Left Ventricular Cineangiography Research Articles

Cineangiographic Diagnosis of Papillary Muscle Involvement in Rheumatic Mitral Stenosis

Left ventricular cineangiography was performed in 25 patients with normal mitral valves and in 49 patients with rheumatic mitral valve disease to estimate the spatial relations between the mitral valve leaflets and papillary muscles. The findings in the pathologic group were compared with observations at operation or with the excised mitral valves. It is concluded that fusion of the papillary muscles with the mitral valve leaflet or severe shortening of the chordae is predicted with a reasonable accuracy preoperatively by means of left ventricular cineangiography. The surgical implications are discussed.

A new method for internal calibration of left ventricular cineangiography.

Previous methods of internal calibration for cineangiography have made use of reference objects such as catheters or wires of known length or diameter. Such devices have either insufficient X-ray resolution, or require a specific orientation within the ventricle which is difficult to confirm. External calibration methods, while eliminating these errors, can only estimate actual position of the left ventricle. The use of a Swan-Ganz balloon catheter as a calibration object diminishes these problems. When positioned within the left ventrical and filled with a radiopaque medium, the balloon is of sufficient size and density to avoid errors induced by previously employed objects. The inflated balloon geometry is simple and reproducible. The use of this internal calibration catheter markedly diminishes major sources of errors in the determination of ventriculograms for both dogs and humans.

Mitral valve prolapse due to coronary artery disease

Controversy exists concerning the etiologic role of coronary artery disease in the prolapsing mitral valve leaflet syndrome. A 35 year old man with progressive coronary artery disease is described. Auscultation before and after his first myocardial infarction revealed only a fourth heart sound; subsequent left ventricular cineangiography demonstrated normal anatomy and function of the mitral valve, despite extensive wall motion abnormalities. Six months later he experienced another myocardial infarction after which the typical mid-systolic click, late systolic murmur of mitral valve prolapse developed. A second left ventricular cineanglogram at this time revealed mid-systolic mitral valve prolapse and mitral regurgitation. This patient's course indicates that myocardial damage from coronary artery disease can cause mitral valve prolapse in patients without preexisting redundant mitral valve tissue.

Effects of sodium nitroprusside on left ventricular diastolic pressure-volume relations.

The effect of sodium nitroprusside on the relationship between left ventricular pressure and volume during diastole was studied in 11 patients with congestive heart failure. Nitroprusside was infused to lower mean arterial pressure approximately 20-30 mm Hg. High fidelity left ventricular pressures were recorded in all patients simultaneously with left ventricular cineangiography (biplane in eight and single plane in three patients), allowing precise measurement of pressure and volume throughout the cardiac cycle. Left ventricular diastolic pressure-volume curves were constructed in each patient from data obtained before and during nitroprusside infusion. In 9 of 11 patients there was a substantial downward displacement of the diastolic pressure-volume curve during nitroprusside infusion, with left ventricular pressure being lower for any given volume with nitroprusside. Serial left ventricular cineangiograms performed 15 min apart in six additional subjects who did not receive sodium nitroprusside showed no shift in the diastolic pressure-volume relation, indicating that the shift seen with nitroprusside was not due to the angiographic procedure itself. A possible explanation for the altered diastolic pressure-volume relationships with nitroprusside might be a direct relaxant effect of nitroprusside on ventricular muscle, similar to its known relaxant effect on vascular smooth muscle. Alternatively, nitroprusside may affect the diastolic pressure-volume curve by affecting viscous properties or by altering one or more of the extrinsic constraints acting upon the left ventricle.

Surgical treatment of postinfarction left ventricular aneurysm in 32 patients.

Thirty-two patients with large postinfarction left ventricular aneurysms shown at operation to consist of fibrous tissue are reported. All had angina and/or breathlessness, and none had a history of embolism. Thirty were correctly diagnosed by left ventricular cineangiography. Two of the 3 patients with inferior and 1 with an anterior aneurysm had associated ventricular septal defects, and 3 patients with an anterior aneurysm had mitral regurgitation. All had major coronary arterial lesions and 68 per cent had double or triple vessel disease. The aneurysm was excised in all patients; in 15 this was combined with saphenous vein bypass grafting of coronary arteries supplying surviving myocardium, in 3 with closure of a ventricular septal defect, and in 3 with mitral annuloplasty or replacement. Operative mortality was 6-2 per cent, and 79 per cent of the survivors are asymptomatic with average follow-up period of 18 months after operation.

