bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in epicardial coronary arterial diameter following intracoronary papaverine in man
Authors: Carlson Eric B. , Gilliam F. Roosevelt , Bashore Thomas M.
Published: March 2007

The effect of intracoronary papaverine administration on epicardial coronary arterial diameter was examined in 18 male patients. Coronary‐artery cineangiograms were acquired with a power injector before intervention, 20 sec after intracoronary saline (control), and 20 sec after administration of papaverine into either the left (12 mg) or right (8 mg) coronary artery. Absolute coronary arterial diameter of a normal‐appearing segment was quantified using a previously validated, fully automated digital edge detection program with an ADAC digital radiographic unit. Baseline coronary arterial diameter of 3.1 ± 0.8 mm did not significantly change after saline administration (3.1 ± 0.9 mm) but did significantly increase (p < .001) to 3.4 ± 0.9 mm after papaverine administration. No significant percent change in diameter occurred in either the left anterior descending (−.5 ± 1.7%), left circumflex (−.2 ± 1.1%), or right (−3.0 ± 3.8%) coronary arteries with saline, but significant (p <.001) increases occurred with papaverine (7.2 ± 4.1%, 7.0 ± 4.5%, 6.8 ± 2.7%, respectively). The response of 7 coronary arteries examined immediately proximal to a significant lesion was not significantly different from the response of the remaining 11 coronary arteries. In conclusion, intracoronary papaverine causes a significant increase in coronary arterial diameter. This has clinical implications for assessing coronary flow reserve with devices that detect flow velocity.
Disappearance of high‐grade left anterior descending stenosis after revasculatization
Authors: Houghton Jan Laws , Callaghan William E. , Frank Martin J.
Published: March 2007

Complete resolution of a high‐grade left anterior descending (LAD) stenosis 6 months after revascularization with a left internal mammary artery (IMA) graft and the first reported case of spontaneous IMA graft spasm during repeat cardiac catheterization for continued atypical chest pain in the same patient are reported. Mechanisms involving regression of atherosclerosis and atypical spasm are briefly discussed.
Kinking of internal mammary grafts: Report of two cases and surgical correction
Authors: Brenot P. , Mousseaux E. , Relland J. , Gaux J. C.
Published: March 2007

Two patients who underwent left internal mammary artery (IMA) anastomoses to the left anterior descending artery (LAD) developed sudden angina associated with anterior ischemic changes on EKG in the early postoperative period, one at 4 hr and the other at 3 days following operation. Digitalized arteriography via retrograde injection of the left brachial artery revealed the IMAs, which were partially obstructed because of looping and Kinking, although the anastomoses to the LAD were patent. Reoperation was successful in relieving obstruction by reducing these abnormalities and resulted in an uncomplicated postoperative course following the second operation. Discussion of the etiology, radiological technique of diagnosis, correction, and prevention of this cause of internal mammary graft failure is presented.
Use of angioplasty guidewire for technically difficult angiography
Authors: Nakhjavan Fred K.
Published: March 2007

A new technique for negotiating severe vessel tortuosity or stenosis is described whereby a PTCA guidewire is initially used to cross the tortuosity or stenosed area. After introduction of a long‐tipped Sones catheter over the PTCA wire and past the stenosis, the latter is exchanged for the usual 0.035‐in guidewire. The Sones catheter is then removed and angiography proceeds as usual.
Variabilities in measurement of coronary arterial dimensions resulting from variations in cineframe selection
Authors: Reiber J. H. C. , van Eldik‐Helleman P. , Visser‐Akkerman N. , Kooijman C. J. , Serruys P. W.
Published: March 2007

To quantitatively analyze a coronary arterial segment from a cineangiogram, an enddiastolic or neighboring cineframe is usually selected, such that a possibly existing coronary lesion is visualized optimally, as judged by the cardiologist. However, different cardiologists may select different (although usually neighboring) frames, even when following the same selection criteria. It is also possible that the frames are selected from different cardiac cycles. In this study the effects of such phase shifts on the reproducibility of the quantitative measurements were studied.

In a total of 38 consecutive patient films obtained at a filmspeed of 25 frames/sec, the frame O demonstrating the severity of a lesion optimally, as judged by a senior cardiologist, the three preceding frames, the three following frames and one frame exactly one cycle prior to or following frame O were selected; frame O was always chosen in the end‐diastolic phase of the cardiac cycle. In each film one coronary arterial segment with a focal lesion was analyzed quantitatively in these eight frames with the Cardiovascular Angiography Analysis System (CAAS).

No significant differences were found in the mean difference and the standard deviations of the differences (variabilities) in the obstruction diameter, interpolated reference diameter, percent diameter stenosis, extent of the obstruction and area of atherosclerotic plaque obtained in the various frames with respect to frame O. Therefore, it may be concluded that the selection of a cineframe for quantitative analysis in the end‐diastolic phase of the cardiac cycle is not very critical; in other words, the obstruction measurements are not time‐dependent for frames in the end‐diastolic phase. It is argued that the quality of mixing of the contrast agent in the arterial segment is a major source of the observed variations; filling artefacts are potentially present in each of the selected frames.
Probe™, a balloon wire: Initial experience
Authors: Dorros Gerald , Lewin Ruben F. , Mathiak Lynne
Published: March 2007

