James E. Crockett

Percutaneous transluminal coronary angioplasty with and without thrombolytic therapy for treatment of acute myocardial infarction

Successful percutaneous transluminal coronary angioplasty (PTCA) was performed during evolving acute myocardial infarction (AMI) in 41 patients. Catheterization was performed within 1 hour of presentation, from 1 to 12 hours (mean 3.3) following symptom onset. In 17 of 29 patients with a totally occluded coronary artery, successful thrombolytic therapy was followed by PTCA of a residual high-grade atheromatous stenosis. Successful PTCA without prior thrombolytic therapy was employed in 11 of 12 subtotal coronary stenoses producing acute infarction syndromes and in two patients having critical coronary stenoses not immediately responsible for AMI. Three patients experienced early in-hospital reocclusion with reinfarction. One death occurred in a patient presenting with cardiogenic shock. All remaining patients had prompt pain relief, subsequent stable clinical courses, and no clinical or late angiographic evidence of coronary reocclusion. Dramatic improvement of regional and global left ventricular function was evident in 22 of 27 patients undergoing late left ventricular angiography. At follow-up, 94% of patients remained free of angina although three required repeat dilatation of recurrent stenoses. We concluded that PTCA may be performed with or without thrombolytic therapy in selected patients with AMI and may reduce the likelihood of late reocclusion following successful thrombolytic therapy.

Comparison of internal mammary artery ligation and sham operation for angina pectoris.

Abstract A sham operation was compared to ligation of the internal mammary arteries in patients with angina pectoris. Patient improvement was identical. The exercise electrocardiogram was not altered by either procedure.

Ruptured congenital aneurysm of the sinus of Valsalva.

Abstract 1. 1. Report is made of a case of congenital aneurysm of the right coronary sinus of Valsalva with rupture into the outflow tract of the right ventricle, and death as a complication of aortography. 2. 2. Cardiac catheterization data are presented. 3. 3. Differential diagnosis and embryology are discussed. 4. 4. A review of the probable mechanism of death is presented.

LIPOMA OF THE HEART.

Abstract Diagnosis and successful surgical removal of an intracavitary right atrial lipoma is reported. The importance of angiocardiography in the diagnosis of such lesions and the necessity for extracorporeal circulation in the surgical removal have been demonstrated.

Relief of angina and congestive failure by Hufnagel valve: subsequent term pregnancy.

Abstract A report is given of a 19-year-old patient with severe free aortic regurgitation due to chronic rheumatic heart disease in Class IV functional capacity. A Hufnagel valve was inserted, with subsequent improvement of her cardiac symptoms and successful completion of a full-term pregnancy.

Idiopathic gardiomegaly with extreme cardiac enlargement

Abstract A case of extreme idiopathic cardiomegaly associated with a hypoplastic aorta is reported. The heart weighed 1,300 gm. The patients clinical course was characterized by recurrent and protracted Stokes-Adam s syndrome which terminated in sudden death.