Use of noninvasive methods in evaluation of left ventricular performance in coronary artery disease. II: Change in systolic time intervals after coronary artery bypass in patients with stable angina.

Serial recording of systolic time intervals (STI) was used to assess changes in left ventricular (LV) function in 92 patients with stable angina undergoing coronary angiography and LV cineangiography. On the basis of angiography, patients were placed in the following study groups: mild or absent coronary artery disease group -21 patients with less than 70 per cent occlusion of all coronary arteries, considered to have non-significant coronary artery disease and not needing bypass surgery; surgical bypass group-52 patients with evidence of significant (less than 70%) obstruction of at least one coronary artery who underwent myocardial revascularization; and medical group-19 patients with evidence of significant coronary artery disease not undergoing bypass surgery. Measured STI, corrected for heart rate and sex, were expressed as indices. No significant differences were noted in the mean STI from the time of initial evaluation to second evaluation 3 to 6 months later in either the mold or absent coronary artery disease patients or the medical group. In the surgical bypass group, however, serial studies at initial angiographic evaulation and 3 to 6 months after bypass surgery showed a shortened pre-ejection period (PEP) from 150 +/- 20 to 142 +/- 16 mn (P less than 0-001), prolonged left ventricular ejection time (LVET) from 396 +/- 21 to 409 +/- 14 ms (P less than 0-02), and decreased PEP/LVET from 0-45 +/- 0-11 to 0-04 +/- 0-07 (P less than 0-02). Paired data analysis of the three groups also showed a significant change only within the surgical bypass group from initial to find study, with a shortened PEP (P less than 0-002), prolonged LVET (P less than 0-001), and decreased PEP/LVET (P less than 0-001). These data suggest improvement in LV function in patients with significant coronary artery disease within a few months of myocardial revascularization, without demonstrable change in STI in those patients with coronary artery disease not subjected to revascularization.

Combined hemodynamic-ultrasonic method for studying left ventricular wall stress: Comparison with angiography

Calculation of left ventricular wall stress in man has traditionally required angiographic and left ventricular pressure measurement, making study of interventions difficult. We have developed a combined hemodynamic-ultrasonic technique for measuring left ventricular meridional wall stress ( σ m ) throughout the cardiac cycle. Simultaneous measurements of left ventricular pressure, ultrasonically determined wall thickness (h[echo]), and minor axis (D[echo]) were made during cardiac catheterization in nine subjects, three with chronic left ventricular pressure overload, four with left ventricular volume overload and two with normal left ventricular function. Within 30 minutes, left ventricular cineangiography was performed in each subject and angiographic wall thickness (h[angio]) and minor axis (D[angio]) were measured. Comparison of values for each subject throughout the cardiac cycle (average 18 data points/cycle) yielded close correlation: For D(echo) versus D(angio), r values ranged from 0.82 to 0.98 whereas for h(echo) versus h(angio), r values ranged from 0.56 to 0.98 for the nine subjects. Meridional wall stress was calculated after the method of Sandler and Dodge as PR i 2 h(2 R i + h ) , where R i equals the inner wall radius, calculated as D/2 for both ultrasonic and angiographic methods. Agreement between ultrasonic and angiographic methods was excellent in each subject, with close superimposition of the stresstime plots constructed by the different techniques. In summary, a new method for measurement of left ventricular wall stress has been developed and validated by comparison with an angiographic reference standard. This method has potential advantages, including the ability to study meridional wall stress continuously and to assess its response to serial interventions.

Operative risk in coronary revascularization of patients with ventricular dysfunction

The initial sixteen month experience in patients undergoing simple revascularization of coronary arteries shows that 81 per cent of these patients were either Class III or Class IV on the basis of the New York Heart Association scale preoperatively; 57 per cent had some degree of ventricular dysfunction on left ventricular cineangiography, 50 per cent had elevated left ventricular graft dysfunction at rest, and 57 per cent had elevation post angiography. The hospital mortality was 1.6 per cent in the first 252 patients, and 2 per cent of the patients had a definite perioperative myocardial infarction and a further 6 per cent had a possible myocardial infarction. The total number of patients operated on between January 1971 and March 1974 now exceeds 1,000 with a total over-all hospital mortality of ten patients or 1 per cent. We believe that mortality and morbidity are essentially unchanged and that the flow study instances of myocardial infarction, pericarditis, and arrhythmia are representative of our over-all experience. Whenever significant valvular disease or ventricular aneurysm is associated with occlusive coronary artery disease, we believe that revascularization is necessary to achieve lower mortality and that ventricular dysfunction per se in patients undergoing revascularization is only a relative contraindication to revascularization.