Coronary angioplasty is unsuccessful in <3–5% of cases because the balloon catheter fails to follow a guidewire that has traversed a lesion. Between June 1986 and August 1987, 31 lesions were unable to be crossed with at least two standard angioplasty catheters. Finally, a 2.0‐mm‐diameter Hartzler LPS (ACS) was utilized and successfully crossed and dilated 16 out of 31 lesions (52%). In the remaining 15 lesions, the ProbeTM (USCI) 2.0 mm diameter × 1.5 cm long balloon wire was able to cross the lesions in 13 (82%) and successfully dilated 12. In one case, lesion rigidity prevented the balloon from expanding at 14 atm. A right coronary artery lesion was attempted in 11 cases, and a left anterior descending and circumflex artery lesion in two patients each. No complications were encountered. In seven out of 12 successful ProbeTM cases, a larger balloon catheter was used to further dilate the artery. This new balloon wire has increased our success rate in severe stenoses and in tortuous vessels with severe distal lesions, in which presently available angioplasty equipment has failed.
Bilateral coronary thrombosis in the absence of inducible coronary spasm, thrombocytosis, coagulation abnormalities, or angiographic evidence of coronary artery disease: Previously undescribed method of myocardial infarction
Authors: Md Alan Feit, , Hazday Marcos S. , Reddy C.V.R. , Md Robert Kipperman,
Published: March 2007

A 32‐year‐old man presented with symptoms and electrocardiographic changes consistent with acute anterolateral myocardial infarction. Selective coronary angiography revealed thromboses in the infarct related artery as well as in the right coronary artery. This case is unique because bilateral in‐situ coronary thrombosis producing acute myocardial infarction was documented in the absence of previously proposed mechanisms.
Concurrent percutaneous balloon valvuloplasty for combined tricuspid and pulmonic stenoses
Authors: Chen Chuan Rong , Lo Zheng Xiang , Huang Zheng Dong , Cheng Tsung O.
Published: March 2007

Percutaneous balloon valvuloplasty was successfully performed in a 55‐year‐old Chinese woman with severe recurrent tricuspid and pulmonic stenoses 11½ years following open valvotomies. An lnoue balloon catheter with the balloon made of double‐layered rubber and nylon micromesh was used. The orifices of the tricuspid and pulmonic valves increased from 13 to 27 mm in diameter and from 6 to 14 mm in diameter, respectively, following concurrent balloon valvuloplasties. The present report demonstrated for the first time the feasibility of percutaneous balloon valvuloplasty for combined valvular stenoses.
A simple modified technique for recording sinus node electrogram
Authors: Deli Zhang , Shulan Chen
Published: March 2007

We recommend a technique for recording a sinus node electrogram (SNE) that is quite simple and makes it easy to locate the electrode poles firmly in the place underlying the sinus node (SN); the success rate is 97%.
Hematologic changes occurring with cardiac catheterization
Authors: Friedman Howard S. , Trivelli Lillian A. , Md Thach Nguyen , Bs Reine Benamor , Cpt Marietta Dorsa, Bs
Published: March 2007

The composition of the blood influences rheology and therefore might affect hemodynamics. During cardiac catheterization and angiography, blood is sampled and contrast media, fluid, and heparin are administered. To determine the effects of these perturbations on the blood cell count and coagulation, femoral vein samples were obtained at the beginning of cardiac catheterization, before heparin, 4,000 U; at the end, before protamine reversal; and after protamine, 40 mg, was administered. At the end of catheterization, 41 ± 3 min after heparin administration, all cellular constituents were significantly lower than control: White (W) blood cells (BC) were 8.1 ± 2.7% lower (P > 0.05), red (R) BC, 10 ± 1.8% (P< 0.05), and platelets (P) 10.9 ± 1.5% (P > 0.05). Protamine lowered further WBC by 23 ± 4% (P > 0.05 and P) by 14 ± 2% (P > 0.05), but did not change RBC (4.13 ± 0.20 × 106 to 4.25 ± 0.23 × 106). Before protamine administration, all patients had a partial thromboplastin time (PTT) 1.5 times the control value and ten of 13 patients had a value greater than 100 sec. Although four of 13 patients had an incomplete reversal of PTT after protamine, none suffered an untoward event. In conclusion, cardiac catheterization produces changes in the cellular composition of the blood, and such changes might influence hemodynamic measurements.
New nonsurgical technique for multiple pericardial biopsies
Authors: Md Jiři Endrys , Md Michal Šimo , Shafie Mohamed Z. , Md Babu Uthaman , Mrcp Yahia Kiwan , Md Tulsidas Chugh , Ali Syed M. , Md Karel Spaček , Yousef A. M. , Cherian George
Published: March 2007

We report a new, nonsurgical technique for obtaining multiple pericardial biopsies in patients with pericardial effusion. A short catheter is introduced by the Seldinger technique under fluoroscopy through the subxiphoid approach. The pericardial fluid is aspirated and the catheter replaced by an 8F teflon sheath with a curved tip. A bioptome is inserted through the sheath, and air is allowed to enter the pericardium. This method outlines the parietal pericardium. The curved sheath directs the bioptome to the left or right wall. Eighteen consecutive patients had an average of eight pieces of pericardium removed. On histological examination, three patients had malignancy. Six had tuberculous granuloma, and mycobacterium tuberculosis was cultured from all six tissue specimens but only once from the fluid. Tissue smears showed acid fast bacilli in four out of six, whereas the fluid was negative in all. The biopsy yielded diagnostic information in nine out of ten patients with a thickened pericardium. There were no complications.
Use of a metal ring‐marked catheter for geometric calibration in quantitative coronary angiography
Authors: Jacobs James H. , Bove Phd Alfred A. , Md , Smith Hugh C. , Chesebro James H.
Published: March 2007

