Coronary Heart Disease

1 Anatomy of the Coronary Vessels.- The Right Arterial System.- The Right Coronary Artery.- The Left Arterial System.- The Main Left Coronary Artery.- The Anterior Descending Coronary Artery.- The Left Circumflex Coronary Artery.- The Atrial Arterial Supply.- From the Left Coronary System.- From the Right Coronary System.- The Conus Artery.- The Veins.- 2 Coronary Arteriography.- Techniques.- History of Coronary Angiography at the University of Minnesota.- Selective Catheterization: Percutaneous Puncture of the Subclavian Artery.- Selective Left Coronary Catheterization: Percutaneous Transfemoral Approach.- Selective Right Coronary Catheterization: Percutaneous Transfemoral Approach.- Procedure for Transfemoral Coronary Arteriography.- Left Ventriculometry.- Cine Imaging.- Advantages and Disadvantages of Cine Recording.- Cut Film Imaging of the Coronary Arteries.- Regional Myocardial Blood Flow Measurements and Radioisotopic Imaging.- Electrocardiographic Changes during Selective Coronary Arteriography.- Complications.- Injection of Air.- Dissection of the Coronary Artery.- Coronary Dissection without Occlusion.- Occlusion after Dissection.- Embolic Occlusion of the Coronary Arteries.- Wedge Injections.- Indications.- Angiographic Projections.- Frontal Projection of Left Coronary Artery.- Right Coronary Arteriogram in Frontal Projection.- Right Anterior Oblique Projection.- Right Anterior Oblique Projection of Right Coronary Artery.- Left Anterior Oblique Projection of Left Coronary Artery.- Left Anterior Oblique Projection of Right Coronary Artery.- Lateral Projection of Left Coronary Artery.- Lateral Projection of Right Coronary Artery.- Multiple Views.- Angiographic Identifications during Systole and Diastole.- Myocardial Bridges.- Pseudomyocardial Bridge.- Measurements of the Coronary Arteries.- Angiographic Assessment of Coronary Artery Disease.- Nature of Obstructive Lesions.- Spasm of the Coronary Arteries.- Coronary Arteries without Identifiable Lesions.- Minimal Obstructive Disease.- Moderate Stenosis.- Severe Stenosis in Intermediate Segment of Right Coronary Artery.- Multiple Lesions in Left Coronary System.- Severe Stenosis in Small Branches.- Occlusion in Two Vessels.- Identification of Obstructive Lesions.- Progression of Lesions.- Delay in Opacification and Clearing.- Administration of Nitrites.- Collateral Circulation.- Bridging Anastomosis.- Kugel's Artery.- Intercoronary Anastomoses with Left Anterior Descending and Posterior Descending.- Septal Collaterals to the Right Coronary Artery.- Occlusion of the Right Coronary Artery with Collaterals from the Left Anterior Descending and Left Circumflex Arteries.- Collaterals to the Right Coronary Artery through Atrial Branches.- Occlusion of Distal Right Coronary Artery with Collaterals from Septal Branches of the Left Anterior Descending Artery.- Segmental Occlusion and Intercoronary Collaterals.- Occlusion of the Left Anterior Descending Artery: Dual Collateral Supply from the Conus Artery and Muscular Branches of Right Coronary Artery.- From Conus Artery and Right Muscular Branches to the Left Anterior Descending Artery.- Collateral Flow to the Left Anterior Descending Artery through Branches of the Posterior Descending Artery Arising from the Left Circumflex.- Collaterals from Left Circumflex to Right Coronary Artery.- Left Circumflex: Source of Collaterals to Occluded Right Coronary and Left Anterior Descending Arteries.- Muscular Branch: Source of Collaterals to Occluded Distal Right Coronary and Left Anterior Descending Arteries.- Collateral Flow to the Moderator Bands of the Right Ventricle.