Emeritus Faculty, Acad Council, Radiology
- Herbert L. Abrams, MD, 1920-2016 In Memoriam ACADEMIC RADIOLOGY 2016; 23 (8): 1067–68
- REPLY: The Murky World of Effective Dose for Cardiovascular CT JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2014; 64 (9): 958
- Gaining Perspective on the Risks of Ionizing Radiation for Cardiac Imaging JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2014; 63 (15): 1490-1492
Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging
2008; 18 (12): 2785-2807
Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multidetector CT is discussed.
View details for DOI 10.1007/s00330-008-1095-6
View details for Web of Science ID 000260837300012
View details for PubMedID 18651153
Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging
INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING
2008; 24 (6): 645-671
Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multi-detector CT is discussed.
View details for DOI 10.1007/s10554-008-9319-z
View details for Web of Science ID 000257986100012
View details for PubMedID 18504647
View details for PubMedCentralID PMC2493606
- What is the value of measuring coronary artery calcification? RADIOLOGY 2008; 246 (1): 1-2
- Use of multidetector computed tomography for the assessment of acute chest pain: a consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2007; 23 (4): 415-427
Ethical considerations in image-based screening for coronary artery disease.
Topics in magnetic resonance imaging
2002; 13 (2): 95-106
Despite marked advances in the treatment and prevention of coronary artery disease (CAD) during the last decade, CAD and its complications continue to account for 20% of all deaths in the United States, more than other cause of death. Moreover, half of those who die suddenly of an acute myocardial infarction have no prior symptoms or overt manifestations of their underlying CAD. As our understanding of the pathophysiology of coronary atherosclerosis improves, diagnostic tests utilizing magnetic resonance (MR) imaging and gated computed tomography are being developed to screen for significant CAD in symptomatic individuals and in those who are preclinical or asymptomatic. Patients with known or suspected CAD might be candidates for MR studies of myocardial perfusion, myocardial contraction under stress, MR coronary arteriography, and plaque characterization. One rationale would be to uncover patients before they have a silent heart attack to institute preventative therapies. Although clinical studies have not definitively demonstrated the efficacy of these modalities, screening sites are proliferating and patients are demanding screening tests for CAD. Radiologists interpreting these tests should understand their underlying rationale, the data referenced to substantiate their use, and their responsibility to inform the patient of the results. This review describes current concepts of the pathophysiology of CAD, the rationale for the various screening tests for CAD that are in use or in development, and the potential value of the results of screening to individual patients. The ethical issues embodied in the performance of screening tests for CAD are placed in the context of the appropriate role of the radiologist as a physician interacting directly with a patient.
View details for PubMedID 12055454
MRI of congenital heart disease: A paradigm of collaboration. New suggestions for a team approach from Madigan Army Medical Center
JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE
2002; 4 (3): 369-372
Over the past decade, there has been increasing use of cardiac MRI in the evaluation of children with congenital heart disease. There has also been an increased number of radiologists and pediatric cardiologists desiring to perform cardiac MRI in the evaluation of these patients. At the present time, the number of pediatric cardiologists and radiologists fully trained in the use of MRI studies for CHD is inadequate to provide this modality at all institutions with MRI capabilities. This article describes the collaborative approach between pediatric cardiology and radiology at Madigan Army Medical Center and its implications for patient care and credentialing.
View details for Web of Science ID 000177858400008
View details for PubMedID 12234108
- A curriculum in cardiothoracic radiology for medical students, with goals and objectives ACADEMIC RADIOLOGY 2001; 8 (12): 1247-1251
Digital storage phosphor chest radiography: An ROC study of the effect of 2K versus 4K matrix size on observer performance
2001; 218 (2): 527-532
To compare observer performance in the detection of abnormalities on 1,760 x 2,140 matrix (2K) and 3,520 x 4,280 matrix (4K) digital storage phosphor chest radiographs.One hundred sixty patients who underwent dedicated computed tomography (CT) of the thorax were prospectively recruited into the study. Posteroanterior and lateral computed radiographs of the chest were acquired in each patient and printed in 2K and 4K formats. Six radiologists independently analyzed the hard-copy images and scored the presence of parenchymal (opacities =2 cm, opacities >2 cm, and subtle interstitial), mediastinal, and pleural abnormalities on a five-point confidence scale. With CT as the reference standard, observer performance tests were carried out by using receiver operating characteristic (ROC) analysis.Analysis of averaged observer performance showed 2K and 4K images were equally effective in detection of all three groups of abnormalities. In the detection of the three subtypes of parenchymal abnormalities, there were no significant differences in averaged performance between the 2K and 4K formats (area below ROC curve [A(z)] values: opacities =2 cm, 0.62 +/- 0.056 [standard error] and 0.59 +/- 0.045; opacities >2 cm, 0.86 +/-.025 and 0.85 +/- 0.030; subtle interstitial abnormalities, 0.73 +/- 0.041 and 0.72 +/- 0.041). Averaged performance in detection of mediastinal and pleural abnormalities was equivalent (A(z) values: mediastinal, 0.70 +/- 0.046 and 0.73 +/- 0.033; pleural, 0.85 +/- 0.032 and 0.86 +/- 0.033).Observer performance in detection of parenchymal, mediastinal, and pleural abnormalities was not significantly different on 2K and 4K storage phosphor chest radiographs.
View details for Web of Science ID 000166728200033
View details for PubMedID 11161174
A model for faculty mentoring in academic radiology
2000; 7 (9): 717-724
The purpose of this report is to describe the development and implementation of a faculty mentoring program in radiology designed to promote the career development of junior faculty and enhance communication in the department.The mentoring program was implemented in five stages: organizational readiness, participant recruitment, mentor matching and orientation, implementation, and evaluation. Evaluations were based on Likert scale ratings and qualitative feedback. A retrospective analysis was also conducted of the annual performance reviews of junior faculty in the areas of research, teaching, patient care, and overall performance.An average of 83% (19 of 23) of the junior faculty participated in the pilot phase of the mentoring program. During five rounds of testing, the median rating (1 indicates not important; 10, extremely important) from responding junior faculty was 10 for overall value of individual mentoring meetings; the median rating for the mentors responding was 8.75. Research and academic development were identified as the areas of greatest importance to the faculty. Research and patient care were most improved as assessed by faculty peers during performance reviews. The schedule of semiannual formal mentoring meetings was reported to be optimal.The program was implemented to the satisfaction of junior faculty and mentors, and longitudinal performance suggests positive effects. Issues to be contended with include confidentiality and the time needed for mentoring beyond already saturated schedules. Overall, the authors propose that mentoring programs can be an asset to academic radiology departments and a key factor in maintaining their vitality.
View details for Web of Science ID 000089143200007
View details for PubMedID 10987334
- A curriculum in chest radiology for diagnostic radiology residency, with goals and objectives ACADEMIC RADIOLOGY 2000; 7 (9): 730-743
Chronic chest pain without evidence of myocardial ischemia/infarction. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 85-88
View details for PubMedID 11037410
Recurrent symptoms following lower extremity arterial bypass surgery. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 89-93
View details for PubMedID 11037411
Recurrent symptoms following lower extremity angioplasty: claudication and threatened limb. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 95-99
View details for PubMedID 11037412
Sudden onset of cold, painful leg. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 101-105
View details for PubMedID 11037413
Unilateral upper extremity swelling and pain. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 107-112
View details for PubMedID 11037414
Shortness of breath--suspected cardiac origin. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 23-27
View details for PubMedID 11037400
Suspected congenital heart disease in the adult. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 67-72
View details for PubMedID 11037407
Suspected bacterial endocarditis. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 73-77
View details for PubMedID 11037408
Acute chest pain--no ECG evidence of myocardial ischemia/infarction. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 79-84
View details for PubMedID 11037409
Hematemesis. American College of Radiology. ACR Appropriateness Criteria.