Percutaneous transthoracic left ventricular cineangiography in patients with prosthetic aortic valves.

The authors describe a technique for studying postoperative left ventricular function and mitral insufficiency in patients with prosthetic aortic valves. Standard transthoracic left ventricular puncture techniques are modified to lessen the risk of injecting contrast material into the myocardium during cineangiography.

Natural history of ventricular-septal defects associated with ventricular-septal aneurysms

The diagnosis of ventricular-septal aneurysm was established by left ventricular cineangiography in forty-four patients. Six of the patients had a ventricular-septal aneurysm without a ventricular-septal defect at the time of their initial catheterization. Twenty-seven patients who had a ventricular-septal defect and ventricular aneurysm as their only significant cardiovascular lesion were followed for a mean of four years and ten months. The left-to-right shunt ratio was less than 1.5:1 in all cases. Shunt size decreased in six out of seven patients subjected to repeat catheterization. In no case were we able to document complete closure of the ventricular-septal defect. Thus, although a ventricular-septal aneurysm may represent a mechanism for partial closure of a ventricular-septal defect, complete closure of the defect appears unlikely if it remains open past the first few years of life.

Myocardial infarction in nine patients with radiologically patent coronary arteries.

Myocardial infarction with normal or near normal coronary arteries on cineangiography and without any other type of heart disease was found in nine (12 per cent) of a series of 78 consecutively studied patients. This combination occurred predominantly in young male patients, and its clinical, laboratory and electrocardiographic features, and its initial course were similar to those of acute myocardial infarction with coronary-artery disease. Multiple risk factors were present in only two patients. Hemodynamic findings were normal or near normal in seven. Areas of localized dyskinesia or hypokinesia were demonstrated in six on left ventricular cineangiography. The long-term clinical course has been benign; in no patient has congestive heart failure, major arrhythmias or recurrence of acute myocardial Infarction developed. It is possible that prolonged, localized coronary-artery spasm or platelet thrombi that subsequently resolved are a part of the pathogenic mechanism. (N Engl J Med 291:427–431, 1974)

Effect of Contrast Agents on Platelet Aggregation and14C-Serotonin Release

A NUMBER of agents are known to inhibit platelet function and potentially to prolong the bleeding time.1 Failure to obtain a history of ingestion of one of these agents frequently leads to misinterpretation of platelet abnormalities. In the course of studying platelet behavior in patients with coronary-artery disease we have observed that a contrast agent used in selective coronary angiography can produce profound alterations in platelet-function tests. Methods The contrast agents used for angiography (Renografin 76) and left ventricular cineangiography (Renovist II) are products of E.R. Squibb and Sons, Incorporated, and contain, respectively, meglumine diatrizoate (66 and 28.5 per cent), . . .

The variable spectrum of echocardiographic manifestations of the mitral valve prolapse syndrome.

The variety of echographic features associated with the mitral valve prolapse syndrome (MVPS) is not yet completely understood. Therefore, ultrasound recordings were obtained in 33 patients in whom mitral prolapse had been documented by biplane left ventricular cineangiography. Echographic abnormailities of the mitral leaflets during systole were recorded in 26/27 MVPS patients and 6/6 with ruptured chordae tendineae. In MVPS, the midsystolic mitral buckling, emphasized in early echocardiographic studies, was observed in only 12 patients. In our study, the most common aberrancy was abnormal pansystolic mitral motion in 14 patients, which in 12 was similar to the pansystolic bowing observed in all six patients with torn chordae. An additional echographic abnormality in MVPS was localized mitral collapse throughout systole in 10/14 patients with pansystolic prolapse; this finding was the most striking defect noted in five, in two of whom it was the only disturbance. Phonocardiography in MVPS showed typical midsystolic click and/or late systolic murmur in only 15/26 patients of whom ten had midsystolic mitral buckling. A variety of systolic clicks and/or murmurs occurred in the 14 patients with generalized bowing and/or localized collapse throughout systole on echocardiography. Thus, the mitral echographic spectrum of MVPS is comprised of three different abnormal patterns of systolic prolapse: buckling in midsystole, pansystolic bowing, and pansystolic collapse. These echocardiographic disorders commonly occur in the absence of classical auscultatory findings in MVPS and the most frequent abnormality on ultrasound is pansystolic bowing of both mitral leaflets.

