Pattern of Infarction Produced by Sodium Iothalamate 80 Per Cent (Angioconray) Invasion of Myocardium

Abstract

With the aid of a barium titanate microphone incorporated in the tip of a specially designed catheter, intracardiac phonocardiograms were recorded in 160 subjects, of whom 20 had normal hemodynamic findings, 97 had congenital heart disease, and the remainder had acquired heart disease.The normal intracardiac phonocardiographic patterns from both the right and left cavities of the heart are described. The diagnostic value of intracardiac phonocardiography in congenital and acquired heart disease is stressed.On intracardiac sound recordings, murmurs are sharply localized in that chamber or vessel which receives the blood flow responsible for their production. Therefore, in the presence of uncomplicated ventricular septal defect, a pansystolic murmur is recorded only within the right ventricle; in cases of patent ductus arteriosus a continuous murmur is recorded only within the pulmonary artery. Both these conditions could be diagnosed or excluded with certainty, even when oxygen studies and clinical signs were equivocal. In cases of pulmonary stenosis an ejection murmur was recorded only within the pulmonary artery and its branches. Infundibular and valvular pulmonary stenosis showed different patterns during withdrawal of the sound catheter into the ventricle. This allowed differentiation between the two types of lesion. In atrial septal defect it was confirmed that murmurs and sounds are produced by the increased flow across the tricuspid and pulmonary valves, rather than by the flow across the defect. In cases of Lutembacher's syndrome a mid-diastolic or presystolic murmur in the inflow tract of the left ventricle was a diagnostic sign.In cases of pure mitral stenosis with apical systolic murmur the tricuspid origin of the murmur could be established. Simultaneous chest and intracardiac phonocardiograms allowed differentiation between valve closure and early diastolic sounds and between intra- and extracardiac sounds.