In this experience, most cases of systolic anterior motion resolved with conservative measures including beta-blockade, vasoconstriction, and fluid administration. Persistent systolic anterior motion with left ventricular outflow tract obstruction was documented in 2.3% of patients who had early systolic anterior motion, but late reoperation was not required. Furthermore, the clinical outcomes of patients with systolic anterior motion are comparable to the current norms for mitral valve repair. Ninety percent of patients were in New York Heart Association class I, 7% were in class II, and 3% were in class III or IV.

We designed and implemented a digital flat-panel-based rotational X-ray coronary angiography technique hypothesizing that luminal disease could be identified with less radiation exposure and contrast usage compared to conventional angiography. Individuals scheduled for diagnostic coronary angiography were prospectively enrolled. In addition to conventional acquisitions in standard planes, subjects underwent one additional left coronary artery (LCA) or right coronary artery (RCA) rotational (spin) acquisition using a predefined trajectory. Radiation exposure and contrast volume were recorded for each run. Seventy-five subjects were enrolled. When compared with standard five-view cine acquisition, LCA spin angiography with one cranial and one caudal run resulted in 34.38% +/- 13.65% less radiation, 18.98% +/- 4.97% less contrast, and comparable assessment of stenosis severity. One spin acquisition compared with three standard cine acquisitions for RCA angiography resulted in 59.31% +/- 29.07% lower radiation, no significant change in contrast, and comparable assessment of stenosis severity. Rotational X-ray coronary angiography provides comparable visualization of coronary anatomy compared with traditional nonrotational coronary angiography with significantly less radiation exposure and contrast volume.

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Arteriovenous fistula presents rarely with liver involvement. A 73-year-old man had new-onset ascites, hepatomegaly, and abnormal liver and renal function test results. An abdominal computed tomogram revealed a 7.6-cm internal iliac aneurysm but no other abnormality to account for his ascites. An aortogram demonstrated a 1.5-cm internal iliac arteriovenous fistula that subsequently was repaired, leading to resolution of his symptoms and laboratory abnormalities. High-output cardiac failure should be considered in the differential diagnosis of patients with new-onset massive ascites, hepatomegaly, and liver test abnormalities.

Arteriovenous fistula presents rarely with liver involvement. A 73-year-old man had new-onset ascites, hepatomegaly, and abnormal liver and renal function test results. An abdominal computed tomogram revealed a 7.6-cm internal iliac aneurysm but no other abnormality to account for his ascites. An aortogram demonstrated a 1.5-cm internal iliac arteriovenous fistula that subsequently was repaired, leading to resolution of his symptoms and labora-tory abnormalities. High-output cardiac failure should be considered in the differential diagnosis of patients with new-onset massive ascites, hepatomegaly, and liver test abnormalities.