Larry P. Elliott

Quantitative left ventricular angiocardiographic findings in mitral stenosis: Detailed analysis of the anterolateral wall of the left ventricle

The observation of diminished motion of the anterolateral wall of the left ventricle in patients with mitral stenosis initiated this study. Twelve patients with mitral stenosis, 4 with right ventricular enlargement of other origin, and 8 normal subjects formed the basis for a quantitative analysis of the left ventricle by left cineventriculography. Our study indicated a markedly impaired contractility of the anterolateral wall of the left ventricle and posterobasal area in our patients with mitral stenosis. The 4 patients with right ventricular enlargement showed the same phenomenon of the anterolateral wall, but an abnormality of the posterobasal area was not evident. A reduced ejection was found in both groups. Our study further implicates a myocardial factor as a cause of reduced cardiac output in mitral stenosis. Lastly, as a potential explanation, we postulate that right ventricular enlargement, in some patients, may produce secondary abnormalities of left ventricular contractility.

Axial cineangiography in congenital heart disease. Section II. Specific lesions.

The value of axial cineangiography in several forms of congenital heart disease serves as an illustrated supplement to Section I. These techniques visualize defects in the entire ventricular and atrial septum. In persistent atrioventricular (A-V) canal, it is possible to visualize all parts of both septa, status of the A-V valves (two valves versus a common A-V valve), and if a common A-V valve, its degree of override. In tetralogy of Fallot, the bifurcation of the pulmonary trunk, entire ventricular septum and coronary arteries are vividly shown. The presence of true and confluent pulmonary arteries versus systemic or bronchial arteries in pseudotruncus is clearcut. In double outlet right ventricle or in transpositions with or without double outlet right ventricle, the mitral valve-semilunar valve relationships, the left ventricular outflow tract, subpulmonary region and a straddling tricuspid valve are well demonstrated. In asymmetric septal hypertrophy, biventricular angiography may be circumvented.

Chest film detection of coronary artery calcification. The value of the CAC triangle.

Eighty-six adult patients were studied by PA chest film and fluoroscopy for coronary artery calcification (CAC). A triangular area (CAC triangle) along the left mid-heart border of the PA chest film was used in identifying CAC. Of 57 patients, 24 (42%) with CAC observed fluoroscopically had a strongly suspected or positive CAC triangle. The CAC triangle in the PA chest film has proved useful in identifying coronary artery calcification on the plain film.

THE COMMON CARDIAC VENTRICLE WITH TRANSPOSITION OF THE GREAT VESSELS

The physician dealing with congenital cardiac disease is not unlikely to be confronted with cases in which there is an abnormal relation between the great vessels (transposition). In analysing such a case, he attempts to determine whether or not there is some obstruction to pulmonary flow, and furthermore whether or not two ventricles are present, and, if so, which artery arises from which ventricle. At times, there is clear clinical evidence for the presence of one ventricle (common ventricle) with both great arteries arising from it. At other times, however, determination as to the existence of one or two ventricles is difficult, but whenever the two great vessels are transposed, one should suspect the presence of a common ventricle. Once this is established, either with or without pulmonary arterial obstruction, the nature of the atrio-ventricular (A-V) valves must be determined. In some cases of common ventricle there are two near-normal atrio-ventricular valves, while in others there is significant malformation of these valves: the latter malformations include common A-V valve and atresia either of the mitral or tricuspid valves.

Diagnosis of Polysplenia Syndrome

Three cases of polysplenia were diagnosed by visceral arteriography. Each patient had a common celiacomesenteric artery. The origin of supply to the dislocated splenic lobules was variable. Such lobules were readily demonstrated at various sites along the greater curvature of the stomach. Plain chest film findings which suggest polysplenia include (a) a stomach position opposite the cardiac apex-aortic arch, (b) malrotation of the gut on barium studies, (c) an enlarged azygos or hemiazygos vein, especially with malposition of the stomach and/or (d) dextrocardia, and (e) absence of the eparterial bronchus. The authors suggest that visceral arteriography is the only definite means of achieving a precise diagnosis.

