William M. Lemmon

Suprasternal Transaortic Coronary Arteriography

Opacification of the coronary arteries has been accomplished by direct needle puncture of the ascending portion of the thoracic aorta via a suprasternal approach and injection of highly-concentrated radiopaque medium. Experience with 35 attempts in 31 patients at such coronary opacification is described. The electrocardiographic observations, the reactions, and the complications incident to the study are discussed. Thirteen of the 31 patients had some type of intrapericardial cardiac surgery subsequent to this procedure, and the surgical observations regarding the status of the coronary arteries are compared with the coronary arteriographic findings.

Appraisal of current surgical procedures for coronary heart disease

Summary One may reasonably conclude from the foregoing discussion that for generalized types of coronary atherosclerosis a “revascularization” operation of the Vineberg type provides maximal objective and subjective benefit. Those individuals who are not deemed capable of withstanding such an intervention may be thought able to undergo a procedure which produces augmentatio,l of the intercoronary arterial cha,mels by the intrapericardial instillation of a silicate powder. For simple palliation of anginal pain, one of the various sympathectomy procedures will provide relief in a high percentage of cases. In the usually younger individual who has not yet suffered from a bout of clinical coronary occlusion, it may be possible to demonstrate by newly developed radiographic technics a localized segmental process within one or more of the major coronary branches. In such a patient, it is possible to achieve a nearly ideal mechanical restoration of coronary patency by an endartereetomy procedure performed by the antegrade approach with the aid of a “heart-lung” apparatus. In severe acute emergencies due to sndden occlusion of a major coronary arterial branch, it should be possible by immediate intervention (thromboendartereetomy) to remove both the thrombus and the underlying atheromatous plaque, and thus to salvage the affected portion of the ventricular wall before final death of the iscbemie myocardium has taken place. Over all of these surgical considerations hangs the inescapable fact that coronary atheroselerosis, like all forms of atherosclerosis, is fundamentally a medical (metabolic) disease. Until a reasonably satisfactory method of prevention or control of this underlying process has been devised, any surgical method of intervention must be, at best, but a temporary stopgap, a mere impediment to its further inexorable advance.

Suprasternal thoracic aortography; suprasternal transthoracic needle puncture opacification of the thoracic aorta.

Direct opacification of the thoracic aorta has engaged the attention of many workers interested in the roentgen evaluation of the cardiovascular system. While aortic opacification may be accomplished by angiocardiography (1), the dilution of the radiopaque medium which occurs during its passage through the right heart chambers, pulmonary circulatory system, and left heart chambers is frequently of such degree that satisfactory visualization is not achieved. This is particularly true in situations where there is either increased pulmonary vascular volume or an increase in the size of the heart chambers such as exists with certain cardiac valvular lesions. Catheter thoracic aortography (2), with direct delivery of the opacifying agent into the thoracic aorta, does regularly effect satisfactory aortic opacification. The procedure, however, requires introduction of a catheter into a peripheral artery and its advancement to a desired position in the aorta. Surgical repair of the vessel opening through which th...

Newer technics helpful in the study of regurgitant lesions of the cardiac valves

Abstract The usefulness of two new radiologic technics, namely, cardiac ventriculography and suprasternal thoracic aortography, in assessment and quantitation of cardiac valvular regurgitant lesions is discussed. Direct needle puncture opacification of the ventricular chambers and the ascending aorta permits an objective appraisal of degrees of regurgitation of the mitral, tricuspid and aortic valves.