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To the Editor: I enjoyed reading Dr Ryan’s superb recount of the historical development of coronary arteriography,1 but I wish to make a comment on its chronology. Dr F. Mason Sones, Jr, of the Cleveland Clinic performed the first selective coronary arteriogram on October 30, 1958.2 The selective right coronary arteriogram photographed by Sones on October 30, 1958, was inadvertently obtained during an aortic root injection in a 26-year-old patient with rheumatic heart disease,3 when the catheter whiplashed into the ostium of the right coronary artery. Although the performance of this selective coronary arteriogram was unintentional, it was the first direct injection of a contrast agent into a coronary artery (Figure). Cine frame from the first selective coronary arteriogram recorded by F. Mason Sones, Jr, on October 30, 1958. …

To the Editor: In the recent editorial by Lenfant,1 the acronym SPARK popped up repeatedly without ever being defined. I even went to the trouble of looking it up from http://www.nhlbi.nih.gov/funding/fromdir/sparkweb.htm for a copy of the SPARK report as the author suggested, but could not find a definition of the acronym SPARK in that report either. Man is the animal that likes to abbreviate,2 …

Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative treatment for hypertrophic obstructive cardiomyopathy (HOCM). We report on the acute, short- and long-term results of our experiences in 119 patients from a single center in China.PTSMA was performed in 119 patients with symptomatic HOCM (mean age 35.4+/-14.8 years, male 80, female 39). All patients had echocardiography performed prior to the procedure, 2-week post-PTSMA, and 6-month post-PTSMA, and 65 patients had echocardiography repeated at 2-year follow-up. The average left ventricular outflow tract (LVOT) gradient was 67.3+/-7.8 mm Hg before the procedure, and 15.9+/-6.8 mm Hg after the procedure (p0.05). The thickness of interventricular septum (IVS) was 23.3+/-5.6 mm before the procedure, 18.6+/-4.8 mm 2-week post-PTSMA (p0.05), and 16.8+/-3.4 mm 6-month post-PTSMA in all of the patients, and 15.6+/-3.1 mm 2-year post-PTSMA in 65 patients. The mean width of LVOT was 6.7+/-2.0 mm before the procedure, 8.2+/-3.4 mm 2-week post-PTSMA (p0.05), 13.7+/-6.3 mm 6-month post-PTSMA and 15.1+/-2.4 mm 2-year post-PTSMA. The incidence of right bundle branch block development post-PTSMA was 52.9%, and three patients (2.5%) had complete heart block. There was no death.PTSMA is a promising non-surgical procedure for symptomatic patients with HOCM because of its low risk and its significant hemodynamic, echocardiographic and clinical improvement. The significant therapeutic remodeling period was up to 6 months rather than 2 years following the procedure.

To the Editor: I read with interest the recent report by Shamsuzzaman et al1 of elevated C-reactive protein (CRP) in patients with obstructive sleep apnea (OSA). Although the patients and control subjects were matched for body mass index (BMI), 36±4 kg/m2 versus 34±4 kg/m2, all were very obese (upper normal BMI=25 kg/m2). Several recent studies have indicated that CRP levels are elevated in obese patients.2–4 Adiposity, in particular visceral adipose tissue, is a key promoter …

To the Editor: I read the recent article on the ENTIRE trial1 several times, each time more carefully and thoroughly than the previous time, in an attempt to find out what the acronym ENTIRE stood for. I could never …

To the Editor: I thoroughly enjoyed Hurst’s dissertation on the etiology of a giant left atrium1 and concurred that a giant left atrium seldom results from severe mitral regurgitation due to a nonrheumatic cause such as mitral valve prolapse. Although I would never dare to challenge Dr Hurst on anything he said or wrote, because I consider him not only as the master clinician of the century but also as my mentor, I thought it might be of interest to point out that there were 2 cases reported in the literature of a giant left atrium associated with mitral valve prolapse.2,3⇓ The presentation in both cases was the Ortner syndrome. Ortner4 in 1897 described 2 patients with mitral stenosis and hoarseness …

The recent report by Fung and Sanderson [1] on Therefore, it is extremely important in future international trials that more attention should be paid the clinical profile of Chinese patients with arto the ethnic make-up and racial background of the rhythmogenic right ventricular dysplasia /carpatients enrolled in order to achieve a meaningful diomyopathy (ARVD/C) is indeed welcome news. result. Contrary to the common belief that ARVD/C is a serious disease responsible for 20% of sudden cardiac deaths in the young [2], Fung and Sanderson found R eferences the incidence of sudden cardiac death in ARVD/C to be low in Chinese patients.

