bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitral valve motion during diastole in patients with complete heart block: Relation of pressure gradients between left atrium and left ventricle
Authors: Matsuda Yasuo , Moritani Kohshiro , Toma Yoichi , Date Toshiaki , Miura Toshiro , Kohtoku Shinya , Ogawa Hiroshi , Matsuda Masako , Matsuzaki Masunori , Kusukawa Reizo
Published: March 2007

We analyzed the high‐fidelity left atrial and left ventricular pressures and the echocardiograms of the mitral valve, left atrium, and left ventricle in patients with complete heart block. During left ventricular diastole, the mitral valve opened, and no pressure gradient was observed between the left atrium and the left ventricle before the left atrial contraction. After the left atrial contraction, the mitral valve closed with persistent higher left ventricular than left atrial pressure. These findings indicated that during the left ventricular diastole in patients with complete heart block, the mitral valve closed after the left atrial contraction, which appeared to be maintained by the pressure gradient between the left ventricle and the left atrium.
Transcatheter retrieval of intracoronary detached angioplasty guidewire segment
Authors: Mikolich J. Ronald , Hanson Michael W.
Published: March 2007

A transcatheter technique of removing a detached angioplasty guidewire segment from the diagonal branch of the left anterior descending coronary artery is described. A standard 0.014 angioplasty guidewire was modified into a “snare” apparatus for retrieval of the detached wire segment. The retrieval was successfully accomplished without intimal dissection, plaque hemorrhage, or vessel occlusion.
Hugging balloons: Coronary angioplasty of oversized vessels with side‐by‐side balloons
Authors: Teirstein Paul S. , Johnson Warren L. , Rutherford Barry D. , Hartzler Geoffrey O.
Published: March 2007

Angioplasty of large (<4.0‐mm) saphenous vein grafts using the largest available (4.0‐mm) balloon catheters may result in inadequate graft dilatation. To avoid leaving a significant residual stenosis, two balloon catheters can be inflated side by side across the stenosis. Herein, we report two cases where this “hugging balloon” technique was used to achieve wide graft patency.
Axillary vein approach for pulmonic valvuloplasty in infants with iliac vein obstruction
Authors: Sideris Eleftherios B. , Baay John E. , Bradshaw Robert L. , Jones John E.
Published: March 2007

Repeated pulmonic balloon valvuloplasty from the axillary vein was performed in two infants with initial transvalvular gradients of 131 and 162 mm Hg. The first angioplasty was performed through the femoral vein and improved the valve gradient in both patients. Because of obstruction of the iliac system the axillary vein approach was used for the second angioplasty. The transaxillary pulmonic valvuloplasty decreased the gradient to acceptable levels, and no complications were noticed. The axillary vein approach can be the alternative to the femoral one in cases with obstructed iliac system or interrupted inferior vena cava.
The paceport catheter: A new pacemaker system introduced through a swan‐ganz catheter
Authors: Simoons M.L. , Demey H.E. , Bossaert L.L. , Colardijn F. , Essed C.E.
Published: March 2007

We describe a new stainless steel, teflon‐coated 2.4 F pacemaker wire with a flexible tip that can be introduced through an extra lumen of a specially designed 7.5 F Swan‐Ganz catheter. The extra lumen opens at 19 cm from the tip of the catheter; this opening can be positioned in the right ventricular cavity. The pacemaker wire can be introduced at the time of insertion of the Swan‐Ganz catheter or later when the need for ventricular pacing arises. The Paceport catheter was tested in 23 patients. Satisfactory ventricular pacing was achieved in 19 patients at thresholds between 0.5 and 4.0 mA (median 2.0 mA). The threshold increased by 1 mA during long‐term pacing (8–24 hr). Attempts to use the pacemaker were abandoned when short runs of ventricular tachycardia developed upon introduction, while an exceptionally high threshold was observed in another patient. The Paceport system is recommended for patients who require hemodynamic monitoring and urgent ventricular pacing.
Use of a satellite‐assisted computer link for long‐distance research collaboration
Authors: Sheehan Florence H. , Dodge Harold T.
Published: March 2007

Research collaboration between investigators located at some distance from each other is not only possible but also feasible. By using satellite‐assisted computer‐to‐computer links, researchers across the United States and overseas work with the staff and facilities of the Cardiovascular Research and Training Center (CVRTC) in the University of Washington, Seattle. This report presents the mechanics, advantages, and results of using such an approach to collaborate with distant colleagues.
Aortic percutaneous transluminal valvuloplasty in elderly patients by balloon larger than aortic anulus
Authors: Rocha P. , Md Baron , Lacombe P. , Bernier A. , Kahn J. C. , Liot F. , Bourdarias J. P.
Published: March 2007

Twenty‐four elderly patients (79 ± 7 years) with long‐standing calcified aortic stenosis have been divided in two comparable groups of 12. The first group was treated with 19 mm balloon percutaneous transluminal valvuloplasty, where the balloon diameter was always smaller than the aortic anulus diameter. Peak‐to‐peak aortic valve gradient decreased from 76 ± 32 mmHg to 30 ± 19 (P > .05), and the aortic valve area, calculated by Gorlin formula, increased from 0.40 ± 0.17 cm2 to 0.57 ± 0.17 (P > .05). The second group was treated with a trefoil 25 mm balloon, always larger than the aortic anulus diameter. In this second group, peak‐to‐peak aortic valve gradient decreased from 73 ± 34 mmHg to 23 ± 15 (P > .05), and aortic valve area increased from 0.47 ± 0.14 cm2 to 0.88 ± 0.36 (P > .05), increasing thus more than in group | (P > .05).

