Echocardiographic Identification of Left Ventricular Cavity Obliteration

We identified 22 patients with angiographic left ventricular cavity obliteration (LVCO), of whom 15 were available for M-mode and two-dimensional echocardiographic evaluation. All 15 patients had chest pain, and 13 had long-standing hypertension. Electrocardiographic evidence of left ventricular hypertrophy was present in ten patients. The echocardiographic criterion for LVCO was apposition of the left ventricular septum with the left ventricular posterior endocardium during systole as demonstrated by either M-mode or two-dimensional systems. LVCO was demonstrated during systole by M-mode echocardiography in seven of 15 patients and by two-dimensional echocardiography in 14 patients. LVCO could not be demonstrated in ten randomly selected patients with normal left ventricular angiograms. Only four patients had significant coronary artery disease. Symmetric or asymmetric left ventricular hypertrophy is an important pathophysiological mechanism in the production of LVCO, and two-dimensional echocardiography is useful in its identification

Preliminary Experience with Digital Subtraction Angiography in Cardiac Evaluation

iVe report our initial experience using digital subtraction angiography (DSA) techniques for cardiac evaluation. DSA of the heart may be performed with intravenous or right atrial injection of contrast medium (IVDSA) and with left ventricular or aortic root contrast injection (lADSA). The right ventricle and the atria are best demonstrated by IVDSA, while the left ventricle and coronary arteries are best demonstrated by lADSA. The advantages and disadvantages of DSA ofthe bean are discussed. Present equipment limitations restrict the routine use of cardiac DSA, but these should be overcome with advances in technology

Practical Value of Echo Doppler Evaluation of Aortic and Mitral Stenosis: A Comparative Study with Cardiac Catheterization

This retrospective analysis compares data derived by echocardiography and cardiac catheterization in the evaluation of aortic and mitral valve stenosis. Sixty-seven patients, aged 69 ± 12 years, underwent 76 catheterization procedures. In all studies the Doppler recording was technically adequate. In 64 studies of patients with aortic stenosis, correlation was good between the gradient obtained at catheterization (peak 51 ± 28 mm Hg, mean 48 ± 24 mm Hg) and the Doppler gradient (peak 73 ± 29 mm Hg, mean 41 ±17 mm Hg) (R = 0.78 peak, 0.77 mean). In 15 studies the aortic valve area, 0.8 ± 0.2 cm2, calculated by the simplified continuity equation, correlated well with the catheterization valve area, 0.7 + 0.3 cm2, calculated by the Gorlin equation (R = 0.80). In 14 studies in mitral stenosis patients, the mean gradient at catheterization was 11 ±5 mmHg compared to the Doppler gradient of 8 ±4 mmHg (R = 0.58). The mitral valve area was 1.1 ± 0.3 cm2 by the Gorlin equation and 1.2 ± 0.3 cm2 by echo Doppler, using pressure half-time. When cardiac rhythm, the presence and severity of regurgitation, and the cardiac index were analyzed, none was shown to have demonstrable influence cm the accuracy of the Doppler study. Doppler echocardiography can be used reliably to assess valvular stenosis in a clinical, noninvasive laboratory where routine tests are performed and interpreted by more than one individual

Intracardiac Phonocardiography in Subaortic Stenosis

The purpose of this study is to explore the value of intracardiac sound recordings for the verification of subaortic stenosis. Intracardiac sound was measured in ten patients with subaortic obstructions. Seven had idiopathic hypertrophic subaortic stenosis, two had a subvalvular membrane, and one had a subvalvular tunnel. In each patient, a systolic murmur was recorded within the left ventricle distal to the obstruction. The murmur was of lower amplitude distal to the aortic valve, and it was of even lower amplitude or absent proximal to the obstruction. In the presence of entrapment, no intraventricular murmur occurred although an apparent subvalvular pressure gradient was observed. The identification and localization of the maximal intensity of a systolic murmur in the ventricular outflow tract may assist in the verification of a subvalvular obstruction and help distinguish between artifactual pressure gradients and gradients indicative of subvalvular stenosis

Subvalvular aortic stenosis associated with dynamic outflow tract obstruction: A case report

Hemodynamic and angiographic findings are described in a 27-year-old patient, who had undergone surgical operation for subvalvular membranous aortic stenosis. Left ventriculography revealed persistence or regrowth of the subvalvular fibrous ring, and hemodynamic data revealed associated dynamic obstruction of the left ventricular outflow tract. The authors emphasize the importance of uncovering associated dynamic obstruction by provocative maneuvers and use of Beta blockers

Management of cardiogenic shock complicating acute myocardial infarction: The Henry Ford Hospital experience and review of the literature

Cardiogenic shock complicating acute myocardial infarction (MI) carries a high mortality which in some series prior to 1980 exceeded 80%. Neither the use of inotropic and vasopressor agents nor intraaortic balloon counterpulsation was found to improve survival in this group of patients. Intravenous thrombolytic agents improve survival in patients with acute MI, but their role in cardiogenic shock is unknown. Reports of the use of surgical and mechanical interventions in patients with severe left ventricular dysfunction were examined to determine if there was any benefit to be derived from restoring blood flow to ischemic areas of the myocardium. It was found that urgent placement of intraaortic balloon counterpulsation followed by coronary bypass surgery may improve survival rates and successful coronary angioplasty also appeared to benefit patients with cardiogenic shock. Similar improvement in survival has been reported after successful coronary reperfusion. In surgical series with predominantly nonmechanical causes of shock, survival has varied from 40% to 88%. Data from our five-year experience in the management of MI patients with cardiogenic shock suggest that coronary revascularization with coronary angioplasty or bypass surgery improves survival in patients with cardiogenic shock especially when performed within 24 hours of the onset of shock