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[The accuracy of surface kymography following myocardial infarcts, with special reference of cardiac aneurysms (author's transl)].

Surface kymography in three planes were performed in 180 patients following myocardial infarcts, and these were compared with the results of coronary angiography and selective laevocardiography. Kymography performed for the diagnosis of cardiac aneurysms and myocardial scars is relatively accurate (53%), as shown by a comparison with the laevocardiograms. Of the aneurysms demonstrated by laevocardiography in the left ventricle (31), it was possible to show 22 (71%) kymographically. In order to achieve these results, it is necessary to examine at least three marginal contours of the left ventricle by kymography (left heart border, anterior and posterior wall). The routine use of kymography before employing invasive techniques provides useful information regarding the optimal plane of the laevocardiogram. Furthermore, it indicates the presence of myocardial disease and the need for further investigation.

Coronary Angiography

Radionuclide kymography for the assessment of regional myocardial wall motion.

Regional myocardial wall motion is usually evaluated qualitatively from ECG-gated end-systolic and end-diastolic blood-pool images. Radionuclide kymography, which displays a one-dimensional scintigraphic image in time, synchronized with the electrocardiogram, provides a method to quantitate this motion. The technique is analogous to M-mode ultrasound in that one dimension is displayed as a function of time, but the activity distribution is displayed in place of acoustic interfaces. The motion of regional myocardial segments can be measured from multiple kymographic projections across the cardiac blood pool, after equilibration of a radioactive tracer. Radionuclide kymography is potentially better quantitatively than gated blood-pool imaging and is not hindered by viewing windows as are single- and multiple-transducer ultrasonography. Regional wall motion determined from radionuclide kymography correlated well with that determined from contrast left ventriculography in a series of patients. Since the kymographic sweep is initiated by the R wave of the ECG and proceeds continuously throughout the cardiac cycle, the temporal sequence of regional myocardial contraction can be directly assessed and related to corresponding portions of the ECG.

Computers

[The diagnostic value of kymography in aortic isthmus stenosis (author's transl)].

The value of kymography was studied in 133 patients in whom a coarctation had been demonstrated angiographically, operatively or pathologically; its value was compared with conventional radiographic examinations. The difference in pulsation between the pib notching, dilatation of the ascending aorta and increased size of the left ventricle on plain films make it possible to diagnose an haemodynamically significant coarctation without any invasive methods. In 124 haemodynamically significant coarctations (93%), the kymogram showed increased pulsation of the dilated left subclavian artery. In nine haemodynamically insignificant or mild coarctations (7%), this sign was absent. Since the radiographic signs are to some extent reversible, it is possible to evaluate the results of surgery by plain chest films and the kymogram.

Adolescent

[Camera-cinematography of the heart (author's transl)].

By "camera-cinematography" of the heart, we mean an isotope method which permits detailed observation of cardiac mechanics without the use of a catheter. All that is necessary is an intravenous injection of 10 to 15 mCi 99mTc human serum albumen followed after ten minutes by a five to ten minute period of observation with a scintilation camera. At this time the isotope has become distributed in the blood. Variations in the precordial impulses correspond with intra-cardiac changes of blood volume during a cardiac cycle. Analysis of the R-wave provides adequate information of cyclical volume changes in limited portions of the heart. This is achieved by a monitor with a pseudo-3-dimensional display; contraction and relaxation of the myocardium can be shown for any chosen longitudinal or horizontal diameter of the heart. Our programme allows simultaneous presentation of the movement of any point on the myocardium as a time-activity curve. The method is recommended as an addition to chest radiography, heart screening or cardiac kymography before carrying out cardiac catheterisation.

Cardiac Output