Cardiac/total adm 10% 16% 21% 23% 24% 31% Coronary 6% 16% 26% 27% 39% 47% Rheumatic 50% 44% 30% 24% 10% 2% Hypertensive 18% 7% 3% 5% 7% 5% Syphilitic 9% 3% 1% 0.2% 0.1% 0.006% Pulmonary 7% 10% 8% 2% 2% 0.4% Congenital 2% 12% 17% 13% 2% 5% Myocarditis 1% 1% 7% 11% 8% 2% Cardiomyopathy 0.05% 0.16% 2% 3% 5% 5% Pericarditis 2% 2% 2% 2% 1% 1% Thyroid 2% 1% 0.24% 1% 0.2% 0.2% Mitral valve prolapse – – – 0.1% 0.5% 0.3%

Although Hippocrates (460-c.375 BC) has been traditionally recognized as the Father of Medicine, the fact that he was seminal in the development of cardiology is much less well known. Evidence is presented to support the notion that Hippocrates could also be considered the Father of Cardiology. Hippocrates also had many of the teachings and practices in common with Confucius (c.551-c.479 BC) and the Yellow Emperor of China (2695-2589 BC). Whereas Confucius was not a physician, the Yellow Emperor was an ancient Chinese physician whose Huang Di Neijing, the Yellow Emperor's Canon of Internal Medicine, is the oldest known treatise of medicine in existence.

To the Editor: I read with interest the dramatic case report by Egred et al.1 However, I was somewhat puzzled by the indication of a left internal mammary artery graft insertion into the left anterior descending coronary artery at the time of the emergency thromboembolectomy. Although the patient had suffered an anterolateral non–Q-wave myocardial infarction 2 months previously, coronary arteriography revealed essentially normal vasculature apart from mild (40%) plaque disease in the proximal left anterior descending coronary artery. The most likely cause of his myocardial infarction was paradoxical coronary embolism,2 because he had experienced paradoxical embolism to …

To the Editor: I was surprised to see Parmley in his recent editorial1 referring to 3 etanercept trials by their acronyms (RENAISSANCE, RECOVER, and RENEWAL) without defining them. …

To the Editor: Coronary artery disease (CAD) is the leading cause of death in the United States. Autopsy studies of war casualties in Korea1 and Vietnam2 showed that subclinical atherosclerosis is evident in late adolescence and early adulthood. The recent report from the Chicago Heart Association Detection Project in Industry study,3 one of the largest and longest …

To the Editor: Of the many new therapeutic agents for slowing the progression of congestive heart failure (CHF), other than antagonizing the renin-angiotensin-aldosterone system, blocking the endothelin receptors seems to be most promising. The two latest reports published in Circulation 1,2 render further support to this exciting concept. Endothelin may contribute …

To the Editor: Certain populations, such as the French and the Greeks, have a low incidence of coronary artery disease, despite a diet relatively high in saturated fat. It has been suggested that regular consumption of red wine may explain this phenomenon, which has been dubbed the “French paradox,”1 ie, the coexistence of a high-fat diet and a low incidence of coronary artery disease. Although the cardioprotective effects of most alcoholic beverages are probably due to an elevation of high-density lipoprotein, as well as the ability of alcohol to prevent platelet aggregation and to increase fibrinolysis, there is an increased favorable effect of red wine.2 The unique cardioprotective properties of red wine reside in the action of flavonoids, which are absent in white wine (with the exception of champagne) and sparse in beer (with the exception of dark beers). The best research flavonoids are resveratrol and quercetin, which confer antioxidant properties more potent than α-tocopherol.2 As was summarized recently by Hung …

To the Editor: I would like to echo the sentiments of Smaha in the “Message from China”1 and add some personal comments. The prevalence of coronary heart disease has changed considerably in China in the past 5 decades, rising from the fifth most common form of heart disease in 1948 to 1957 to the second most common form of heart disease from 1958 to 1979, and to the most common form of heart disease in 1980 to 1989, where …

To the Editor: I read with interest the excellent report on sudden cardiac death with apparently normal heart by Chugh et al.1 Of note was the finding that 28 of 270 hearts (10%) had pathological criteria for mitral valve prolapse. In addressing the association between mitral valve prolapse and sudden cardiac death, the authors classified these hearts as having a nonspecific structural abnormality. Such an assumption is open to question. Evidence to date suggests that the predominant mechanism of sudden cardiac death in mitral valve prolapse is fatal ventricular …

We present a brief historical vignette about one of the pioneer cardiothoracic surgeons, Leo Eloesser, from our personal recollections and descriptions of part of his long life that was spent in China. Although this article deals mainly with his time in China during his close association with the senior author, Dr Eloesser is certainly one of the most extraordinary surgeons of the 20th century.