2000; 215: 113-119
View details for PubMedID 11037415
Congenital diaphragmatic hernia associated with aortic coarctation
29th Annual Meeting of the Canadian-Association-of-Paediatric-Surgeons
W B SAUNDERS CO-ELSEVIER INC. 1998: 943–45
Congenital diaphragmatic hernia (CDH) may be associated with other anomalies, most frequently cardiovascular in nature. Despite fetal echocardiography, diagnosis of an accompanying cardiac malformation often is not made until after birth and sometimes not until after extracorporeal membrane oxygenation (ECMO) has been instituted. Aortic coarctation associated with CDH may occur as an isolated, surgically correctable malformation or it may be a component of the usually fatal left heart "hypoplasia" or "smallness" syndrome. The authors present two cases of aortic coarctation associated with CDH requiring ECMO that illustrate the management challenges of these coincident diagnosis. In one case, the accompanying coarctation was suspected and required precannulation angiography for confirmation, whereas in the other case, the diagnosis of coarctation was not made until after ECMO cannulation. Depending on its anatomic location and severity, an aortic coarctation associated with life-threatening CDH may limit the physiological efficacy of venoarterial ECMO. Furthermore, arterial cannulation for extracorporeal support requires that flow through the remaining carotid artery be maintained during aortic reconstruction, which may prove difficult for lesions best treated by subclavian flap angioplasty. When the diagnosis of coincident aortic coarctation and CDH is suspected or proven before institution of extracorporeal support, serious consideration should be given to venovenous bypass, because this may provide better postductal oxygenation and facilitate aortic repair with the option of left carotid artery inflow occlusion.
View details for Web of Science ID 000074327400034
View details for PubMedID 9660236
- Coronary artery calcification: Pathophysiology, epidemiology, imaging methods, and clinical implications - A statement for health professionals from the American Heart Association CIRCULATION 1996; 94 (5): 1175-1192
The use of magnetic resonance imaging in adult congenital heart disease.
American journal of cardiac imaging
1995; 9 (1): 15-28
Magnetic resonance (MR) imaging techniques have evolved sufficiently to produce clinically relevant studies that depict the anatomy and physiology of the heart. Applications to congenital cardiac disease in adult patients are numerous. MR imaging is particularly useful for noninvasive evaluation of the aorta in patients with aortic arch anomalies and coarctations and to study the results of palliative and corrective surgery for transposition of the great arteries and for reconstructive procedures that restore sufficient pulmonary blood flow. MR imaging is superior to transthoracic echocardiography in defining the anatomy of the central pulmonary arteries. Recent technological advances permit motion studies acquired during a single breath-hold and can be used to accurately measure stroke volume, ejection fraction, regional wall motion, and wall thickening from both ventricles. Functional parameters, such as the velocity and volume of blood flow in vessels, valve gradients, regurgitant flow, shunt flow, and pulmonary artery blood flow into each lung are readily performed. This review article documents the value of MR imaging in adult patients with congenital disorders of the heart, pulmonary arteries, and aorta, and includes illustrations of typical examples.
View details for PubMedID 7894229
NEPHROTOXICITY OF IONIC AND NONIONIC CONTRAST-MEDIA IN 1196 PATIENTS - A RANDOMIZED TRIAL
1995; 47 (1): 254-261
The incidence of nephrotoxicity occurring with the nonionic contrast agent, iohexol, and the ionic contrast agent, meglumine/sodium diatrizoate, was compared in 1196 patients undergoing cardiac angiography in a prospective, randomized, double-blind multicenter trial. Patients were stratified into four groups: renal insufficiency (RI), diabetes mellitus (DM) both absent (N = 364); RI absent, DM present (N = 318); RI present, DM absent (N = 298); and RI and DM both present (N = 216). Serum creatinine levels were measured at -18 to 24, 0, and 24, 48, and 72 hours following contrast administration. Prophylactic hydration was administered pre- and post-angiography. Acute nephrotoxicity (increase in serum creatinine of > or = 1 mg/dl 48 to 72 hours post-contrast) was observed in 42 (7%) patients receiving diatrizoate compared to 19 (3%) patients receiving iohexol, P < 0.002. Differences in nephrotoxicity between the two contrast groups were confined to patients with RI alone or combined with DM. In a multivariate analysis, baseline serum creatinine, male gender, DM, volume of contrast agent, and RI were independently related to the risk of nephrotoxicity. Patients with RI receiving diatrizoate were 3.3 times as likely to develop acute nephrotoxicity compared to those receiving iohexol. Clinically severe adverse renal events were uncommon (N = 15) and did not differ in incidence between contrast groups (iohexol N = 6; diatrizoate N = 9). In conclusion, in patients undergoing cardiac angiography, only those with pre-existing RI alone or combined with DM are at higher risk for acute contrast nephrotoxicity.(ABSTRACT TRUNCATED AT 250 WORDS)
View details for Web of Science ID A1995PZ59700032
View details for PubMedID 7731155
POSTOPERATIVE EVALUATION OF PULMONARY-ARTERIES IN CONGENITAL HEART-SURGERY BY MAGNETIC-RESONANCE-IMAGING - COMPARISON WITH ECHOCARDIOGRAPHY
AMERICAN HEART JOURNAL
1994; 128 (6): 1139-1146
Palliative and corrective operations for the treatment of cyanotic congenital heart disease frequently involve or potentially influence the size of the pulmonary arteries. Echocardiography and magnetic resonance imaging (MRI) are two noninvasive imaging techniques currently used to assess morphologic abnormalities of the pulmonary arteries. The purpose of this study was to evaluate the role of MRI in comparison with echocardiography for defining morphologic changes of the pulmonary arteries after congenital heart surgery. The MRI scans and echocardiograms of 33 patients with surgery involving or affecting the pulmonary arteries were compared. The pulmonary outflow tract, pulmonary confluence, right and left pulmonary arteries, and surgical shunts were separately evaluated. Cineangiography and surgical reports were used to confirm findings. MRI and echocardiography were equivalent for demonstrating abnormalities of the right ventricular outflow tract, main pulmonary artery, and a variety of pulmonary shunts. MRI was superior to echocardiography in demonstrating abnormalities of the right and left pulmonary arterial branches (p < 0.001). MRI is effective for monitoring pulmonary arterial status after surgery and is superior to echocardiography for the evaluation of the right and left pulmonary arteries.
View details for Web of Science ID A1994PV55700010
View details for PubMedID 7985594
Magnetic resonance imaging in adult congenital heart disease.
Journal of thoracic imaging
1994; 9 (4): 219-229
Some patients with congenital cardiac anomalies develop their first symptoms as adults, and many more will survive to adulthood with congenital lesions that have been treated surgically. Magnetic resonance imaging (MRI) currently provides sufficient morphological information to allow the anatomical diagnosis of congenital abnormalities involving the heart and the great arteries. Newer MR techniques have also been developed that provide functional information such as measurements of valve gradients, stroke volumes, regurgitant volumes, and shunt volumes. Cardiac evaluation utilizing MR techniques may soon replace cardiac catheterization for the preoperative diagnosis of congenital heart disease and its long-term follow-up.
View details for PubMedID 7830293
COMPARISON OF IOPROMIDE WITH IOHEXOL AND IOPAMIDOL IN CORONARY ARTERIOGRAPHY AND LEFT VENTRICULOGRAPHY
International Forum on Current Considerations in Contrast Imaging
LIPPINCOTT-RAVEN PUBL. 1994: S107–S111
Low-osmolality contrast agents, ionic and nonionic, are being used more frequently in coronary arteriography. A new nonionic contrast agent, iopromide, has recently become available for use in clinical trials. The purpose of this phase II-phase III Food and Drug Administration (FDA) trial was to compare the side effects and diagnostic quality of iopromide with iohexol and iopamidol for coronary arteriography and left ventriculography.Two separate double-blind trials were performed using iopromide and comparison nonionic contrast agents. In the first trial, 41 patients were randomized to receive iopromide or iopamidol. The second trial was a three-center trial involving 120 patients, of whom half received iopromide (370 mg I/mL) and the other half received iohexol (350 mg I/mL). In a third study, 26 patients received iopromide (370 mg I/mL) according to an open-label design.Comparison of iopromide with the other agents revealed that there were no significant differences in adverse events between iopromide and the comparison agents. Most adverse reactions were mild or moderate in severity in all patient groups. There was no difference in the patients' perceptions of heat and pain and no statistically significant difference in systolic or diastolic blood pressure at baseline, at 30 to 60 minutes, or at 24 hours after the procedure. No difference was found in the biochemical or hematologic analysis at baseline or at 24-hour follow-up. No difference between the contrast media groups in terms of the quality of the left ventriculogram or the quality of the coronary arteriography was noted.Compared to the other nonionic agents, iopromide showed no statistically significant differences in terms of safety or efficacy.
