J. Stauffer Lehman

CLINICAL CORRELATION OF CORONARY ARTERIOGRAPHY.

Abstract Selective coronary arteriography is a satisfactory technic in the study of the distribution and severity of atherosclerosis in patients with coronary heart disease. This investigation analyzes the placement and gradation of pathology in patients with angina pectoris whose resting electrocardiograms varied from normal patterns to tracings indicative of past transmural myocardial infarctions. Atherosclerosis was visualized as a diffuse process involving two or three main arteries even in those individuals who had the earliest clinical form of coronary heart disease, namely, angina pectoris and a normal resting electrocardiogram. The severity of the atherosclerotic process in terms of its stenosing effect on the vascular vessels increased materially as the electrocardiographic tracing deteriorated from normal to a pattern indicative of a past transmural myocardial infarction. Channels of anastomosis did not develop when atherosclerosis was diffuse but not occlusive. Particular attention is drawn to patients with angina pectoris and normal resting electrocardiograms who had in the past RS-T or T wave abnormalities or both. The occlusive disease in these patients was considerable and hardly compatible with the term “mild coronary.”

Evaluation of “coronary vasodilators” by coronary arteriography

Abstract The primary purpose of a coronary vasodilator is to increase the caliber of the coronary vascular bed. Selective coronary arteriography currently is the most direct and effective means of evaluating changes in the size of the coronary arteries in the intact organism. Utilizing this method of examination, it is apparent that glyceryl trinitrate and erythrityl tetranitrate have coronary vasodilating actions even in those patients with overt and serious coronary atherosclerosis. The demonstration of this action, however, does not imply that coronary blood flow is consequently improved.

Quantitation of Aortic Valvular Insufficiency by Catheter Thoracic Aortography

Aortic valvular insufficiency is, with few exceptions, a consequence of rheumatic endocarditis or syphilitic aortitis. Rheumatic involvement of the aortic valve may produce varying degrees of stenosis or valvular insufficiency, either alone or in combination. The advent of surgical methods for treatment of rheumatic aortic valvular lesions has increased the importance of radiological study of the valve, determination of the extent and character of its pathological changes, and the degree of its functional impairment. While roentgen visualization of the aortic valve can be achieved by angiocardiography, provided a good “levo” study is obtained, or by cardiac ventriculography with introduction of a radiopaque medium by either transthoracic needle puncture or transaortic catheterization of the left ventricle, the most satisfactory method for radiologic study is catheter thoracic aortography. The procedure of catheter thoracic aortography was introduced in 1948 by Radner (1), who inserted a catheter into the ...

An Evaluation of Cardiovascular Contrast Media

The increasing application of cardiovascular opacifying procedures to the diagnosis of congenital malformations of the heart and great vessels and to the study of acquired cardiovascular disease has promoted an acceleration of effort toward the search for and formulation of more satisfactory radiopaque media. Within recent years, a number of compounds and formulations of newer types have been introduced while, at the same time, there has been progress in the development of additional opacifying procedures and technics for the diagnosis of congenital heart disease and disease states of the cardiac valves, coronary arteries, and pulmonary circulation. None of our present-day methods of cardiovascular opacification is completely devoid of danger to the patient; none is wholly innocuous. In large measure, the inherent hazards relate to the injected radiopaque medium. In the amounts and dosages necessary for effective opacification, any or all of the currently employed radiopacifying agents can, on occasion, p...

Suprasternal Transaortic Coronary Arteriography

Opacification of the coronary arteries has been accomplished by direct needle puncture of the ascending portion of the thoracic aorta via a suprasternal approach and injection of highly-concentrated radiopaque medium. Experience with 35 attempts in 31 patients at such coronary opacification is described. The electrocardiographic observations, the reactions, and the complications incident to the study are discussed. Thirteen of the 31 patients had some type of intrapericardial cardiac surgery subsequent to this procedure, and the surgical observations regarding the status of the coronary arteries are compared with the coronary arteriographic findings.

Colonic calcification and polyposis in schistosomiasis. Report of a case.

