Left Ventricular Cineangiocardiography Research Articles

Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography

Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography

A Study on Left Atrial Transport Function

Left atrial (LA) storage fraction is defined as the ratio of storage volume of the left atrium (LA) during ventricular systole to left ventricular (LV) stroke volume. To test their hypothesis that left atrial (LA) storage fraction is increased to compensate for impaired LV filling in the heart of aged subjects or with impaired LV ejection fraction, the authors studied 33 "normal" subjects and 25 patients with coronary artery disease. LA volume was measured by LA cineangiocardiography, and LV stroke volume and LV ejection fraction were measured by LV cineangiocardiography. To further evaluate the determinants of changes in LA storage fraction, they measured the ratio of LA active release volume to LV stroke volume, and the ratio of LA passive release volume to LV stroke volume. In "normal" subjects, LA storage fraction was increased with age (r = 0.584, P < 0.01). In patients with coronary artery disease, LA storage fraction was increased as LV ejection fraction was decreased (r = -0.525, P < 0.01). In both cases, LA active release fraction was significantly associated with changes in LA storage fraction rather than in LA passive release fraction. They conclude that LA storage fraction may be an important determinant of LV filling mainly through the LA active release fraction.

Quantitative Left Ventricular Cineangiocardiography in the Dog: Measurement and Usefulness of Left Ventricular Volume

Quantitative Left Ventricular Cineangiocardiography in the Dog: Measurement and Usefulness of Left Ventricular Volume

Left ventricular cineangiocardiography in endocardial cushion defect (persistent common atrioventricular canal).

SummaryThe diagnostic features by which endocardial cushion defects may be recognised at left ventricular cineangiocardiography in oblique projections are presented and the criteria which may be used to assess the importance of an inter‐ventricular component of the defect are described. The general diagnosis of endocardial cushion defect is indicated with accuracy and no false positives or false negatives have been encountered. The method has also been accurate in distinguishing the complete form of the defect (with large interventricular component) from the partial form (without significant interventricular communication). The intermediate form (with small interventricular component) was mistaken for the complete form of the defect in one instance, but in 18 further patients in whom a definitive anatomical assessment was available the radiological assessment was accurate.

Left ventricular akinesis: experimental production, haemodynamic effects, and results of excision.

Myocardial infarcts were produced in 25 dogs by ligation of the left anterior descending coronary artery and distal arterial injection of agar solution. The resultant infarcts were excised either acutely (one week) or chronically (four to six weeks). Left ventricular cineangiocardiography and haemodynamics were performed before and after infarctectomy. Haemodynamics were measured at rest and during infusion of angiotensin II, acetylcholine, and isoproterenol. These findings were compared with those from 11 control dogs, five of which underwent excision of normal myocardium. After infarctectomy, cardiac output was not significantly changed. Although left ventricular akinesis resulted in a measurable decrease in left ventricular function, excision of the akinetic segment did not improve function.

Abnormal left ventricular contraction in patients with mitral stenosis.

Twenty-five patients with pure mitral stenosis and nine normal subjects were studied by selective left ventricular cineangiocardiography. Left ventricular volumes were measured at end systole, throughout diastole, and at end diastole. Although filling curves showed that the left ventricles filled slowly in patients with mitral stenosis, normal end-diastolic volumes were attained provided diastole lasted 400 msec. Despite normal end-diastolic volumes, end-systolic volumes were significantly larger ( P &lt; 0.0005) in the patients with mitral stenosis (av=64.6 ml) than in normal subjects (30.8 ml). Correspondingly, left ventricular ejection fractions were significantly lower ( P &lt; 0.0005) in the patients with mitral stenosis (55.7%) than in the normal subjects (76.7%). Qualitative analysis of the cineangiocardiograms demonstrated that 20 patients with mitral stenosis had distortion, immobility, and rigidity of the posterobasal area of the left ventricle. It is hypothesized that a rigid "mitral complex" immobilizes the posterobasal area of the left ventricle in patients with mitral stenosis, thereby impairing left ventricular contraction, and that this impairment is an important factor in the reduced cardiac output of these patients.

Left ventricular cine-angiocardiography in endocardial cushion defect.

Left ventricular cine-angiocardiography in endocardial cushion defect.

The ballooning mitral valve in patients with the “precordial honk” or “whoop”

Eight patients with a “precordial honk” or “systolic whoop” were studied by complete right and left heart catheterization and left ventricular cineangiocardiography. The patients were divided into two groups on the basis of the absence (group 1) or presence (group 2) of significant heart disease. In all 5 patients in group 1 and in 1 in group 2, ballooning of the mitral valve into the left atrium during ventricular systole was demonstrated on the cineangiograms. The ballooning mitral valve was associated with late systolic mitral insufficiency in 4 of the 5 patients in Group 1. The incidence of the ballooning mitral valve in this laboratory was determined from 200 consecutive left ventricular cineangiocardiograms obtained from patients with a variety of cardiac lesions. Twelve of these patients (6%) had a ballooning mitral valve, and 10 of these 12 had coexisting mitral insufficiency. The electrocardiographic features of patients with a “precordial honk” or “whoop” were discussed, and possible mechanisms for the genesis of the sound were suggested. That the “precordial honk” is intracardiac in origin has been demonstrated by several investigators using intracardiac phonocardiography. This report presents anatomic evidence for these data i.e., ballooning of the mitral valve and late systolic mitral insufficiency.