To the Editor: I enjoyed reading the case report on Prinzmetal’s angina that appeared in a recent issue of the Journal.1 I reported a variant of Prinzmetal’s angina 27 years ago …

Article history: Received 26 May 2010 Accepted 26 May 2010 Available online 30 June 2010 farming and 13 million in retail trade. Tobacco taxes are source of revenue for the government and accounted for abo dollars in 1992, or about 10% of all revenue [4]. The tobacc is the biggest source of tax revenues in China. Thus the go that needs money to raise living standards in China is as a tobacco revenue as smokers are to nicotine. It is a dilemma

To the Editor: The findings reported by Shively et al1 that dexfenfluramine-induced valvulopathy may regress after cessation of …

To the Editor: The case report by Brandspiegel et al1 and the subsequent letter to the editor by Watkins and Blumenthal2 both demonstrated conclusively a relationship between a stressful event and a transient compromise of coronary perfusion. That a person could be “worried to death”2 has a parallel example in people being “scared to death.” The Los Angeles, Calif, earthquake on January 17, 1994, at 4:31 am provided an unusual opportunity to study features of the relation between emotional stress and the triggering of sudden cardiac death (SCD), as was …

To the Editor: We are writing in support of the conclusions reached by Iung et al1 concerning the late results of percutaneous balloon mitral valvuloplasty (PBMV). The French experience confirmed the Chinese experience that was reported earlier with a larger number of patients, namely, a PBMV can be performed with good late results in a variety of patient subsets.2 3 The Inoue balloon technique, which the Chinese investigators have used since November 19854 and the French investigators began using more recently, is the procedure of choice for the treatment of mitral stenosis.5 We also found that a hemodynamic evaluation did not provide any information additional …

To the Editor: I read with interest but some skepticism the article on the triggering of myocardial infarction by cocaine by Mittleman et al.1 They reported that in the first hour after cocaine use, the risk of acute myocardial infarction was 23.7 times …

To the Editor: The echocardiogram on the cover of the June 1, 1999, issue of Circulation is a beautiful illustration of an impending paradoxical embolism. Unfortunately, neither the text1 nor the key words of the article made any mention of this condition. Impending paradoxical embolism2 is a surgical emergency. This diagnosis would not have been possible before the advent of echocardiography. However, to diagnose paradoxical embolism, contrast echocardiography should be performed during and after a Valsalva maneuver.3 The mere establishment …

To the Editor: I hate to write a letter to the editor to comment on another letter to the editor, especially if the author of the latter is a respected colleague of mine. However, in this case, I must make an important point regarding conformity to accepted writing style. Ferguson1 in his sobering letter on …

To the Editor: The report from the Stroke Prevention: Assessment of Risk in a Community (SPARC) study1 stating that atrial septal aneurysm (ASA) is associated with an increased risk of stroke is important for 2 reasons. (1) It definitively establishes the prevalence of ASA in the general population at 2.2%. The true prevalence of ASA was underestimated before the routine use of echocardiography, especially transesophageal echocardiography.2 (2) It supports the previous conjecture that paradoxical embolism is the predominant mechanism of cardioembolism in ASA.3 Although 2 previous multicenter studies4 5 suggested paradoxical embolism as a possibility …

To the Editor: I read with interest the article on long-term follow-up after percutaneous mitral valvuloplasty with the Inoue balloon catheter by Hernandez et al.1 They reported a restenosis rate of 39% at 7 years. My colleagues from China and I recently reported our experience with the same technique in a follow-up study up to 11 years in the first 202 patients2 among the original 4832 patients treated in China.3 The restenosis rate was 8%, which is very respectable and actually better than that after surgical closed commissurotomy (25% …

Sir, In the recent review article by McMechan and Adgey,1 there were eight trial acronyms only one of which (DBLE) was ever defined. Journal readers, as well as unsophisticated cardiologists like me, often find the enigmatic collections of unexplained acronyms to be an aggravating experience2 and a hopeless puzzle, especially because each new trial generates a new and often more imaginative acronym.3 I …

Sir, I enjoyed reading the excellent review article on the management of Black hypertensive patients by Gibbs et al. 1 Having practiced for nearly three decades in Washington, DC where nearly 3/4 of the population is Afro-American, I wish to confirm that beta-blockers and angiotensin-converting-enzyme (ACE) inhibitors are less effective at lowering high …