Murray G. Baron

Embolization of left atrial myxoma after transseptal cardiac catheterization

Abstract Systemic embolization of an unsuspected left atrial myxoma during cardiac catheterization is described. Prompt histopathologic examination of the embolie specimen established the diagnosis, allowing the tumor to be successfully removed during cardiopulmonary bypass. The mechanism that led to the embolization and suggestions for avoidance of the complication are described.

Angiocardiographic Evaluation of Valvular Insufficiency

Incompetence of any of the cardiac valves can be easily evaluated by selective angiocardiography. Factitious insufficiency may result from faulty catheter placement or from ventricular extrasystoles caused by the pressure injection of the contrast agent. False negative results are almost nonexistent, and if no insufficiency is seen on a technically adequate angiocardiogram, the valve can be considered to be competent.

Abnormalities of the Mitral Valve in Endocardial Cushion Defects

Absence of the atrioventricular septum and a cleft in the anterior leaflet of the mitral valve is characteristic of almost all anomalies resulting from maldevelopment of the endocardial cushions. These changes produce a specific angiocardiographic picture, characterized in systole by a scalloped right border of the left ventricular outflow tract, with a small lucent notch within it, and in diastole by a gooseneck appearance of the subaortic portion of the ventricle. This appearance is independent of the associated hemodynamic changes or the presence of other lesions. Because the angiocardiogram provides a direct demonstration of the underlying anatomic abnormalities, it is the most sensitive diagnostic method for the recognition of an endocardial cushion defect.

Right aortic arch with ruptured aneurysm of anomalous left subclavian artery

Abstract An aneurysm in the anomalous left subclavian artery developed in an elderly woman with a right aortic arch and an aberrant left subclavian artery (left ligamentum arteriosum connected to the left common carotid artery). The aneurysm gradually enlarged, eventually rupturing with exsanguination. A progressive increase in the size of this aneurysm was associated with symptoms and anatomic findings consistent with the subclavian “steal” syndrome.

Clinical diagnosis of isolated subpulmonic (supracristal) ventricular septal defect

Abstract In 7 patients, isolated subpulmonic ventricular septal defect was identified by selective left ventricular angiocardiography and, in 6, confirmed by direct surgical observation. Each of the 7 patients exhibited characteristic auscultatory and phonocardiographic findings signaling the presence of this lesion. The murmur of subpulmonic ventricular septal defect was pansystolic and crescendo-decrescendo in configuration. Maximal intensity appeared in the first and second left intercostal spaces with preferential radiation of the murmur upward toward the left clavicle and jugular notch. The absence of pure right ventricular hypertrophy in the electrocardiogram aided in distinguishing the murmur from that associated with isolated valvular pulmonary stenosis. Selective left ventricular angiocardiography is currently the most valuable clinical modality for positive identification of the subpulmonic ventricular septal defect.

Radiologic Notes in Cardiology Dissecting Aneurysm of the Aorta

The diagnosis of a dissecting aneurysm can be suggested by the clinical findings or plain films of the chest but a definitive diagnosis cannot be made without angiography. Selective aortography is the procedure of choice as it provides the maximum amount of information at a relatively low risk. Important diagnostic findings include a double lumen within the aorta, separation of the opacified channels by a linear lucency, absence of filling of one or more major branches of the abdominal aorta, or a thickening of the aortic wall when there is no flow in the false channel. Because of the seriousness of the lesion, once the diagnosis of a dissecting aneurysm is suggested, aortography should be performed with a minimum of delay.

Radiologic Notes in Cardiology Postinfarction Aneurysm of the Left Ventricle

Detection of postinfarction aneurysms of the left ventricle has become increasingly important with the development of surgical techniques for the treatment of this lesion. Although the diagnosis can be established in some cases from chest films and cardiac fluoroscopy, angiocardiography is required for adequate preoperative evaluation. If surgery to excise the aneurysm is contemplated, coronary angiography should also be performed.

Right Aortic Arch

A right aortic arch usually produces several abnormal shadows on a standard frontal film of the chest. The aortic knob protrudes from the right side of the mediastinum, the trachea is deviated to the left, and the descending aorta can be identified along the right side of the spine. A more conclusive diagnosis can be made from the indentation produced by the arch on the barium-filled esophagus. This also serves to distinguish the two types of right aortic arch. The presence of a large indentation on the posterior aspect of the esophagus is characteristic of the type of arch most frequently associated with a vascular ring. A right arch without a posterior component is commonly associated with significant congenital heart disease.

Late systolic murmur of rheumatic mitral insufficiency

Of 184 patients with acute rheumatic fever and associated mitral insufficiency encountered during a 15 year period, 34 manifested a mid-late systolic murmur or a nonejection click, or both, during the course of follow-up. The mid-late systolic murmur later disappeared in four patients whose condition is now considered normal. In one of the four, systolic prolapse of the mitral valve was demonstrated on an angiocardiogram obtained when the systolic murmur was present. Since disappearance of the murmur there has been no evidence of systolic prolapse on meticulous echocardiographic study of the mitral valve. In another child with angiographically demonstrated systolic prolapse of the mitral valve the systolic murmur has also disappeared, but systolic prolapse is still evident on echocardiographic study. None of the 34 patients with a mid-late systolic murmur manifested the T wave abnormalities commonly associated with the familial variety of mitral valve prolapse.

The Angiocardiographic Diagnosis of Valvular Stenosis

The angiocardiographic diagnosis of valvular stenosis depends on demonstrating a limitation in the motion of the cusps or leaflets so that the valve cannot open completely. In general, this technique is best for study of the pulmonic and aortic valves although a fairly accurate evaluation of the pliability or rigidity of a stenotic mitral valve can also be made. The normal valve cusps are usually not seen during systole, but, when they are stenotic, they assume a domelike configuration, bulging in the direction of blood flow. This is easily seen and is quite characteristic. Despite the degree of stenosis, so long as the cusps or leaflets are not severely fibrotic, they can appear normal in their diastolic position.