By Zeev Vlodaver M.D., Kurt Amplatz M.D., Howard B. Burchell M.D., Jesse E. Edwards M.D. (auth.)
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Extra info for Coronary Heart Disease: Clinical, Angiographic, & Pathologic Profiles
1975), such measurements were made without complications using a gamma camera. Following imaging of the coronary arteries, the patient is placed under the gamma camera and approximately 20 mCi of xenon-133, dissolved in 1 to 5 cc of Ringer's solution are injected as a bolus through the selectively placed catheter (Figure 33D). The exhaled radioactive gas is drawn through an isolated duct system to an outside exhaust. A recording is made by a gamma camera using a pinhole collimator, and the radioxenon washout curves are analyzed using a monoexponential method, aided by the computer.
The second source of thromboembolism consists of the formation of a stasis clot in the C because of an improper flushing technique. This embolus may be much larger than the fibrin sheath on the C surface and may well represent a comparatively common cause of thromboembolism, resulting in stroke or myocardial infarction. The contrast material is probably not solely responsible for a significant number of myocardial infarctions. As could be shown by the xenon washout technique, the intracoronary injection of contrast material markedly increases myocardial tissue flow because of diffuse vasodilatation.
On rare occasions, however, a diffuse peripheral spasm may be induced by the contrast material as observed in one of our patients. The RC stayed opacified for 2 min with no evidence of dissection; severe chest pain and ECG changes of ischemia resulted. After administration of nitroglycerin and oxygen, the RC system slowly cleared and the patient made an uneventful recovery. It is possible that in this case a diffuse peripheral vasal spasm occurred, resulting in acute myocardial ischemia. Dislodged atheromatous material represents a third source of thromboembolism.
Coronary Heart Disease: Clinical, Angiographic, & Pathologic Profiles by Zeev Vlodaver M.D., Kurt Amplatz M.D., Howard B. Burchell M.D., Jesse E. Edwards M.D. (auth.)