View details for Web of Science ID A1994NR59200021
View details for PubMedID 8071037
- LESSONS FROM HISTORY - WHY RADIOLOGISTS LOST CORONARY ANGIOGRAPHY AND WHAT CAN BE DONE TO PREVENT FUTURE SIMILAR LOSSES INVESTIGATIVE RADIOLOGY 1994; 29 (4): 480-484
PERIPHERAL ATHERECTOMY WITH THE ROTABLATOR - A MULTICENTER REPORT
JOURNAL OF VASCULAR SURGERY
1994; 19 (3): 509-515
View details for Web of Science ID A1994NA32900015
SPIRAL CT OF RENAL-ARTERY STENOSIS - COMPARISON OF 3-DIMENSIONAL RENDERING TECHNIQUES
1994; 190 (1): 181-189
To evaluate the accuracy of computed tomographic (CT) angiography in the detection of renal artery stenosis (RAS).CT angiography was performed in 31 patients undergoing conventional renal arteriography. CT angiographic data were reconstructed with shaded surface display (SSD) and maximum-intensity projection (MIP). Stenosis was graded with a four-point scale (grades 0-3). The presence of mural calcification, poststenotic dilatation, and nephrographic abnormalities was also noted.CT angiography depicted all main (n = 62) and accessory (n = 11) renal arteries that were seen at conventional arteriography. MIP CT angiography was 92% sensitive and 83% specific for the detection of grade 2-3 stenoses (> or = 70% stenosis). SSD CT angiography was 59% sensitive and 82% specific for the detection of grade 2-3 stenoses. The accuracy of stenosis grading was 80% with MIP and 55% with SSD CT angiography. Poststenotic dilatation and the presence of an abnormal nephrogram were 85% and 98% specific, respectively.CT angiography shows promise in the diagnosis of RAS. The accuracy of CT angiography varies with the three-dimensional rendering technique employed.
View details for Web of Science ID A1994MW25300036
View details for PubMedID 8259402
5-YEAR ANGIOGRAPHIC FOLLOW-UP OF FACTORS ASSOCIATED WITH PROGRESSION OF CORONARY-ARTERY DISEASE IN THE CORONARY-ARTERY SURGERY STUDY (CASS)
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
1993; 22 (4): 1141-1154
The Coronary Artery Surgery Study (CASS) required participants to undergo follow-up angiography at 5 years to identify clinical and angiographic features associated with progression of coronary artery disease.The CASS randomized 780 patients at 11 participating clinical centers between an initial strategy of medical therapy versus bypass surgery. Five clinical sites accomplished follow-up angiography in > 50% of their randomized subjects within a 42- to 66-month period after the entry arteriogram (n = 314).Qualified clinical site angiographers, using side by side film review, evaluated an average of 13 segments/patient on both arteriograms for initial stenosis severity, morphologic features, lesion location and occurrence of disease progression or occlusion. Progression was defined as further definite narrowing by > or = 15% and occlusion as lesion progression to > or = 98%. Lesions were subcategorized as to whether they were univariate and had or had not been treated with bypass surgery. Multivariate logistic regression analyses were performed.For nonbypassed segments, right coronary artery and left anterior descending artery proximal and midlocations were associated with disease progression. For stenosis-containing segments, the initial severity, a non-left anterior descending artery location and increased treadmill duration predicted progression. Segment occlusion was associated with initial lesion severity, right coronary artery location and subsequent interval myocardial infarction. There were few predictors of progression or occlusion in bypassed arteries, other than initial lesion severity.Univariate and multivariate associations with lesion progression and occlusion included diabetes, lesion location, elevated cholesterol level, interval infarction and lesion morphology. These angiographic results, collected in a prospective trial, are consistent with known risk factors.
View details for Web of Science ID A1993MQ36200027
MULTICENTER TRIAL OF IONIC VERSUS NONIONIC CONTRAST-MEDIA FOR CARDIAC ANGIOGRAPHY
AMERICAN JOURNAL OF CARDIOLOGY
1993; 72 (11): 770-775
Contrast agents used for cardiac angiography are different in regard to ionicity, osmolality and physiologic effects. The nonionic contrast media have been shown to have less toxic effects and a better safety profile than do higher osmolar agents. To better assess this risk, clinically stable patients undergoing cardiac angiography were stratified according to the presence of diabetes mellitus, and level of serum creatinine, and then randomized to receive either iohexol (Omnipaque 350) or sodium meglumine diatrizoate (Renografin 76). All adverse events that occurred during and immediately after angiography were tabulated. A multivariate model was used to identify patients at increased risk for adverse outcome. The 1,390 patients were randomized to iohexol (n = 696) or diatrizoate (n = 694). Significant differences were found in the number of patients with contrast media-related adverse (iohexol vs diatrizoate: 10.2 vs 31.6%; p < 0.001) and cardiac adverse (7.2 vs 24.5%; p < 0.001) events. Severe reactions and the need for treatment were more frequent with diatrizoate than with iohexol, but there was no difference in the incidence of death. The presence of New York Heart Association classification 3 or 4 and serum creatinine > or = 1.5 mg/dl predicted a higher incidence of adverse events as a result of contrast media alone. Use of iohexol is associated with a lower incidence of all types of adverse events during cardiac angiography than is diatrizoate.
View details for Web of Science ID A1993LZ35600006
View details for PubMedID 8213508
HEALTH-POLICY IN RADIOLOGY - CARDIAC RADIOLOGY - A SURVEY OF ITS CURRENT STATUS
1993; 28 (6): 545-549
View details for Web of Science ID A1993LG81200012
- CARDIAC RADIOLOGY - AN ASSET TO RADIOLOGY INVESTIGATIVE RADIOLOGY 1993; 28 (6): 550-556
USING PATIENT REPORTS TO ASSESS HEALTH-RELATED QUALITY-OF-LIFE AFTER TOTAL HIP-REPLACEMENT
QUALITY OF LIFE RESEARCH
1993; 2 (1): 3-11
Data on disease severity, co-morbidity, and process of care were obtained from the medical records of 356 patients without rheumatoid arthritis undergoing a first unilateral total hip replacement at four teaching hospitals in California and Massachusetts. Socio-demographic characteristics, functional status prior and subsequent to hospitalization, and improvement in health status were measured with a patient questionnaire 12 months after discharge. Completed questionnaires were received from 284 patients, a response rate of 79.8%. The questionnaire was acceptable to patients, reliable, and had good construct validity. The data indicate substantial benefits from hip arthroplasty. As expected, pre-surgical functioning was a strong predictor of outcomes 1 year after surgery. Controlling for pre-surgical functioning, age was not related to outcomes.
View details for Web of Science ID A1993LF05200001
View details for PubMedID 8490615
PAH EXTRACTION AND ESTIMATION OF PLASMA-FLOW IN DISEASED HUMAN KIDNEYS
AMERICAN JOURNAL OF PHYSIOLOGY
1991; 261 (4): F726-F733
We have analyzed the efficiency with which p-amino-hippuric acid (PAH) is extracted (EPAH) by patients with healthy kidneys (n = 13) or kidneys damaged by chronic cyclosporin nephropathy (n = 21) or primary glomerulopathy (n = 12); respective values (mean +/- SE) for EPAH were 0.87 +/- 0.03, 0.77 +/- 0.03, and 0.69 +/- 0.04. Judged by a 131I-hippuran-to-PAH clearance ratio of 0.75 +/- 0.05, extraction ratio of hippuran was less efficient than EPAH in three glomerulopathic patients. A direct relationship was defined between EPAH and glomerular filtration rate (GFR) (r = 0.54) or calculated efferent oncotic pressure (IIE; r = 0.41, P less than 0.01). Curve fitting by means of quadratic spline functions revealed GFR and IIE to be additive in predicting EPAH (R2 = 0.45). Linear model prediction methods and a sample reuse technique failed to predict EPAH reliably from GFR and preglomerular oncotic pressure (IIA); however, 95% prediction intervals exceed 0.30 EPAH units in width. We conclude that oncotic pressure (presumably reflecting albumin concentration) along with GFR is predictive of EPAH depression in humans with chronic renal disease. However, even sophisticated curve-fitting techniques are too imprecise for accurate prediction of EPAH in a given individual. We submit that renal venous sampling to determine EPAH continues to be necessary for the accurate determination of the rate of plasma flow in the injured human kidney.