Ostium secundum atrial septal defect associated with balloon mitral valve in children

Abstract Eight children with an ostium secundum atrial septal defect and balloon mitral valve are described. Leftward-superior QRS forces, abnormal T waves and suggestive apical auscultatory findings (midsystolic click or a late systolic murmur of mitral insufficiency) were frequently observed and led to the erroneous diagnosis of ostium primum atrial septal defect in six cases. Lack of any or all of these manifestations did not preclude the presence of a balloon mitral valve. The prognostic importance of this valvular lesion indicates the need to perform left ventriculography in all patients with an atrial septal defect.

The radiologic evaluation of the patient with suspected pulmonary thromboembolic disease.

The risks of anticoagulant and surgical therapy for pulmonary thromboembolic disease make a high degree of diagnostic certainty imperative. The pitfalls inherent in basing the diagnosis on clinical and laboratory information are discussed, and the radiologic and isotopic studies available to the clinician are presented, with special emphasis on their sensitivity and specificity and guidelines for their intelligent use.

Late superior vena cava syndrome after superior vena cava-right pulmonary artery anastomosis. Report of four cases.

Abstract Cyanotic congenital heart disease and decreased pulmonary blood flow were palliated in four patients by superior vena cava—right pulmonary artery (SVC-RPA) shunts. Between four months and two years after SVC-RPA anastomosis, a late progressive form of SVC syndrome developed. Signs of the syndrome included facial edema, severe headaches and, in two patients, abnormal enlargement of head circumference, with increased intracranial pressure. These were associated with increasing cyanosis and hematocrit and decreasing exercise tolerance. In three patients prompt disappearance of signs of SVC syndrome and marked clinical improvement followed systemic—left pulmonary artery shunting or open-heart repair of the underlying malformation. The SVC-RPA shunt was left intact in each patient. Late, reversible SVC syndrome in patients with SVC-RPA shunts may be secondary to a progressive decrease in blood flow to the left lung. In the fourth case, a persistent left superior vena cava draining into the left atrium...

The differential diagnosis of restrictive myocardiopathy and chronic constrictive pericarditis without calcification: Value of coronary arteriography

Abstract The coronary arteriograms of 106 patients were analyzed to determine the angiographic relation of the coronary vessels to the ventricular epicardium. Six of these 106 patients had hemodynamic findings suggesting restriction. One of these 6 patients had documented calcific constrictive pericarditis. It was determined that (1) the ventricular epicardium can easily be delineated by the coronary arteries in patients without pericardial thickening or effusion; (2) extension of the heart shadow beyond the defined epicardium under these circumstances represents pericardial thickening; and (3) patients with primary myocardial restriction can be distinguished from those with chronic constrictive pericarditis without calcification by utilizing coronary arteriography to define the ventricular epicardium.

The Anomalous Relationship of the Inferior Vena Cava and Abdominal Aorta as a Specific Angiocardiographic Sign in Asplenia1

The visceral anomaly known as agenesis of the spleen (herein referred to as asplenia) has been adequately described (2). The condition is almost universally associated with multiple and complex anomalies of the heart. These generally include common atrium, common atrioventricular valve, common ventricle, transposed great vessels, severe pulmonary stenosis or atresia, and anomalies of the pulmonary veins. The complex nature of the intracardiac malformations usually precludes correction by surgical technics. Nevertheless, it is important to recognize the syndrome of asplenia in order to exclude other forms of cyanotic heart disease which are amenable to surgical repair. Upon review of the forward angiocardiograms in these cases, it became apparent that the relationship between the inferior vena cava and abdominal aorta was anomalous. Because of this preliminary observation, we were motivated to review the angiocardiograms in several other cases to determine whether or not this anomalous relationship was dia...