Quantitative coronary angiography depends on accurate measurement of catheter shaft diameter for correction of X‐ray magnification errors. We compared the use of coronary catheters with a single metal ring (R), inserted during manufacture, with measurements using the edges of the catheter shaft (S) as a calibration mark. Both ring and shaft were 2.50 mm in diameter. On unmagnified X‐ray images, the ring measured 2.49 ± .040 mm, and the shaft measured 2.39 ± .040 mm in diameter. Quantitative coronary angiography using both ring and shaft for calibration provided the same percent stenosis (R: 72 ± 12; S: 71 ± 13), but stenosis cross‐sectional area was 28% different (R: 1.44 ± .24; S: 1.84 ± .34 mm2). Use of the catheter shaft for calibration causes overestimation of actual coronary artery dimensions. To prevent this problem, absolute measurements of coronary artery dimensions should be made with metal ring‐marked catheters.
Percutaneous entry of the brachial artery for transluminal coronary angioplasty
Authors: Kamada Roy O. , Fergusson David J. G. , Itagaki Raymond K.
Published: March 2007

Angioplasty is most commonly performed with catheters introduced percutaneously into the femoral artery. A brachial approach has previously been described that employs arteriotomy and cutdown. We describe here the technique and initial results of an alternative method of brachial entry, wherein the catheter is introduced percutaneously. Angioplasty has been performed in 26 patients in this manner, without complications.
Use of temporary pacemakers during coronary angioplasty: An evolving experience with ventricular fibrillation in 400 cases
Authors: Johnson Lewis W. , Bowser Michael A. , Lozner Eugene C.
Published: March 2007

Because of a perceived high frequency of ventricular fibrillation when a pacemaker catheter was placed in the right ventricular apex during PTCA, we reviewed our first 400 cases for this complication. The incidence of ventricular fibrillation in the entire group was 10 of 400 cases (2.5%) compared with 17 of 3,806 (0.4%) diagnostic coronary arteriograms performed in our laboratory during the same time period (P < .001). Ventricular fibrillation occurred more frequently during PTCA when the pacemaker catheter tip was placed in the right ventricular apex (8 of 63 cases, 12.6%) than when it was positioned in either the pulmonary artery, vena cava, or when a pacemaker catheter was not used (2 of 337 cases, 0.6%, P < .001).

Based on these data we have developed a policy of inserting temporary pacemakers prophylactically during PTCA only for patients undergoing dilation of dominant right or dominant left circumflex coronary arteries and in patients with acute myocardial infarction.
Coronary arteriography in dogs following blunt cardiac trauma: A longitudinal assessment
Authors: Sabbah Hani N. , Mohyi James , Stein Paul D.
Published: March 2007

The purpose of the study was to examine the effects of blunt cardiac trauma on the epicardial coronary arteries of dogs by using sequential coronary arteriographic studies. A direct impact to the anterior surface of the heart at a velocity of 12 m/sec was delivered by an air pressurized impactor in eight of ten dogs with the chest open and the pericardium intact. Selective coronary arteriograms were performed percutaneously with the chest closed starting just before trauma and repeated afterward at intervals of 3 hours, 3 days, 2 weeks, and 5 weeks. Two of ten dogs were sham operated and did not undergo impact to the heart. The coronary arteries in these two dogs remained angiographically normal throughout the study period. In dogs that underwent impact and were maintained for the entire duration of the study (seven of eight dogs), injury to the epicardial coronary arteries occurred in every instance. Injury was limited mostly to branches of the left anterior descending and right coronary arteries. The left circumflex coronary artery, which was posterior to the site of impact, was always spared. The types of injury included complete branch occlusion, partial coronary obstruction, extravasation, and in one instance, an arteriovenous fistula. In nearly all instances, these injuries became evident angiographically between 3 hours and 3 days after impact and usually were completely resolved after 2 to 5 weeks. These observations indicate that the epicardial coronary arteries may be compromised by nonpenetrating cardiac impact. The resulting coronary pathology, however, resolved within a few weeks after injury.
Acute myocardial infarction during percutaneous aortic balloon valvuloplasty
Authors: Md Ubeydullah Deligonul , Kern Morton J. , Bell Stephen T. , Md Gregory Gabliani , Md Arthur Labovitz , Md Michel Vandormael
Published: March 2007

Balloon valvuloplasty has been shown to be a relatively safe and effective intervention in palliating the symptoms of severe calcific aortic stenosis in the elderly [1–7]. Although the mechanism of balloon valvuloplasty is plastic deformation and fracture of the calcified valve tissue [2], complications such as embolic events or acute myocardial infarction due to aortic balloon valvuloplasty are very rare. Previously published reports mentioned only one case of cerebral embolism [5] and two patients with late fatal myocardial infarction [4]. In this report we present an elderly patient with calcific aortic stenosis who developed an acute lateral myocardial infarction during percutaneous balloon aortic valvuloplasty.
Use of angioplasty guiding catheters for improved coronary artery opacification
Authors: Vetrovec George W. , Thomas John H. , Md David Alpert
Published: March 2007

The following report describes the use of the high flow injection characteristics of a coronary angioplasty guiding catheter to improve coronary opacification in a patient with exceedingly high coronary runoff. This technique offers improved coronary visualization in special cases.
Assessment, of coronary angioplasty: Comparison of visual assessment, hand‐held caliper measurement and automated digital quantitation
Authors: Md Demosthenis Katritsis , Lythall Bs David A. , Mb , Cooper Ian C. , Ba Alex Crowther , Webb‐Peploe Michael M.
Published: March 2007