Clinical tolerance to balloon inflation was not the same according to individual patients but was similar between the two groups; complications were comparable in the two groups. These results suggest that aortic valvuloplasty by trefoil balloon larger than aortic anulus can provide wider aortic valve area without increasing complication rate.
Visualization of isolated conus artery as a major collateral pathway in patients with total left anterior descending artery occlusion
Authors: Md Masakazu Yamagishi , Md Kazuo Haze , Md Jun Tamai , Md Kenichi Fukami , Md Shintaro Beppu , Md Tsuyoshi Akiyama , Md Kunio Miyatake
Published: March 2007

To examine the existence of isolated conus artery (ICA) as a source of collateral circulation, we selectively visualized the ICA in patients with left anterior descending coronary artery (LAD) occlusion using a no. 5 French catheter. One hundred and fifty patients with a total LAD occlusion were selected from 639 consecutive patients who had diagnostic coronary angiography during an 18‐month period; the ICA was found in 45 patients. Among these patients, 30 showed the ICA as a collateral vessel supplying the distal LAD. In nine of these patients, conventional left and right coronary angiography did not reveal any other significant collateral vessels, and the distal LAD was perfused mainly by the collaterals from the ICA. No serious complications such as ventricular fibrillation or myocardial infarction occurred during these procedures. These results indicate that the selective ICA visualization is clinically important when conventional left and right angiography does not demonstrate collaterals to the obstructed LAD.
Percutaneous mitral balloon valvotomy during pregnancy in a patient with severe mitral stenosis
Authors: Palacios Igor F. , Block Peter C. , Wilkins Gerard T. , Rediker Donald E. , Daggett Willard M.
Published: March 2007

Percutaneous mitral balloon valvotomy (PMV) was performed successfully in a 41‐year‐old pregnant patient with severe mitral stenosis. The patient had a 21‐week gestation and was severely limited by symptoms resulting from critical mitral stenosis. PMV resulted in a decrease in the diastolic mitral gradient from 26 to 2 mm Hg and an increase in both cardiac output (from 4.2 to 5.7 I/min) and mitral valve area (from 0.7 to 3.7 cm2). She had marked symptomatic improvement, no further heart failure, and a full‐term, normal delivery.

This case report indicates that PMV may be the treatment of choice in the management of pregnant patients with incapacitating symptoms caused by severe mitral stenosis.
Technique for guiding catheter exchange during coronary angioplasty while maintaining guidewire access across a coronary stenosis
Authors: Newton C. Mark , Lewis Stephen A. , Vetrovec George W.
Published: March 2007

This case report describes a technique for guiding catheter exchange while angioplasty extended guidewire access is maintained across a coronary artery stenosis with a 245cm‐0.035‐in.‐long wire in the aorta to exchange for a more favorable guiding catheter. The indications, technique, and outcome of a case are described; it illustrates the usefulness of maintaining angioplasty guidewire access in a difficult‐to‐cross coronary stenosis.
Coronary artery dissection secondary to blunt chest trauma
Authors: Md Satish Kohli , Saperia Gordon M. , Waksmonski Carol A. , Md Stephen Pezzella , Singh Frcp Jang B. , Md
Published: March 2007

A 38‐yr‐old woman presented with an anterolateral myocardial infarction following blunt chest trauma sustained in a motor vehicle accident. Subsequent cardiac catheterization revealed a large left ventricular aneurysm and angiographic evidence of dissection of the proximal left anterior descending artery. Review of the literature and management are discussed.
Transluminal coronary angioplasty in the treatment of silent ischemia
Authors: Md Patrick Bergin , Myler Richard K. , Shaw Richard E. , Stertzer Simon H. , Clark David A. , Md Colman Ryan , Murphy Ms Mary C. , Rn
Published: March 2007

Fifty‐four asymptomatic patients with positive thallium exercise tests underwent coronary angiography followed by coronary angioplasty (PTCA), as the primary therapy for silent ischemia. The procedure was technically successful in 89% of these patients. Emergency bypass graft surgery was necessary in 2 (3.6%) and q‐wave myocardial infarction occurred in 1 (1.8%) of these.

All fifty‐four patients have been followed for a mean of 35 months since angioplasty. Of the 48 patients with initially successful PTCA, 12 had either clinical restenosis (9/14 or 19%) or a new lesion (3/48 or 6%) during follow‐up, which required a repeat PTCA. At the longest follow‐up, 46 (85%) had been successfully treated with one or more PTCA procedures. Two patients (3.6%) had sustained late q‐wave myocardial infarction and two additional patients reported angina pectoris. There were no deaths.

