Biomedical subjects
Publications and source records attributed to C Zollikofer.
Left atrial-coronary sinus fenestration is a rare cause of a left-to-right or right-to-left shunt which occurs most commonly with a persistent left superior vena cava. These fenestrations may represent the only pathway for an obligatory right-to-left or left-to-right shunt in atrioventricular valve atresia. Four cases are presented.
A new theory of the mechanism of percutaneous arterial angioplasty is advanced. For this study, abdominal aortas and coronary, renal, superior mesenteric, and iliac arteries were obtained from cadavers. In addition, the iliac arteries of dogs were dilated and studied. No evidence of significant compression or redistribution of plaques could be found, supporting the theory that atheromatous material is incompressible. Cracking of the intima and separation of it from the media were histologically demonstrated following angioplasty. It is proposed that the stretched media distends following dilatation, carrying with the intima and atheromatous material. Once the media is freed from the encasing effect of the intima, it adapts to the circulatory needs of the body. Beyond a certain point, the arterial widening becomes permanent, due to an overstretching of the muscle fibers, which is demonstrated by a corkscrew deformity of the muscle cell nuclei.
A new device for the safe delivery of the Gianturco stainless steel coils is described, which can be selectively placed in a predetermined area.
Regional segmental wall motion analysis assumes a linear or radial grid system. In this study, motion patterns of points on the canine endocardium were evaluated. Radiopaque endocardial and epicardial markers were inserted along the anterior and posterior descending coronary arteries. Postoperative cine radiography showed that the endocardial markers did not move along either linear or radial grids. The endocardial and epicardial markers were shown to have different patterns of movement.
Two benign leiomyomas are described together with their radiographic and sonographic appearance, and the literature is reviewed. In large, asymptomatic renal masses, which are well circumscribed on angiography, a benign intrarenal leiomyoma may be considered. Nonechogenicity and relatively good through-transmission seem to substantiate the diagnosis.
Intrarenal arterial aneurysm is an uncommon manifestation of allograft rejection. We present two cases of transplant rejection with aneurysm formations. One case simulated polyarteritis nodosa, while in the other, the aneurysm appeared similar to those seen in post-stenotic arterial dilatation.
A new technique for embolization with compressed Ivalon plugs is described. Fourteen arteries--six renal, three splenic, two pulmonary, one left gastric, and two abdominal aortas--were occluded in six dogs. In one case of renal artery embolization, three plugs were used, and in one case of abdominal aorta embolization, two were needed for total occlusion. In all other cases only one plug was used. Total occlusion was angiographically demonstrated up to five months following embolization in all but one case. In this case, recanalization was thought to have occurred because of overcompression of the Ivalon plug.
Anomalies and disease processes of the coronary arteries in children are uncommon. However, with the recent advances in cardiac surgical techniques, many of these lesions are amenable to surgery that requires accurate anatomic delineation by angiography. Ascending aortography is the angiographic procedure commonly used to image the coronary arterial anatomy in children. In some instances this procedure fails to show the extent or nature of the pathologic process. In some cases, selective coronary arteriography is essential for successful management. Twelve patients are presented in whom selective coronary arteriography was indicated, and its value is compared with that of nonselective angiography. Indications for selective coronary arteriography in children are given, and its complications are also discussed.
Five patients with a combination of truncus arteriosus and interruption of the aortic arch are reported. The combination of those defects significantly increases the surgical risk. This rare cardiac malformation can only be diagnosed radiographically. An aberrant right subclavian artery is present in 25% of patients. It is helpful in suspecting the diagnosis from plain films of the chest. The diagnosis can be made from a ventriculogram, but usually a truncogram is necessary to define the anatomy of the aortic arch.
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Eleven cases of vascular pseudotumors were reviewed and grouped into four categories according to clinical and radiological findings. On the IVP we found two patterns of filling defects: [1] Smooth indentations or filling defects in AV fistulas and renal artery aneurysms and also in the case of a congenital AV malformation due to an enlarged draining vein. [2] Multiple mottled filling defects caused by collaterals in stenoses of renal artery branches. This appearance is also described in the literature for congenital AV malformations. The angiographic findings in each of the four categories are discussed. The role of angiography is stressed as the diagnostic test of choice to establish the correct diagnosis of these benign lesions and to define optimal treatment.
Coarctation of the abdominal aorta is an uncommon process but an important cause of systemic hypertension. Angiography is the investigation of choice to establish a diagnosis and document the extent of involvement. However, angiography does not provide an etiological diagnosis; and it may not be possible to distinguish an acquired coarctation from a congenital process. Three patients with coarctation of the abdominal aorta are presented.
With increasing use of indwelling venous catheters, embolization of intravascular catheter fragments has become a well-known complication. Because of the high risk and serious complications, embolized fragments should be retrieved whenever possible. Four cases of successful nonsurgical percutaneous catheter retrieval (two adults and two children) are described using a wire loop and a hook-shaped catheter technique. The method described allow a safe and rapid retrieval and should always precede surgical exploration.
Doming of the pulmonary valve is considered an important angiographic sign for valvar stenosis. But, this sign cannot be used with similar specificity following valvotomy because at the time of surgery a bicuspid valve is created. Pre- and postoperative hemodynamic data and right ventriculograms are reviewed in 22 patients with simple pulmonary valvar stenosis. There was no correlation between the transvalvar gradient and appearance of the pulmonary valve after surgery.
Aneurysm of the ascending aorta with aortic regurgitation is most commonly caused by cystic medial necrosis. Replacement of the aortic valve and diseased aorta with a composite graft and re-implantation of coronary arteries is the surgical treatment of choice at the authors' institution. The most important late complication of this procedure is hemorrhage at the anastomotic sites. Radiology plays an important role in the management of these patients. The angiographic appearance of cystic medial necrosis and the radiological features and postoperative complications of composite grafts in 15 patients are described.
Pheochromocytomas are usually hypervascular tumors exhibiting dense stain during angiography. The cystic nature of the neoplasm or tumor necrosis can result in failure of opacification of the mass or a central lucent area. Four cases of pheochromocytoma are described where a central avascular zone was surrounded by a dense rim of contrast, giving a "ring sign." Since this appearance is best seen in the capillary and venous phases, delayed films are essential.
Two cases of percutaneous transfemoral embolization of facial hemangiomas and arteriovenous (AV) malformations are reported. In both cases, Ivalon shavings were injected through a percutaneously placed catheter to permanently occlude peripheral feeders of the AV malformation. In one case, because of the size of the large venous sacs associated with the malformation, a steel coil was introduced to form a baffle, over which several additional strands of surgical silk were introduced to obliterate these sacs. These cases emphasize the need for embolization of small feeding arteries to prevent recurrence by collateral channels. To achieve this, specific-sized emboli are necessary; Ivalon is a suitable embolic material.
Diffuse areas of narrowing and dilatation involving the main renal artery are the most common angiographic findings in fibromuscular dysplasia (FMD), together with the presence of renal artery stenosis. The development of false aneurysms of the renal artery and arteriovenous fistulas are uncommon manifestations. Large, partially thrombosed and calcified renal artery aneurysms are described and their differential diagnosis is stressed.