PubMed · 13670592
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H C URSCHEL, E J ROTH. 1959. Electronically controlled coronary arteriography.. https://doi.org/10.1097/00000658-195908000-00010
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BACKGROUND AND OBJECTIVE: Absolute numbers of cardiovascular procedures are higher in Germany as compared to other European countries. This fact is used as an argument for overuse. Therefore other indicators of an inappropriate use of these resources should be of interest. PATIENTS AND METHODS: The relationship between diagnostic cardiac catheterisations and consequent revascularisation procedures were compared in 8 European countries. In addition the indication criteria for cardiac catheterisations were reviewed in a German registry of 205.581 consecutive inpatients. RESULTS: Revascularisation procedures after diagnostic catheterisations in 8 countries range from 39,1 % to 57,9 %. Germany reaches 43,2 %. A relation between absolute numbers of diagnostic and percent subsequent revascularisation procedures does not exist. In a German registry the following indications for cardiac catheterisation could be identified: Acute Coronary Syndrome 22,9 %. Angina pectoris according to the Canadian Cardiac Society classification was present: CCS II/III in 80,3 %, CCS IV in 17,2 %. An exercise test was performed in 43 %. Final diagnoses were: significant coronary disease 69,5 %, exclusion of disease 9,4 %, lesions < 50 % 9 %, other cardiac disease 12,1 %. CONCLUSION: Absolute numbers cannot be used as an indicator of overuse of cardiovascular procedures. Instead standards for data acquisition should be established on European, national and regional levels. In addition a validation procedure for criteria has to be developed in order to judge the appropriateness of indications for invasive cardiac procedures in different health care systems.
OBJECTIVE: To evaluate the feasibility of the arterial switch for surgical repair of transposition, defined as the combination of concordant atrioventricular and discordant ventriculo-arterial connections, after late referral. METHODS: From March 2000 to August 2001, six children underwent an arterial switch procedure following left ventricular preparation because of late referral. The mean age at referral was 8.3 months, with a range from 3 to 25 months, and mean body weight was 5.3 kg, with a range from 3.7 to 9.3 kg. The mean saturation of oxygen was 57%, with a range from 50 to 72%. Associated defects included a restrictive ventricular septal defect in three patients, aortic coarctation in one, and partially anomalous pulmonary venous connection in one. The mean interval between referral and the arterial switch procedure was 3.7 months, within a range from 1 to 7 months. A mean of 1.5 surgical procedures were undertaken to prepare the left ventricle, the most being 3 procedures, including combinations of creation of an inter-atrial communication in four patients, banding of the pulmonary trunk in five, and creation of a systemic-to-pulmonary arterial shunt in three. We evaluated left ventricle ejection and shortening fractions, left ventricular diastolic diameter and volume, right and left ventricular wall thicknesses, and the ratio of right to left ventricular values by echocardiography at referral, immediately before, and one week after the arterial switch procedure. RESULTS: All children are alive and well, with a mean follow-up of 17 months, ranging from 9 to 26 months. Echocardiography showed a statistically significant decrease of the ratio between right and left ventricular wall thicknesses, from 1.33 +/- 0.26 at referral to 0.79 +/- 0.08 before the switch procedure (p < 0.005). Left ventricular function was adequate after arterial switch, with a mean ejection fraction of 79.3%, ranging from 66 to 87%, and a mean shortening fraction of 41.7%, ranging from 30 to 49%. CONCLUSIONS: Despite late referral, and initially inadequate left ventricular volume and mural thickness, children with transposition can successfully be treated with the arterial switch procedure, provided that the left ventricle is adequately prepared, using echocardiography to monitor left ventricular morphology and function.
BACKGROUND: End-diastolic (ED), end-systolic (ES) left ventricular (LV) volumes and LV ejection fraction (LVEF) are important parameters for clinical decision making in heart disease. In clinical practice the frames from cine-angiography with the largest and smallest opacified LV areas are visually selected and the endocardial borders traced as LVED and LVES contours, respectively. We compared the accuracy of this visual method using two frames with a semi-automated computer assisted frame-by-frame analysis of the complete opacified cardiac cycles. METHODS AND RESULTS: In 17 patients a biplane LV cine-angiogram was obtained at 25 frames/s. Complete frame-by-frame analysis was performed using semi-automatic border detection software. Experienced independent observers visually selected and manually traced LVED and LVES in the so-called visually assessed two-frame method in a consensus meeting. LV volumes were calculated by the area-length method. Mean LVEDV, LVESV and LVEF were 133 +/- 57, 56 +/- 40 ml and 61 +/- 16%, respectively, for the visually assessed two-frame method, and 117 +/- 49, 53 +/- 33 ml and 60 +/- 13%, respectively, for the semi-automated computer assisted frame-by-frame method. LVEDV was significantly higher in the visually assessed two-frame method (p < 0.01). Linear regression analysis showed an excellent correlation between semi-automated computer-assisted frame-by-frame and the visually assessed two-frame LVEDV (y = 1.2x - 2.9; r2 = 0.98), LVESV (y = 1.2x - 8.2; r2 = 0.97) and good linear correlation for LVEF (p = 1.2x - 3.6; r2 = 0.82). Bland-Altman analysis showed respectively a bias of 16.4, 2.4 ml and 5.0% with overall wide limits of agreement (-6.6 and 39.4 ml; -16.6 and 21.4 ml; -9.0% and 19.1%). CONCLUSION: Correlation is excellent when visually assessed LVED and LVES are compared with a semi-automated computer assisted frame-by-frame analysis. However, the visually assessed two-frame method tends to overestimate the volumes obtained by semi-automated computer-assisted frame-by-frame analysis, especially for LVEDV, indicating that visual selection will yield a higher LVEF, which may influence clinical decision making.