Cardiovascular radiology最新文献

The enzymatic response to contrast media after coronary angiography was observed in 24 patients. The enzymes studied were glutamic oxaloacetic transaminase (SGOT), glutamic pyruvic transaminase (SGPT), lactic dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (alpha-HBDH), gamma-glutamyl transferase (gamma-GT), creatine phosphokinase (CPK), and the myocardial-specific isoenzyme of CPK (CK-MB). Angiography produced no significant elevations in SGOT, SGPT, alpha-HBDH, LDH, or CK-MB activities; gamma-GT increased up to the twelfth hour. High levels of CPK and CK-MB observed in one patient were found to be products of a thymus carcinoma. In vitro examinations also showed that concentrations of contrast media used in coronary angiography do not inhibit gamma-GT, LDH, and CPK activities.

Forty-three patients with deep vein thrombosis were given fibrinolytic therapy with streptokinase and/or urokinase. In all patients the diagnosis was made phlebographically, and repeat phlebography was performed after termination of therapy. Sixty-four of 104 vein segments initially occluded (62%) were partially or completely recanalized. No vein segments particularly suitable for fibrinolytic therapy could be defined. The therapy was as successful in cases in which the thrombosis extended over several segments as in those in which the occlusions involved only one or two segments. Similarly, there was no difference in the success rate for thrombi that were still freely floating and for thrombi that occluded the veins completely. It is recommended that fibrinolytic therapy be given in suitable cases in which clinical symptoms have persisted up to two weeks; in some cases this limit may even be extended up to one month.

A case of an accessory hepatic artery from the dorsal pancreatic artery is illustrated. A discussion of anatomic variations and embryology of the arterial blood supply to the liver from the celiac axis and aberrant blood supply from other vessels is presented with a consideration of the surgical and diagnostic significance of anatomic variance.

Two patients with a right aortic arch, right patent ductus arteriosus, and mirror-image branching of the brachiocephalic vessels are described. The clinical, angiographic, and surgical findings in these two cases are detailed, and a description of the embryologic basis for these anomalies is given.

The validity of angiocardiographic measurements in assessing the severity of pulmonic valve stenosis was determined. The pulmonic valve orifice area was measured in the lateral projection on cineangiocardiographic films in 24 patients with valvar pulmonic stenosis. The valve orifice area was also obtained in the same patients by the Gorlin and Bache formulae. The right ventricular output value required for insertion in these formulae was obtained by angiocardiographic right ventricular volume measurement and by the Fick method. The correlation between the directly measured valve orifice area and the area calculated using the Fick principle and the Bache formula was 0.80. The substitution of angiocardiographically measured right ventricular stroke volume for the Fick value gave a correlation of 0.82. The results support validity of employing direct angiocardiographic measurements of pulmonic valve orifice area and angiocardiographic right ventricular volume measurements for quantitative assessment of the severity of pulmonic valve stenosis. The angiocardiographic methods thus represent an alternative to the Fick technique which can be used in conditions where the Fick method cannot be expected to give valid results.

Nondissecting, chronic, thoracic aortic aneurysms (TAA) may be associated with such vascular complications as aorto-cardiac, aorto-superior vena caval (SVC) and aorto-pulmonary arterial (PA) fistual formation, and/or SVC or PA compression. Dissecting TAA have been associated with these lesions far less often. This report summarizes the occurence and outcome of the following complications of dissecting TTA: (1) SVC obstruction; (2) aorto-right and -left atrial, aorta-right ventricular and aorto-PA fistula formation; (3) compression of the PA and (4) hematoma of the interatrial septum. Two patients are described with aortic dessection complicated by: (1) SVC obstruction and aorto-left atrial fistula; and (2) aorto-PA fistula. These complications are rarer with aortic dissection, because of the acute, catastrophic nature of this lesion. When dissection is chronic, however, arteriovenous fistulae are often well tolerated, and urgent surgical intervention seems to be unnecessary.

A polyurethane prepolymer was evaluated as a transcatheter embolizing agent. Low viscosity permits injection through small catheters. Polymerization is initated on contact with blood and completed within 10 seconds. Downstream propagation is better then that of cyanoacrylate and comparable to that of silicone rubber. No systemic toxicity was observed in acute animal experiments. However, dissolution of arterial walls and extravasation out of the vascular bed of chronically embolized organs suggest significant local tissue toxicity and make further evaluation necessary before clinical testing.

The value of angiography in the management of abdominal aortic aneurysms (AAA) was assessed in 100 consecutive patients with AAA. Angiographic information influenced management decisons and/or surgery performance in 75: In 23 patients at high risk for surgery because of associated medical problems, it helped in deferring surgery; in 52 patients it resulted in a change of operation from a standard aneurysm resection with conventional grafting to a more conservative procedure (three patients), more extensive grafting (45 patients) and/or the addition of other vascular reconstructions (32 patients). Angiography is considered an integral step in the routine preoperative workup of AAA and is particularly valuable for the determination of important anatomic details about the aneurysm (upper and lower extensions, relation to the renal arteries), the detection of associated vascular disease (of renal, visceral, pelvic and peripheral arteries), and the demonstration of aberrant renal arteries and collateral visceral circulation. Catheter techniques are considered most suitable and safe for examination of AAA.

To evaluate its potential as an alternative to angiography in the diagnosis of pancreatic tumors, we performed selective vein catheterization for hormone assay on 11 patients with islet cell tumors and islet cell hyperplasias. In all patients, the abnormal pancreatic tissue was correctly localized preoperatively by this method.