Angioplasty as a primary therapy for silent ischemia appears efficacious, with success and restenosis rates comparable to those in the symptomatic population. Eventfree survival is improved, compared with natural history data for patients with silent ischemia from other studies. Prudent risk/benefit analysis may help to define subgroups most likely to benefit from this intervention.
Brachial artery injury as a complication of cardiac catheterization: Percutaneous transluminal angioplasty and streptokinase as a treatment alternative
Authors: Md Paolo Angelini , Bush Howard S.
Published: March 2007

Brachial artery injuries are a well‐described complication of cardiac catheterization. Traditional therapy has involved surgical repair. We report a case treated with baloon angioplasty followed by streptokinase. This procedure may provide a treatment alternative in a select group of patients.
Prolonged selective urokinase infusion in totally occluded coronary arteries and bypass grafts: Two case reports
Authors: Md Louis McKeever , Md Joseph Hartmann , Md Vincent Bufalino , Md Joseph Marek , Md Alan Brown , Md Mark Goodwin , Md Nicholas Stamato , Md John Cahill , Md Michael Colandrea , Md Firouz Amirparviz
Published: March 2007

Reports are presented demonstrating a technique for dissolving thrombus in coronary arteries and bypass grafts by using prolonged selective infusion of urokinase via an infusion wire. This allows one to pass a steerable guide wire through the culprit stenosis and perform angioplasty on a distal lesion which could not be previously seen.
Late thrombotic occlusion of saphenous vein grafts: Successful recanalization using thrombolytic therapy
Authors: Grill Howard P. , Brinker Fsca Jeffrey A. , Md
Published: March 2007

We report two cases in which thrombosis was the primary cause of vein graft occlusion many years after bypass surgery. Both displayed minimal thrombolysis immediately after a selective infusion of streptokinase but were patent when reimaged hours later. Such therapy may be helpful when graft occlusions are associated with a large volume of thrombus.
Acquired coronary artery fistula: A sign of mural thrombus
Authors: Lucca Michael J. , Tomlinson Gregory C.
Published: March 2007

This is a case report documenting an acquired coronary artery fistula from the left anterior descending artery through a mural thrombus into the left ventricle by serial coronary arteriography. This abnormality may be an early clue to mural thrombus formation and help provide guidance in making therapeutic anticoagulation decisions.
Systolic and diastolic performance in normal human subjects as measured by ultrafast computed tomography
Authors: Wachspress Joseph D. , Clark Neil R. , Untereker William J. , Kraushaar Barbara T. , Kurnik Peter B.
Published: March 2007

Ultrafast computed tomography (ultrafast‐CT) is a minimally invasive imaging modality with very short acquisition time and excellent anatomic definition. It shows promise of providing precise measurement of right and left ventricular volumes, left ventricular mass, and left ventricular diastolic function with a single test. We expand on the knowledge regarding normal humans by studying ten normal volunteers in the short axis. Cardiac volumes and mass (mean ± 1 S.D.) were as follows: 1) left ventricle: end‐diastolic volume index (mlm2) = 61 ± 15, end‐systolic volume index (ml/m2) = 19 ± 7, stroke volume index (ml/m2) = 43 ± 9, cardiac index (liters/min/m2) = 2.7 ± .5, ejection fraction (%) = 70 ± 7, end‐diastolic mass (g/m2) = 95 ± 15; 2) right ventricle: end‐diastolic volume index (ml/m2) = 76 ± 19, end‐systolic volume index (ml/m2) = 35 ± 13, stroke volume index (ml/m2) = 40 ± 8, cardiac index (liters/min/m2) = 2.6 ± .5, ejection fraction (%) = 55 ± 6. Stroke volume index differed by 1.6 ± 2.0 ml/m2 between ventricles.

Measurement of global and segmental left ventricular diastolic function revealed: 1) Peak filling rate (end‐diastolic volumes/second): global = 2.29 ± .40, base = 1.78 ± .49, midventricle = 2.49 ± .57, apex = 3.13 ± .39 (P < .001, base vs. apex; P < .01, base vs. midventricle and midventricle vs. apex); 2) time to peak filling rate (msec): global = 193 ± 24, base = 192 ± 20, midventricle = 194 ± 26, apex = 190 ± 19 (P = NS between levels).

Thus, the current study substantiates and expands the accuracy and utility of ultrafast‐CT in providing comprehensive evaluation of systolic and diastolic function in chuman subjects at rest with a single, minimally invasive procedure.
Variability and reproducibility of quantitative left ventricular angiography
Authors: Rigaud M. , Hardy A. , Castadot M. , Rocha P. , Dubourg O. , Delorme G. , Bardet J. , Bourdarias J. P.
Published: March 2007

To evaluate the reproducibility of left ventricular angiography for the assessment of left ventricular (LV) function and regional wall motion, two ventriculographies were performed in the 30° right anterior oblique (RAO) projection, at 15‐minute intervals, in 19 patients undergoing coronary angiography. Heart rate, left ventricular systolic pressure, and end‐diastolic pressure were measured 15 minutes after the first angiography returned to the baseline values (71.0 ± 14.1 vs. 72.2 ± 15.5 beats/minute, 153.6 ± 18.0 vs. 152.8 ± 19.9 mm Hg, 21.7 ± 8.6 vs. 20.9 ± 7.3 mm Hg, respectively). Global and regional LV performance was analyzed by two observers with a computer‐assisted technique. Intraobserver mean variation of end‐diastolic volume and ejection fraction was less than 3% of the control value. Interobserver mean variations for the same parameters were less than 4% of control values. For both observers, there was no significant variation of LV end‐diastolic volume and ejection fraction from one study to the other. Under stable hemodynamic conditions, the mean observed variations were, depending on the observer, 5–6% of the control value for LV end‐diastolic volume and 5% for ejection fraction.

