N. Goebel

Persisting myocardial sinusoids of both ventricles as an isolated anomaly : Echocardiographic, angiographic, and pathologic anatomical findings

The persistence of myocardial sinusoids in both ventricles as an isolated anomaly is described. A 21-year-old patient had progressive heart failure considered as cardiomyopathy of obscure etiology. Two-dimensional echocardiography demonstrated channel-like structures in the thickened myocardium of both hypokinetic ventricles. Angiography showed a honeycomblike inner contour in both ventricles. Autopsy proved the diagnosis of persistent sinusoids in a thickened myocardium.

Treatment of abdominal angina with percutaneous dilatation of an arteria mesenterica superior stenosis

Percutaneous transluminal dilatation of an atherosclerotic stenosis of the superior mesenteric artery was done in a 65-year-old women with abdominal angina. The patient was relieved of abdominal pain immediately after the dilatation.

Assessment of stenoses in coronary angioplasty. Inter- and intraobserver variability

Three observers twice assessed coronary artery lesions of 10 patients in three oblique views using the films obtained before, immediately after, and six months after percutaneous transluminal coronary angioplasty. In order to improve accuracy of the interpretation, the stenoses were traced from the cine projector and the diameters measured with a calibrated magnifying glass. Interobserver and intraobserver variability of the commonly used method assessing only the projection showing the most severe stenosis was compared to that of a method assessing the mean of three projections. The interobserver coefficients of variation were 7.0% for using the one projection showing the most severe stenosis and 6.4% for using the mean of three projections (not significant). The intraobserver coefficient of variation was significantly reduced from 16.0 to 10.5% (P less than 0.0001) by using the mean of three projections. The assessment of three projections instead of one justifies the additional time needed by significantly increasing assessment reliability which is of great importance in evaluating and comparing anatomical results of percutaneous transluminal coronary angioplasty.

Anomalous Origin of the Left Thyrocervical Trunk as a Cause of Residual Pain after Myocardial Revascularization with Internal Mammary Artery

A patient with successful implantation of an internal mammary artery graft in the left anterior descending coronary artery complained of residual but different anginal pain after operation. Ischemia was demonstrated during a manual stress test. Angiography revealed anomalous origin of the thyrocervical trunk from the internal mammary artery. Angina and ischemia disappeared after the trunk was ligated.

Huge left coronary artery aneurysm associated with multiple arterial aneurysms

Natural history of an aneurysm at the bifurcation of the left coronary artery is reported. A gradual increase in its size occurred over an 18-year period until it was a huge and partially thrombosed sac. It was associated with ectasia of the right coronary artery, aneurysms of the left subclavian artery and thoracic aorta, and calcified dilatations of the branches of the celiac trunk.

Spurious aneurysm after myocardial infarct

False aneurysms of the left ventricle after myocardial infarction arae the result of perforation, which usually require early surgical treatment. The clinical features are not characteristic. The chest x-ray may provide important evidence for the diagnosis. Non-invasive diagnosis is possible by means of echocardiography and computer tomography; it is confirmed by angiocardiography. The authors experience with nine cases is described.