Iopamidol in cardioangiography: a retrospective, multicenter study. Part I. Adult patients.

To evaluate the occurrence of complications during diagnostic or interventional catheterization a retrospective analysis of catheterization procedures in 12 Italian laboratories using the nonionic contrast medium (CM) iopamidol (370 mgI/ml) was performed. Data obtained on 26,219 patients greater than or equal to 14 years are presented. The overall complication rate was 1.89% (485/26,219). The overall mortality rate was 0.1% (27/26,219). Procedure related complications were 389 (1.48%) and CM related complications were 106 (0.4%). No death was attributed to CM. Ventricular fibrillation (VF) rate was 0.11% comparable to the low rate observed with nonionic CM in other studies and less than the rate observed in surveys concerning the use of ionic CM. Fifty-seven thrombotic events were recorded (0.22%), a rate comparable with other surveys with ionic and nonionic CM. The total complication rate (6.1%), the rates of coronary occlusion (1.34%), myocardial infarction (0.37%) and urgent coronary artery by-pass grafting (0.5%) in 1,348 coronary angioplasties were lower than those recorded in previous surveys. These data confirm a good tolerability and no increased risk of VF and thrombotic events with iopamidol in cardiac catheterization.

[Prognostic stratification of non complicated acute myocardial infarct. Usefulness of the dipyridamole test with ecg-echo-thallium 201]. / Stratificazione prognostica dell'ima non complicato. Utilità del test al dipiridamolo con ecg-eco-tallio 201.

84 patients (pts) with recent first uncomplicated myocardial infarction underwent during the early post-infarction period, dipyridamole (D) test (EKG-ECHO-THALLIUM) and coronary arteriography in order to verify its feasibility, safety and usefulness in the detection of residual jeopardized but viable myocardium and in the diagnosis of multivessel disease. 69 pts performed a pre-discharge exercise test. During the execution of D test no major side effect occurred. The D-Echo was positive for residual ischemia in 41 pts (48.8%), the D-Thallium in 49 pts (58.3%) and the exercise test in 30 pts (43.5%). Both the imaging techniques allow the recognition of viable myocardium within the infarct zone (homozonal positivity) or outside the infarct zone (heterozonal positivity). The sensibility and specificity for multivessel disease are, respectively: with D-echo 50% and 100%; with D-thallium 60% and 100%; with exercise test 48% and 63%. D test has better diagnostic accuracy than exercise test in detecting multivessel disease; in particular we emphasized the excellent specificity of D-echo and D-thallium test. Poliparametric approach with D-test and exercise test gives a better stratification of the ischemic post-infarction risk.

[Left atrial myxoma: radioisotopic diagnosis]. / Mixoma atriale sinistro: diagnosi radioisotopica.

A case of left atrial Myxoma shown on an equilibrium radionuclide ventriculography is presented. The finding were consistent with the ecocardiographic patterns and the gross anatomy of the tumour. The analysis of various parameters obtained with gated radionuclide cardiac blood pool scan shows that the Fourier phase image is another method to detect and study this disease.

[Surgical therapy of the dissection of the ascending aorta. Experience in the use of the G. R. F. biological glue]. / Sulla terapia chirurgica della dissecazione dell'aorta ascendente. Esperienza nell'impiego della colla biologica G.R.F.

Nine patients with dissecting aneurysm of the ascending aorta (type A dissection) were operated upon. Six cases had an acute dissection, whereas three cases had a chronic type of dissection. The ascending aorta was replaced with a Dacron tubular prosthesis after solidification of the external and the internal layers of the two aortic stumps using a G.R.F. biological glue. Early and late results as well as the possible complications during the post-operative course are reported. Furthermore the advantages in using the G.R.F. glue are discussed in details. They are mainly represented by the excellent solidification of the aortic stumps, by the possibility to correct the aortic regurgitation without valve replacement and particularly by a good hemostasis of the surgical sutures.

[Fixed subvalvular aortic stenosis. Monodimensional echocardiographic findings]. / Stenosi aortica sottovalvolare fissa. Reperti ecocardiografici monodimensionali.

19 patients affected by discrete subvalvular aortic stenosis were studied by M-mode echocardiography. The diagnosis was confirmed by cardiac catheterism and angiocardiography and by anatomic evidence in operative room. The most frequent echocardiographic pattern was the abnormal protosystolic movement of aortic valve leaflets, that was found in all the patients. A discrete linear echo in the outflow tract of the left ventricle was observed in almost half of the cases. In 40% of the cases the left ventricular outflow tract was narrowed. The relations between these echocardiographic patterns and the anatomical kinds of discrete subaortic stenosis are discussed. No correlations were found between echocardiographic patterns and severity of the subaortic stenosis.

