Ditriokon: A New Cardiovascular Contrast Agent

Abstract

Ditriokon (Mallinckrodt) is an aqueous solution of diprotrizoate sodium (Miokon, 31.4 per cent) and diatrizoate sodium (Hypaque, 36.7 per cent), with a combined organic iodine content of 40 per cent (Table I). The greatest value of this new mixture lies in its low viscosity, which makes it possible to inject the contrast substance rapidly and at room temperature. Clinical experience with Ditriokon has been obtained in over 200 patients during the past year. Recently, “fortified” Ditriokon has been used in 21 patients. This compound contains 9.9 per cent sodium acetrizoate (Urokon) in addition to Miokon (31.4 per cent) and Hypaque (36.7 per cent). The many advantages of these new contrast agents over other commercially available media form the basis of this report. Method of Study Beginning on July 16, 1959, a detailed study was made of 72 consecutive patients, varying in age from two months to seventyfive years, who received injections of Ditriokon for intravenous angiocardiography. Whenever possible, a special needle stopcock (Robb-Steinberg) unit was inserted percutaneously; otherwise a cut-down was made. In other patients bilateral simultaneous rapid injections of one-half of the total dose of the drug were made in each arm for intravenous abdominal aortography (8). The dose in adults for angiocardiography was 50 c.c. For angiocardiography in children, it was 1 c.c. per kilogram of body weight. For abdominal aortography it was also 1 c.c. per kilogram of weight. Repeat injections for additional lateral or oblique views were made soon after the first study in 70 of the 72 patients in whom the cardiovascular system was visualized. Eleven of the 26 patients receiving bilateral injections for abdominal and peripheral aortography had a second bilateral injection. In 3 instances a third bilateral injection was made. Premedication, even in apprehensive patients, was not given. In the children who required a general anesthetic, atropine was administered prior to anesthesia. The meal preceding the intravenous study was omitted to allay nausea and vomiting. The erect position was used in adults for cardiovascular visualization. In infants and children angiocardiography was performed with the patients supine. For abdominal aortography and peripheral arteriography studies were also made in the supine position. Following each injection, the patient was carefully observed for dyspnea, cough, sneezing, vomiting, flushing, urticaria, or skin rash. In addition, subjective reactions such as warmth, nausea, dizziness, chilliness, headache, anxiety, and arm pain were noted. In several instances, serial blood pressure readings were made. Continuous electrocardiographic tracings were obtained in 3 patients during and after injection of the contrast agent.