Digital subtraction coronary angiograms (DSA) of 27 patients who had undergone coronary angioplasty (PTCA) to a total of 32 lesions were analyzed using an automated border‐detecting computer program and hand‐held caliper measurement of diameter percent stenosis. The results were compared with visual interpretation of the 35‐mm cineangiograms. Visual reports significantly overestimated the pre‐PTCA diameter percent stenosis (P < .001) and underestimated the residual post‐PTCA narrowing compared with the automatic computer program (P < .001). Caliper measurements overestimated significantly the pre‐PTCA stenosis in comparison with the computer (P < .01), but post‐PTCA the two methods did not differ significantly (P = .105). There was a positive but poor correlation between caliper and computer measurements (r = .43, P < .05) performed on the pre‐PTCA digital angiograms. Post‐PTCA the two methods correlated better (r = 0.78, P < .001), but further statistical analysis showed important discrepancies between them. The correlation of visual reports and computer measurements was poor pre‐PTCA (Kendall's r = 0.32, P < .05) and not statistically significant post‐PTCA(r = 0.64, P = .5).

We conclude that there is observer bias in the visual reporting of angioplasty results, so that pre‐PTCA lesions are overestimated, whereas post‐PTCA are underestimated. Hand‐held caliper measurement improves the assessment of coronary stenoses in comparison with the visual report but still may not altogether eliminate observer bias; it may overestimate the pre‐PTCA stenoses compared with automated border detection.
Simultaneous double balloon coronary angioplasty through a single guiding catheter for bifurcation lesions
Authors: Thomas Edward S. , Williams David O.
Published: March 2007

To enhance the safety, efflcacy and expediency of coronary bifurcation lesion angioplasty, we report the use of two dilatation catheters, advanced simultaneously through a single guide catheter in three patients. Successful dilatation was performed in each. The technique involves the use of either two new low‐profile dilatation catheters in an 8 French large lumen guide catheter or a single new low‐profile dilatation catheter coupled with a conventional over‐the‐wire catheter within a new large lumen 9 French guide.
Percutaneous double balloon aortic valvuloplasty in an adult patient with calcific aortic stenosis and a bjork‐shiley prosthetic mitral valve
Authors: Ruiz Carlos E. , Boltwood Chester M. , Lau Francis Y. K.
Published: March 2007

Percutaneous transluminal balloon valvuloplasty is a new technique in interventional cardiology which to date has been applied successfully in the dilatation of all four cardiac valves [1–4]. Although the different techniques appear to be quite effective, the safety of these procedures has not been fully explored. In particular, because of the close anatomic relationship of the aortic and mitral annuli, the safety of aortic valvuloplasty in patients with mitral valve prosthesis is unknown. Therefore, we report the applicability of a percutaneous double balloon valvuloplasty in an elderly patient with calcific aortic stenosis and a Bjork‐Shiley mitral valve prosthesis.
Simplified two‐wire technique for bifurcation lesions during coronary angioplasty
Authors: Bowser Michael A. , Lozner Eugene C. , Johnson Lewis W.
Published: March 2007

Bifurcation lesions are commonly encountered in coronary angioplasty. This paper describes a simplified approach to the problem with emphasis on the equipment used.
Use of exchange wires in coronary angioplasty
Authors: Bogart Douglas B. , Brown Barbara , Mortko Paula , Miller John T.
Published: March 2007

A 300 cm exchange guide wire was used as the primary wire in 59 consecutive patients referred for percutaneous transluminal coronary angioplasty. The success rate of the angioplasty using this as the only wire was 92% (54 of 59), and we were able to pass the exchange guide wire into the distal vessel in 56 of the 59 patients (95%). We believe the exchange wire technique has a place in the first‐line approach to complex coronary angioplasty.
Hemodynamic abnormalities during coronary angiography: Comparison of hypaque‐76, hexabrix, and omnipaque‐350
Authors: Piao Zhen En , Murdock David K. , Hwang Ming H. , Raymond Richard M. , Scanlon Patrick J.
Published: March 2007

The hemodynamic effects induced by coronary angiography in dogs with low osmolar ionic dimer Hexabrix (HB) and nonionic Omnipaque‐350 (OM) were compared to the standard ionic contrast medium, Hypaque‐76 (H76), both in the normal heart and in one with simulated severe cardiac disease. Left coronary angiography was performed in 12 “normal” closed‐chest dogs with 10‐cc injections of H76, HB, and OM in a randomized, blinded fashion. The maximal change in the left ventricular (LV) systolic pressure (SP), mean aortic pressure (MAP), left ventricular end diastolic pressure (LVEDP), and LV dp/dt were recorded. The LVSP and MAP fell 30 ± 3 mm Hg and 26 ± 4 mm Hg with H76, 22 ± 2 mm Hg and 19 ± 2 mm Hg with HB, and 7 ± 1.5 mm Hg and 5 ± 1 mm Hg with OM (P < .001). The LVEDP increased 4.8 ± 0.5 mm Hg with H76, 3 ± 0.5 mm Hg with HB, but only 0.2 mm Hg with OM (P < .001). The LV dp/dt decreased 392 ± 63 mm Hg/sec with H76 and 235 ± 21 mm Hg/sec with HB, but increased 411 ± 50 mm Hg with OM (P < .001). In eight additional open‐chest dogs, left coronary angiography was performed 1 hr after occlusion of the proximal LAD coronary artery and in the presence of a critical circumflex coronary artery (CX) stenosis. Occlusion of the LAD and the creation of a CX stenosis produced a 22 ± 3 mm Hg decrease in LVSP, a 310 ± 64 mm Hg/sec decrease in LV dp/dt, and a 4.7 ± 0.6 mm Hg increase in the LVEDP; 7 cc H76 produced a further 34 ± 6 mm Hg decrease in LVSP, compared with 13 ± 3 mm Hg with HB and 5.3 ± 1.5 mm Hg with OM (P < .001). The LV dp/dt decreased 505 ± 89 mm Hg/sec with H76, 210 ± 64 mm Hg with HB, but increased 265 ± 31 mm Hg with OM (P .001). The LVEDP increased 5.5 ± 1 mm Hg with H76, compared with 2.8 ± 0.6 mm Hg with HB and 0.37 ± 0.26 mm Hg with OM (P < .001). Thus, both low osmolar contrast media caused significantly less myocardial depression than the standard ionic contrast agents. OM is particularly devoid of myocardial depressive effects and produces less hemodynamic alteration than HB.
Angiographic coronary morphology in postinfarction angina
Authors: Lo Ying‐Sui A. , Abi‐Mansour Pierre , Kaplan Kerry J. , Kramer Barry L. , Hill Irene R. , Meyers Sheridan , Lesch Michael
Published: March 2007

