Cardiovascular radiology最新文献

A new operation for the treatment of cirrhosis and portal hypertension has recently been described involving arterialization of the portal vein in combination with an end-to-side portacaval shunt. We present, for the first time, the appearances at wedge hepatic venography. No significant change is seen in the wedge hapatic pressure as a result of this technique, and the sinusoidal pattern is preserved. Filling of the portosplanchnic collaterals is not as frequent as after end-to-side shunts alone, and the appearances seem to reflect improved sinusoidal perfusion. The clinical results have been encouraging.

An arteriovenous fistula between the systemic and pulmonary circulations may be congenital, as in bronchopulmonary sequestration, or the communication may be acquired. Inflammatory disease, trauma, and, rarely, neoplasm have been implicated as possible causes of acquired communications. We describe a patient who had a systemic artery-to-pulmonary vein fistula that was secondary to a recurrent sarcoma of the chest wall. Review of the literature failed to reveal a previous report of a similar case.

The changes in coronary collateral circulation after bypass surgery were analyzed in 50 patients with coronary disease. The demonstration of collateral circulation was found to be dependent upon the severity of the coronary heart disease and the patency of the bypass. When the graft was patent, it was usually not possible to visualize the collateral circulation demonstrated preoperatively. When the bypass was occluded, the same collateral circulation as before surgery was frequently found.

A multipurpose "wire-ship" catheter has been developed for selective catheterization of branches arising from the aorta. The catheter tip is formed in three dimensions to allow simple selective catheterization and to provide improved stability during injection of contrast media by power injector or by hand. For successful catheterization it is essential to match the diameter of the catheter coil to the aortic lumen at the specific level to be studied; consequently, five standard sizes of coil diameter from 10--18 mm are currently produced. With an additional side hole in the coil, semiselective angiograms may be obtained. The wire-whip catheter has been used in over 200 angiographic examinations. The renal, celiac, superior and inferior mesenteric circulations have been most commonly studied, but other aortic branches such as the bronchial, intercostal, phrenic, and lumbar arteries have been catheterized as well. There have been no serious complications.

Sonography was performed on 41 patients, 24 of whom were suspected of having abdominal aortic aneurysms and 17 of whom had symptomatic peripheral vascular disease. The accuracy of sonography in the diagnosis of aneurysms of the abdominal aorta was evaluated, and the instances in which angioggraphy contributed to the management of these patients was defined. Sonography is adequate for the diagnosis and management of many aneurysms of the abdominal aorta. Aortography is necessary when: (1) an inadequate study has been obtained, (2) the iliac arteries are not visualized, (3) renal or mesenteric artery involvement is suspected, (4) multiple or lobulated aneurysms are found, or (5) the aorta is very tortuous.

Left ventricular cineangiogram in a 2-year-old child with a large ventricular septal defect, pulmonary atresia and a previous Waterston anastomosis opacified clearly the right pulmonary artery but the left pulmonary artery could not be visualized. The later was thought to be due to obstruction or kinking of the right pulmonary artery proximal to the Waterston anastomotic site. A left pulmonary vein wedge angiogram performed via a No. 5 end-hole catheter with 4.0 cc of meglumine diatrizoate (75% Hypaque) injected under pressure (less than 100 PSI) visualized the left pulmonary artery in a retrograde fashion. The size of the left pulmonary artery at this study was comparable to its size measured at the time of a subsequent left Blalock-Taussig anastomosis. Pulmonary vein wedge angiography with 0.3 cc/kg body weight of contrast material injected over a two second period (less than 100 PSI) appears to be a useful technique in demonstrating the pulmonary arteries when these cannot be visualized by conventional antegrade techniques.

Four patients with aneurysms of the inferior pancreaticoduodenal artery are described. All had occlusion of the celiac axis at its origin, with the inferior pancreaticoduodenal arcades serving as a collateral pathway. We propose that the association of the celiac axis occlusion and aneurysms in the collateral supply via the pancreatic arcades is more than coincidental. Awareness of this relationship may be of significance in planning therapeutic intervention.

Four infants with type C double aortic arch (double aortic arch with aberrant left subclavian artery) are discussed. The diagnosis was based on symptoms and signs of tracheoesophageal compression with a bilateral impression in the frontal plane of the esophagogram, as well as on early visualization of the aberrant left subclavian artery during counter-current right brachial angiography. Division of the atretic segment of the left arch and of the ligamentum arteriosum relieved the symptoms.

Catheter dislodgement is a major cause of technical failures in intraarterial vasopressin therapy for gastrointestinal bleeding. Ten such cases were observed in the past five years. In seven patients catheter dislodgement led to recurrent bleeding during vasopressin infusion. In one patient aortic infusion of vasopressin caused recurrent bleeding and reversible acrocyanosis of the feet, and in two patients vasopressin infusion into the left renal artery resulted in chest pain and hematuria. Catheter dislodgement should be suspected if bleeding that was initially controlled recurs during vasopressin infusion.

Twenty-two cases with communication of an artery and the portal vein or one of its tributaries are discussed. Four conditions in which relatively significant arterio-portal shunts may exist can be differentiated: (1) angiodysplasias or arteriovenous malformations, (2) cirrhosis of the liver and inflammatory lesions, (3) traumatic and postoperative lesions, and (4) benign and malignant tumors. The significance of the portal vein's early opacification during arteriographic examinations of the abdominal organs is discussed, and the findings are compared to those reported in the literature.