View details for Web of Science ID A1991GK86900112
View details for PubMedID 1928382
VARIATIONS IN LENGTH OF STAY AND OUTCOMES FOR 6 MEDICAL AND SURGICAL CONDITIONS IN MASSACHUSETTS AND CALIFORNIA
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1991; 266 (1): 73-79
--To determine the extent to which interinstitutional variations in length of stay are explained by differences in patient characteristics and to determine whether patients in hospitals with shorter lengths of stay had worse outcomes.--We reviewed patients' medical records and surveyed patients between 3 and 12 months after hospital discharge using a questionnaire.--Six teaching hospitals in California and Massachusetts.--A cohort of 2484 selected patients who had been hospitalized for acute myocardial infarction or to rule out acute myocardial infarction, coronary artery bypass graft surgery, total hip replacement, cholecystectomy, or transurethral prostatectomy. Between 73% and 84% of the patients with each condition completed a follow-up questionnaire.--In-hospital complications, deaths, length of stay, functional status after hospital discharge, readmission, and patient satisfaction with hospital care were analyzed.--Significant interinstitutional differences in length of stay were noted for all conditions except rule-out acute myocardial infarction. Statistical adjustment for case-mix differences accounted for most of the interinstitutional differences in length of stay for total hip replacement but explained little of the differences in the other conditions. When we controlled statistically for other predictors, length of stay did not have a significant impact on deaths, functional status after hospital discharge, the probability of readmission, or patient satisfaction with hospital care.--More research is needed to determine the medical practices that are related to variations in lengths of stay. Routinely available outcome data may help preserve quality in the face of efforts to decrease costs by effecting more standardized practices of care.
View details for Web of Science ID A1991FT93400030
View details for PubMedID 2046132
FREQUENCY AND MECHANISM OF BRADYCARDIA IN CARDIAC TRANSPLANT RECIPIENTS AND NEED FOR PACEMAKERS
AMERICAN JOURNAL OF CARDIOLOGY
1991; 67 (16): 1385-1389
Orthotopic cardiac transplantation is occasionally complicated by unexplained bradyarrhythmias. Sinus node injury as a consequence of operation or acute rejection has anecdotally been linked to the development of bradycardia early after transplantation. These arrhythmias are empirically managed by pacemaker implantation, the indications for which remain poorly defined. This retrospective study examined the 20-year experience of our institution with bradyarrhythmias after transplantation to determine the predisposing factors and indications for pacemaker implantation. Forty-one of 556 patients in our cardiac transplant program (7.4%) received permanent pacemakers between 1969 and 1989. The predominant rhythm disturbances were junctional rhythm (46%), sinus arrest (27%) and sinus bradycardia (17%). Most patients were asymptomatic (61%), and presented in the early post-transplant period (73%). Four possible predisposing factors were evaluated: (1) graft ischemic time, (2) rejection history, (3) use of bradycardia-inducing drugs, and (4) anatomy of blood supply to the sinoatrial (SA) node. No significant differences existed between patients with and without pacemakers with regard to the first 3 variables. However, after transplantation angiograms showed that prevalence of abnormal SA nodal arteries was greater in patients with than without pacemakers (p less than 0.02). Pacemaker follow-up at 3, 6 and 12 months showed persistent bradycardia (60 to 90 beats/min) in 88, 75 and 50% of patients, respectively. The most common pacemaker complication (15%) was lead displacement at time of biopsy. These results suggest that disruption of the SA nodal blood supply may be an important predisposing factor in the development of bradycardias.
View details for Web of Science ID A1991FR02000014
View details for PubMedID 2042569
MONORAIL SYSTEM FOR PERCUTANEOUS REPOSITIONING OF THE GREENFIELD VENA-CAVAL FILTER
1990; 176 (3): 872-874
The authors describe a technique for removing or repositioning a malpositioned Greenfield inferior vena caval filter. A "monorail" system was used, in which a wire was passed from the femoral vein through the apical hole in the filter and out the internal jugular vein; the wire was held taut from above and below and thus facilitated repositioning or removal of the filter. The technique was used successfully in two cases.
View details for Web of Science ID A1990DV57900054
View details for PubMedID 2389052
ANGIOGRAPHIC IMPLICATIONS OF CARDIAC TRANSPLANTATION
AMERICAN JOURNAL OF CARDIOLOGY
1989; 64 (9): E16-E21
View details for Web of Science ID A1989AP62500004
Angiographic implications of cardiac transplantation.
American journal of cardiology
1989; 64 (9): 16E-21E
Coronary vascular disease in the cardiac transplant recipient has become the third most frequent cause of death or retransplantation after infection and acute rejection. A unique pattern of concentric fibrointimal thickening develops within 1 year of cardiac transplantation; however, it is relatively inapparent on routine arteriography. The disease progresses primarily in distal vasculature, leading to progressive occlusion. Angiographically discrete lesions associated microscopically with advanced atherosclerotic plaques frequently occur in the more proximal vessels often associated with thrombus. The number of rejection episodes is somewhat predictive of the development of transplant coronary disease. Annual arteriograms performed in cardiac transplant recipients have revealed several distinctive angiographic features that include clockwise rotation of the heart, presence of coronary arterial-cameral fistulae, presumably resulting from right ventricular endomyocardial biopsy specimens and collateralization of the brachial anastomosis from coronary atrial branches. It is concluded that serial angiography in cardiac transplant recipients is important in the early detection of progressive graft atherosclerosis, a process that is clinically silent until such time as overt heart failure or cardiogenic shock occurs.
View details for PubMedID 2672763
PULL-THROUGH APPROACH TO PERCUTANEOUS ANGIOPLASTY OF TOTALLY OCCLUDED COMMON ILIAC ARTERIES
1989; 172 (1): 111-113
A method has been developed to increase the probability of success of percutaneous transluminal balloon angioplasty of total occlusions of the common iliac artery when conventional methods have failed. In 10 patients with a totally obstructed iliac artery, a guide wire was passed through a catheter placed from the contralateral side around the aortic bifurcation and antegrade through the total obstruction. The end of the wire was either snared by a retrieval basket or guided through a sheath in the ipsilateral common femoral artery, thus providing a firmly anchored pathway for subsequent manipulations. Balloons were then inserted retrograde through both common femoral arteries and dilated. In the first five patients, ipsilateral retrograde passage of a guide wire had failed despite multiple attempts with a variety of devices. In the other five patients, the contralateral antegrade approach was used initially. The new method was successful in all 10 patients with totally obstructed common iliac arteries.
View details for Web of Science ID A1989AB75000022
View details for PubMedID 2525789
NATURAL-HISTORY OF THE FALSE CHANNEL OF TYPE-A AORTIC DISSECTION AFTER SURGICAL REPAIR - CT STUDY
1989; 170 (3): 743-747
To evaluate the false channel after surgical repair of a type A aortic dissection, postoperative computed tomographic (CT) scans were retrospectively reviewed in 33 patients. Initial CT demonstrated persistence of a double channel distal to the site of surgical repair in 26 patients (79%). In four of these patients serial CT demonstrated enlargement of the false channel, a finding that contributed to the decision to repeat surgery. Progression of thrombus was noted in five patients. Peripheral calcification within the aortic wall of the false channel, presumably located on the "pseudointima," was found in six patients. Because of the progressive nature of type A dissections in the postoperative period, serial CT examinations can provide important information on patients who have undergone surgical correction of a type A dissection.
