal to the location of the thermoprobe. Alterations were observed in accordance with generally accepted morphologic criteria for myocardial infarction. The coronary artery branch in which the thermoprobe was located showed erythrocyte and platelet aggregates immediately after the heating episode, which disappeared within a few min, as demonstrated by coronary arteriography. Injection of radiolabelled microspheres into the coronary circulation after induction of the myocardial lesion, cryosectioning of the heart and autoradiography revealed a lack of blood flow in the damaged myocardial region. We consider this new method a suitable tool for further studies on the complex pathology involved in the development of myocardial infarction.

Coronary by-pass operation--graft and left ventricular function.

Of 121 patients surviving a by-pass operation 114 have been folowed up hitherto. At first follow-up - usually one year after operation - the angina pectoris was relieved in 87% of the patients and in 85% at least one vein by-pass was patent. A high correlation was found between subjective result and graft patency. Advanced arterial changes at preoperative coronary angiography did not prevent good result after surgery. In about half of the patients whose pain was relieved, the left ventricular ejection fraction was increased postoperatively. However, in many patients, who were subjectively improved, the ejection fraction was unchanged or even decreased.

Femoral Lesion Change in Relation to Measured Risk Factors in the Stockholm-Uppsala Trial

Our access to highly efficient drugs against hyperlipoproteinemia (1,2) and to a high resolution femoral angiography technique (3) prompted us to study the effect of pronounced serum-lipid lowering on the development of femoral atherosclerosis in hyperlipoproteinemia.

Arteriography of Patients Included in a Regression Study

For a long time femoral arteriography has been used to visualize atherosclerosis. The criteria were very rough from the beginning, since the technique was used for preoperative evaluation and in the operative cases most of the lesions were total or subtotal occlusion of the arteries.

Cineangiographic and Intraoperative Measurements of the Size of the Aortic Valve Annulus

From the Department of Diagnostic Radiology (Head: H. Lodin) and Thoracic Surgery (Head: L. Johansson), University Hospital, Uppsala, Sweden. This report was presented at the Fifteenth Annual Meeting of the International College of Angiology, Lisbon, Portugal, July 1973. The use of biological material in aortic valve surgery, such as homografts, heterografts and autogenous tissue, demands careful preoperative determination of the size of the aortic annulus. An exact determination is particularly important when using ring-supported fascia lata grafts prepared prior to the operation so as to reduce the time of surgery. Fishmann, Bogren and Carlssonl 1