Biomedical subjects
Publications and source records attributed to H A Baltaxe.
Ultrasonography is accurate for diagnosis of abdominal aneurysms and clots within them. However, due to technical factors, occlusive clots within the aorta can be missed even at high gain. The authors report three cases in which total occlusion of the abdominal aorta was misdiagnosed as a free lumen occupied by a small clot. An explanation for the shortcomings of ultrasound is offered.
Nine patients, 4--60 years old, had single or multiple left ventricular outpouchings, best seen during diastole, and believed to represent congenital diverticula. The 14 diverticula, 5--28 mm long, were either along the diaphragmatic or anterior ventricular wall. Only one patient had his diverticulum surgically removed; the wall was lined by thick endocardium surrounded by normal myocardium. The lesions did not produce local or systemic complications. All patients had normal chest radiographs. The material suggests that left ventricular diverticula not associated with midline anomalies are perhaps not very rare and should be distinguished from cardiac aneurysm.
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Recognition of the presence of a malignant pericardial effusion is important because of the insidious onset and life-threatening potential. This report presents data on three patients with metastasizing carcinoma of the breast, all admitted with a presumptive clinical diagnosis of malignant pericardial effusion. Two of the three revealed a diffuse concentration of Tc-99m PPi within the myocardium. In these cases the diagnosis was confirmed by identification of malignant cells in the pericardial fluid. We suggest that the use of labeled phosphate agents may allow early recognition of myocardial involvement in patients with disseminated neoplasm that results in malignant pericardial effusion.
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Physiological potentiation during ventriculography is more helpful than the routine ventriculogram in predicting postoperative ventricular function. The authors describe a control device which allows the operator to flexibly program a pacing stimulus, thus making it possible to obtain both a resting beat and an optimum potentiated beat during a single ventriculographic study.
Left ventircular performance and graft patency were studied postoperatively at 2 weeks in 19 patients, and at 9 months in 15 patients. At early follow-up, left ventricular ejection fraction and mean rate of circumferential shortening were unchanged for the group as a whole, but were slightly improved in patients who had had a moderately abnormal preoperative ejection fraction of 0.30 to 0.60. At late follow-up, 10 of 14 patients had occluded at least one graft or the proximal segment of the grafted coronary artery and had an associated decrease in ventricular function. The risk of graft occlusion was greater if the preoperative ejection fraction was decreased; seven of 10 patients with a preoperative EF of less than 0.60 suffered one or more graft occlusions, but only three of 16 patients with a preoperative EF greater than 0.60 had a postoperative graft occlusion (p is less than 0.05). The results suggest that bypass graft surgery is not generally indicated as a measure to improve ventricular function in patients with ischemic heart disease.
Left ventriculography with selective coronary angiography was performed on 13 patients with acute myocardial infarcts complicated by cardiogenic shock of left ventricular failure and hypotension. Twelve patients (92-3%) tolerated the procedure well. Irreversible ventricular fibrillation resulting in death occurred in one patient 7-7%) during the opacification of the left coronary artery. Seven (87-5%) of the eight patients treated surgically and two (50%) of the four patients treated medically died. This study shows that although acute myocardial infarction increases the risk of coronary angiography, it is justifiable if surgical therapy is contemplated.
A review of 1,000 consecutive coronary angiograms, most of them performed for evaluation of angina pectoris, yielded 9 examples of congenital anomalies of the coronary arteries. In 2 cases the angina may have been due to malposition of the left coronary artery or one of its branches. There were 2 cases of aberrant origin of the circumflex artery from the right coronary artery, 2 cases of aberrant left anterior descending artery, 3 cases in which all three major coronary branches arose from the right aortic sinus, and 2 cases of coronary artery fistulas. Malposition of the coronary artery should be considered as a possible cause of angina.
Changes in total and regional left coronary blood flow in response to ventriculography were studied using electromagnetic and microsphere techniques. Correlation of coronary flows by these methods showed excellent agreement (r = 0.947). Ventriculography produced a characteristic triphasic response in total flow and in endocardial/epicardial perfusion ratios. Changes in coronary flow can be explained as a result of hypotension and vasodilatation.