View details for Web of Science ID A1989T273400027
View details for PubMedID 2916028
- THE VASCULAR WAR OF 1988 JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1989; 261 (3): 418-419
ECHOCARDIOGRAPHIC-LIKE ANGLED VIEWS OF THE HEART BY MR IMAGING
JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY
1988; 12 (2): 181-195
Cardiac magnetic resonance (MR) imaging has developed rapidly to rival echocardiography as a noninvasive imaging modality. Anatomic detail may exceed that currently available using echocardiography techniques, and the ability to image moving protons may compete with Doppler color flow mapping in detecting valvular diseases and shunts. Because of the considerable clinical experience with echocardiography, as angled MR imaging planes become available as standard software packages, it may be useful for MR cardiac imaging to use standard, accepted echocardiographic nomenclature and imaging planes. This article describes the principles used to obtain long and short axis MR images that are comparable with echocardiographic imaging planes. Diagrams and illustrations are provided to orient the viewer using nomenclature common to echocardiography. These views may eventually be useful for functional analysis of the left ventricle and for detection and evaluation of valvular heart disease and intracardiac shunts.
View details for Web of Science ID A1988M543100001
View details for PubMedID 3351027
DIAGNOSTIC CHALLENGES FOLLOWING CARDIAC TRANSPLANTATION
RADIOLOGIC CLINICS OF NORTH AMERICA
1987; 25 (2): 367-376
It is now almost two decades since the first human cardiac transplantation was performed. Recipients will require close follow-up by their referring physicians outside of the main referral centers. This article is intended to assist the referring physician in choosing the most appropriate diagnostic studies throughout the posttransplant period.
View details for Web of Science ID A1987G568700014
View details for PubMedID 3547483
THROMBOEMBOLIC COMPLICATIONS OF PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY FOR MYOCARDIAL-INFARCTION
CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS
1987; 13 (2): 100-106
To determine the incidence of thromboembolic complications of percutaneous transluminal coronary angioplasty (PTCA) in the setting of recent and acute myocardial infarction, the clinical sequelae and coronary angiographic findings were examined in a series of 13 patients who underwent PTCA either as acute intervention during the infarction or as treatment for recurrent myocardial ischemia that occurred soon after the initial completed infarction. In all cases, the angiographic appearance in the infarct-related artery was that of thrombus in the setting of total or subtotal occlusion. Balloon dilatation without antecedent thrombolytic therapy, was performed in 14 arteries and was successful in establishing reperfusion with reduction of the degree of intraluminal narrowing to less than 50% in all cases. Residual thrombus at the site of inflation was noted in two cases (15%), and embolization was noted in four cases (29%), for an incidence of complication of 44%. In five of six instances in which either residual thrombus or embolization were noted, the initial infarction had occurred greater than 24 h before. In only one of seven cases in which PTCA was used as acute intervention during infarction of less than 4 h duration was the presence of residual thrombus noted after PTCA. Therefore, these findings suggest that thromboembolic complications after PTCA in the setting of recent or acute myocardial infarction are uncommon when the syndrome is less than 4 h duration; however, complications are relatively frequent when infarction has occurred greater than 24 h before. PTCA as a primary intervention in this latter setting should be approached cautiously.
View details for Web of Science ID A1987G788900004
View details for PubMedID 2953429
CARDIOVASCULAR LASER RESEARCH AT STANFORD-UNIVERSITY
SEMINARS IN INTERVENTIONAL RADIOLOGY
1986; 3 (1): 61-63
View details for Web of Science ID A1986A677600009
OPTIMIZING STRATEGIES FOR LASER ANGIOPLASTY
1985; 20 (8): 860-866
The intrinsic optical properties of normal and diseased vascular tissues and their interaction with continuous wave (cw) and pulsed laser light were investigated to determine the optimal source for laser angioplasty. Both intima and atheromatous plaque demonstrated increasing spectral absorbance at shorter wavelengths (in the near ultraviolet). The relative differences in absorbance between diseased and nondiseased tissues were not sufficient to allow selective ablation of plaque. Atheromatous plaque appears more resistant than normal intima to damage by cw argon laser. The interaction of tissue with a high-power, pulsed ultraviolet laser showed a nonlinear response as pulse repetition rate and pulse energy were varied. From theoretical considerations and our experimental results, we propose that a pulsed ultraviolet laser with 50 millijoules of power per pulse and a repetition rate of 10 pps would be safer and more effective for recanalization than the cw argon laser.
View details for Web of Science ID A1985AUK4500013
View details for PubMedID 2934348
DIGITAL SUBTRACTION ANGIOGRAPHY OF CORONARY GRAFTS - OPTIMIZATION OF TECHNIQUE
AMERICAN JOURNAL OF ROENTGENOLOGY
1985; 145 (6): 1185-1190
Forty patients who had undergone coronary artery bypass surgery were studied with digital subtraction angiography (DSA) to develop an outpatient screening technique for coronary artery bypass graft visualization. Of 103 grafts in 40 patients, 101 were seen: 95 were clearly patent and in six the stump of an occluded graft was seen. Of 32 grafts seen in 14 patients using intraarterial DSA, only 13 (41%) were demonstrated using intravenous DSA. Intraarterial DSA is an effective screening procedure to determine bypass graft patency. However, volumes of 40-45 ml of 76% contrast medium injected at rates of at least 20 ml/sec must be used for each injection to obtain a diagnostic image, and since each projection is complementary and contributes some information, several injections must be used to complete an examination.
View details for Web of Science ID A1985AUJ5200018
View details for PubMedID 3904369
PERCUTANEOUS TRANS-LUMINAL LASER ANGIOPLASTY FOR TREATMENT OF PERIPHERAL VASCULAR-DISEASE - CLINICAL-EXPERIENCE WITH 16 PATIENTS
1985; 156 (3): 619-624
Percutaneous transluminal laser angioplasty of the peripheral arteries was performed in 16 patients with pain at rest, objective evidence of severe peripheral ischemia, conditions requiring amputation, and/or medical contraindications to surgery. In 14 patients the ipsilateral femoral artery was entered in an antegrade direction using the Seldinger technique, base-line angiograms taken, and laser angioplasty performed using argon ions transported to the target site by a 400-mu quartz fiber. Patency was established in 50% of cases and correlated directly with both total energy delivered and time and power per exposure: the lower the energy, the higher the patency rate. Complications included spasm, pain, and mechanical or laser perforation. The authors conclude that while percutaneous transluminal laser angioplasty of peripheral arteries using argon radiation is possible in man, its clinical value has not been established.
View details for Web of Science ID A1985ANZ9200008
View details for PubMedID 3161118
- RUPTURE OF A CORONARY-BYPASS GRAFT ANEURYSM - CT EVALUATION AND COIL OCCLUSION THERAPY AMERICAN JOURNAL OF ROENTGENOLOGY 1983; 141 (5): 1060-1062
EVALUATION OF PERIPHERAL VASCULAR-DISEASE USING DIGITAL SUBTRACTION ANGIOGRAPHY
1983; 147 (2): 393-398
Intravenous digital subtraction angiography (DSA) facilitates imaging of peripheral arteries and bypass grafts on an outpatient basis. Forty-five patients underwent intravenous peripheral angiography, 16 following placement of bypass grafts. Complex oblique and sagittal angulations optimize visualization of bifurcations and overlapping vascular structures. Reprocessing techniques using integrated masks and contrast images allow for diagnostic delineation of fine vascular detail. This is a practical, noninvasive, well tolerated method for both diagnostic screening and follow-up evaluation of patients with peripheral vascular disease.
View details for Web of Science ID A1983QL99900015
View details for PubMedID 6340157
- TRANSCATHETER EMBOLIZATION OF A LEAKING PSEUDOANEURYSM OF SAPHENOUS-VEIN AORTOCORONARY BYPASS GRAFT CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1983; 9 (6): 591-594
LEFT MAIN CORONARY-ARTERY STENOSIS - ANGIOGRAPHIC DETERMINATION
1983; 68 (3): 484-489
Reliability of angiographic assessment of the left main coronary artery segment was evaluated by review of 106 coronary cineangiograms from the Coronary Artery Surgery Study. The films were interpreted by three groups of angiographers: those at a clinical site, those at a quality control site, and those on a study census panel. Among the readings of these three groups, there was 41% to 59% agreement on the severity of the lesion, with 80% agreement on whether the lesion was greater or less than 50%. The severity of lesion, its location, or presence of ectasia or calcium did not affect the discrepancy rate, whereas segments that were unusually short, diffusely diseased, or obscured by overlapping vessels were especially difficult to interpret.
