Nonobstructive and obstructive hypertrophic cardiomyopathies.
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Adult↗
Biomedical subjects
C B Higgins
Publications and source records attributed to C B Higgins.
Hypertrophic cardiomyopathies.
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Cardiomyopathies↗
Echocardiographic diagnosis: pitfalls in the premature infant with a large patent ductus arteriosus.
Thirty-one infants with clinical and radiographic evidence of a large left-to-right shunt across a patent ductus arteriosus underwent echocardiographic study to determine the magnitude of shunting. Seven patients were found to have a normal-left atrial dimensions and a normal left atrial/aortic root dimension at the time when physical and roentgenographic findings of a large PDA were most pronounced. In contrast, left ventricular end diastolic dimensions were excessive in these infants. After ductal closure (four, surgery; two, indomethacin, one, spontaneous) the left ventricular end diastolic dimension fell to the normal range. Optimal echocardiographic accuracy in infants with PDA should combine analysis of both atrial and ventricular dimensions; the former, used alone, may be misleading.
Ductus Arteriosus, Patent↗
Left coronary artery anatomy in patients with bicuspid aortic valves.
The anatomy of the proximal left coronary artery in 33 adult patients with bicuspid aortic valves was compared with that in 33 adult patients with aortic valve disease of other aetiologies and with that in 50 adult control patients with no valve or congenital heart disease. Patients with bicuspid aortic valves had a higher incidence of immediate bifurcation of the left main coronary artery, of left main coronary length less than 10 mm, and of left coronary artery dominance. The mean length of the left main coronary artery was significantly less in the patients with bicuspid aortic valves. These variations from the usual coronary artery anatomy may be part of the developmental abnormalities responsible for bicuspid aortic valves, and require evaluation and consideration when considering angiography and valve replacement in patients with aortic stenosis.
Anthropometry↗
False aneurysms of the left ventricle. Identification of distinctive clinical, radiographic, and angiographic features.
False aneurysms of the left ventricle were observed in 14 patients. They were caused by obstructive coronary arterial disease with resultant myocardial infarction in 11, bacterial endocarditis in 1, a knife wound in 1, and disruption of a ventriculotomy in 1. Most of them extended posteriorly on the lateral radiograph, as opposed to the usual anterior position of true aneurysms. Enlargement was frequently observed on sequential studies. Angiography usually demonstrated involvement of the diaphragmatic or posterolateral segment due to occlusion of the right coronary artery; in contrast, true aneurysms are apical or anterolateral and are due to occlusion of the left anterior descending artery. The frequency of rupture of false aneurysms points up the importance of dinstinguishing them from true aneurysms.
Aged↗
Critical aortic stenosis in neonates.
Twelve infants with valvular aortic stenosis manifested symptoms of heart failure during the first 2 months of life. Nine became symptomatic and demonstrated cardiomegaly and pulmonary vascular congestion during the first week of life. The other 3 infants became symptomatic at 3-8 weeks. Echocardiograms revealed normal or enlarged left atrial and ventricular dimensions excluding hypoplastic left heart. Left ventriculography demonstrated segmental dysfunction in 7 infants and generalized hypokinesis in 2 others. Trabecular effacement corresponded with the sites of left ventricular dysfunction. Postoperative studies revealed a decrease in cardiac size and improvement in segmental dysfunction in most infants.
Aortic Valve Stenosis↗
Alterations in calcium levels of coronary sinus blood during coronary arteriography in the dog.
Intracoronary administration of contrast materials causes myocardial depression which is related to serveral physiochemical properties of the contrast solution. The role of variations in ambient calcium ions (Ca++) in mediating this effect was evaluated in 19 anesthetized dogs. Sodium meglumine diatrizoate caused decreases in left ventricular peak systolic pressure (LVPSP),-12.6 +/- 3.2%, and dp/dt at a left ventricular pressure (LVP) of 40 mm Hg, -14.3 +/- 4.1%. The total calcium (Cat) decreased from 10.2 +/- 0.2 to 6.5 +/- 0.2 mg%, while Ca++ decreased from 4.6 +/- 0.1 mg% to 2.3 +/- 0.7 mg%. In the presence of systemic hypocalcemia the myocardial depressant actions of this contrast materials were accentuated. Intracoronary administration of contrast material with added Ca++, calcium sodium meglumine metrizoate, caused no myocardial depression. Total calcium decreased only slightly (10.2 +/- 0.2 to 9.1 +/- 0.2 mg%), while Ca++ increased (4.8 +/- 0.1 to 5.1 +/- 0.2 mg%. During systemic hypocalcemia, the calcium metrizoate compound induced increases in LVPSP and dp/dt/LBP40. Thus, contrast materials caused myocardial depression which, at least in part, was related to reduction of ambient calcium through a dilutional and binding action. The addition of Ca++ to monomeric contrast materials reversed the myocardial depressant action and produced a transient rise in ambient Ca++.
Animals↗
Left atrial dimension on the frontal thoracic radiograph: a method for assessing left atrial enlargement.
Left atrium size on the frontal radiograph was assessed by measuring the distance from the middle of the "double density" to the left main bronchus in 148 normal patients and 48 consecutive patients with echocardiographic evidence of left atrial enlargement. The measurement was less than 7.0 cm in 96% of normal patients and greater than 7.0 cm in 90% of patients with left atrial enlargement. This measurement is more easily obtainable than measurements and signs requiring a cardiac series, and is usually readily available for sequential evaluations of left atrial size. It is a less reliable gauge of left atrial size in children.
Adolescent↗
Radiographic and echocardiographic evaluation of newborns treated with indomethacin for patent ductus arteriosus.