To investigate the pathophysiologic relevance of angiographically irregular coronary stenoses in postinfarction angina (PIA), we analyzed the clinical course and coronary angiograms of 73 patients studied within 30 days of infarction. Coronary lesions were classified as smooth or irregular. Thirty‐six patients had PIA (Group 1) and 37 had an uncomplicated course (Group 2). Irregular lesion(s) in patent infarct‐related arteries were found in 77% of Group 1 vs. 24% of Group 2 patients (P < 0.005). Irregular lesion(s) in any coronary artery were found in 58% of Group 1 versus 19% of Group 2 patients (P < 0.002). Other univariate predictors of PIA included older age, hypertension, angina before myocardial infarct, lower peak creatine kinase, three‐vessel disease, and higher modified Gensini score. Multivariate analysis ranked lesion irregularity as the strongest predictor of PIA. Our data suggests that ruptured atherosclerotic plaques may be important in the pathogenesis of PIA. It is possible that lesion irregularity is associated with an active process and/or a residual thrombus, which may be responsible for postinfarction angina.
Emergency balloon angioplasty and digital subtraction angiography in the management of an acute latrogenic occlusive dissection of a saphenous vein graft
Authors: Roy Paul , Finci Leo , Bopp Pierre , Meier Bernhard
Published: March 2007

A 63‐year‐old male with status post quadruple aortocoronary bypass surgery suddenly complained of chest pain and had ST‐segment elevation in lead III during routine coronary angiography. Subsequent selective injections showed occlusion of the bypass graft to the right coronary artery, whereas by digital angiography done 15 min earlier it had been patent. Iatrogenic dissection of the graft was assumed, and balloon recanalization was immediately performed. Chest pain and signs of ischemia rapidly resolved, and no evidence of myocardial infarction was found until hospital discharge.
Local infection after percutaneous transluminal coronary angioplasty: Relation to early repuncture of ipsilateral femoral artery
Authors: Wiener Roy S. , Ong Ling S.
Published: March 2007

We describe two cases of groin infection following repuncture of the femoral artery to perform coronary angioplasty soon after diagnostic coronary arteriography. This serious complication can be avoided by using the contralateral femoral artery in this setting, even if the previously used entry site appears benign.
Myocardial ischemia with aortocoronary artery gradient reversal during right coronary angioplasty
Authors: Shah Yogesh , Kern Morton J.
Published: March 2007

Aortocoronary gradients are useful in assessing luminal obstructions and collateral supply during PTCA. Reversibility of collateral flow is demonstrated in a 51‐year old angina patient.
Power injection of contrast media during percutaneous transluminal coronary artery angioplasty
Authors: Goss Jerome E. , Ramo Barry W. , Raff Gilbert L. , Maddoux Gerry L. , Heuser Richard R. , Shadoff Neal , Leatherman George F.
Published: March 2007

Visualization of the coronary arteries during all phases of percutaneous transluminal coronary angioplasty using hand‐held contrast media injection devices is suboptimal. Power injection of contrast media for diagnostic coronary cineangiography has been performed in over 18,000 cases without power injector complication. Here we report our experience with 294 patients using power injection for visualization during all phases of PTCA. It provides optimal visualization of the coronary arteries and has not been associated with complications. It is a safe and efficient system with reduction in both the time and radiation exposure required to perform PTCA and allows determination of the adequacy of the result without unnecessary recrossing of the area of dilatation.
Safety and convenience of a mechanical injector pump for coronary angiography
Authors: Ireland M. A. , Davis M. J. E. , Hockings B. E. F. , Gibbons F.
Published: March 2007

Coronary angiography and left ventriculography was performed in 5,887 consecutive patients over a 5‐year period using a mechanical injector pump activated by a foot switch. Five coronary dissections occurred, four of the right coronary artery and one of the left internal mammary artery, which had been grafted to the left anterior descending artery. One patient had angina following an air embolus; there were no significant intramyocardial injections of contrast agent. The pressure generated in the catheter by hand injection of contrast agent was compared with that generated by the injector pump. Contrast agent was injected through a 7F Judkins Right 4 and an 8F Sones catheter by hand at slow, medium, and fast rates by hand and by the injector pump at 2,3, and 4ml/sec; maximum pressure generated was recorded. Although the pressures generated through a Sones catheter were similar using both methods, pressures with hand injection were much more variable. The pressures generated with hand injection through a Judkins catheter were lower than those with pump injection, but again the pressures showed much greater variability with hand injection.