View details for Web of Science ID A1983RD90200004
View details for PubMedID 6872161
- ISOLATED TOTAL OCCLUSION OF THE LEFT MAIN CORONARY-ARTERY AMERICAN JOURNAL OF ROENTGENOLOGY 1983; 141 (6): 1304-1306
REVASCULARIZATION OF TRACHEAL ANASTOMOSIS FOLLOWING HEART LUNG TRANSPLANTATION
1983; 18 (6): 500-503
The mechanism by which tracheobronchial arterial supply is reconstituted following heart-lung transplantation was investigated in seven monkeys (3 allografts, 2 autografts, and 2 nontransplanted control monkeys) and three patients. Descending tracheal branches of the thyrocervical arteries provided the major tracheal vascular supply. A collateral branch arising from atrial branches of the left coronary artery supplied tracheobronchial branches in the region of the carina in one allograft. In the three patients studied to date by coronary arteriography, a similar collateral supply to the region of the carina and proximal bronchi was demonstrated from atrial branches of both the left and right coronary circulation.
View details for Web of Science ID A1983RQ66200002
View details for PubMedID 6417043
HEALING AND REVASCULARIZATION OF THE TRACHEAL ANASTOMOSIS FOLLOWING HEART-LUNG TRANSPLANTATION
1982; 33: 236-238
View details for Web of Science ID A1982QD33400102
THE USE OF COMPUTED-TOMOGRAPHY IN THE DIAGNOSIS OF CORONARY-ARTERY BYPASS GRAFT PATENCY
CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
1980; 3 (1): 3-8
In a preliminary evaluation of the use of dynamic computed tomography (CT) for the detection of patent aortocoronary bypass grafts, 30 patients were scanned either during the early postoperative period or after graft patency was determined by angiography. To visualize the proximal grafts, CT scans were taken through the aortic root following an intravenous bolus injection of contrast medium. Patent bypass grafts to the left anterior descending and right coronary arteries were demonstrated in 77.5%, while posterior grafts to the circumflex and obtuse marginal coronary arteries were detected in 40%. With its potential for extracting dynamic events, CT scanning provides a new, noninvasive modality for the diagnosis of patent bypass grafts, which heretofore have only been visualized by selective angiography.
View details for Web of Science ID A1980JW69900001
View details for PubMedID 6966186
CONTRIBUTION OF ASYNERGIC CONTRACTION TO HALOTHANE-INDUCED MYOCARDIAL DEPRESSION
ANESTHESIA AND ANALGESIA
1980; 59 (3): 178-185
We investigated the possibility that myocardial asynergy (dyscoordinate contraction) is a contributing mechanism to the impairment of cardiac function produced by halothane. Coronary cineangiograms were performed in seven dogs, awake and at 1, 2, and 3 MAC halothane. The relative motions between four arterial bifurcations (six segments) were plotted as an indication of changing ventricular dimensions. To quantitate ventricular asynergy, we calculated anisotropy (AI) and asynchrony (AS), the coefficient of variation of mean shortening (S-) and of mean time to half shortening (T-50), respectively, of the six segments. From these a myocardial performance index (MPI) was derived: MPI = S-/AI + T-50 + AS. In general, S- and MPI decreased with increasing halothane concentration. Anisotropy showed a trend, although usually insignificant, toward increasing, while AS did not change. These observations have two implications. First, asynergy of contraction contributes little, if anything, to halothane-induced impairment of myocardial performance. Second, changes in measurements of intact cardiac performance, such as dP/dtmax, may be reasonably valid during halothane, provided loading conditions are taken into account.
View details for Web of Science ID A1980JJ09800003
View details for PubMedID 7189347
NEW ASPECTS OF CORONARY ANGIOGRAPHY
RADIOLOGIC CLINICS OF NORTH AMERICA
1980; 18 (3): 501-514
By combining the standard oblique projections used in coronary arteriography with sagittal or axial angulation of the x-ray beam in relation to the heart, the information provided by this study can be significantly enhanced. This approach is especially useful in assessing the patency of coronary artery bypass grafts.
View details for Web of Science ID A1980LE38700010
View details for PubMedID 7005934
TRAUMATIC PULMONARY ARTERY LEFT ATRIAL FISTULA - UNUSUAL CASE OF CYANOSIS IN AN ADULT
AMERICAN HEART JOURNAL
1979; 98 (3): 366-370
Eighteen months after sustaining a stab wound to the left upper chest, a 59-year-old man presented with cyanosis and extertional dyspnea. Arterial desaturation due to a central 22 per cent right-to-left shunt was present. A selective pulmonary arteriogram demonstrated a fistula between the main pulmonary artery and the left atrium. At operation the fistula was closed. A laceration of the pulmonic valve and healed pericarditis were present. Marked symptomatic improvement followed the operation, but a murmur of pulmonic valvular regurgitation persisted. The fistula and laceration of the pulmonic valve were probably traumatic in origin.
View details for Web of Science ID A1979HK45300015
View details for PubMedID 474383
ISOLATED SINGLE CORONARY-ARTERY - DIAGNOSIS, ANGIOGRAPHIC CLASSIFICATION, AND CLINICAL SIGNIFICANCE
1979; 130 (1): 39-47
Isolated single coronary artery is a rare congenital anomaly occuring in approximately 0.024% of the population. This entity can be diagnosed during life only by coronary angiography. Ten patients with isolated single coronary artery are reported. Based on angiographic analysis, a new classification is proposed, according to the site of origin and anatomical distribution of the branches. Typical angina did not occur with single coronary artery in the absence of coexisting coronary artery disease or aortic stenosis. No correlation was apparent between the type of anomalous patterns and the symptoms of angina.
View details for Web of Science ID A1979GB83700007
View details for PubMedID 758666
LONG-TERM SERIAL ANGIOGRAPHIC STUDIES AFTER CORONARY-ARTERY BYPASS SURGERY
1979; 60 (2): 250-259
Twenty-six patients underwent repeat coronary angiography 5--8 years after saphenous vein coronary artery bypass surgery (SVCABG). These patients were selected from the first cohort of 117 patient who had SVCABG because they had obtained essentially complete relief of angina, and because all grafts were patent at initial angiography 11.2 months (mean) after surgery. Of the 39 grafts (1.5 grafts per patient) patent at 1 year, 34 (87.2%) were patent at reexamination 76 months (mean) (range 65--103 months) after SVCABG. Graft occlusion could not be predicted by the early angiographic appearance of the graft itself or its proximal or distal anastomosis. In some cases, narrowing or irregularity consistent with intimal hyperplasia appeared to progress, while in others it developed at late follow-up. Progressive narrowing occurred in 96% (22 of 23 grafted vessels) of the native coronary arteries proximal to the graft anastomosis. Progresssion to a stenosis greater than 75% or total occlusion was seen distal to the graft anastomosis in eight of 39 grafts (20%). Of 103 non-bypassed major vessels, 56% showed some progression of disease and half of these progressed to significant stenoses (greater than 75% luminal narrowing). There were no apparent predictors to indicate whether progression in nongrafted coronary arteries would occur preferentially in a previously stenotic or nonstenotic vessel, although 80% of vessels with initial stenoses greater than 75% progressed to total occlusion.
View details for Web of Science ID A1979HD86300007
View details for PubMedID 312703
EFFECTS OF ERGONOVINE MALEATE ON CORONARY ARTERIAL SIZE
1979; 59 (1): 82-89
Changes in coronary arterial size due to ergonovine maleate are described and quantitated in 90 patients--18 with typical angina pectoris, 56 with atypical chest pain, nine with variant angina pectoris, and seven heart transplant (allograft) recipients. We observed two angiographic changes in the diameter of coronary arteries: 1) spasm, which was characterized by occlusion or marked (greater than 85%) focal or diffuse vessel narrowing, or 2) relatively mild and diffuse vessel narrowing, which was interpreted as the normal pharmacologic response to the drug. Serial bolus injections of 0.05 mg, 0.10 mg and 0.25 mg of ergonovine maleate produced diffuse narrowing of the diameter of coronary arteries of 10 +/- 1.5%, 16 +/- 1.4% and 20 +/- 1.3% (mean +/- SEM), respectively, in the 72 patients with anginal syndromes who did not develop coronary spasm. The degree of coronary arterial narrowing was the same in heart transplant recipients and in patients with normally innervated hearts who did not develop coronary spasm. We believe the normal pharmacologic response to ergonovine maleate was due to a direct vasoconstrictor action of the drug; this action was independent of neural control extrinsic to the heart.