Pacemaker-induced cardiovascular failure: Hemodynamic and angiographic observations

A 71 year old woman underwent permanent transvenous right ventricular pacemaker implantation for prolonged syncope and atrioventricular conduction defects. Each time the patient's heart rate spontaneously decreased to less than 70 beats/min, cardiovascular collapse with hypotension and reduced cardiac output occurred. Left ventricular cineangiography performed during both sinus rhythm and right ventricular pacing demonstrated reduced left ventricular end-diastolic volume, secondary to a loss of atrial contribution to left ventricular filling, and severe, acute mitral regurgitation with significantly decreased effective stroke volume and cardiac output. Pacing from the left ventricular endocardium had the same effect. The detrimental effects of cardiac pacing necessitated removal of the right ventricular pacemaker.

Electrocardiographic, arteriographic and hemodynamic correlation studies in coronary heart patients with aneurysm or akinesis of left ventricle.

Abstract. The results from left ventricular cineangiography have been compared with ECG, coronary arteriographic and hemodynamic findings in 59 selected patients with coronary heart disease. All patients showed abnormal left ventricular contraction patterns; ventricular aneurysm was present in 22 patients, and ventricular akinesis in 37. All patients with aneurysm had a previous history of myocardial infarction, and there was a close correlation between the ECG pattern and the angiographic findings, while unspeciftc ECGs were commonly seen in patients with akinesis. All patients had severe coronary artery stenosis. No aneurysm was seen without occlusion of the major local artery, while the anatomical location of the arterial stenosis showed a less consistent relationship to the angiocardiographic findings in patients with akinesis. Left ventricular end‐diastolic pressures were analysed before and after left ventricular angiography and found to be elevated in most patients. No differences were found between patients with aneurysm compared with those with akinesis.

The role of angiography in cardiogenic shock.

Eighty patients with cardiogenic shock secondary to myocardial infarction were treated with the intra-aortic balloon pump (IABP). The initial response to pumping was good, with resolution of shock in 80%. Sixty-eight patients did not tolerate subsequent withdrawal from IABP and were termed balloon-dependent. Selective coronary and left ventricular cineangiography in 52 balloon-dependent patients identified 30 possible surgical candidates. Operative procedures in 24 produced 9 survivors (37%). Persistent dependence upon mechanical circulatory assistance after myocardial infarction may not indicate massive ventricular infarction. Early angiography after initial hemodynamic improvement on IABP is an essential step in the identification of those patients with persistent, reversible ischemia in whom emergency surgery may be indicated.

Acute Mitral Regurgitation Resulting from Ruptured or Elongated Chordae Tendineae<subtitle>AUSCULTATORY AND PHONOCARDIOGRAPHIC FINDINGS</subtitle>

Eighteen patients with severe acute mitral regurgitation requiring operation have been described. The history, physical signs and phonocardiographic findings were compared with the anatomical findings at operation. Fourteen had ruptured chordae tendineae (five anterior leaflet: eight posterior leaflet: one both leaflets) and four had elongated chordae with prolapsing leaflets. The commonest auscultatory finding was an apical pan-systolic murmur with a mid-systolic crescendo which was often propagated to the base and into the neck thus simulating aortic stenosis. The mid-systolic crescendo appeared to be due to the regurgitant flow of a high velocity jet through a relatively small regurgitant orifice. The basal propagation was due to the regurgitant jet being directed forwards and medially against the atrial septum in the region of the aortic root. This type of murmur was found in patients with either anterior or posterior leaflet chordal rupture and also in some patients with elongated chordae. It was therefore of no help in differentiating these lesions. A plateau shaped pan-systolic murmur was never found in patients with ruptured chordae to the posterior leaflet. A loud first heart sound was often present particularly in the presence of an intact anterior leaflet. All patients had third heart sounds and all but one of those in sinus rhythm had an atrial sound which was often associated with a palpable atrial impulse and a tall ‘A’ wave on the apexcardiogram. The clinical findings therefore did not readily distinguish between the different groups of patients. Left ventricular cine-angiography was the best method of determining the site of leaflet prolapse. Although an underlying cause was found for ruptured chordae in most of the Group IA patients, the aetiology was obscure in the remainder. The Group II patients with elongated chordae and voluminous leaflets clearly had degeneration of the valve tissues but whether this was acquired or due to an inherited anomaly remains unknown.

Roentgenographic assessment of left ventricular size in man: a standardized method.

