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Ten elderly patients with aortic valve stenosis and with a small calcified annulus (less than 20 mm) were treated by ultrasonic valve debridement (UVD) while 17 other elderly patients underwent aortic valve replacement (AVR) during the same period. The clinical and doppler results were assessed for a mean follow-up period of 20 months. Patients with significant aortic regurgitation or associated valve disease were excluded. The patients were studied by m-mode, two-dimensional and Doppler echocardiography before, immediately after, and at 6 months interval after the procedure. A successful decalcification was achieved in 8 patients. The valve was replaced in 2 patients because of cusp perforation or unsatisfactory intraoperative result. All patients showed significant postoperative increase in the mobility of the valve cusps, decrease in the amount of calcium, decrease of the aortic mean valve gradient (from 62 +/- 25 to 23 +/- 6 mmHg, p less than 0.001) and increase of the aortic valve area (from 0.49 +/- 0.11 to 1.21 +/- 0.3, p less than 0.001). The mean valve gradient was slightly higher after UVD than after AVR and showed a slight trend to further increase during follow-up, although only one patient had evidence of restenosis. A mild aortic valve insufficiency was present postoperatively in 6 patients. Worsening of insufficiency was noted in 2 patients during the follow-up period and one subject was re-operated on. Surgical ultrasonic debridement of the aortic valve may be effective in selected surgical candidates with small calcified valve and annulus, but subsequent occurrence of aortic insufficiency and restenosis may seriously limit its application.

A 14 year old girl on oral contraceptive treatment for menstrual disorders, was admitted with an acute anterior myocardial infarction and underwent immediate coronary arteriography and intracoronary thrombolysis (urokinase 350,000 units) within 4 hours of the onset of symptoms. A segmental occlusion of the left anterior descending artery with no evidence of coronary atherosclerosis elsewhere was shown. A successful re-canalization was documented after fibrinolytic therapy. The present is the first reported case, in a patient of this age, with an angiographic demonstration during the acute phase of the thromboembolic pathogenesis of myocardial infarction in contraceptive users. The potential benefit of early thrombolytic treatment in this rare clinical setting is thus suggested.

A standardized method for the representation and filing of coronary angiographies is proposed. Semi-automatic reference is guided by a computer algorithm. The final report displays a diagram which shows all the information in graphic and alpha-numeric form. Personalized coronary anatomy is drawn using the Coronary Artery Surgery Study (CASS) guidelines. The algorithm semi-automatically designs coronary segments according to CASS criteria. Five levels of percentage reduction in luminal transverse diameter (25, 50, 75, 90, 100%) can be represented. In addition, plaque morphology (concentric or eccentric, greater or less than 0.5 cm in size) and plaque complications, (calcification, ulceration, thrombosis, aneurysmal dilatation, wall irregularity, and diffuse disease) can be added as additional information. Twenty pathological entities (stenosis or plaque complications) can be filed for each patient. Collateral circulation can be represented by identifying the site of origin, one or more mid-points on the pathway, and the point of contact with the recipient vessel. As many as 10 single pathways can be identified. The same method can represent and file by-pass grafting using different symbols. Data can be easily put into the computer in three to four minutes. Coding and filing are automatically stored. Ten Mb can contain 4355 reports, including patient data and five lines of optional comment. Data can be retrieved in the original graphic form or the system can analyze filed data and retrieve series of patients with a given angiographic pattern. This option enables comprehensive research to be performed on any patient population, selecting subgroups of patients with specific anatomic and/or pathologic characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical angioplasty of the left main coronary artery for severe iatrogenic stenosis has been done on a 40 year old female patient operated upon five months before for mitral and aortic valve prosthetic replacement. Postoperative angiocardiographic study showed patent left main trunk and the patient is angina-free six months post-operatively. Operative indication and surgical technique are discussed as an alternative to aorto-coronary by-pass surgery for left main proximal stenosis without peripheral lesions. It does not result from literature that this surgical technique has ever been employed in patients previously operated with open heart surgery.

Phase-amplitude images and phase distribution histograms, derived from a temporal Fourier analysis of equilibrium ecg-gated blood pool studies, were used to assess the overall wall motion synchronism and to detect regional wall motion abnormalities in 69 consecutive patients with suspected or documented coronary artery disease, in whom biplane contrast left ventriculography and coronary angiography were performed. Four regions were considered on the 15 degrees caudal left-anterior oblique view radionuclide image, in order to identify the 7 conventional angiographic left ventricular wall segments (as the American Heart Association Council of Cardiovascular Surgery). Regional abnormalities on the phase-amplitude images from the 15 degrees caudal left anterior oblique view scans were studied in order to identify local hypokinesis, akinesis or dyskinesis (in accord to definitions used for contrast cineangiography) relative to seven conventional left ventricular wall segments. Results of phase-amplitude image analysis were compared with those of contrast cineangiography. The parametric images showed overall sensitivity of 82% and 92% respectively towards biplane and monoplane (left anterior oblique) contrast cineangiography, with a high degree of specificity (97%). Most akinetic and dyskinetic segments were correctly identified. A significant phase delay (greater than or equal to 70 degrees) from mean value, always occurred in dyskinetic segments and generally related to the severity of the wall motion abnormality. Lower accuracy was observed for hypokinetic regions; sensitivity was lower for apical and antero-lateral segments.(ABSTRACT TRUNCATED AT 250 WORDS)

Many different techniques have been previously reported for non-surgical transluminal removal of foreign bodies from venous system or right heart chambers, while only few cases of transluminal extraction from arterial vascular bed or left heart chambers have been published. We report a successful attempt of a Judkins' catheter fragment extraction from the aortic arch by a homemade loop-snare device. Tying the distal end of a long flexible guide-wire on the tip of a 8F Cournand catheter we obtained an easy to handle device which is practicable using instruments always available in any catheterization room.