The pump was found to be safe, reliable, predictable, and convenient when used for coronary angiography with Sones and Judkins catheters. It eliminates the need for a trained assistant during the procedure of coronary angiography.
Accurate determination of the transaortic valve gradient using simultaneous left ventricular and femoral artery pressures
Authors: Krueger Steven K. , Orme Eric C. , King Charles S. , Barry William H.
Published: March 2007

Accurate determination of the transaortic valve gradient has required two catheters, one in the left ventricle and one in the ascending aorta. We now report a new technique for measurement of the transaortic valve gradient from the simultaneous left ventricular (LV) and femoral artery (FA) pressure tracings. This technique was compared with the “true” gradient obtained by measurement of the simultaneous LV and central aortic pressures, and is accurate (R = 0.999) and relatively simple. Other approaches used to determine the mean transaortic valve gradient were less accurate: simultaneous LV‐FA (R = 0.981); aligned LV‐FA (R = 0.974); averaged simultaneous and aligned LV‐FA (R = 0.981); and nonsimultaneous LV‐aorta pullback (R = 0.953). Thus, this new technique provides an accurate transaortic valve gradient without requiring the use of two central catheters.
The potential risk of thrombosis during coronary angiography using nonionic contrast media
Authors: Hwang Ming H. , Piao Zhen En , Murdock David K. , Giardina John J. , Pacold Ivan , Loeb Henry S. , Reyes Cesar V. , Scanlon Patrick J.
Published: March 2007

The influence of contrast media on coagulation has an important association with thromboembolic complication during coronary angiography. In this study, whole blood was methodically mixed with nonionic contrast medium, lohexol (IOH), conventional ionic contrast medium, Hypaque‐76 (H76), and low osmolar ionic dimer Hexabrix (HB) in vitro. The thrombotic propensity of contrast agents can be evaluated by measuring the clot formation of the mixtures. The experiments were repeated with whole blood after systemic heparinization. In the in vitro study, 5 ml of canine (N = 10) and 3 ml of human (N = 11) whole blood was incubated for 30 min in glass tubes with equal volumes of IOH, H76, HB, and 0.9% NaCl before heparinization. Clot formation with IOH and 0.9% NaCl were seen both in dogs (4.0 ± 0.7 gm and 5.6 ± 0.8 gm) and in patients (1.4 ± 0.9 gm and 2.9 ± 1.3 gm), whereas no clot was seen with H76 or XB. Following heparinization, no clot was visualized in any mixture of whole blood with contrast media or 0.9% NaCl. Similar results were observed in the catheter‐syringe system with canine blood (N = 11) mixed with the contrast agents. Blood clots found in 15 min and 30 min of IOH were 0.07 ± 0.08 gm and 0.44 ± 0.20 gm (P < 0.01) and of NaCl were 0.29 ± 0.37 gm and 0.69 ± 0.38 gm (P < 0.01). No clot was present in HB and H76. After heparinization no blood clot was found in any mixtures of the catheter‐syringe system.

It is concluded that unlike ionic contrast media, nonionic contrast agents appear to have less inhibitory effects on blood clot formation and, thus, it might be associated with a higher risk of thromboembolic complications during coronary angiography. Since heparin inhibits clotting in the presence of nonionic medium, its use is particularly recommended when this medium is to be used in coronary angiography.
Relation between transpulmonary pressure and right ventricular isovolumetric pressure change during respiratory support
Authors: Jardin François , Brun‐Ney Dominique , Cazaux Pierre , Dubourg Olivier , Hardy Anne , Bourdarias Jean‐Pierre
Published: March 2007

Simultaneous recordings of airway pressure, pleural pressure, and right ventricular (RV) pressure were obtained during mechanically controlled ventilation in a group of patients requiring respiratory support. Changes in transpulmonary pressure (calculated as airway pressure minus pleural pressure) were measured at end‐expiration and end‐inspiration during intermittent positive pressure ventilation with or without the application of a positive end‐expiratory pressure, and were related to RV isovolumetric pressure changes at the onset of systole. It was found that any increase in transpulmonary pressure by intermittent positive pressure ventilation, or positive end‐expiratory pressure (PEEP), or both, was associated with a proportional increase in RV isovolumetric pressure change. Moreover, when lung volume was progressively increased by incremental increases in tidal volume or PEEP level, transpulmonary pressure and RV isovolumetric pressure changes were strongly and linearly correlated. These results suggest that: 1) RV isovolumetric pressure change might be used as an index of RV output impedance during respiratory support by mechanically controlled ventilation; and 2) lung inflation resulting from the use of a positive airway pressure during respiratory support can increase RV output impedance and thereby contribute to the decrease in RV stroke output.
Complement activation from protamine sulfate administration after coronary angiography
Authors: Click Roger L. , Homburger Henry A. , Bove Alfred A.
Published: March 2007

