A new technique: Right ventriculography using a preshaped catheter

Right ventriculography with a preshaped catheter (J- or L-shaped) was evaluated in make the diagnosis of tricuspid regurgitation. Thirty normal subjects who did not have valvular disease showed no evidence of tricuspid regurgitation or premature ventricular contractions during injection except in one case. On the other hand, 24 patients with combined aortic and mitral valve disease showed mild to moderate tricuspid regurgitation in 11 patients and severe tricuspid regurgitation in eight patients. Only two patients developed frequent run of premature ventricular contraction during injection. Seven patients with severe tricuspid regurgitation were found to have severe tricuspid regurgitation during surgery. No evidence of tricuspid regurgitation was found In all six patients with isolated aortic valve disease. We can conclude that right ventriculography by the preshaped catheter improves the diagnostic accuracy of tricuspid regurgitation and a grading system of tricuspid regurgitation by angiography is proposed.     

Exercise radionuclide assessment of left ventricular function before and after coronary bypass surgery

The effects of elective saphenous vein coronary artery bypass surgery on left ventricular ejection fraction were assessed by using exercise first-pass radionuclide angiography in 66 consecutive patients. All patients with left main coronary artery or concomitant valvular disease were eliminated from the study. Before surgery, 7 patients had normal postexercise left ventricular function (Group 1), 33 had normal resting left ventricular function with an abnormal response to exercise (Group 2), and 26 had an abnormal resting left ventricular ejection fraction with an abnormal response to exercise (Group 3). Following surgery, patients in all three groups had no change in mean resting left ventricular ejection fraction; however, patients in Groups 2 and 3 had significant improvement in mean postexercise left ventricular ejection fraction (p less than 0.0001 and p less than 0.0054 respectively), whereas patients in Group 1 did not. Previous studies reported improvement in postexercise ejection fraction in patients with reduced resting left ventricular function and with an ischemic response to exercise (Group 3). But this is the first study to confirm improvement in postexercise function in patients with normal resting function and an ischemic response to exercise (Group 2).     

Rest-exercise radionuclide angiographic assessment of left ventricular function in chronic aortic regurgitation: significance of serial studies in medically versus surgically treated groups

Forty consecutive asymptomatic patients with chronic aortic regurgitation who underwent three serial yearly rest and postexercise radionuclide angiograms were compared with 27 consecutive patients with chronic aortic regurgitation and aortic valve replacement who were studied preoperatively, 3 and 15 months postoperatively. Patients were divided into four subgroups based upon the resting left ventricular ejection fraction and the functional reserve on the initial study. Of the 40 medically treated patients, 19 (47.5%) and 24 (60%) demonstrated a response at least one type lower at 12 months and 24 months, respectively. Initial functional reserve, initial duration of exercise, and the change in exercise duration during the 24 months was not associated with changes in resting or postexercise left ventricular ejection fraction. A seesaw pattern was observed between the resting and the postexercise left ventricular ejection fraction as ventricular function deteriorated. We observed in the surgical groups a reversal of the seesaw interaction between the resting and postexercise ejection fraction seen in the medical patients. In the surgical groups the left ventricular end-diastolic pressure, initial functional reserve, initial duration of exercise, and change in exercise duration postoperatively were not predictors of improvement in left ventricular function at 15 months. Comparing medical and surgical serial data, we suggest yearly radionuclide angiographic determination of rest left ventricular ejection fraction in asymptomatic patients with chronic aortic regurgitation. When the rest ejection fraction is less than 50%, exercise angiography should be performed to determine functional reserve. When functional reserve is also abnormal, surgery should be recommended.     

Cavernous lymphohemangioendothelioma of the right atrium--a case report

The authors report a successful resection of a rare cystic tumor in the right atrium, discovered in an asymptomatic patient with atrial fibrillation. The cystic nature of the tumor was characterized by two-dimensional echocardiogram preoperatively. The site of attachment and movement of the tumor were clearly shown by cine computed tomography preoperatively. The tumor contained numerous endothelium-lined cavernous channels and groups of red blood cells. These features are distinctly different from those of other cystic tumors.     

Quantitation of shunting at the atrial level using rapid acquisition computed tomography with comparison with cardiac catheterization

Contrast-enhanced rapid acquisition computed tomography was employed to quantitate intracardiac shunts in two adult patients. Contrast medium was injected through a median antecubital vein and data were accumulated using the R wave-triggered flow mode. Time-density curves from a region of interest were generated by a gamma variate fit method and areas under the curves were calculated. Comparisons of calculated left to right shunts (Cases 1 and 2) with results of computed tomography and right to left shunt (Case 2) with cardiac catheterization data resulted in close agreement. This is the first report of quantitation of intracardiac shunts at the atrial level in humans by rapid acquisition computed tomography.     

Cryothermal mapping of recurrent ventricular tachycardia in man

Intraoperative reversible cryothermal mapping of recurrent ventricular tachycardia was performed in seven patients with left ventricular aneurysms with use of a 0 degrees C ice probe. A single, reproducible cryotermination site was found in each patient. The cryotermination site was uniformly located in an area where local electrograms obtained during ventricular tachycardia showed electrical activation during the diastolic portion of the surface electrocardiogram, and was different than the site of activation coincident with the onset of the QRS complex on the surface electrocardiogram (earliest reactivation site or ERS) by 4.5 +/- 2.7 cm (mean +/- SD) in five of seven patients. Sinus rhythm late potentials were recorded at the cryotermination site in five of six patients and from the ERS in one. In five patients, extensive subendocardial resection including both the ERS and cryotermination sites was performed. In two patients only the cryotermination site was excised. In six survivors, including one in whom only the cryotermination site was excised, ventricular tachycardia could not be induced 2 weeks after surgery and has not recurred during the follow-up period of 7 to 17 months (12 +/- 4.5 months, mean +/- SD). Reversible cryothermal mapping may provide additional important information not obtained by standard electrogram mapping of ventricular tachycardia that may help guide surgical therapy of recurrent ventricular tachycardia.