The cinefluorographic detection and recording of calcifications within the heart: results of 803 examinations.

Abstract

In the past, many different methods have been employed for demonstrating calcifications within the heart, including roentgenography (1–4), roentgen kymography (5), and planigraphy (6). Each of these has definite limitations. Over the last two years there have been performed in the Veterans Administration Hospital, Minneapolis, Minn., 803 cinefluorographic examinations for this purpose, and it is the authors' opinion that cinefluorography is now the method of choice for detecting and localizing cardiac calcification. In the diagnosis, treatment, and prognosis of cardiac disease (7), the detection of calcification within the heart is of significance. Often its recognition in the mitral or aortic valve or in the coronary arteries helps in arriving at a differential diagnosis. Furthermore, it may modify the surgical approach. A calcified mitral valve may be fractured rather than cut. During mitral commissurotomy cerebral embolization occurs more frequently if there is calcification in the valve. In the coronary arteries, calcification means arteriosclerosis. The deposits are usually to be seen in advanced atheroma of the intima and in a patient of forty or fifty may reasonably be taken to indicate a decreased life expectancy. Technic of Detecting Calcifications in the heart Our method of examining the heart cinefluorographically is as follows: In the postero-anterior view the pulsations of the right cardiac border and great vessels are recorded, beginning at the diaphragm and moving upward to include the superior vena cava and azygos vein. In this film sequence , calcifications in the pericardium, right coronary artery, and ascending aorta may be noted (Fig. 1). The second film sequence is a recording of the left heart border from the left subclavian artery down to the left hemidiaphragm. In this view, calcifications in the arch of the aorta, pulmonary artery, left atrium, left coronary artery, and myocardium of the left ventricle are demonstrated. The patient is then turned into a right anterior oblique position and the third sequence is obtained, from the diaphragm to the pulmonary artery and thence down the left heart border to the diaphragm again. These views are excellent for detecting calcifications in the mitral and aortic valves (Fig. 2), and in the right and left coronary arteries (Fig. 3). A recording of the right atrium and ascending aorta is next made in the left anterior oblique projection, followed by views of the midcardiac mass, which includes the right coronary artery, aortic valve, and left coronary artery (Fig. 4). With the patient still in the left anterior oblique position, a record is made of the pulsation of the posterior border of the heart. This includes the mitral valve area (Fig. 5). Finally, in the right lateral view, beginning in the inferoposterior part of the cardiac silhouette, a sequence is obtained of the Hospital. A majority of the patients were males between forty and seventy years of age, who were referred because of their cardiac symptoms.