Evaluation of left ventricular function (ejection fraction and segmental wall motion) by single pass radioisotope angiography.

Changes in ejection fraction (EF) and segmental wall motion (SWM) have been shown to be sensitive indicators of left ventricular (LV) function. This information is only obtainable by contrast angiography or gated blood pool scans. Gated studies assume a fixed geometry for the LV for EF determinations, are lengthy and limited primarily to the LAO projection. We correlated contrast and Tc-99m pertechnetate angiograms by singl pass radioisotope angiography (immediately preceding the contrast study) in 12 patients. EF was calculated from the LV time/activity curve and values ranged from .21 to .72. Angiographic correlation yielded r = 0.97. Regional LV wall motion was evaluated by dividing a summated cardiac cycle into 16 frames and dynamically and sequentially displaying these frames. Regional wall motion evaluation of four LV quadrants correlated well with angiography (r = 0.97). For quantitation these images were divided into four anterior and four inferior segments and the areas of respective segments were compared and expressed as a shortening fraction. SWM compared favorably with angiographic determinations (r ranged from 0.70 to 0.99). Thus, single pass radioisotopic determinations of EF and SWM in the RAO projection correlated well with the angiographic values and provide essential quantitative information of LV function otherwise unobtainable at the bedside.

Cardiovascular abnormalities in cutis laxa.

Cutis laxa is manifest histologically by fragmentation of elastic tissue throughout the body. The aorta and other systemic vessels show dilatation, elongation and even aneurysm formation. We report multiple pulmonary artery branch stenoses in a child who had cutis laxa. Pulmonary artery stenoses may be the cause of the pulmonary hypertension and right heart failure observed in patients with this condition.

Cough-induced cardiac compression. Self-administered from of cardiopulmonary resuscitation.

Eight patients undergoing coronary angiography were successfully resuscitated from ventricular fibrillation (VF), and three of these patients remained conscious and alert for 24 to 39 seconds after VF by coughing every one to three seconds. The mean aortic systolic pressure induced by cough was 139.7 mm Hg (+/- 3.8) and only 60.7 mm Hg (+/- 5.1) by external cardiopulmonary resuscitation (CPR). Cough-CPR, accomplished by abrupt, forceful coughing maintains consciousness by rhythmic compression of the heart, has several advantages over external CPR in the catheterization laboratory, and may be applicable to other situations where serious rhythm disturbances are recognized before unconsciousness occurs.

Technique for serial right and left ventricular endocardial biopsy in dogs.

A method is described for obtaining left and right ventricular endocardial biopsies repeatedly over a period of 3-6 mo in the dog. The left ventricular endocardial biopsy technique consists of the placement of a catheter via the venous route across the atrial septum and into the left ventricle. The biopsy catheter is in turn placed within this transseptal catheter. Tissues obtained by this method were satisfactory for both light and electron microscopic examination. At postmortem examination, only minimal and insignificant damage existed at the biopsy site. Consequently, we recommend this technique for the study of progressive pathologic changes in the endocardium that occur during the course of an experiment which can be identified and quantified in comparison to the control state.

Self-administered cardiopulmonary resuscitation by cough-induced cardiac compression.

Repeated rhythmic (every 1-3 sec.) coughs were documented to maintain consciousness up to 39 seconds in 3 patients developing ventricular fibrillation during coronary arteriography. The arterial pressure wave resulting from a cough exceeded that induced by external chest compression in 2 individuals in whom both techniques were employed and in 5 others treated by external compression alone. Cough-induced cardiac compression is self-performed, and compared to external chest compression is less likely to traumatize the chest wall or heart and can be performed in any position on any surface. It is recommended that patients undergoing coronary arteriography be previously trained to cough abruptly and repeatedly every 1-3 seconds. The potential for utilizing this technique in other areas (i.e., CCU, home) is less favorable than in catheterization-induced ventricular fibrillation, but it might be employed successfully in patients with premonitory symptoms of ventricular arrhythmias or Stokes-Adams seizures. The prior training of high risk individuals (and their spouses) to induce effective coughing in the victim might be lifesaving.

Long-term treatment of severe hypertension with minoxidil, propranolol and furosemide.

Thirteen patients with severe hypertension were treated with combined minoxidil, propranolol, and furosemide (mean daily doses 33 mg, 475 mg, and 578 mg, respectively) for nine to twenty-five months (mean 13.8). Average mean blood pressure while on aggressive therapy with conventional medication was 144 +/- 14 mm Hg; on minoxidil and propranolol it was 108 "/- 10 mm Hg (P less thator to optimum blood pressure control and required large doses of furosemide to control. Propranolol blunted the reflex tachycardia associated with arteriolar dilator therapy but all patients continued with a clinically hyperdynamic circulation. Seven of seven had elevated ejection fractions on echocardiogram, and two of three had elevated cardiac indices. Three of three who had heart catheterization had pulmonary hypertension which was aggravated by exercise. An additional three patients on hydralazine, propranolol, and furosemide also had pulmonary hypertension suggesting this is not unique to minoxidil. Two of thirteen developed pericardial effusions. Renal function improved in three and worsened in three.