Several similar projections utilizing cranial and caudal angulation of the X-ray tube in various obliquities have been described recently for coronary angiography and left ventriculography. These views provide improved visualization of the proximal branches of the left coronary artery, the region of the crux of the right coronary artery, and the left ventricle in the left anterior oblique projection; structures which in the conventional projections are often superimposed on one another or are foreshortened. The confusing and conflicting terms--"oblique clockwise and anticlockwise table base turn," "half-axial," "angulated," "sit up," "caudo-cranial sagittal augulation," "cranio-caudal sagittal angulation," and "lordotic" projections--should be discarded in favor of the terms "cranial angulation projection" and "caudal angulation projection." The appropriate anterior, rather than the posterior obliquity should be used to refer to rotation of the patient, or the X-ray beam around his long axis.
A patient with relapsing polychondritis and thoracic and abdominal aortic aneurysms is described. The aortic changes were due to aortitis, which primarily involved the media, with increased vascularization, perviascular infiltration of mononuclear cells, increased amounts of collagen and decreased amounts of elastic tissue and sulfated acid mucopolysaccharides. Aortic aneurysms frequently occur in relapsing polychondritis; they are usually in the ascending aorta but may be multiple and involve the abdominal aorta; involvement of the ascending aorta results in aortic regurgitation and left ventricular failure, and involvement of the abdominal aorta may be clinically silent and result in fatal rupture.
Hepatomography was performed by injecting emulsified Ethiodol into the hepatic artery of 9 beagles. The hepatogram was dense and remained long enough for diagnostic tomography. Contrast material was eliminated in part through the kidneys and disappeared from the liver within 24 hours after injection. The dogs were sacrificed 36 hours to 4 months after contrast injection. Longlasting ill effects were observed in only one dog which died of hepatitis. The death of this prompted the use of a more dilute emulsion which was beeter tolerated by all subsequent animals.
The authors describe a case of spurious complete obstruction of the inferior vena cava in a 60-year-old man, which proved to be the result of a Valsalva maneuver. It is recommended that if an apparent abnormality is noted on supine inferior vena cavography, the position of the patient be changed and additional films obtained in different projections without the Valsalva maneuver.
The possible beneficial effects of added calcium ions to contrast media to diminish myocardial toxicity was evaluated in 93 cardiac catheterizations with cardioangiography, performed in 50 children and adolescents. Two contrast media with equal iodine content (370 mg/ml) and similar physical properties were used: Isopawue-370, containing 0.34 mg calcium/ml, and Renografin-76, not containing calcium. It is concluded that addition of calcium to contrast media for cardioangiography in children and adolescents does not alter their myocardial, fluid or electrolyte effects when injected selectively into the cardiac chambers or great vessels.
Measurements of the thickness of the septum were made in 26 cardiac specimens and in 13 patients. There were 10 normal specimens, five with aortic stenosis, two with asymmetric septal hypertrophy, four with hypertensive cardiovascular disease, and five with idiopathic cardiomyopathy. Patient measurements were obtained by visualizing the septum during simultaneous left and right ventriculography on angiograms obtained in the left anterior oblique projection. Four patients were normal, five had aortic stenosis, and four had a symmetric septal hypertrophy. Measurements derived from normal cardiac specimens and angiographic appearance suggested that the normal septum is a smooth-walled structure with right and left ventricular surfaces parallel, diverging only slightly at the apex of the ventricle. In aortic stenosis and idiopathic cardiomyopathy, the septum tends to be biconvex with maximal thickening in its middle third. Hypertensive cardiovascular disease produces uniform septal thickening, resembling an exaggeration of normal. However, in asymmetric septal hypertrophy no consistent patterns of hypertrophy or septal thickening are evident; bulging can be present at any point along the left ventricular surface of the septum.
Four cases of oxyphilic cortical renal adenomas identified by angiography are described. A suggestive angiographic appearance is outlined for adenomas limited to the cortex: avascularity or hypovascularity; renal vessels splayed and stretched around tumor base; faint parenchymal blush during nephrograpm phase; and tumor well marginated, appearing to arise from the renal cortex. Masses that fulfill the above criteria are adequately treated with excisional biopsy if frozen section confirms their benignity.
Patients with isolated total interruption of the arch of the aorta not accompanied by other cardiovascular anomalies may survive to advanced age. Their symptoms and course resemble those of patients with postductal coarctation of the aorta. However, there are basic differences in the pathologic findings in these two types of anomalies that may be of aid in the radiographic diagnosis.