Coaxial technique for catheterization of the coronary arteries with a very dilated ascending aorta.

This article describes a simple yet effective method to catheterize the coronary arteries when the ascending aorta is very dilated. Two catheters are used in a coaxial fashion. It was possible to catheterize a patient with a 9 cm wide ascending aorta.     

Cardiac catheterization and selective coronary angiography in ascending aortic aneurysm or dissection

Cardiac catheterization and coronary angiography can be technically demanding and is potentially risky in patients with ascending aortic aneurysm or dissection. We describe our approach to and results in catheterizing 63 patients with ascending aortic pathology. © 1994 Wiley-Liss,Inc..     

Natural history of a dilated ascending aorta after aortic valve replacement.

BACKGROUND: Little information is available regarding the incidence of aortic dissection or rupture in patients with a dilated ascending aorta after aortic valve replacement (AVR). The present clinical study aimed to demonstrate the incidence of aortic complications after AVR in patients with a dilated ascending aorta and to clarify those risk factors associated with the progression of a dilated ascending aorta or late aortic events. METHODS AND RESULTS: A total of 35 patients with a dilated ascending aorta at the time of AVR were enrolled. A dilated ascending aorta was defined as 40 mm or greater in diameter by preoperative computed tomography or operative findings. The baseline ascending aorta diameter ranged from 40 to 55 mm with a mean of 44.8+/-4.4 mm. There was a high frequency of bicuspid valve disease in patients with a dilated ascending aorta (57%). The mean follow-up interval was 8.1+/-3.5 years (range: 2.3-13). Aortic events occurred in 5 patients (aortic dissection in 1, rupture in 2, reoperation in 2) during the follow-up. One aortic dissection developed at a baseline aortic size of 42 mm, whereas 2 aortic ruptures occurred at baseline aortic sizes of 47 mm and 50 mm. There was no statistically significant univariate association between any of the patient clinical characteristics and late aortic events or ascending aortic progression. CONCLUSION: Although the clinical course of patients with a dilated ascending aorta is unpredictable, aortic events may occur even in patients with a baseline aortic diameter of <50 mm. Therefore, preventive aortic surgery at the time of AVR should be considered to prevent aortic dissection or rupture in patients with an even slightly dilated ascending aorta with a diameter of 40 to 50 mm, unless the patient has a high operative risk or older age.     

Anomalous origin of the right coronary artery from the ascending aorta. Diagnosis by digital subtraction angiography

The anomalous origin of a coronary artery often poses diagnostic difficulties at angiography. The right coronary artery is more rarely affected than the left. A patient is presented in whom the right coronary artery arose from the ascending aorta. The diagnosis of this rare anomaly was facilitated by the use of digital subtraction aortography and allowed selective angiography of the artery with an appropriately shaped catheter.     

Double-inversion technique for coronary angiography viewing in dextrocardia.

This report describes a simple angiographic viewing rule for coronary angiography in patients of dextrocardia with obstructive coronary artery disease, which could correct the unfamiliar angulated pictures of the coronary tree in dextrocardia into the familiar conventional angiographic pictures of a normally located heart and its associated ease of interpretation.     

Double-catheter technique for catheterization of the left coronary artery in a patient with an ascending aorta aneurysm

We describe our experience performing cardiac catheterization of the left coronary artery in a patient with an aneurysm of the ascending aorta using a double-catheter technique. A 7 Fr guiding catheter was advanced into the aortic root and a longer multipurpose diagnostic catheter was passed through the guiding catheter, which enabled the extension of the whole catheter system. In addition, this technique allowed us to reach the ostium of the left coronary artery and perform coronary angiography.     

Unusual "high take off" of the right coronary artery from the ascending aorta

An exceedingly rare anomaly is described in which the right coronary artery originated two centimetres above the left posterior sinus of Valsalva in association with an aortic valve having two leaflets.     

Demonstration of the ascending aorta in infective endocarditis by intravenous digital subtraction angiography.

Four patients with infective endocarditis were examined by digital subtraction angiography immediately before operation. In three a root abscess was suspected and the remaining patient was believed to have a false aneurysm at an infected aortic cannulation site. In all the cases digital subtraction angiography showed the structure in several projections and confirmed the presence of a cavity. Subsequent operation confirmed the site and nature of the lesions.     

Platypnoea-orthodeoxia in an elderly man with patent foramen ovale and dilated ascending aorta

We report the case of an 85-year-old male with platypnoea-orthodeoxia associated with patent foramen ovale (PFO) and ectatic ascending aorta, in the absence of any significant pulmonary pathology.     

"Ambulatory" approach to selective coronary angiography: our results and experience

The authors present a group of their first 110 patients subjected to selective coronarography during an average 7-hours hospitalization period. In selection of patients they respect the criteria ruling out the following approach: age above 70 years, distance of the patients domicile above 80 km or inaccessibility of catheterization laboratory within 45 minutes, serious aortic valve disease, unstable coronary syndromes, insulin treated diabetes mellitus, renal insufficiency, cardiac insufficiency, grade III or IV, severe left ventricular dysfunction, history of malignant arrhythmia, acute myocardial infarction or cerebrovascular attack during month preceding examination, coronary finding calling for urgent revascularization, complicated course of examination and mental inability of patient. All coronarographies were performed by a 4F catheterization instrument, no complications were recorded and readmission to hospital was not called for. An early check-up by telephone was accepted by half the patients. When all the above criteria are respected the authors recommend this procedure as a standard one without the need of hospital admission.     

Calcific aorta and coronary artery: two cases of calcific ascending aorta and descending aorta

Calcific aorta is a disease of old age and is an independent risk factor for morbidity and mortality. Here, we present two patients with calcific aorta at different levels. One with a descending porcelain aorta, and modified Bentall’s procedure was done. Second is a patient who is having a calcific ascending aorta and coronary artery. Coronary artery bypass grafting from left internal mammary artery to left anterior descending was done for the patient. The calcification and its morbidity had been discussed briefly.     

Modified Judkins catheters for selective coronary angiography in infants and young children.

The purpose of this study was to assess 4 Fr Judkins catheters with modified shorter tips for performing selective coronary angiography in infants and young children. Twenty patients ranging 6 weeks to 3. 8 years of age were enrolled. Retrograde left heart catheterization and selective coronary angiography were performed. Right (JR) and left (JL) catheters with modified 1.5- and 2.5-cm curves (Cordis) were used. Thirty-six of 37 coronary arteries were successfully cannulated and demonstrated. Median procedure time was 95 sec for the right and 50 sec for the left coronary artery. Median fluoroscopy time was 1.1 min for the right and 0.7 min for the left coronary artery. The JL 1.5 appeared best suited for patients less than 75 cm tall. The JR 1.5 was suitable for patients up to 85 cm tall. Taller patients required the 2.5-cm curves. It is concluded that these modified 4 Fr Judkins catheters were effective.     

The ascending aorta in aortic stenosis.

Dilatation of the ascending aorta, a frequently reported sign of aortic stenosis, was assessed in 47 patients for whom aortic angiograms has been recorded. Twenty-eight of the patients had rheumatic valvar disease and 19 had congenital aortic stenosis. A simple ratio between the maximal width of the mid-ascending aorta and the width of the aortic root was calculated. Patients with congenital aortic stenosis had significantly greater supravalvar aortic dilatation than did those with rheumatic aortic valve involvement. There was no correlation between the pressure difference across the aortic valve and degree of dilatation of the ascending aorta.