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Bilateral internal mammary artery implantation —Postoperative assessment
Abstracts <:orrelation of Ultrasound with Angiocardiography in Measuring Left Ventricular Diastolic Volume. H. FEIGENBAUM,nf.o., F.A.c.c., S. B. WOLFE, M.D., K. 1,. POPP, M.D., C. L. HAINE and H. T. DODGE, \LD.. I .A.c.c., Indianapolis, Ind. and Birmingham, 1ln. _Asimple noninvasive technic for obtaining a left \-entricular internal dimension (LVID) has been developed using pulsed reflected ultrasound. This study attempts to correlate this ultrasound measurement with angiocardiographically determined left ventricular volume (LVV). Diastolic left ventricular dimensions and volume were obtained using biplane angiocardiographic: diagnostic technics on 17 patients undergoing cardiac catheterization. Nonsimultaneous ultrasound examinations were made with an ultrasonoscope utilizing a 2.25 megahertz transducer with a repetition rate of l,OOO/sec. With the patient in the recumbent position, the transducer was placed in the fourth or fifth intercostal space along the left sternal border. It was directed pos teriorly and somewhat laterally and inferiorly so as to record ccboes from the posterior wall of the left ventricle (LV\21) and from the interventricular septum (IVS). The echoes were recognized by their characteristic location, intensity and motion. LVID represented the distance between the endocardial surl’acc of the LVW echo and the left ventricular 11’S echo during end-diastole as indicated by a simultaneous electrocardiogram. LVID correlated well with both the angiographic long and short left ventricular axes (long axis, r 0.8623; fi < 0.001; short axis, 1’ 0.8832; fi < 0.001). LVID and LW correlated best when LVID was cubed (r 0.9171; f) < 0.001). Utilizing the regression equation to prrdic t LVV from LVID3, the range of error was +6.i to -42 cc. The results indicate that the ultrasound measurement LVID represents a dimension somewhere between the left ventricular short and long axes and, when cubed, can provide a clinically useful estimate of left ventricular diastolic volume. Bilateral Internal Mammary Artery Implantation -Postoperative Assessment. D. J. G. FERGUSSON, hr.~.. R. A. QUINT, M.D., R. G. FAVALORO,M.D. and E. LtxuIzAnroh-, 3I.D., Cleveland, Ohio. The results in 150 consecutive cases of bilateral internal mammary artery implantations are reviewed. Clinical and angiographic assessments were made approximately one year postoperatively. Sixty-eight subjects (45%) were considered VOLUME23, JANUARY1969
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greatly improved symptomatically and 39 (26%) moderately improved: 16 (1 I’%) showed no improvement. There were 14 (9%) early and 11 (7%) late deaths. Two patients were lost to followup study. Selective internal mammary arteriograms were obtained in 96 of the 127 survivors. The right internal mammary artery was opacified in 9.3 instances. The implant was patent in 90 and communicated with the anterior descending artery in 62. The left internal mammary artery, opacified in every case, was patent in 91 and communicated with one or more coronary arteries in 61. Clinical results in patients with two implants communicating with coronary arteries were as follows: greatly improved 29 patients, moderately improved 5, no improvement 1; with one communicating implant: greatly improved 23, moderately improved 18, no improvement 5; with neither vessel communicating: greatly improved 4, moderately improved 4, no improvement 4. Comparison of preoperative coronary arteriograms with incidence of internal mammary-coronary anastomoses showed that when coronary lumen diameter was reduced at least 90% and pre-existing intercoronary collaterals to the obstructed vessel were present, such anastomoses formed to the anterior descending artery in 96% (43 of 45), to the circumflex in 82% (32 of 39) and to the right coronary artery in 41% (24 of 58). The Effect of Dexamethasone on Cardiac Conduction: A Study of the Rate of Depolarization. J. C. FISCHER, M.D., K. GREENSPAN, PH.D., F.A.c.c., R. E. EDMANDS,M.D. and C. FISCH, M.D., F.A.c.c., Indianapolis, Ind. Transmembrane resting potentials (TRP), action potentials, and the maximal rising velocity (MRV) of phase 0 were recorded from isolated canine Purkinje fiber (false tendon) and papillary muscles before, during and after glucocorticoid (dexamethasone) perfusion. The purpose of these experiments was to study the manner in which steroids affect cardiac impulse propagation. Conventional intracellular microelectrode technics were utilized; then data recorded on magnetic tape with displaced reproduce heads for accurate synchronization were displayed on a Tektronix oscilloscope. Direct photography of phase 0 was performed with sweep speeds ranging from 2 X lo4 to 5 X 104 mm./sec. Control MRV’s of the Purkinje cells ranged from 500 to 800 v./sec., TRP’s from 8% 100 mv. Administration of dexamethasone to the perfusate resulted in a mean increase in MRV by 80 v.isec. unattended by any significant change
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greatly improved symptomatically and 39 (26%) moderately improved: 16 (1 I’%) showed no improvement. There were 14 (9%) early and 11 (7%) late deaths. Two patients were lost to followup study. Selective internal mammary arteriograms were obtained in 96 of the 127 survivors. The right internal mammary artery was opacified in 9.3 instances. The implant was patent in 90 and communicated with the anterior descending artery in 62. The left internal mammary artery, opacified in every case, was patent in 91 and communicated with one or more coronary arteries in 61. Clinical results in patients with two implants communicating with coronary arteries were as follows: greatly improved 29 patients, moderately improved 5, no improvement 1; with one communicating implant: greatly improved 23, moderately improved 18, no improvement 5; with neither vessel communicating: greatly improved 4, moderately improved 4, no improvement 4. Comparison of preoperative coronary arteriograms with incidence of internal mammary-coronary anastomoses showed that when coronary lumen diameter was reduced at least 90% and pre-existing intercoronary collaterals to the obstructed vessel were present, such anastomoses formed to the anterior descending artery in 96% (43 of 45), to the circumflex in 82% (32 of 39) and to the right coronary artery in 41% (24 of 58). The Effect of Dexamethasone on Cardiac Conduction: A Study of the Rate of Depolarization. J. C. FISCHER, M.D., K. GREENSPAN, PH.D., F.A.c.c., R. E. EDMANDS,M.D. and C. FISCH, M.D., F.A.c.c., Indianapolis, Ind. Transmembrane resting potentials (TRP), action potentials, and the maximal rising velocity (MRV) of phase 0 were recorded from isolated canine Purkinje fiber (false tendon) and papillary muscles before, during and after glucocorticoid (dexamethasone) perfusion. The purpose of these experiments was to study the manner in which steroids affect cardiac impulse propagation. Conventional intracellular microelectrode technics were utilized; then data recorded on magnetic tape with displaced reproduce heads for accurate synchronization were displayed on a Tektronix oscilloscope. Direct photography of phase 0 was performed with sweep speeds ranging from 2 X lo4 to 5 X 104 mm./sec. Control MRV’s of the Purkinje cells ranged from 500 to 800 v./sec., TRP’s from 8% 100 mv. Administration of dexamethasone to the perfusate resulted in a mean increase in MRV by 80 v.isec. unattended by any significant change