Figure 1. Sixteen-row multislice computed tomography: interventricular communication.An 82-year-old female was admitted for syncope with previous history of chest pain. Physical examination revealed low blood pressure and an apical murmur. Echocardiogram: sinus rhythm and ST-segment elevation leads II, III and, aVF. Transthoracic echocardiogram was of poor technical quality because of obesity. Multislice computed tomography (MCT) was performed, which revealed a dilated right ventricle and apical ventricular septum rupture (Fig. 1). 1 Coronary angiography revealed severe left coronary atherosclerosis and occlusion of the right coronary artery. Shunt from the left to the right ventricle was confirmed by angiography (Fig. 2).Multislice computed tomography is a useful tool for patients with myocardial infarction and murmur. Figure 2. Left ventricle angiogram with contrast shunt to right ventricle (Big picture: right anterior oblique view. Small picture: left anterior oblique view).Reference 1. Zipes DP, Libby P, Bonow RO, Braunwald E: Braunwald's Hert Disease.
A new technique for right heart catheterization using a Mullins' sheath is described. This device allows a Swan-Ganz catheter to reach pulmonary artery position easily and permits simultaneous pressure recordings in right heart chambers, thus avoiding a double venous puncture and two catheters. This new technique, its indications, and our experience in 29 patients are described. It is most useful in patients with severe pulmonary hypertension and in those conditions in which accurate right heart pressure measurements are needed.
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