A series of 33 consecutive preterm newborns who were treated with indomethacin, a drug which acts to close the patent ductus arteriosus, were studied retrospectively to examine the efficacy of chest radiography and echocardiography in diagnosing the presence of a significant patent ductus arteriosus. Radiographic changes in pulmonary vascular engorgement, pulmonary edema, and cardiac size on the anteroposterior film tended to precede the clinical changes of shunt appearance and resolution. The echocardiographic left atrial to aortic ratio (LA/Ao) supplemented the radiographic findings. The time of disappearance of the ductus arteriosus shunt, as judged by clinical findings, was identified accurately by radiographic and echocardiographic findings in the majority of cases; errors of under- and overestimation occurred in a minority of patients. In assessing both the presence and the resolution of the shunt, greater reliability was possible by using both radiographic and echocardiographic findings than by using either method alone.
Diagnostic Errors↗
Provocation of coronary spasm with ergonovine maleate. New test with results in 57 patients undergoing coronary arteriography.
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.
Adult↗
Interruption of the aortic arch: preoperative and postoperative clinical, hemodynamic and angiographic features.
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.
Adolescent↗
Therapeutic embolization for intractable chronic bleeding.
Intractable, chronic vaginal and/or vesicle bleeding complicating pelvic cancers in five women was treated by transcatheter embolization of the hypogastric artery or its branches. Bleeding was presumed to be from hypervascular granulation tissue formed in response to irradiation in two patients and from tumor tissue in three. The embolic materials were Gelfoam and Oxycel reinforced autologous clots. Bleeding was stopped or reduced in volume by at least 90% in each patient. This form of therapy was useful even though bleeding site was not demonstrated angiographically.
Chronic Disease↗
Patent ductus arteriosus in preterm infants with idiopathic respiratory distress syndrome. Radiographic and echocardiographic evaluation.
Clinical, radiographic, echocardiographic and operative findings were evaluated in 55 preterm infants with idiopathic respiratory distress syndrome (IRDS) complicated by patent ductus arteriosus (PDA). Pulmonary plethora was detected prior to age seven days in 52 infants, and prior to murmur detection in 42 infants. In those with large shunts, only 35% had cardiomegaly while 78% had a significant increase in cardiothoracic ratio (C/T) on sequential radiographs. Moreover, within 48 hours after ligation, 91% of infants had a significant decrease in C/T. Echocardiographic left atrial to aortic ratio (LA/Ao) was elevated in 71% with large shunts. In one patient with a large shunt there was neither a sequential increase in C/T nor an increased LA/Ao. Severity of left-to-right shunting across a PDA in the newborn was reliably gauged by combined radiographic and echocardiographic evaluation. Either modality alone failed to reflect the presence of a large volume shunt in a number of infants.
Ductus Arteriosus, Patent↗
Differences in the velocity-displacement relationship of systolic contraction of normal and ischemic canine myocardium.
In the canine model there exist major differences in the velocity-displacement relationships of systolic contraction between normal and ischemic myocardium. These differences are noninvasively measurable in vivo from video recordings of the fluoroscopic image of the heart, and can be detected within the time period of one cardiac cycle. Velocity data is plotted against the corresponding wall displacement on orthogonal axes (phase-space), producing characteristic loops which give an immediate visual indication of myocardial dysfunction.
Animals↗
Effects of contrast media on the conducting system of the heart. Mechanism of action and identification of toxic component.
Infusion of progressive volumes of meglumine sodium diatrizoate (Renografin 76) into the arteries to the sinoatrial and atrioventricular nodes in anesthetized dogs produced a dose rate-dependent decrease in heart rate and an increase in "PR interval." At high dose rates, Renografin 76 caused sinus arrest and complete heart block in 50% and 70% of the animals, respectively. Saline and meglumine solutions (0.939 M) equiosmolar with Renografin 76 produced similar effects. Infusions of metrizamide (equal in iodine content with Renografin 76), dextrose solution (0.939 M), and autologous blood each had substantially less effects. Contrast media have a direct inhibitory action on sinoatrial automaticity and atrioventricular conductivity which is dependent on ionic strength, not iodine content.
Animals↗
The role of bronchial arteriography and therapeutic embolization in hemoptysis.
A case is presented which demonstrates the value of bronchial arteriographic studies in localizing and treating hemoptysis. The patient was bleeding from an old post-tuberculous bulla and for several reasons was not a candidate for surgery. Bronchial arteriographic studies demonstrated both hypervascularity in the region of the cavity and also a mycotic aneurysm of a bronchial artery. After therapeutic embolization with gelatin (Gelfoam), the hypervascularity and aneurysm were no longer opacified. Active bleeding abruptly ceased and, except for a single mild recurrence, has not recurred during the three months since therapeutic embolization. The major theoretic risk of bronchial arteriographic study and therapeutic embolization is spinal injury. It is believed that permanent injury can almost be avoided, providing proper technique is used.
Bronchial Arteries↗
Clinical and arteriographic features of Prinzmetal's variant angina: documentation of etiologic factors.
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.
Age Factors↗
The significance of mitral valve prolapse in middle-aged and elderly men.
The clinical, roentgenographic, phonocardiographic, ECG, and echocardiographic data were evaluated in 40 consecutive middle-aged and elderly male patients with echocardiographically detectable systolic prolapse of mitral valve leaflets. Prolapse was present during more than half of systole in 31 patients and was holosystolic in six patients. In most instances, both leaflets prolapsed during systole. The closing velocity and excursion of the anterior leaflet were frequently increased particularly in association with evidence of mitral insufficiency. A majority of the patients had cardiac symptomatology. Moreover, roentgenographic and/or ECG evidence of cardiac enlargement or hypertrophy was evident in 45 percent of patients with mitral valve prolapse.
Aged↗