The authors describe the clinical and radiographic features of a case of mixed infection by Schistosoma mansoni and S. haematobium in which left colon calcification, rectosigmoid polyposis, and protein-losing enteropathy were demonstrated. The typical radiographic appearance of urinary schistosomiasis, i.e., bilateral hydroureter and calcified bladder and ureters, was also present.

Selective Coronary Arteriography

In its evolution, coronary arteriography has passed through stages of initial exploratory opacifications in experimental animals, the development of various technics for coronary visualization, and their clinical trial to its present important position in the diagnosis and assessment of coronary artery disease. Interest in this procedure as a clinically useful tool is attested to by its inclusion in most current symposia concerned with overall considerations of coronary artery disease, and by the rapidly increasing number of medical centers applying coronary arteriography in clinical studies of this disorder. Historically, coronary arteriography dates from Rousthois (1) on angiocardiography in experimental animals, published in 1933, while Radner (2) in 1945 achieved the first opacification of coronary arteries in living man. A variety of technics for radiologic opacification of the coronary arteries has been studied and described (3–6), and the senior author has reviewed and discussed considerations of ...

Acquired aortic valvular stenosis. Its diagnosis by conventional radiological study.

Stenosis of the aortic valve may be of congenital or acquired origin. Among the congenital malformations of the heart and great vessels, aortic stenosis is not an uncommon lesion. It may occur as stenosis of the valve itself or as a localized area of constriction in the ascending aorta above the valve, so-called supravalvular stenosis. Congenital constriction of the outflow tract of the left ventricle is a well recognized entity, but since it does not involve the aorta per se, the lesion hardly deserves the oft applied designation of subaortic stenosis. In the average general practice of radiology, the acquired form of aortic valvular stenosis is much more frequently encountered than is the congenital type, and it is to the consideration of acquired constriction that the present communication will be limited. The etiology of acquired aortic stenosis has been the subject of considerable study. Two principal causes have been propounded: namely, aortic sclerosis or fibrosis and rheumatic valvulitis. Kiloh (1...

Suprasternal thoracic aortography; suprasternal transthoracic needle puncture opacification of the thoracic aorta.

Direct opacification of the thoracic aorta has engaged the attention of many workers interested in the roentgen evaluation of the cardiovascular system. While aortic opacification may be accomplished by angiocardiography (1), the dilution of the radiopaque medium which occurs during its passage through the right heart chambers, pulmonary circulatory system, and left heart chambers is frequently of such degree that satisfactory visualization is not achieved. This is particularly true in situations where there is either increased pulmonary vascular volume or an increase in the size of the heart chambers such as exists with certain cardiac valvular lesions. Catheter thoracic aortography (2), with direct delivery of the opacifying agent into the thoracic aorta, does regularly effect satisfactory aortic opacification. The procedure, however, requires introduction of a catheter into a peripheral artery and its advancement to a desired position in the aorta. Surgical repair of the vessel opening through which th...

High concentrations of diatrizoate methylglucamine.

The formulation of high-concentration sodium and methylglucamine diatrizoate compounds for use as intracardiac and intravascular opacifying agents appears to be a further significant step toward the objective of attaining a completely safe and satisfactory opacification medium. Recent progress in the claboration of procedures requirinp direct introduction of relatively large amounts of undiluted radiopaque solutions into the cardiac chambers, the aorta, and larger arteries emphasizes the need for a continued search for ideal vaso-opacifying agents. Such procedures as selective catheter angiocardiography, catheter aortography, suprasternal thoracic aortography, cardiac ventriculography, and the several procedures designed for coronary arteriography require rapid boluslike injection of densely opacifying contrast media. Our experience in the use of high-concentration sodium and methylglucamine diatrizoate agents forms the basis of this report. The media we used were Cardiografin? in both 85 and 90.5 per cent concentrations, and Hypaquel in 85 and 90 per cent concentrations. Cardiografin 85 per cent is a viscous fluid, containing 85 per cent of the methylglucamine salt of Rcnografin acid. I t has an iodine content of 40 per cent. The 90.5 per cent solution of Cardiografin contains 30.5 per cent of the sodium salt and 60 per cent of the methylglucamine salt of Renografin acid. The iodine content is 46.5 per cent. I ts viscosity (Brookfield) a t 25°C. is