Walt F. Weaver

Bilateral arteriosclerotic coronary arterial aneurysms successfully treated with saphenous vein bypass grafting

A man with ischemic heart disease was discovered to have bilateral coronary arterial aneurysms that were sucessfully treated with saphenous vein grafting. Preoperative coronary arteriograms revealed a tight luminal stenosis at the proximal end of the large aneurysm in the left anterior descending artery, suggesting poststenotic dilatation as an etiologic or contributing factor. The right coronary artery was totally occluded proximally, but was noted to be aneurysmal at operation. This is the 14th published case of nonfistulous coronary arterial aneurysm diagnosed in vivo, and the first associated with proximal luminal stenosis.

Correlation between segmental early relaxation of the left ventricular wall and coronary occlusive disease.

Fifty of 305 patients studied angiographically had segmental early relaxation phenomenon (SERP) of the anterolateral or apical left ventricular wall. Fourteen of the 50 patients had cardiac abnormality other than, or in addition to, coronary occlusive disease. Of the remaining 36 patients, 35 had significant lesions in the left anterior descending artery (LAD) and one had occlusion of the proximal left circumflex artery. SERP was noted in 35 (37.2 per cent) of 94 patients with LAD disease who did not have severe anteroapical contraction abnormality. SERP was found in none of 49 patients who had neither significant coronary occlusive disease nor other cardiac abnormality. Eight patients were restudied after bypass grafting of the LAD. Three patients with patent grafts no longer demonstrated SERP. Five had persistent SERP, but four of these had occluded LAD grafts or nongrafted disease in other vessels supplying the anterolateral wall. Myocardial ischemia appears to be one cause, but probably not the only cause, of SERP.

Mid-diastolic aortic valve opening in severe acute aortic regurgitation.

SUMMARYA case of severe acute aortic regurgitation is reported. Echocardiographic findings included mid-diastolic opening of the aortic valve, premature closure of the mitral valve, diastolic shuddering of the anterior mitral leaflet, probable prodemonstration of the flail aortic cusp in the left ventricular outflow tract, and increased left atrial and left ventricular dimensions. Correlation with hemodynamic, angiographic and surgical evidence is made.

Bilateral nonfistulous congenital coronary arterial aneurysms

A 15 year old boy collapsed and died after participating in a basketball game. Autopsy revealed bilateral congenital coronary arterial aneurysms. The diagnosis was made post mortem but, retrospectively, might have been suspected during life, even before angiography. The clues to the correct diagnosis were chest pain, a systolic and diastolic murmur and a mass on the right heart border in the chest roentgenogram.

Membranous subaortic stenosis complicated by aneurysm of the membranous septum and mitral valve prolapse

The clinical, echocardiographic, and catheterization findings in a patient with discrete subaortic stenosis, aneurysm of the membranous interventricular septum, and mitral valve prolapse are presented. Echocardiography showed a subaortic membrane, abnormal aortic valve motion, accentuated systolic anterior motion of the membranous interventricular septum, and prolapsing mitral leaflets. Cardiac catheterization confirmed the diagnoses. The possible functional interrelationship of these lesions is discussed.

Results of Elective Aortocoronary Saphenous Vein Graft Surgery in a Community Hospital

In a community hospital setting, without academic affiliation or house staff coverage, 145 patients had elective saphenous vein graft surgery between January 1970 and January 1973. Patients with good left ventricular function, with or without associated procedures, had an operative mortality of 2.4%. The surgical mortality of patients who had associated procedures was 9.5%. The overall operative mortality was 6.2% with an immediate postoperative myocardial infarction rate of 17%. Results in 38 patients with pre-infarction angina were no different from the group as a whole. The risk of surgery is best categorized by a combination of angiographic severity of coronary artery disease plus severity of left ventricular dysfunction estimated by left ventriculogram.