ArticleRoentgenographic assessment of left ventricular size in man: a standardized method.T M Kazamias, M P Gander, J H Gault, W J Kostuk, and J Ross JrT M Kazamias, M P Gander, J H Gault, W J Kostuk, and J Ross JrPublished Online:01 Jun 1972https://doi.org/10.1152/jappl.1972.32.6.881MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByThe initial chest x-ray in acute myocardial infarction. Prediction of early and late mortality and survival.Circulation, Vol. 61, No. 5Prognosis after acute myocardial infarction: a multivariate analysis of mortality and survival.Circulation, Vol. 59, No. 6Noninvasive evaluation of the patient with suspected coronary artery diseaseCurrent Problems in Cardiology, Vol. 3, No. 4Variability, reproducibility, and applications of precordial ST-segment mapping following acute myocardial infarction.Circulation, Vol. 57, No. 6Ätiologische und pathophysiologische Grundlagen des akuten MyokardversagensEchocardiographic and Roentgenographic Determination of Left Ventricular Size after Coronary Arterial Bypass Graft SurgeryChest, Vol. 72, No. 4Technetium-99m pyrophosphate myocardial uptake in patients with stable angina pectorisThe American Journal of Cardiology, Vol. 40, No. 1Serial measurements of left ventricular ejection fraction by radionuclide angiography early and late after myocardial infarctionThe American Journal of Cardiology, Vol. 38, No. 4Favorable effects of orally administered digoxin on left heart size and ventricular wall motion in patients with previous myocardial infarctionThe American Journal of Cardiology, Vol. 37, No. 5Beneficial effects of nitroglycerin on abnormal ventricular wall motion at rest and during exercise in patients with previous myocardial infarctionThe American Journal of Cardiology, Vol. 37, No. 4Left ventricular performance assessed by radionuclide angiocardiography and echocardiography in patients with previous myocardial infarction.Circulation, Vol. 52, No. 6Quantitative relationships between potassium-43 imaging and left ventricular cineangiography following myocardial infarction in man.Circulation, Vol. 52, No. 6Comparative Effectiveness of Exercise Testing and Continuous Monitoring for Detecting Arrhythmias in Patients with Previous Myocardial InfarctionCirculation, Vol. 50, No. 2Effects of submaximal isometric handgrip on left ventricular size and wall motionThe American Journal of Cardiology, Vol. 33, No. 1Correlations Between the Chest Film and Hemodynamics in Acute Myocardial InfarctionCirculation, Vol. 48, No. 3Effects of intravenously administered propranolol on wall motion abnormalitiesThe American Journal of Cardiology, Vol. 31, No. 6Left Ventricular Size after Acute Myocardial InfarctionCirculation, Vol. 47, No. 6 More from this issue > Volume 32Issue 6June 1972Pages 881-4 https://doi.org/10.1152/jappl.1972.32.6.881PubMed5034354History Published online 1 June 1972 Published in print 1 June 1972 Metrics

Selective coronary and left ventricular cineangiography during intraaortic balloon pumping for cardiogenic shock.

Eleven patients underwent selective coronary and left ventricular cineangiography during intraaortic balloon pumping for acute myocardial infarction and cardiogenic shock. Studies were performed when the clinical and hemodynamic trend predicted in-hospital death. Angiograms were reviewed by dividing the left ventricle into six segments, each with its characteristic coronary perfusion. No patient with avascular and akinetic segments survived with or without surgery. One patient with residual perfusion of all segments showed massive necrosis at operation that eventually led to his death. In four patients the findings of residual contraction and perfusion of most segments suggested reversible ventricular dysfunction. Three of these underwent coronary surgery with two excellent survivors.

Left atrial myxoma: Hemodynamic and phonocardiographic features

Two cases of left atrial myxoma are presented, with a review of clinical clues which may help in distinguishing this disease from mitral valve disease. Suggestive features in the apexcardiogram and internal and external phonocardiograms are discussed, together with related hemodynamic events indicated on the pulmonary capillary wedge, left atrial and left ventricular pressure tracings. The origins of various auscultatory features are analyzed in the light of specific hemodynamic events. Hemolytic anemia was present in one case, and ruptured chordae tendineae with scarring and myxomatous degeneration of the mitral leaflets in the other. Possible mechanisms for these lesions related to myxoma are discussed. The role of cardiac fluoroscopy, left ventricular cineangiography and the levophase of pulmonary angiography in helping to delineate left atrial myxoma is also mentioned.