View details for Web of Science ID A1979GB93000012
View details for PubMedID 758127
CT DEMONSTRATION OF CARDIAC STRUCTURES
AMERICAN JOURNAL OF ROENTGENOLOGY
1979; 133 (1): 75-81
Cross-sectional cardiac anatomy was studied by computed tomography (CT) in normal patients and in patients with well documented cardiac pathology. Specific cardiac chambers, aortic and pulmonary artery enlargement, ventricular aneurysms, coronary artery, and intracardiac calcifications were demonstrated using a 3 sec scan time with and without intravenous iodinated contrast media. Although CT imaging of the heart is in its infancy, the clarity with which cardiac chambers and other structures were visualized is encouraging and suggests the potential value of CT scanning for detecting significant intracardiac pathology on routine thoracic CT scans.
View details for Web of Science ID A1979GZ44100013
View details for PubMedID 110073
FATE OF THE FALSE LUMEN FOLLOWING SURGICAL REPAIR OF AORTIC DISSECTIONS - ANGIOGRAPHIC STUDY
1979; 133 (1): 1-8
Postoperative angiography was performed in 27 patients who had surgical repair for aortic dissections. The ascending aorta was involved in 22 dissections (Type A), while in five dissections it was uninvolved (Type B). Findings were assessed between two weeks and 13 years postoperatively. Despite the primary surgical objective to abolish flow in the false lumen, the majority of patients, whether symptomatic or not, continued to harbor patent distal false channels. In certain cases, one or more vital aortic branches were perfused solely by the false lumen. Initial postoperative angiography is indicated for determined surgical results as well as the functional significance of late angiographic findings, should symptoms recur. Further extension of the initial dissection, redissection, or enlargement of localized saccular aneurysms may mandate late reoperation. These conditions manifest themselves by pain, aortic regurgitation, neurological sequelae, or compromise of blood flow to a vital organ or extremity.
View details for Web of Science ID A1979HN67500001
View details for PubMedID 382246
Six-year clinical and angiographic follow-up of patients with previously documented complete revascularization.
1978; 58 (3): I194-9
Relatively little information is available concerning the late clinical and angiographic status of patients with initially successful coronary bypass surgery. From 72 patients who had angiography 1 year after bypass surgery, we restudied at 6 years 19 patients with complete revascularization. At 1 year, 14 patients were asymptomatic and five had minimal anginal symptoms. Five years later, eight patients had redeveloped angina, and 11 retained their initial postoperative status. Overall graft patency at 6 years was 86%; 52% of the patients had atherosclerotic progression to > or = 70% luminal narrowing in a major unbypassed vessel or in a major vessel distal to bypass. The patients with unchanged symptoms all had patent grafts, while 11 of the 15 (73%) grafts were patent in patients with symptomatic deterioration (NS). However, progression of coronary disease occurred in seven of eight patients (88%) with worsened symptoms, as opposed to three of 11 patients with unchanged symptoms (P < 0.05). We conclude that late symptomatic deterioration following coronary bypass surgery is common, and that it usually reflects progression of coronary artery disease.
View details for PubMedID 14740702
6-YEAR CLINICAL AND ANGIOGRAPHIC FOLLOW-UP OF PATIENTS WITH PREVIOUSLY DOCUMENTED COMPLETE REVASCULARIZATION
1978; 58 (3): 194-199
View details for Web of Science ID A1978FM12800035
CORONARY ARTERIAL NARROWING IN TAKAYASUS AORTITIS
AMERICAN JOURNAL OF CARDIOLOGY
1977; 39 (5): 744-750
A patient with Takayasu's aortitis and angina pectoris due to severe narrowing of the right and left coronary arterial ostia is described. Takayasu's arteritis produces a panaortitis, with thickening of the adventitia predominating, and an inflammatory cell infiltrate involving the adventitia, outer media and vasa vasorum. Narrowing of the coronary arteries in this disease is due to extension into these arteries of the processes of proliferation of the intima and contraction of the fibrotic media and adventitia that occur in the aorta. The distal coronary arteries usually do not manifest arteritis and are normal in caliber. Angina pectoris may be the first symptom of the disease if the coronary arteries are the initial site of severe arterial narrowing. The coronary arterial bypass graft operation is effective therapy for treating coronary arterial narrowing due to Takayasu's arteritis.
View details for Web of Science ID A1977DF50500019
View details for PubMedID 16478
INTRA-ARTERIAL ANALGESIA IN PERIPHERAL ARTERIOGRAPHY
AMERICAN JOURNAL OF ROENTGENOLOGY
1977; 128 (5): 737-739
A pilot study involving 36 patients was undertaken to test the efficacy of combining 1% lidocaine with 60% methylglucamine iothalamate for relief of the severe burning pain often experienced during peripheral arteriography. Of 24 patients premedicated with meperidine hydrochloride and promethazine hydrochloride, 12 received lidocaine with the contrast medium and 12 did not. The remaining 12 patients were premedicated with diazepam and received lidocaine with the contrast material. By both subjective and objective criteria, those patients receiving lidocaine in the intraarterial injection of contrast medium suffered less pain. Optimum results were achieved for the lidocaine group receiving analgesic premedication. No adverse reactions attributable to the lidocaine were encountered. Subsequent to completion of the pilot study, more than 300 patients have been studied with similar impressive results of pain relief and safety.
View details for Web of Science ID A1977DF79300004
View details for PubMedID 404894
INTERRUPTION OF AORTIC-ARCH - PREOPERATIVE AND POSTOPERATIVE CLINICAL, HEMODYNAMIC AND ANGIOGRAPHIC FEATURES
AMERICAN JOURNAL OF CARDIOLOGY
1977; 39 (4): 563-571
Interruption of the aortic arch, studied in 10 patients, was associated with a variety of other cardiac anomalies in 8 patients and was an isolated anomaly in 2. Clinical and angiographic evaluation in the former group revealed congestive heart failure and generalized cyanosis in early infancy, pulmonary and systemic arterial hypertension and a variety of intracardiac and aortic shunt. The two patients with an isolated anomaly had clinical and hemodyanmic features not dissimilar from those of severe coarctation but interruption of the aortic arch was demonstrated on aortography. Surgical treatment was successful in four of the eight infants with associated anomalies and in both children with the isolated defect. Postoperative angiography revealed several related complications and the status of the aortic reconstruction. Clinical angiographic recognition of this lesion is important because operative intervention has been successful in an increasing number of patients.
View details for Web of Science ID A1977DB12200014
View details for PubMedID 848442
PROVOCATION OF CORONARY SPASM WITH ERGONOVINE MALEATE - NEW TEST WITH RESULTS IN 57 PATIENTS UNDERGOING CORONARY ARTERIOGRAPHY
AMERICAN JOURNAL OF CARDIOLOGY
1977; 40 (4): 487-491
Ergonovine maleate (Ergotrate) was given to 57 patients undergoing coronary arteriography for investigation of angina occurring at rest or without provocation when routine study showed normal arteries or insufficient occlusive disease to explain their symptoms. This provocative test induced coronary arterial spasm in 13 patients, 10 of whom had definite Prinzmetal's angina. The spasm was easily reversed with sublingually administered nitroglycerin. The spasm was occlusive or nearly occlusive in nine patients, and there was associated reproduction of the chest pain and S-T elevation similar to the spontaneous episodes. One patient with Prinzmetal's angina had S-T depression rather than elevation in association with the chest pain. The other three patients without Prinzmetal's angina had focal narrowing without coronary occlusion, reproduction of the chest pain or electrocardiographic changes. Of the 44 patients who did not demonstrate coronary spasm in response to ergonovine, 29 had normal coronary arteries and 15 had various degrees of atherosclerotic occlusive disease. We conclude that cautious administration of ergonovine maleate during coronary arteriography can be safely used to elicit coronary spasm in some patients who have insufficient fixed occlusive disease to explain their symptoms.