Analysis of segmental wall motion was also highly reproducible. The mean intraobserver variation (% of control value) of wall motion ranged from 4.4% to 9.2%, depending on the sectors studied. The mean interobserver variation, whatever the sector, ranged from 6.9% to 13.5%. The mean interstudy variability for both observers ranged from 6.6% to 15%. In conclusion, any change greater than 6% for end‐diastolic volume, 5% for ejection fraction, and 15% for radial shortening should be considered as significant, provided that hemodynamic conditions are unchanged.
Effects of respiration and vasodilation on venous volume in animals and man, as measured with an impedance catheter
Authors: Ferguson James J. , Miller Michael J. , Sahagian Peter , Aroesty Julian M. , McKay Raymond G.
Published: March 2007

Venous return determines cardiac preload and is in turn affected by respiration and vasodilation. The purpose of the present study was to examine the dynamics of venous return and venous volume, using impedance volume measurements in the venous system. In order to develop a methodology for the assessment of venous volume and venous return in man, we first studied 17 endotracheally intubated and ventilated anesthetized closed‐chest dogs. We measured central venous and inferior vena cava (IVC) pressure (micromanometer) and volume (impedance catheter). Studies were done above and below the diaphragm with normal ventilation, with positive end‐expiratory pressure (PEEP), and with beta‐adrenergic blockade and i.v. nitroglycerin. Intrathoracic IVC volume fell and extrathoracic IVC volume rose with lung inflation, while PEEP raised extrathoracic IVC volume and lowered intrathoracic IVC volume. Nitroglycerin lowered intrathoracic IVC volume. Beta blockade did not affect IVC volume, ventilatory variation, or response to PEEP and nitroglycerin. We performed similar studies in 14 human subjects during normal quiet respiration, with measurements above and below the diaphragm, and with interventions including Valsalva maneuver and i.v. nitroglycerin. Intrathoracic IVC volume fell and extrathoracic IVC volume rose with expiration and Valsalva maneuver. Nitroglycerin again lowered intrathoracic IVC volume.

We conclude that venous volume and the dynamics of venous return can be assessed in animals and man with an impedance catheter. Specifically, we show the divergent effects of respiration, ventilation, PEEP, and nitroglycerin on IVC volumes above and below the diaphragm. Beta‐adrenergic blockage does not appear to play a role in altering any of these effects. Continuous measurement of venous pressure and impedance volume may be used in the future to examine more closely venous pressure‐volume relationships.
Left heart catheterization by direct ventricular puncture: Withstanding the test of time
Authors: Morgan J. M. , Gray H. H. , Gelder C. , Miller G. A. H.
Published: March 2007

If retrograde arterial catheterization of the left ventricle fails because of a stenosed native or tissue valve or is contraindicated because of the presence of a mechanical aortic prosthesis, then alternative routes of access to the left ventricle are either transseptal or direct (transapical) left ventricular puncture. The transseptal approach is contraindicated in the presence of a mechanical mitral valve prosthesis. Under these circumstances we have used direct transapical left ventricular puncture in the treatment of 112 patients and have found this technique to be successful with little associated risk. A major complication occurred in 3% of the patients, but the study provided the required data in 95%, and these figures compare favorably with the reported results of transseptal catheterization.
Angina and vasospasm at rest in a patient with an anomalous left coronary system
Authors: Maddoux Gerry L. , Goss Jerome E. , Ramo Barry W. , Raff Gilbert L. , Heuser Richard R. , Shadoff Neal , Leatherman George F. , Blake Kathleen , Wilson John N. , Deane William M. , Hoyt Thomas W. , Fowler Burt N. , Gerety Richard L. , Sansonetti Diane
Published: March 2007

An anomalous left main coronary artery with passage between the right ventricular infundibulum and aortic root has been incriminated as the causation of sudden death in a small number of individuals, many of whom are quite young. Mechanical features such as angulation and compression are most often incriminated. A 59‐year‐old man with such a coronary anomaly who had chest pain at rest, ST segment elevation, and ventricular tachycardia, but who had no evidence of effort‐related myocardial ischemia, is reported. Improvement in the degree of coronary tone in the anomalous left main coronary with intracoronary nitroglycerin administration was demonstrated. This represents the first report of an individual with an anomalous left main coronary system with ventricular tachycardia/ventricular fibrillation and documented vasospasm in the anomalous artery.
Initial coronary occlusion improves tolerance to subsequent prolonged balloon inflations
Authors: Heibig Jacques , Bolli Roberto , Harris Scott
Published: March 2007

An acute coronary occlusion with severe ischemic signs during percutaneous transluminal coronary angioplasty was successfully treated with a long balloon inflation. Subsequent balloon inflations did not produce ischemic signs. Distal coronary occlusion pressure rose significantly during balloon inflations of more than 2 min. It is hypothesized that an initial ischemic occlusion may improve tolerance to prolonged coronary occlusions. The underlying mechanism may be that further coronary collateral circulation is recruited over time.
Mitral valve rupture during percutaneous dilation of aortic valve stenosis
Authors: De Ubago Jose Luis M. , De Prada Jose Antonio Vazquez , Moujir Fernando , Olalla Juan Jose , Figueroa Alvaro , Colman Thierry
Published: March 2007

A 62‐year‐old patient underwent catheter balloon valvuloplasty for aortic valve stenosis. During the procedure, iatrogenic severe mitral regurgitation was induced, requiring emergency surgery. At operation, extensive laceration of the septal mitral leaflet was found; chordae tendinae were intact.

