Harold A. Baltaxe

The incidence of congenital anomalies of the coronary arteries in the adult population.

A review of 1,000 consecutive coronary angiograms, most of them performed for evaluation of angina pectoris, yielded 9 examples of congenital anomalies of the coronary arteries. In 2 cases the angina may have been due to malposition of the left coronary artery or one of its branches. There were 2 cases of aberrant origin of the circumflex artery from the right coronary artery, 2 cases of aberrant left anterior descending artery, 3 cases in which all three major coronary branches arose from the right aortic sinus, and 2 cases of coronary artery fistulas. Malposition of the coronary artery should be considered as a possible cause of angina.

Left Atrial Enlargement: Correlation of Left Atrial Volume with Cardiac Series, Ciné-esophagography, and Electrocardiography

Measurements of maximal and minimal left atrial volume were obtained from 9 control children and 52 patients with congenital heart disease or pulmonary disease. The volume measurements were correlated with readings of left atrial enlargement by cardiac series and electrocardiography. These studies showed that left atrial volume must be enlarged 2.5 times beyond normal limits before cardiac series and electrocardiography can consistently define left atrial enlargement. Hence cardiac series with barium swallows and electrocardiography are unreliable guides to the size of the left atrium, especially in the presence of minimal or moderate enlargement.

Clinical studyTotal occlusion of the left main coronary artery: A clinical, hemodynamic and angiographic profile☆

Abstract Although left main coronary artery stenosis has been extensively revicwed, total occlusion of the left main coronary artery has received scant attention. Six patients were diagnosed at cardiac catheterization as having total occlusion of the left main coronary artery over a period of seven years at two institutions. They ranged in age from 32 to 72 years, and all had symptoms ranging from NYHA Class 1-IV at initial presentation. One patient died three days after coronary artery bypass graft surgery. Of the remaining five, two treated medically are alive four and 40 months after catheterization, and three treated with coronary artery bypass graft surgery are alive three, 66 and 68 months after catheterization. Electrocardiogram showed prior myocardial infarction in three patients, stress tests were positive in three of four patients, and hyperlipidemia was present in the five tested. In the three patients without prior myocardial infarction, left ventricular function was preserved (ejection fractions=0.52, 0.55 and 0.64; left ventricular end-diastolic pressures=6, 9 and 14 mm Hg). Injection of the right coronary artery in this group revealed extensive collaterals filling the left coronary artery. The three patients with prior myocardial infarction had impaired left ventricular function (ejection fractions=0.18, 0.30 and 0.33; left ventricular end diastolic pressures=26, 35 and 35 mm Hg) and sparse intercoronary collaterals. Patients with total occlusion of the left main coronary artery have a varying clinical presentation and may have prolonged survival. In patients with good collaterals, left ventricular function may be preserved.

Shunts between the coronary and pulmonary arteries with normal origin of the coronary arteries

Abstract Seven patients with shunts between the coronary and the pulmonary arteries with normal origin of both coronary arteries are described. Symptoms, when present, may be related to critical diversion of local blood flow or to the size of the shunt relative to total coronary blood flow. Maximal exercise testing may aid in finding those patients in whom the shunt leads to myocardial ischemia and may be a convenient way to follow up asymptomatic patients. These small shunts are frequently difficult to detect by sensitive methods; selective coronary arteriography proved to be the most helpful diagnostic procedure. Indications for surgery are not well established, but would include (1) relief of symptoms, (2) prophylaxis against complications of coronary artery disease and (3) the prevention of bacterial endarteritis.

Pulmonary Lymphangiectasia Demonstrated by Lymphangiography in 2 Patients with Noonan's Syndrome

Two cases of pulmonary lymphangiectasia associated with Noonans syndrome are described. Chest films showed diffuse pulmonary intersitial infiltrates from infancy. Lymphangiograms demonstrated obstructive changes and collateral formation in the retroperitoneal, mediastinal, pulmonary, and cervical lymphatics and extensive opacification of the pulmonary and visceral pleural lymphatics. Possible mechanisms and causes of the lymphatic malformation are discussed.

Inability To Show Clot: One Limitation of Ultrasonography of the Abdominal Aorta

Ultrasonography is accurate for diagnosis of abdominal aneurysms and clots within them. However, due to technical factors, occlusive clots within the aorta can be missed even at high gain. The authors report three cases in which total occlusion of the abdominal aorta was misdiagnosed as a free lumen occupied by a small clot. An explanation for the shortcomings of ultrasound is offered.

The Angiographic Appearance of Primary and Secondary Tumors of the Liver

The angiographic findings in 78 cases of hepatic tumor are analyzed in an attempt to find points of differentiation between primary and secondary disease. Vascularity is the most significant feature, with primary tumors being generally more vascular than secondary. No definite relationship was seen between the type of disease and liver enlargement, spleen enlargement, presence of cirrhosis, or vessel abnormalities. Obstruction or deviation of the portal vein appears to result from primary disease, but this is not specific. Differential diagnosis of other than highly vascularized tumors is extremely difficult.

The Angiographic Appearance of Hydatid Disease

Abstract The angiographic features of 6 hydatid cysts are presented. The appearance of a vascular rim in the capillary-venous phase during the angiographic study is described in those hepatic and renal cysts which do not show excessive calcification. The cardiac cyst, which demonstrates paradoxical pulsations at fluoroscopy, presents as a mass arising from the left ventricular wall and must be distinguished from an aneurysm. Direct left ventriculography in the presence of an echinococcal cyst can be performed if the operator injects the ventricle from its outflow portion.

Arteriography in Diagnosis and Management of Acquired Peripheral Soft-Tissue Masses

Arteriograms of 40 peripheral soft-tissue masses were analyzed and grouped into 3 categories. Type 1 showed coarse tumor vascularity; all were histologically or clinically malignant. In Type 2 the arteries were profuse but fine and slightly irregular with a definite blush during the capillary phase; all were either malignant or inflammatory in origin. Type 3 masses were completely avascular, and the 4 in this series were benign. In addition, angiography helps to identify the feeding arteries, detect tumor recurrence after previous excision, localize the area to biopsy, and evaluate a persistent mass after trauma.

Impaired Left Ventricular Contractility in Ischemic Heart Disease: Angiographic and Histopathologic Correlations

Ventricles of 21 patients with coronary artery disease examined by coronary angiography and left ventriculography were studied histologically. The amount of fibrosis was compared to the decrease in function indicated by ventriculography, elevation of left ventricular end diastolic pressure (LVEDP), and reduction of ejection fraction. In 51% of ventricular segments dysfunction paralleled the presence or absence of fibrosis. In 42%, dysfunction, more severe than the fibrosis, was due to ischemia or coronary steal. Patchy fibrosis in 7% did not significantly decrease function. Severe decrease in ejection fraction and elevation of LVEDP may be due to ischemia not fibrosis.