Ventriculo-atrial regurgitation following prosthetic replacement of the mitral valve: Angiocardiographic and hemodynamic findings ∗

Partial detachment of a mitral ball-valve prosthesis, resulting in left ventriculo-atrial regurgitation, may be responsible for persistent symptoms of diminished cardiac reserve following mitral valve replacement. Such persistent regurgitation is difficult to detect and to differentiate by clinical means from other causes of residual disability, since the characteristic pansystolic murmur of mitral regurgitation is often absent. The present study reports the clinical findings, hemodynamic data, and the results of left ventricular cineangiocardiography in 18 patients following mitral valve replacement. All of the patients had persistent hemodynamic abnormalities, and in 17 the left atrial pressure was elevated. On cineangiocardiography, it was observed that some degree of ventriculo-atrial regurgitation always occurred with “normal” function of the prosthetic valve. However, the appearance of this type of regurgitation differed angiocardiographically from that caused by partial detachment of the prosthesis. The characteristics of regurgitation resulting from detachment of the valve were defined cineangiographically in 8 patients, and confirmed in 6 of these 8 patients, who were reoperated upon. In 6 other patients the clinical and hemodynamic abnormalities appeared to be due solely to abnormal function of the left ventricular myocardium. It is suggested that the diagnosis of ventriculoatrial regurgitation should be suspected and left ventricular cineangiocardiography should be performed in patients who fail to improve following mitral valve replacement or who exhibit abnormal cardiac dynamics at postoperative cardiac catheterization.

Aneurysmal protrusion of the posterior leaflet of the mitral valve: An auscultatory-electrocardiographic syndrome

In previous communications, evidence has been produced that apical late systolic murmurs are invariably due to mitral regurgitation, and that the commonly associated nonejection systolic clicks result from abnormalities of the mitral chordae tendineae. The present paper describes 5 patients with both of these auscultatory findings who had, in addition, electrocardiographic signs compatible with posteroinferior myocardial ischemia or infarction. Left ventricular cineangiocardiography was performed in 4 of the 5 patients, and an aneurysmal dilatation of the posterior leaflet of the mitral valve was demonstrated. It is postulated that distortion of the circumflex coronary artery by the abnormal mitral valve may be the cause of the electrocardiographic features. The probability is briefly discussed that in some instances the mitral valve anomaly results from a genetically determined defect, or weakness, of the posterior leaflet.

Cardiac perforation following left ventricular cineangiocardiography.

A case of perforation of the left ventricle during selective cineangiocardiography in a 27-month-old child with aortic stenosis is reported. Perforation was visualized during the power injection, and subsequent cardiac tamponade developed. Immediate pericardiocentesis resulted in rapid improvement and the child made an uneventful recovery. At cardiac surgery for aortic valvotomy 5 days later no abnormalities of the pericardium were noted but there was a small area of discoloration on the posterior left ventricular free wall. Prevention of poor catheter positioning is suggested as the major preventive measure to avoid such complications during selective ventricular angiocardiography.

TRANSIENT MYOCARDIAL DAMAGE SECONDARY TO EXTRAVASATION OF CONTRAST MATERIAL DURING LEFT VENTRICULAR ANGIOCARDIOGRAPHY.

In a patient with moderate valvular aortic stenosis transient myocardial injury resulted from extravasation of contrast material into the posterolateral wall of the left ventricle during selective left ventricular cineangiocardiography via the transseptal approach. The patient developed anterior upper chest pain, runs of idioventricular rhythm followed by spontaneous return to sinus rhythm with elevated ST segments, and increase in serum transaminase levels. Lack of previous reports of transient myocardial damage secondary to extravasation of contrast material, increased possibility of such accidents with increased use of selective left ventricular angiocardiography, and possible preventive methods were emphasized.

The significance of late systolic murmurs

1. 1. Four patients with apical systolic murmurs confined to mid-late systole, and 3 patients with pansystolic murmurs with late accentuation were subjected to left ventricular cineangiocardiography. Regurgitation of dye into the left atrium during ventricular systole occurred in all 7 patients. 2. 2. Inhalation of amyl nitrite, a Valsalva maneuver, and intravenous injection of phenylephrine resulted in a fairly constant alteration in the intensity and the time of maximal accentuation of these murmurs. The conclusion is that the pattern of change is compatible with that of a mitral regurgitant systolic murmur. 3. 3. The common association of late murmurs with mid-late systolic clicks is confirmed, and reasons for suspecting that these clicks are due to fibrosed chordae are discussed. 4. 4. The importance of appreciating that late systolic murmurs are due to mildmitral incompetence is stressed. Although little hemodynamic alteration is present, these patients are presumably potential candidates for subacute bacterial endocarditis, and, in younger patients, prophylaxis against rheumatic activity is indicated.