Retrospective examination of the cineangiogram revealed the presence of balloon indentation at the chordal level during inflation, which disappeared at full inflation. Mitral valve rupture was probably related to balloon entrapment in chordae tendinae, severe chordal stretching at inflation, and subsequent valve laceration.

This severe complication or aortic valvuloplasty in adults has not been reported previously and probably could be avoided by careful observation of guidewire and balloon position before inflation.
Fatal aortic rupture: An unusual complication of percutaneous balloon valvuloplasty for acquired valvular aortic stenosis
Authors: Vrolix Matty , Piessens Jan , Moerman Philip , Vanhaecke Johan , De Geest Hilaire
Published: March 2007

A case report complicated by a perforation of the ascending aorta during percutaneous balloon valvuloplasty for acquired aortic stenosis in a bicuspid aortic valve is presented. The clinical and pathological findings are discussed. It is suggested that in patients with hard calcified valve cusps and calcifications of the aortic annulus balloon sizes exceeding the aortic diameter should be avoided.
Coronary air embolism during coronary angioplasty
Authors: Hadjimiltiades Stavros , Goldbaum Thomas S. , Mostel Ed , Mintz Gary S. , Kimbiris Demetrios
Published: March 2007

A case is described in which the use of the Hartzler microcatheter during coronary angioplasty resulted in coronary air embolism. The recognition, prevention, and mechanism of this occurrence are discussed.
Dual connection of the left anterior descending coronary artery to the left and right coronary arteries
Authors: Bittner Vera , Nath Hrudaya P. , Cohen Mark , Soto Benigno
Published: March 2007

Origin of the left anterior descending coronary artery from the right coronary artery is a well‐described but rare congenital coronary anomaly. In this report, we describe two cases in which the mid left anterior descending coronary artery is connected to the right coronary artery through an intraseptal connecting vessel, while the proximal left anterior descending coronary artery originates normally from the left main coronary artery. This previously unreported pattern suggests partial persistence of the peritruncal ring, which occurs during normal embryologic development of the coronary circulation. Even though it is classically described as an epicardial structure, the vascular pattern in our cases suggests that the peritruncal ring may have an intramural segment in some individuals.
Echocardiographic findings in patients with acquired immunodeficiency syndrome (AIDS) and AIDS‐related complex (ARC)
Authors: Kinney Evlin L. , Brafman David , Wright Robert J.
Published: March 2007

Although a variety of cardiac abnormalities have been described in AIDS patients, it is unclear whether these are incidental findings or they presage clinically important heart disease. Also, because AIDS‐related complex (ARC) is, in general, a milder form of AIDS, we wondered if echocardiographic abnormalities would differ in kind or in frequency, when compared with AIDS. To answer these questions, we studied the echocardiographic findings and the demographic features of 15 patients with AIDS and 24 patients with ARC. The ARC group had abnormalities in the same proportion as in our AIDS group, except for echocardiographic mitral valve prolapse. The MVP, however, did not appear to be due to intrinsic valvular disease. Rather, echocardiographic MVP was associated with low body weight (P = .02) but not with the cardiac signs or symptoms of MVP. Four AIDS patients had LV dysfunction. Of the echocardiographic variables, only a wide EPSS was significantly correlated with survival, as it is in other populations. We conclude that although echocardiographic abnormalities are common in AIDS and ARC patients, most of these abnormalities lack clinical significance.
Anomalous drainage of the inferior vena cava into a left atrial connection: A case report involving a 41‐year‐old man
Authors: Meyers David G. , Latson Larry A. , McManus Bruce M. , Fleming William H.
Published: March 2007

A 41‐year‐old man had an anomalous inferior vena cava directly connected to the left atrium demonstrated by contrast echocardiography, magnetic resonance imaging, angiography, and at operation. The anomaly is due to developmental failure of the right sinus venosus valve, septum secundum, and dorsal portion of the atrial septum.
Myocardial infarction due to multiple coronary‐ventricular fistulas
Authors: McLellan Bruce A. , Pelikan Peter C. D.
Published: March 2007

Coronary‐ventricular fistulas have been described in both right and left coronary arteries and have been implicated in causing cardiac symptoms and coronary ischemia. We present a case of three‐vessel coronary‐ventricular fistulas emptying into both ventricles, associated with a left‐to‐right shunt and a myocardial infarction.
Coronary bifurcation stenoses: The kissing balloon probe technique via a single guiding catheter
Authors: Myler Richard K. , McConahay David R. , Stertzer Simon H. , Johnson Warren , Cumberland David C. , Boucher Ralph A. , Hidalgo Benito
Published: March 2007

A new technique employing two balloon probes via a single (large‐lumen) guiding catheter is described. Examples involving the left anterior descending, diagonal, left main (protected), left circumflex‐obtuse marginal, and atrioventricular branches and the right coronary artery‐posterior descending and posterolateral branches are described and illustrated.