- The Left Coronary Branchless Tree Appearance.- 3 Variations in Levels of Origin of the Coronary Arteries.- Normal.- Abnormal.- Congenital High Takeoff of the Right Coronary Artery.- Acquired High Takeoff of Coronary Arteries.- High Takeoff: Angiographic Observations.- Illustrative Cases.- High Takeoff of Right Coronary Artery: Sudden Death.- Low Origin of Right Coronary Artery: Angiographic Demonstration.- 4 Variations in Sites of Origin of the Coronary Arteries.- Origins of the Left Circumflex Coronary Artery from the Right Aortic Sinus.- Anatomy.- Angiography.- Origin of the Left Circumflex Coronary Artery from the Right Coronary Artery.- Anatomy and Aortography.- Selective Angiography.- Complications following Aortic Valve Replacement.- Complications Associated with Removal of Left Atrial Myxoma.- Origin of the Anterior Descending Coronary Artery from the Right Coronary Artery.- Without Congenital Heart Disease.- In the Tetralogy of Fallot.- Independent Origins of the Anterior Descending and Circumflex Coronary Arteries from the Left Aortic Sinus.- Anatomy.- Angiography.- Origin of the Right Coronary Artery from the Posterior (Noncoronary) Sinus.- Origin of Both Coronary Arteries from the Right Aortic Sinus.- Arteriographie Demonstration.- Origin of Both Coronary Arteries from the Left Aortic Sinus.- 5 Hypoplasia of the Coronary Arteries.- Right Coronary System.- Right Coronary Artery.- Posterior Descending Artery.- Left Coronary System.- Anterior Descending Artery.- Circumflex Artery.- Circumflex and Short Posterior Descending Arteries.- 6 Variations in the Length of the Left Coronary Artery.- Normal Left Coronary Artery.- Unusually Long Left Coronary Artery.- Short Left Coronary Artery.- Angiographic Demonstration.- Associated with Hypoplasia of the Right Coronary Artery.- Complications following Coronary Perfusion: Postoperative Acute Myocardial Infarction.- 7 Single Coronary Ostium in the Aorta.- Single Coronary Artery.- Entire Coronary System Arising from the Aorta.- True Single Coronary Artery.- Single Coronary Artery Bifurcating into Right and Left Coronary Arteries.- Atresia of a Coronary Ostium.- Origin of One of Two Coronary Arteries from the Pulmonary Trunk.- Origin of the Right Coronary Artery from the Pulmonary Trunk: Arteriographie Demonstration.- Origin of the Left Coronary Artery from the Pulmonary Trunk: Arteriographie Demonstration.- Origin of the Left Coronary Artery from the Right Pulmonary Artery.- 8 Abnormal Communications of the Coronary Arteries.- Communication of the Right Coronary Artery with the Coronary Sinus.- Communication of the Left Circumflex Coronary Artery with the Coronary Sinus.- Communication of the Right Coronary Artery with the Right Ventricle.- Communication of a Single Left Coronary Artery with the Right Ventricle.- Coronary Angiomatous Malformations Communicating with the Right Ventricle.- Communication of the Conus Branch of the Anterior Descending Artery with the Pulmonary Trunk.- Communication of Conus Branch of the Right Coronary Artery with the Pulmonary Trunk.- 9 Pathology of Obstructive Coronary Disease.- Lesions of the Coronary Ostia.- Right Coronary Ostial Spasm.- Left Coronary Ostial Spasm.- Ostial Stenosis: Angiographic Demonstration.- Stenosis of Left Coronary Ostium.- Right Coronary Ostial Stenosis Secondary to Atherosclerosis.- Left Coronary Ostial Stenosis Secondary to Atherosclerosis.- Ostial Stenosis following Aortic Valvular Replacement.- Ostial Stenosis Secondary to Aortic Disease.- Coronary Atherosclerosis.- Normal Structure of Coronary Arteries.- Primary Nature of Lesions.- The Fibrous Lesion.- Orientation of Atheromas.- Distribution of Lesions.- Complicating Lesions.