Stenosis of the common pulmonary venous (PV) channel after Senning's operation for complete transposition of the great arteries is a serious problem, and a method 'for noninvasive diagnosis is highly desirable. Therefore, our purpose was to devi'se a method to diagnose PV channel stenosis noninvasively. The newly created common PV channels were measured and the short-axis views of the'left ventricle were observed by means of two-dimensional echocardiography in 16 patients who had undergone Senning's procedure. In seven patients we used the original procedure and in nine patients we used a modified procedure with a pedicled pericardial patch. The shape of the left ventricle became round abruptly when the width of the PV channel decreased below a critical'value (a range of 6 to 9 mm). Three patients with a relatively round-shaped left ventricle and a narrow PV channel (below 9 mm) were all confirmed to have PV channel stenosis at reoperation. All of the patients with a wide PV channel (above 10 mm) and a flat-shaped left ventricle were in good condition both clinically and as determined from the catheterization data. After the operation, patients who had tricuspid regurgitation, pulmonary vascular obstruction, or residual left ventricular outflow tract stenosis had a relatively round-shaped left ventricle even though the PV channel was wide enough (above 10 mm). Measurement of the PV channel confirmed the effects of these conditions. Correct diagnosis of PV channel stenosis can therefore be made by observing the shape of the left ventricle and by measuring the PV channel. Circulation 68, No. 3, 545-549, 1983. AS OUR EXPERIENCE with Senning's procedure' for the complete transposition of the great arteries (TGA) increases, we recognize that stenosis of the newly created common pulmonary venous (PV) with a median age of 27 months. The body surface area ranged from 0.31 to 0.87 In2, with a median value of 0.46 Mi2. The follow-up periods ranged from 20 days to 25 months, with a mean value of 6 months (table 1).Instruments. The ultrasonic instrument used was a Toshiba sonolayergraph model SSH-l 1A with a 2.4 MHz transducer or an ATL Mark III mechanical sectorscanner. First we measured the width of the PV channel by two-dimensional echocardiography. Next, deformity of'the left ventricle was evaluated from the short-axis view at the level of the papillary muscles. This information was compared with catheterization data obtained within 48 hr after the echocardiographic study. The ultrasonic planes used for this study are shown in figure 1. From the first view (top) the width of the PV channel can be measured. The transducer was placed on the second or third left intercostal space at a parastemal position with'a slight'angulation along the line between the left shoulder and the right hip. This provided a long-axis view of the PV channel at the base of the heart. The second view (bottom) is the short-axis view of the left ventricle at the level of the papillary muscle. This view is used for the estimation of left...

Background: There is a paucity of data on the effect of optimal intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with standard PCI or coronary artery bypass grafting (CABG) in patients with multivessel disease. Methods and Results:The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1,021 patients undergoing multivessel PCI including the left anterior descending coronary artery using IVUS aiming to meet the prespecified criteria for optimal stent expansion. We conducted propensity score matching analyses between the OPTIVUS group and historical PCI or CABG control groups from the CREDO-Kyoto registry cohort-3 (1,565 and 899 patients) fulfilling the inclusion criteria for this study. The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization. In the propensity score-matched cohort (OPTIVUS vs. historical PCI control: 926 patients in each group; OPTIVUS vs. historical CABG control: 436 patients in each group), the cumulative 1-year incidence of the primary endpoint was significantly lower in the OPTIVUS group than in the historical PCI control group (10.4% vs. 23.3%; log-rank P<0.001) or the historical CABG control group (11.8% vs. 16.5%; log-rank P=0.02).Conclusions: IVUS-guided PCI targeting the OPTIVUS criteria combined with contemporary clinical practice was associated with superior clinical outcomes at 1 year compared with not only the historical PCI control, but also the historical CABG control.

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