This new technology (balloon probes and large‐lumen guiding catheter) permits an effective and simplified alternative to the use of the single‐guide/two‐wire and doubleguide/two‐dilatation catheter‐wire approaches in selected cases in which significant branch vessels (vis‐a‐vis myocardial regional blood supply) are at risk.
Coronary arteriography 1984–1987: A report of the registry of the society for cardiac angiography and interventions. II. An analysis of 218 deaths related to coronary arteriography
Authors: Lozner Eugene C. , Johnson Lewis W. , Johnson Sarah , Krone Ronald , Pichard Augusto D. , Vetrovec George W. , Noto Thomas J. ,   The Registry Committee of the Society for Cardiac Angiography and Interventions
Published: March 2007

In a 42‐month period, 218 deaths occurred in 222, 553 patients undergoing coronary arteriography (0.098%). Age > 60 years, NYHA Class IV function, presence of left main coronary disease, and ejection fraction < 30% all significantly increased the risk of the procedure. Sex and approach (brachial or femoral) used for the catheterization did not affect mortality. Since the SCAI report in 1982, the death rate has dropped significantly in high‐risk patients. Low‐risk patients (NYHA Class I or normal coronary arteries) who died generally were elderly or had associated valvular heart disease.
Early occlusion following successful coronary angioplasty: Clinical and angiographic observations
Authors: Goldbaum Thomas , Disciascio Germano , Cowley Michael J. , Vetrovec George W.
Published: March 2007

To assess clinical and angiographic features of early occlusion after percutaneous transluminal coronary angloplasty (PTCA), 25 successful PTCA procedures (3%) with early occlusion were analyzed from a PTCA population of 917. Twenty patients (80%) had unstable angina, while 12 (48%) had a recent (< 1 mo) myocardial infarction subtended by the PTCA vessel. All patients received a calcium blocker, aspirin, dipyridamole, and heparin prior to PTCA. In 20 of 25 patients (80%), occlusion occurred in the catheterization laboratory, while five occurred out of laboratory, three within 5 hours and 1 each within 24 and 48 hours. Angiographic features before PTCA included complex lesions (hazy, stained, or ulcerated) in 12 (48%) and intracoronary filling defects in eight patients (32%). Post‐PTCA intracoronary filling defects were present in 17 dilated stenoses (68%). Compared to a consecutive control population of 100 patients with similar demographics but without acute occlusion, the frequency of unstable angina, acute myocardial infarction, and filling defects was greater in patients with early occlusion (P < .001 for all). Intracoronary nitroglycerin was utilized in all patients with reopening in only one (4%), while bypass surgery was performed in five (20%). Intravenous streptokinase was administered to two patients with reperfusion in one. Immediate repeat PTCA was successful in 15 of 17 patients (88%).

In summary, recent unstable angina, myocardial infarction, complex lesions or intracoronary filling defects before and particularly after PTCA all suggest an association of clot with early occlusion. Immediate repeat PTCA is frequently successful.
Coronary angioplasty in a patient with dextrocardia
Authors: Gaglani Rajesh , Gabos Dennis K. , Sangani Bharat H.
Published: March 2007

This report, concerning the procedures applied to a patient with dextrocardia, describes how such a patient was able to undergo a normal diagnostic catheterization. These data should be added to the limited data on interventional procedures in patients who have this anomaly.
Single large‐balloon percutaneous mitral valvuloplasty
Authors: Herrmann Howard C. , Kussmaul William G. , Hirshfeld John W.
Published: March 2007

Successful percutaneous balloon mitral valvuloplasty was performed in six patients utilizing single large (up to 30 mm diameter) balloons. Mitral valve area increased from 1.1 ± 0.1 to 2.5 ± 0.3 cm2 (P < 0.01), and there were no complications or significant increases in mitral regurgitation. Single largeballoon mitral valvuloplasty may be as effective as the currently used double‐balloon technique and may allow the procedure to be performed more easily and quickly.
Morphology of coronary lesions in the prediction of early ptca outcome
Authors: Haft Jacob I. , Bassil Habib F. , Goldstein Jonathan E. , Haik Bruce
Published: March 2007

The coronary lesions in 164 patients who underwent 194 PTCA procedures were analyzed in an effort to define if there were morphological characteristics that would predict thrombotic problems following percutaneous transluminal angioplasty (PTCA). Patients with smooth and concentric or eccentric lesions rarely had difficulty at PTCA, whereas those with filling defects or with eccentric and irregular lesions frequently had postprocedure thrombi. Total occlusions were amenable to angioplasty when there was lesion staining present, but the success rate was significantly less in patients in whom there was no staining. These findings suggest that the acute outcome of PTCA can be predicted on the basis of the morphology of coronary lesions on preprocedure angiography.
Acute reocclusion during percutaneous transluminal coronary angioplasty: Immediate and long‐term outcome
Authors: Buccino Kenneth R. , Brenner Alan S. , Browne Kevin F.
Published: March 2007

Acute total occlusion of a coronary artery during percutaneous transluminal coronary angioplasty (PTCA) has previously resulted in emergency surgical intervention (CABG). We retrospectively surveyed 211 elective procedures and 65 procedures for acute myocardial infarction (AMI). There were 42 patients (pts) [29 elective (14%) and 13 AMI (20%)] in whom total occlusion occurred after initial dilation had been achieved. In 30 of 42 pts reangioplasty successfully reperfused the vessel. Ten patients (24%) required CABG and two (5%) were treated medically for AMI. Death occurred in 2 pts due to irreversible cardiogenic shock despite successful angioplasty. After 6 months follow‐up 22 pts remained asymptomatic. It is concluded that aggressive redilation of total occlusions which develop during PTCA will frequently result in a successful angioplasty with a long‐term restenosis rate comparable to uncomplicated angioplasty.
Results of percutaneous valvuloplasty for calcific aortic stenosis with different balloon catheters
Authors: Voudris V. , Drobinski G. , L'Epine Y. , Sotirov I. , Moussallem N. , Canny M.
Published: March 2007