The cause of hypotension after reversal of heparin by protamine has not been well defined. In this study we evaluated complement activation (C3a and C4a) by the heparin‐protamine complex in 46 consecutive patients (40 received protamine sulfate to reverse heparin, and six did not) during and after coronary angiography. In patients receiving protamine sulfate, there was a significant increase in C3a over the value before protamine sulfate administration (P<.001) or in patients who did not receive protamine sulfate (P<.05): 807 ± 100 ng/ml vs. 274 ± 75 ng/ml. There were no significant changes in C4a after protamine sulfate administration. These results indicate that the alternate complement pathway is activated when protamine sulfate is administered after coronary angiography. This may induce hypotension as well as platelet aggregation and thrombus formation and may contribute to coronary instability. Therefore, in unstable patients, heparin reversal by protamine should not be done routinely.
Role of intracoronary thrombus in acute complications during percutaneous transluminal coronary angioplasty
Authors: Arora Rohit R. , Platko William P. , Bhadwar Kavita , Simpfendorfer Conrad
Published: March 2007

Coronary angiograms from 2,372 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) were retrospectively reviewed for the presence of intracoronary thrombus (ICT) before dilatation. Patients with evolving acute myocardial infarction and those receiving thrombolytic therapy were excluded from analysis. Coronary artery thrombus was present in 126 patients (6%) (group 1). When compared to 2,246 patients (group 2) without ICT, group 1 had a higher incidence of unstable angina, 74 % vs. 66% (<0.06), previous myocardial infarction, 59% vs. 37% (P < .0001), and history of a recent myocardial infarction, 28% vs. 9% (P < .0001). Patients with predilation intracoronary thrombus had a higher risk for acute occlusion, 6% vs. 2% (P < .002); however, the incidence of emergency coronary bypass surgery and myocardial infarction was similar in both groups. Therefore, the presence of predilatation intracoronary thrombus heralds an increased risk of acute occlusion, but not myocardial infarction or emergency coronary artery bypass surgery.
Survival after myocardial infarction caused by acute left main coronary artery occlusion: Case report and review of the literature
Authors: Cohen Mylan C. , Ferguson David W.
Published: March 2007

We report a 44‐year‐old white male presenting with an acute anterior myocardial infarction. Cardiac catheterization at 2 weeks postinfarction revealed total occlusion of the left main coronary artery. There was a normal dominant right coronary artery supplying moderate collaterals to the left coronary system. The patient was managed with conservative therapy and was N.Y.H.A. functional class II on followup 2 years later. A review of the literature relative to myocardial infarction caused by acute left main coronary artery occlusion is presented, and unique features of these cases are described.
Fracture of a balloon on a wire device during coronary angioplasty
Authors: van den Brand Marcel , de Feyter Pim , Serruys Patrick , Zijlstra Felix , Bos E.
Published: March 2007

In a 61‐year‐old patient with unstable angina an attempt was made to dilate a severe stenosis in a tortuous obtuse marginal branch. The initial attempt with conventional equipment was not successful; although the wire could be advanced distal to the stenosis, a 2.0 balloon did not cross the stenosis. A second attempt with a balloon on a wire device resulted in fracture of this catheter, with the distal 2.8‐cm‐long fragment looped in the left coronary artery. Immediate bypass surgery was performed and the broken fragment was easily removed from the left coronary ostium. The patient made an uneventful recovery.
The probe exchange catheter
Authors: Dorros Gerald , Lewin Ruben F.
Published: March 2007

In order to provide exchange capability to non‐over‐the ‐wire systems (i.e., Probe), an exchange catheter composed of an inner sheath catheter (.039″ external diameter) and a 4 French outer catheter was devised. The system was utillized to exchange between an over‐ to a non‐over‐the‐wire system, different non‐over‐the‐wire systems, and to provide balloon dilatation backup to the soft non‐over‐the‐wire systems in difficult‐to‐engage vein graft takeoff. The system was sccessful utilized in 50 patients without any related complications.
Complications of cardiac catheterization and angiography in patients with valvular heart disease
Authors: Folland Edward D. , Oprian Charles , Giacomini John , Schechter Eliot , Shabetai Ralph , Henderson William G. , Hammermeister Karl E. , Sethi Gulshan ,   The Participants In The Va Cooperative Study On Valvular Heart Disease
Published: March 2007

Complications were surveyed prospectively in 2,029 catheterizations performed on 1,483 patients from the 13 centers participating in the VA Cooperative Study on Valvular Heart Disease. Complications were reported in 6.9% of 1,559 preoperative procedures of which 2.6% were major and 0.2% fatal. Clinical predictors of complications were hypertension and the precatheterization diagnosis of aortic stenosis. Nevertheless, patients with aortic stenosis successfully tolerated left ventriculography, which was routinely performed regardless of the magnitude of gradient. Procedural predictors of complication were brachial arteriotomy (vascular occlusion) and transseptal catheterization (tamponade). Among the 470 postoperative catheterizations performed solely for research purposes, there were six complications, of which five were bleeding events in patients taking warfarin. Transseptal catheterization was safer in postoperative patients with no cases of tamponade in 125 procedures.
Left ventricular outflow obstruction by a mitral valve prosthesis: Doppler ultrasound and cardiac catheterization findings
Authors: Byrnes Timothy J. , Guillory William R. , Hanley Henry G.
Published: March 2007

Left ventricular outflow tract obstruction by a mitral valve prosthesis was noted several years following surgery when symptoms of congestive heart failure occurred. The diagnosis was made using two‐dimensional echocardiography and Doppler techniques and confirmed at heart catheterization, using micromanometer tipped catheters.
Comparison of the frequency response characteristics of catheter‐mounted piezoelectric and micromanometric phonotransducers
Authors: Garcia Juan C. , Layton Steven A. , Rubal Bernard J.
Published: March 2007

