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Rationale and Objectives: Low-osmolality contrast agents, ionic and nonionic, are being used more frequently in coronary arteriography. A new nonionic contrast agent, iopromide, has recently become available for use in clinical trials. The purpose of this phase II-phase III Food and Drug Administration (FDA) trial was to compare the side effects and diagnostic quality of iopromide with iohexol and iopamidol for coronary arteriography and left ventriculography., Methods: Two separate double-blind trials were performed using iopromide and comparison nonionic contrast agents. In the first trial, 41 patients were randomized to receive iopromide or iopamidol. The second trial was a three-center trial involving 120 patients, of whom half received iopromide (370 mg I/mL) and the other half received iohexol (350 mg I/mL). In a third study, 26 patients received iopromide (370 mg I/mL) according to an open-label design., Results: Comparison of iopromide with the other agents revealed that there were no significant differences in adverse events between iopromide and the comparison agents. Most adverse reactions were mild or moderate in severity in all patient groups. There was no difference in the patients' perceptions of heat and pain and no statistically significant difference in systolic or diastolic blood pressure at baseline, at 30 to 60 minutes, or at 24 hours after the procedure. No difference was found in the biochemical or hematologic analysis at baseline or at 24-hour follow-up. No difference between the contrast media groups in terms of the quality of the left ventriculogram or the quality of the coronary arteriography was noted., Conclusion: Compared to the other nonionic agents, iopromide showed no statistically significant differences in terms of safety or efficacy.

Rationale and Objectives: A number of pressures have taken their toll on cardiovascular (CV) imaging in radiology. We conducted a survey to develop accurate information about the current status of cardiac radiology (CR) that might guide future responses and initiatives., Methods: To assess the current status of CR, a survey form was sent to all 117 active radiologist members of the North American Society for Cardiac Imaging (N = 72) and/or the Council on Cardiovascular Radiology of the American Heart Association (N = 98). The topics of inquiry included 1) present CR staffing; 2) specific adult and pediatric CR activities (cardiac plain-film interpretation, cardio-angiography (CA), echocardiography, nuclear cardiology (NC), and CV magnetic resonance imaging (MRI); 3) CR instruction of radiology residents; and 4) CR fellowship activities., Results: The survey was concluded with 64 (55%) individual responses from 58 (67%) different centers with CR groups. An overall need for CR staff (average unfilled positions/center = 0.4) was indicated. Regarding CR activities, the following were reported: 1) universal cardiac plain-film interpretation by radiologists, with most CR groups involved (adult, 64%; pediatric, 64%); 2) moderate CR contributions to CA (adult, 62%; pediatric, 57%), of which cine interpretation was the most common form (79% and 85%, respectively); 3) rare CR involvement in echocardiography (adult, 9%; pediatric, 6%); 4) low-level CR involvement in NC (adult, 16%; pediatric, 17%), but high level when combined with that of nuclear medicine (93% and 91%, respectively); and 5) almost universal radiology responsibility for CV MRI (adult, 96%; pediatric, 96%), with extensive CR involvement (77% and 82%, respectively). Of 46 reporting academic centers, most (76%) required CR training of residents; a smaller proportion (33%) of all centers offered CR fellowships., Conclusions: Because of the insights gained from this survey, recommendations can be better made to strengthen CR based on a foundation in plain-film interpretation, computed tomography, NC, and MRI.

The mechanism by which tracheobronchial arterial supply is reconstituted following heart-lung transplantation was investigated in seven monkeys (3 allografts, 2 autografts, and 2 nontransplanted control monkeys) and three patients. Descending tracheal branches of the thyrocervical arteries provided the major tracheal vascular supply. A collateral branch arising from atrial branches of the left coronary artery supplied tracheobronchial branches in the region of the carina in one allograft. In the three patients studied to date by coronary arteriography, a similar collateral supply to the region of the carina and proximal bronchi was demonstrated from atrial branches of both the left and right coronary circulation.

The intrinsic optical properties of normal and diseased vascular tissues and their interaction with continuous wave (cw) and pulsed laser light were investigated to determine the optimal source for laser angioplasty. Both intima and atheromatous plaque demonstrated increasing spectral absorbance at shorter wavelengths (in the near ultraviolet). The relative differences in absorbance between diseased and nondiseased tissues were not sufficient to allow selective ablation of plaque. Atheromatous plaque appears more resistant than normal intima to damage by cw argon laser. The interaction of tissue with a high-power, pulsed ultraviolet laser showed a nonlinear response as pulse repetition rate and pulse energy were varied. From theoretical considerations and our experimental results, we propose that a pulsed ultraviolet laser with 50 millijoules of power per pulse and a repetition rate of 10 pps would be safer and more effective for recanalization than the cw argon laser.