View details for Web of Science ID A1977DX64200001
View details for PubMedID 910712
CLINICAL AND ARTERIOGRAPHIC FEATURES OF PRINZMETALS VARIANT ANGINA - DOCUMENTATION OF ETIOLOGIC FACTORS
AMERICAN JOURNAL OF CARDIOLOGY
1976; 37 (6): 831-839
Coronary arteriography performed in 17 patients with Prinzmetal's variant angina demonstrated high grade fixed obstructions in 9 patients (Group I) and insignificant or no fixed lesions in 8 patients (Group II). Group I consisted mostly of middle-aged or elderly men with S-T segment elevations in various sites; Group II included five younger women with S-T segment elevations in inferior electrocardiographic leads. In Group I patients, arteriography revealed a discrete high grade lesion located proximally in a major coronary artery in four patients and multivessel involvement in five patients. In Group II patients, spontaneous spasm was documented in three patients and spasm was pharmacologically provoked in two others during arteriography. The current study indicates that spasm is the responsible pathogenetic mechanism of myocardial ischemia in some patients with Prinzmetal angina and that this mechanism may be suspected from the clinical characteristics of these patients.
View details for Web of Science ID A1976BQ73700002
View details for PubMedID 1266748
CLINICAL AND ANGIOGRAPHIC FEATURES OF PULMONARY ARTERIOVENOUS-FISTULAS IN CHILDREN
1976; 119 (1): 171-175
Multiple pulmonary arteriovenous fistulas were demonstrated angiographically in 8 patients who exhibited cyanosis and polycythemia during childhood. Cyanosis was first observed during infancy in 5 patients. The diffuse (telangiectatic) type was present in 2 cases, while the remainder were of the multiple discrete type with one or two dominant fistulas. The clinical and angiographic features and surgical implications of multiple pulmonary arteriovenous fistulas in these children and those reported previously are discussed.
View details for Web of Science ID A1976BK83900040
View details for PubMedID 1257439
COMPLICATIONS OF PERCUTANEOUS TRANSFEMORAL CORONARY ARTERIOGRAPHY
1976; 27 (3): 317-321
Complications statistics in 1625 patients undergoing selective coronary angiography by Judkin's technique have been analysed for four major areas-death, myocardial infarction, cerebral vascular accidents, and femoral thrombosis. Over a six-year period, considerable decrease in the number of complications has occurred. Myocardial infarctions have decreased from 2.4% (1967-71) to 0.44% (1973), an improvement related to careful catheter flushing, guidewire insertion technique and careful pressure monitoring within the coronary arteries. Cerebral accidents have decreased from a maximum of 1.3% (1972) to none (1973). This is also related to catheter guidewire techniques, and to avoidance of entering the cerebral vessels inadvertently when crossing the aortic arch with the coronary catheter. Femoral artery thromboses have decreased from 2.7% (1967-71) to none (1973). This is due to monitoring the dorsalis pedis pulse when compressing the femoral artery and avoiding complete femoral arterial obstruction with the associated lack of flow ultimately leading to thrombosis. Death rate has remained essentially unchanged (0.3-0.6%).
View details for Web of Science ID A1976BX64500006
View details for PubMedID 975738
UNUSUAL FORM OF TRANSPOSITION COMPLEX - UNCORRECTED LEVO-TRANSPOSITION WITH HORIZONTAL VENTRICULAR SEPTUM - REPORT OF 2 CASES
1976; 53 (1): 190-195
A distinctive angiographic appearance is described in two patients who had uncorrected levo-transposition of the great vessels. Although levo-transposition with inversion of the ventricles usually results in physiologically corrected transposition, in these patients the anatomy was arranged in such a way as to result in an uncorrected transposition. The following elements were responsible for this physiological condition: normal atrial situs, inverted ventricles with "criss-cross" atrioventricular flow, levo-transposed great arteries. In addition, the morphological right ventricle was hypoplastic, left sided and superior to the left ventricle and the ventricular septum was horizontal in position. The two ventricles were connected via a large ventricular septal defect. The importance of accurate, detailed, preoperative angiographic demonstration of the anatomic situation is stressed.
View details for Web of Science ID A1976BB49400030
View details for PubMedID 1244244
SPONTANEOUSLY AND PHARMACOLOGICALLY PROVOKED CORONARY ARTERIAL SPASM IN PRINZMETAL VARIANT ANGINA
1976; 119 (3): 521-527
Eleven of 21 consecutive patients with Prinzmetal angina (PMA) exhibited no significant fixed stenoses of the coronary arteries. Spontaneous coronary arterial spasm was demonstrated in 3 patients. Ergonovine maleate produced near-total occlusion of a major vessel in 3 of 4 other patients with PMA, but did not provoke spasm in 10 without PMA. The current study documents spasm as the mechanism of myocardial ischemia in some patients with normal coronary arteries and provides initial and favorable diagnostic results with provocative pharmacoangiography in this entity.
View details for Web of Science ID A1976BR92300002
View details for PubMedID 935383
REVERSAL OF DOMINANCE OF CORONARY ARTERIAL SYSTEM IN ISOLATED AORTIC-STENOSIS AND BICUSPID AORTIC-VALVE
1975; 52 (2): 292-296
The dominance of the coronary arterial system was determined angiographically in 75 adult patients with isolated aortic stenosis with or without insufficiency, 25 adult patients with pure aortic insufficiency, 51 adult patients with combined aortic stenosis and mitral valve disease, and 44 children with bicuspid aortic valves. There was an unusually high incidence of left dominance in adults with isolated aortic stenosis (36%) and in children with bicuspid aortic valves (56.8%). These findings suggest the existence of a variant developmental complex consisting of a bicuspid aortic valve and reversal of dominance of the coronary arterial system. Furthermore, it adds support to the concept that progressive stenosis of a bicuspid aortic valve is frequently the etiology of isolated aortic stenosis in adults.
View details for Web of Science ID A1975AM20300016
View details for PubMedID 1149210
AORTO-CORONARY VENOUS BYPASS GRAFTS - CORRELATION OF ANGIOGRAPHIC CHARACTERISTICS WITH CLINICAL RESULTS
1974; 43 (9): 491-494
View details for Web of Science ID A1974U555900006
- CORONARY ARTERIOGRAPHY IN LONG-TERM HUMAN CARDIAC TRANSPLANTATION SURVIVORS CIRCULATION 1974; 50 (4): 838-843
- TAKAYASUS ARTERITIS - ANGIOGRAPHIC STUDY WITH REMARKS ON ETHNIC DISTRIBUTION IN ISRAEL AMERICAN JOURNAL OF ROENTGENOLOGY 1974; 122 (1): 13-28
- DUPLICATION AND PAIRED INFERIOR VENA-CAVA WITH AN ABSENT RIGHT KIDNEY ANGIOLOGY 1974; 25 (11): 746-751
- RADIOGRAPHIC CHANGES IN CARDIAC CONTOUR FOLLOWING CARDIAC TRANSPLANTATION RADIOLOGY 1974; 111 (2): 303-306
- EFFECT OF ATRIAL-PACING ON LEFT VENTRICULAR DYNAMICS OF A TRANSPLANTED CANINE HEART ANNALES CHIRURGIAE ET GYNAECOLOGIAE 1973; 62 (4): 190-198
- RESULTS OF DIRECT CORONARY-ARTERY SURGERY FOR TREATMENT OF ANGINA-PECTORIS NEW ENGLAND JOURNAL OF MEDICINE 1973; 288 (11): 535-539
- CONGENITAL CORONARY-ARTERY ANOMALIES - EXPERIENCE AT STANFORD UNIVERSITY HOSPITAL (1963-1971) JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1973; 226 (12): 1425-1429
- EFFECTS OF ATRIAL-PACING ON SYNERGY AND HEMODYNAMICS OF ORTHOTOPICALLY TRANSPLANTED CANINE HEART CIRCULATION 1973; 48 (2): 386-391
- ANGIOGRAPHIC DEMONSTRATION OF COLLATERAL DEVELOPMENT IN EXPERIMENTAL CORONARY-ARTERY OCCLUSION WITH AMEROID CONSTRICTORS INVESTIGATIVE RADIOLOGY 1973; 8 (3): 131-137