- Nonatheromatous Coronary Disease.- Embolism.- Primary Dissecting Aneurysm.- Dissecting Aneurysm following Cannulation.- Proliferative Lesion following Cannulation.- Arteritis.- Miscellaneous.- 10 Angiocardiographic-Pathologic Correlations.- Coronary Arteries.- Confirmation of Normal.- False Negative: Atherosclerosis Grades II through III.- False Negative and Agreement.- Correlative Studies Using Longitudinal Sections and Postmortem Angiography.- Left Ventricle.- Normal Left Ventricular Contraction.- Akinesis and Focal Scars.- Akinesis and Conglomerate Subendocardial Myocardial Scarring.- Circumferential Akinesis and Infarction 304 Combination of Disorders.- 11 Angina Pectoris.- Definition.- Stable Angina Pectoris.- Normal Coronary Arteriogram.- Spasm of the Proximal Right Coronary Artery.- Associated with Aortic Stenosis and Normal Coronary Arteries.- Severe Obstructive Coronary Disease without Myocardial Infarction.- Previous Myocardial Infarction.- Systemic Hypertension Associated.- Familial Hyperlipidemia.- Associated with Aortic Stenosis and Obstructive Coronary Disease.- Congestive Heart Failure with Minimal Myocardial Scarring.- Congestive Heart Failure with Extensive Myocardial Scarring.- Mitral Insufficiency.- Unstable Angina Pectoris.- Myocardial Infarction with Minimal Scarring.- Myocardial Infarction with Extensive Scarring.- Aneurysm of the Left Ventricle.- As a Prodrome of Myocardial Infarction.- 12 Intermediate Syndrome.- Definition.- Illustrative Cases.- Case 1.- Case 2.- 13 Acute Myocardial Infarction.- Definition.- Anatomic Locations.- Pathologic Features.- Clinical Manifestations.- Subendocardial Infarction.- Transmural Infarction.- Atypical (Silent Episode).- Associated with Normal Coronary Arteriograms.- Sinus Bradycardia and Hypotension as Initial Problems.- Simulation of Acute Pulmonary Embolism.- Complication of Coronary Arteriography.- Complications.- Arrhythmias.- Heart ("Pump") Failure.- Thromboembolism.- Rupture of the Heart.- Rupture of the Free Wall of the Left Ventricle.- Late Rupture of the Free Wall of the Left Ventricle.- Rupture of the Free Wall of the Left Ventricle: Formation of False Aneurysm.- Angiographic Demonstration.- Rupture of a Large False Aneurysm of the Left Ventricle.- Rupture of a Small False Aneurysm of the Left Ventricle.- Rupture of the Ventricular Septum.- Rupture of a Papillary Muscle.- Rupture of a Papillary Muscle and of the Free Wall of the Left Ventricle.- Rupture of a Papillary Muscle: Chronic Mitral Insufficiency.- 14 Healed Myocardial Infarction.- Ventricular Scarring without Electrocardiographic Evidence of Previous Infarction.- Complications.- Congestive Heart Failure.- Left Ventricular Aneurysm.- Mitral Insufficiency.- Sudden Death.- 15 Surgical "Revascularization".- General Considerations.- Bypass Grafting.- Indications.- States Unfavorable for Graft.- Complications in Grafts.- Postoperative States.- Intramyocardial Vascular Implant.- Vineberg Procedure.- Vineberg Procedure Combined with Bypass Graft Procedure.- Vein Graft Implanted within the Left Ventricle.- Endarterectomy.- Postoperative Thrombosis.- Postoperative Occlusion by a Proliferative Lesion.- Changes following Probing of an Artery.- 16 Surgical Therapy for Myocardial Infarction and Its Sequelae.- Acute Myocardial Infarction without Associated Lesions.- Resection of Necrotic Myocardium.- Acute Myocardial Infarction Complicated by Arrhythmia.- Rupture of the Ventricular Septum.- Mitral Valvular Insufficiency.- Left Ventricular Aneurysm.- Resection of a False Aneurysm.- Resection of a True Aneurysm.- Associated with Rupture of the Ventricular Septum: Long-Term Survival.