[Dyslipidemia and coronary disease. Clinico-coronarographic study]. / Dislipidemia e coronaropatia. Studio clinico-coronarografico.

An inverse relationship between alpha-cholesterol and coronary atherosclerosis was observed in 200 male patients given coronographies. Specifically the lowest alpha-cholesterol levels were observed in patients with the most serious and widespread atherosclerotic lesions. This inverse correlation was maintained at the same level in all age groups.

[The natural development of arteriosclerotic coronary disease. Coronarographic study in time intervals]. / L'evoluzione naturale della coronaropatia aterosclerotica. Studio coronarografico seriato nel tempo.

In 96 patients with coronary artery disease a coronary arteriography was performed twice at least with some months' interval, in order to establish the rate of progression of coronary atherosclerosis and the factors which could affect this progression. It was possible to select patients with progression of the coronary arteria lesions from patients with no increase of coronary stenosis. From the angiographic point of view, the progression of angina and the appearance of myocardial infarction are connected with a general progression of arterial lesions on all main coronary branches. As to the electrocardiographic aspects, the ECG at rest give no informations about the evolution of the coronary disease. Among the risk factors the smoking only has some importance in order to predict the progression of the coronary atherosclerosis.

[Aortic valve disease and coronary atherosclerosis. Clinical and coronarographic study (author's transl)]. / Valvulopatia aortica e aterosclerosi coronarica.

77 patients with aortic valve disease have undergone heart catheterization in prevision of valve replacement: in this group the incidence of angina pectoris and the incidence of coronary artery disease associated with the valvular disease have been evaluated. The most important data resulting from out study are: 1) High frequency of angina pectoris both aortic stenosis and in aortic regurgitation: respectively about 60% and 50%. 2) The frequency of coronary atherosclerosis associated with aortic valve disease is much higher in aortic stenosis than in aortic regurgitation: respectively 35% versus 15%. 3) Coronary atherosclerosis associated with aortic stenosis frequently occurs (about 30%) also in young-aged patients (under 40 years). On the contrary in case of aortic regurgitation it occurs much more frequently in elderly patients. 4) The absence of angina both in aortic stenosis and in aortic regurgitation virtually excludes the presence of associated coronary atherosclerosis. 5) The presence of angina in aortic stenosis indicated either severe valvular stenosis or associated coronary artery disease (in this case the valvular stenosis is mild or moderate). The presence of angina in aortic regurgitation indicates either severe impairment of left ventricular performance or associated coronary atherosclerosis.

[Myocardial infarction in young people. A coronary angiographic study in 21 patients under the age of 30 (author's transl)]. / Infarto miocardico giovanile. Studio coronarografico di 21 pazienti in età inferiore a 30 anni.

The Authors have taken into account 21 patients who complained of myocardial infarction before they were 30 years old. We performed coronary angiography, left ventriculography and left cardiac catheterization in all the patients. In 20 cases we found atherosclerotic alterations (50 or greater obstruction) at least in one of the three main braches of coronary tree. The coronary angiography in one patient showed a picture of dissection of right coronary. The alterations are localized more frequently on the anterior descending branch than on the right coronary. On the contrary we found very seldom atherosclerotic lesions on the circumflex artery. Monovascular alterations were more frequent than plurivascular alterations (more than 40% of the total). Left ventricular function was out of order in almost all cases. In summary the important differences between young patients with myocardial infarction and older patients are the following: 1) from the clinical point of view the sudden onset of myocardial infarction without previous symptoms of angina pectoris; 2) from the angiography point of view high incidence of monovascular alterations and low incidence of collateral circulations.

[Coronary cardiopathy]. / La cardiopatia coronarica

Results obtained with selective coronariography, ventriculography, left catheterisation and the measurement of systolic times were compared in a series of 110 patients. Evaluation of vascular alterations with the aid of a coronary index showed that their entity was closely related to the incidence of asynergia and the extent to which left ventricular function was compromised. Index values were proportional to decrease of the DP/DT ratio, increased telediastolic pressure, lengthening of the pre-ejection phases and shortening of left ventricular systole. The physiopathological and clinical significance of these results is discussed.