Martial A. Demany

Angina pectoris and slow flow velocity of dye in coronary arteries—A new angiographic finding

Abstract The coronary arteriograms of 6 patients with the anginal syndrome revealed a normal coronary arterial tree. This finding was associated with a strikingly slow flow rate of the angiographic dye through the major vessels. This feature is discussed in detail and a theory of small vessel disease is suggested. The purpose of this paper is to bring into focus a new angiographic finding. Its cause is hypothesized and requires clarification by further studies which should include accurate flow measurements, metabolic determinations, and myocardial biopsics.

Correlation between coronary arteriography and the postexercise electrocardiogram.

Abstract Seventy-five patients with chest pain were studied with a double Master exercise test (post-exercise electrocardiogram) and coronary cine-arteriography to determine the correlation between these two methods of indicating the presence and severity of coronary artery disease. In 33 patients, the description of the chest pain was not that of classic angina pectoris. In this group, coronary cinearteriography revealed no disease while 10 patients had a positive double Master exercise test. Forty-two patients had pain that was quite characteristic of angina pectoris. In this group, coronary artery disease was demonstrated in all patients by coronary cinearteriography while 24 of these patients had a negative Master test. Study of the coronary arteriograms showed no significant difference in the severity and distribution of the disease between patients with a positive postexercise electrocardiogram and those with a negative postexercise electrocardiogram. The incidence of demonstrable collateral channels was identical in both groups. Selective coronary arteriography has confirmed previous doubts regarding the diagnostic reliability of the postexercise electrocardiogram in the individual patient with chest pain.

Progressive Muscular Dystrophy: Hemodynamic, Angiographic, and Pathologic Study of a Patient with Myocardial Involvement

This paper describes the case of a young man with progressive muscular dystrophy who had supraventricular arrhythmias and intractable congestive failure. Hemodynamic studies and left cineventriculographic findings were compatible with a diagnosis of severe left ventricular failure.Coronary cinearteriography showed an abrupt ending of the artery to the sino-atrial node. At necropsy, a noninflammatory degeneration was found in this particular vessel. The pathogenesis of the cardiac arrhythmias seen in this condition is discussed in the light of these cineangiographic and histopathologic observations.

Cor triatriatum: Preoperative diagnosis in an adult patient

Abstract The clinical manifestations and hemodynamic and cineangiocardiographic findings in a 20 year old woman with cor triatriatum are described. The diagnosis was made before successful corrective surgery. Emphasis is placed on the hemodynamic and cineangiocardiographic findings that lead to making the correct diagnosis before surgery. The possibility of a cure after surgical correction makes it mandatory to consider this condition as a cause of obstruction to inflow to the left ventricle even in an adult patient.

Rare metastasis of primary bronchogenic carcinoma to sigmoid colon: Report of a case

The authors present a case of a rare metastasis of bronchogenic carcinoma to sigmoid colon. Carcinoma of the lung usually spreads locally to adjacent mediastinum or paratracheal lymph nodes via the lymphatics. When tumor invades the pulmonary vein, distal metastases are most often to brain, suprarenal glands, or bones. Primary bronchogenic carcinoma has been reported to metastasize to jejunum, maxillary antrum, small bowel, tongue, and rarely to other organs. The authors believe that metastasis to the large intestine is most exceptional. Occurrences of rare metastasis are not well understood, though one theory implicates sites of previous trauma.

Thrombosis of a mitral disc-valve prosthesis: Diagnostic importance of the absent opening click

Abstract Severe thrombosis of a mitral Kay-Suzuki disc valve developed in a patient 42 months after its insertion and while the prothrombin time had been maintained in the therapeutic range. The most significant clinical finding was the disappearance of the opening click. Hemodynamic and angiographic studies confirmed the diagnosis. The thrombosed prosthesis was successfully replaced. The recurrence of manifestations due to obstruction of blood flow at the mitral area, associated with the disappearance of the opening click, can be considered as pathognomic for thrombosis of the mitral prosthesis.

Congenital anomalies of the coronary arteries. A report of three cases.

a Associate, Marie L. Coakley Cardiovascular Laboratory, St. Vincent Charity Hospital, Cleveland, Ohio 44115. b Director, Marie L. Coakley Cardiovascular Laboratory, St. Vincent Charity Hospital, Cleveland, Ohio. The myocardium receives its blood supply from two arteries. The left coronary artery arises from the left aortic sinus and divides almost immediately into two major branches: the anterior descending artery which gives off several branches to the ventricular septum and the circumflex artery which, after coursing around the base of the left ventricle, terminates in a posterior descending branch. The right coronary artery arises from the right aortic sinus and follows the coronary sulcus at the base of the right ventricle to reach the posterior interventricular groove. Congenital anomalies of the coronary arteries are found in a very small number of individuals; and in those, the coronary circulation does not follow the usual pattern. Congenital anomalies of the coronary arteries can be classified as follows:

An angiocardiographic sign for the evaluation of the stenotic mitral valve

Abstract A new angiographic sign allowing a more accurate evaluation of a stenotic mitral valve is described. This is an area of negative contrast or pseudofilling defect appearing at the end of left atrial systole but absent during the remaining part of the cardiac cycle. Open heart surgery in 24 of 25 patients has confirmed that this is due to the protrusion or the aortic leaflet of a stenotic, but pliable and soft mitral valve that can easily and adequately be opened by commissurotomy. The type of surgery (commissurotomy vs. prosthetic replacement) can be predicted from the presence or absence of this angiographic sign. This sign was present in 25 cases of mitral stenosis and absent in 56. The latter had a stiff stenotic mitral valve at operation.

Meticulous Repair of the Arteriotomy in Prevention of Thrombosis Following Left Cardiac Catheterization and Coronary Arteriography

* Associate, Marie L. Coakley Cardiovascular Laboratory, Saint Vincents Charity Hospital, Cleveland, Ohio 44115. † Associate, Marie L. Coakley Cardiovascular Laboratory, Saint Vincents Charity Hospital, Cleveland, Ohio 44115. ‡ Director, Marie L. Coakley Cardiovascular Laboratory, Saint Vincents Charity Hospital, Cleveland, Ohio 44115. Catheterization of the left cardiac chambers and of the aorta can be accomplished by various techniques,l, 2 which, with the exception of the transseptal method3 and of the percutaneous puncture of the left ventricle,4 require the introduction of a catheter into a peripheral artery. Selective coronary arteriography can be performed only via a peripheral artery.5, s Percutaneous arterial puncture followed by catheter replacement of the needle 2. s, 7 has been advocated as the method of choice, but arteriotomy of the surgically exposed vessel is preferred by others.1, 5, 8 This report deals with the precise care of the arteriotomy, and its importance in preventing thrombosis of the catheterized vessel.

Internal mammary artery-left ventricular fistula: a complication of Vineberg's operation.

From the Medical and Surgical Cardiovascular Sections, St. Vincent Charity Hospital, Cleveland, Ohio. This study was supported by a grant from the United Health Foundation, Ashland, Ohio. * Supported by a grant from the United Health Foundation, Ashland, Ohio. Among the many operations designed to improve coronary insufficiency, Vineberg’s procedurel has been recently recommended with enthusiasm.2 2