Percutaneous aortic valvuloplasty is a palliative treatment for patients with calcific aortic stenosis who would be poor candidates for surgical treatment. The results and associated complications of this procedure were analysed in a series of 47 patients in which different types of dilating catheters were used. In 25 patients a single balloon (19 mm) was used (group A), in 13 patients a bifoil balloon (2 × 15mm) (group B), and in the remaining nine patients (group C) a trefoil balloon (3 × 10mm) was used. An increase in aortic valve area was achieved in all patients. The results obtained with the bifoil balloon were better than with the other types of balloon catheter, with an increase in aortic area of + 118% vs. + 74% (monofoil) and + 76% (trefoil) (P < 0.05). The tolerance of the inflation procedure was also better with this type of balloon, as it allowed for shorter inflation and deflation times. These results show that balloon aortic valvuloplasty, when indicated, is best performed with a bifoil balloon dilating catheter, and undue complications usually do not occur.
Angioplasty of unusually large coronary arteries using the hugging balloon technique via a single guiding catheter
Authors: Mayo Joseph R. , Myler Richard K. , Stertzer Simon H. , Cumberland David C. , Bashour Tali , Manubens Sergio , Hidalgo Benito
Published: March 2007

Unusually large native coronary arteries, in particular those supplying expansive regions of myocardium, may not be adequately dilated using currently available coronary angioplasty catheters. The “hugging balloon” technique, in which two dilatation catheter balloons are simultaneously inflated side‐by‐side, has been previously described for lesions in large saphenous vein grafts using the double guiding catheter (and dual entry site) technique. With the development of large lumen guiding catheters and lower profile dilatation catheters, we report the initial use of the hugging balloon technique via a single guiding catheter in oversized native coronary arteries.
Percutaneous aspiration of a coronary thrombus
Authors: Lablanche Jean Marc , Fourrier Jean Louis , Gommeaux Antoine , Becquart Jean , Bertrand Michel E.
Published: March 2007

Right coronary artery occlusion by a thrombus occurred during the coronary angiography performed in a patient with anterior myocardial infarction. Emergency coronary aspiration was undertaken via a 9F guiding catheter, which allowed the thrombus to be removed. The patient, who was in cardiogenic shock, immediately improved and was subsequently discharged without any complications or sequelae.
Percutaneous transluminal angioplasty in diffuse subtotally occluded vein grafts
Authors: Shimshak Thomas M. , Hartzler Geoffrey O.
Published: March 2007

In this brief case report, we describe the results of percutaneous transluminal angioplasty in two diffusely diseased, atretic saphenous vein grafts 18 and 72 months after surgery. At late follow‐up, both patients remain angina‐free. Although the diffuse nature of such lesions may be associated with increaced rates of restenosis, these preliminary observations support future efforts to dilate similar, chronically diseased saphenous vein grafts.
Use of pulmonary capillary wedge aspirates for the antemortem diagnosis of pulmonary microvascular tumor
Authors: Safian Robert D. , Come Steven E. , Kadin Marshall , Lorell Beverly H.
Published: March 2007

The diagnosis of pulmonary lymphangitic carcinoma usually requires fiberoptic bronchoscopy with transbronchial biopsy, percutaneous needle aspiration of the lung, and/or open lung biopsy. We performed right heart catheterization in three patients with adenocarcinoma, in whom the diagnosis of pulmonary lymphangitic carcinoma was made on the basis of cytologic examination of pulmonary capillary blood.
Preoperative left ventricular wall stress, ejection fraction, and aortic valve gradient as prognostic indicators in aortic valve stenosis
Authors: Smucker Mark L. , Manning Scott B. , Stuckey Thomas D. , Tyson Donald L. , Nygaard Thomas W. , Kron Irving L.
Published: March 2007

Patients with aortic valve stenosis (AS) and left ventricular (LV) dysfunction may dramatically improve after aortic valve replacement, but operative risk is high. In an earlier study, all patients with low preoperative wall stress and low ejection fraction, or with low aortic valve gradient, died or had persistent heart failure after operation. Because wall stress is difficult to calculate, we reassessed its effect and the effect of other preoperative characteristics on outcome in 66 consecutive catheterization patients with predominant aortic stenosis referred for valve replacement. Despite ejection fraction that was inordinately low compared with afterloading wall stress in nine patients, seven patients improved with surgery. All three patients with ejection fraction < 20% improved after surgery. Two of three patients with mean aortic valve gradients of < 30 mm Hg improved. Mortality was 33% in patients with mean gradient < 30 mm Hg and 19% with mean gradient < 50 mm Hg. In the 54 patients with calculated aortic valve areas of ≤ 0.8 cm2, 1 (2%) had continuing heart failure, while 6 of 12 (50%, P < .01) patients with aortic valve areas of 0.9–1.2 cm2 had continued symptoms of or died of heart failure. Patients who died or failed to improve after operation were older (71 ± 9 years) than those who improved (65 ± 9 years, P = .02). We conclude that wall stress calculations do not predict which patients with aortic stenosis will benefit from aortic valve replacement and that poor left ventricular function and low mean aortic valve gradient do not absolutely preclude operation. On the other hand, low gradient, non‐critical valve area, and advanced age are all relative contraindications to aortic valve replacement in aortic stenosis.
Ruptured aneurysm of the sinus of valsalva with single coronary artery
Authors: Goto Yasutoshi , Matsuno Yoshio , Yoshikane Hideki , Murakmi Rinji , Morioka Shigefumi , Moriyama Katsutoshi , Yamada Kinya
Published: March 2007