This study compares the frequency response characteristics of catheter‐mounted piezoelectric sound transducers with micromanometric transducers. The tip of a 8F catheter with two piezoelectric transducers and two micromanometers was inserted into a water‐filled chamber that had a speaker fixed at one end. The speaker was driven by a power amplifier and sine wave generator. The outputs of the transducers were connected to a low‐level amplifier. The piezoelectric transducer behaved as a tunable high‐pass filter that could be modified by altering the input impedance of the low level amplifier; the frequency response characteristics were examined at five input impedances ranging from 0.96 to 11.8 megohms. The peak‐to‐peak outputs of the piezoelectric and pressure transducers were recorded at frequency ranges from DC to 1 kHz with a wide‐band oscilloscope. The ratio of the outputs from the piezotransducer and micromanometer (Vph/Vpr) was plotted vs. frequency for each input impedance and analyzed to determine the piezotransducer's output resistance and equivalent capacitance; roll‐off frequencies were then calculated. The equivalent capacitance of the piezo‐element was determined to be 500–700 picofarads. Series capacitance acted with network resistance to produce a predictable frequency‐dependent change in signal amplitude and phase angle. The inherent noise of the pressure transducer was found to be approximately 0.2 mm Hg, while the noise of the piezoelectric transducer was immeasurably low. The piezoelectric phonotransducers were superior to micromanometer transducers in their higher gain and lower noise, suggesting that these transducers may prove useful to physiologic and clinical studies for measuring intravascular sound.
Stenotic anomalous circumflex artery causing myocardial infarction following angioplasty of a right coronary artery stenosis
Authors: Rivitz S. Mitchell , Garratt Kirk N.
Published: March 2007

A 68 yr‐old male with evidence of persistent inferior wall ischemia after successful PTCA of a solitary right coronary artery (RCA) lesion was found to have an anomalous left circumflex artery (LCX) arising from the ostium of the RCA. The LCX harbored an atherosclerotic subtotal obstruction, which was then successfully dilated with resolution of the myocardial ischemia. Although not known to have a statistical predisposition to atherosclerotic disease, diseased anomalous coronary arteries can be responsible for myocardial ischemia and infarction. A thorough search for such vessels is warranted in patients with abnormal diagnostic tests and no apparent obstructive lesions in the normally positioned arteries. Similarly, when ischemia does not resolve after successful treatment of a coronary stenosis, anomalous coronary arteries should be sought.
Angiocardiographic evaluation of right ventricular size and morphology in tricuspid atresia
Authors: Boucek Mark M. , Sturtevant Jane E. , Jaffe Richard B.
Published: March 2007

The potential for right ventricular growth and physiological repair in tricuspid atresia may influence the type of Fontan procedure. To evaluate preoperative right ventricular assessment, we compared the right ventricular size and morphology determined by selective right ventricular catheterization with axial left ventricular angiography. In seven consecutive patients with tricuspid atresia and ventriculo‐arterial concordance, the right ventricular volume was 12.8 ± 9.4 cc, with a predicted normal volume (based on body surface area) of 31 ± 16 cc, 43% (range 24–78%) of normal. Right ventricular injection outlined a right ventricular area twice that visualized from an axial left ventricular injection (33.2 vs. 16.5 cm). All patients had a well developed but small trabecular portion of the right ventricle, often unopacified with left ventricular injection. Subinfundibular narrowing adjacent to the ventricular septal defect was invariably present, creating, in effect, a two‐chambered right ventricle. Selective right ventriculography demonstrates the unique morphology of the right ventricle in patients with tricuspid atresia not visualized by axial left ventriculography.
Wearing of caps and masks not necessary during cardiac catheterization
Authors: Laslett Lawrence J. , Sabin Alisa
Published: March 2007

Although cardiac catheterization‐related infections are rare, caps and masks are often worn to minimize this complication. However, documentation of the value of caps and masks for this purpose is lacking. We, therefore, prospectively evaluated the experience of 504 patients undergoing percutaneous left heart catheterization, seeking evidence of a relationship between whether caps and/or masks were worn by the operators and the incidence of infection. No infections were found in any patient, regardless of whether a cap or mask was used. Thus, we found no evidence that caps or masks need to be worn during percutaneous cardiac catheterization.
Entrapment of venous catheter following inferior vena caval spasm
Authors: Dalvi B. V. , Gupta K. G. , Munsi S. C. , Vengsarkar A. S.
Published: March 2007

This is a report of a case in which a 5F high‐flow right coronary catheter with its guide wire was entrapped within the inferior vena cava following a venous spasm. Local infusion of nitroglycerin (NTG) relieved the spasm, and the guidewire–catheter assembly could be safely retrieved.
Complete membranous obstruction of inferior vena cava: Case treated by balloon dilatation
Authors: Loya Y. S. , Sharma Satyavan , Amrapurkar D. N. , Desai H. G.
Published: March 2007

A 30 year‐old male with the Budd‐Chiari syndrome due to complete membranous obstruction to the inferior vena cava was successfully treated by Brockenbrough needle puncture followed by balloon dilatation of the membrane. The procedure produced marked symptomatic relief and excellent haemodynamic and angiographic results. The case is reported to highlight the application of balloon angioplasty in this rare condition.
Large air embolus complicating coronary angioplasty
Authors: Haraphongse Mant , Rossall Richard E.
Published: March 2007

With the substantial advances in technology and further refinements in the technique of coronary angioplasty, the potential for and manifestations of complications may have changed from those observed in populations studied previously. We describe a rare complication of percutaneous transluminal coronary angioplasty (PTCA), a large air embolus obstructing coronary flow, which is related to the newer technology. The air embolus was successfully extracted by aspiration through the balloon angioplasty catheter.