This paper will report the case of a patient with an aneurysm of Valsalva's sinus accompanied by single coronary artery (the presence of only a single ostium of the coronary arteries), who survived for 14 years, under conservative treatment, after a rupture of the aneurysm. In this patient the aneurysm of Valsalva's sinus ruptured from the right coronary sinus into the right ventricular outflow tract. The single coronary artery originated from the left coronary sinus, and the right coronary artery branched from the left main trunk and ran dorsally to the aorta. No case of ruptured aneurysm of Valsalva's sinus accompanied by a single coronary artery has been reported in the literature. After 14 years of conservative treatment, the patient was surgically treated by direct suture of the ruptured aneurysm and by aortic valve replacement. The postoperative course was uneventful.
Transient acute severe aortic regurgitation complicating balloon aortic valvuloplasty
Authors: Sadaniantz Ara , Malhotra Rahul , Korr Kenneth S.
Published: March 2007

Transient, acute severe aortic regurgitation documented by hemodynamic and Dopplerechocardiographic assessment was observed in an elderly woman immediately following balloon aortic valvuloplasty for critical aortic stenosis. Aortic regurgitation responded to medical therapy and resolved within 24 hr. Potential mechanisms are discussed. We suspect that an oversized balloon to aortic ring area stretched the annulus, separating the valve cusps and resulting in severe regurgitation, which rapidly normalized.
Open‐Ended guidewire: New technique for balloon angioplasty of chronically occluded coronary arteries
Authors: Vassanelli C. , Turri M. , Morando G. , Menegatti G. , Zardini P.
Published: March 2007

Chronic total coronary occlusion is a growing indication to percutaneous transluminal coronary angioplasty. Since primary success of balloon angioplasty in this condition is usually limited by the difficulty of crossing the occlusion, different techniques have been described for this purpose, such as use of stiff guidewires, coronary infusion catheters, guidewires with an olive‐shaped tip, or new developing methods (atherectomy, laser), in association with balloon dilatation.

Here, we describe our initial experience with a thick (0.035 in) and relatively stiff open‐ended guidewire, which has an inner (0.018 in diameter) lumen provided with a core wire. Several advantages are considered. The core wire yields a perfect means of steerability of the whole system, while pushability of a thicker guidewire is much greater. Moreover, the core wire can be removed, and contrast injections beyond the occlusion through the inner lumen can assure proper intraluminal location. Finally, position across the occlusion can be kept easily, since an exchange wire for conventional balloon catheters can be inserted in the inner lumen of the open‐ended guidewire.
Percutaneous atherectomy of occlusive peripheral vascular disease: Stenoses and/or occlusions
Authors: Dorros Gerald , Lewin Ruben F. , Sachdev Naveen , Mathiak Lynne
Published: March 2007

Percutaneous atherectomy was performed using the Simpson Atherocath™ on 131 patients (87 male, 66%) with a mean age of 65 years. Clinical characteristics included evidence of significant coronary disease in 50%, hypertension in 46%, diabetes in 41%, and prior neurologic deficit in 32% of patients. The indication for atherectomy was claudication in 114 (87%) and rest pain, gangrene, or ulcer in 17 patients (13%). Atherectomy was successfully performed in 136/139 stenoses (98%) and in 56/56 occluded vessels with or without prior balloon angioplasty. No serious complications resulting in limb loss or emergency vascular surgery were encountered. Histopathology of retrieved specimens showed that 66% had atheromatous plaque, 45% had tunica media, and 30% had a form of thrombus. Material obtained from an occluded vessel was more likely to have thrombus and tunica media present than that from a stenosis (P < 0.02 and P < 0.05, respectively). Early angiographic follow‐up (mean time, 17 weeks) showed a relatively low (17%) lesion recurrence rate. Percutaneous atherectomy can be successfully utilized in stenotic and occluded peripheral arteries with good success and no serious complications; stenoses appear to have a low recurrence rate.
Difficult deflation of probeTM balloon due to twisting the system
Authors: Hamada Yoshio , Matsuda Yasuo , Takashiba Kiyoshi , Ohno Hiroshi , Fujii Banyo , Ebihara Hironori , Hyakuna Eiji
Published: March 2007

While using the balloon‐on‐a wire device, we experienced a case of difficult deflation of the ProbeTM balloon system. Blockage of the balloon system was possibly caused by twisting the system to reach and pass the lesion in the branch of left circumflex coronary artery. The duration of inflation was 20 min, causing prolonged ischemia.
A complication of prolonged urokinase infusion into a chronically occluded aortocoronary saphenous vein graft
Authors: Andersen Rolf L. , Kemp Harvey G.
Published: March 2007

Recanalization of a chronically occluded aortocoronary saphenous vein graft was performed, using a prolonged intracoronary infusion of urokinase followed by percutaneous transluminal coronary angioplasty (PTCA). Despite an angiographically successful result, the patient developed acute myocardial infarction, presumably secondary to distal migration of partially lysed thrombus. One week after successful angioplasty, the graft was once again proximally occluded.
Percutaneous coronary angioplasty of large venous graft using peripheral dilatation catheter
Authors: Heijer Peter Den , Van Dijk Rene B. , Berg Fred Van Den , Bakhuizen Rene , Lie K. I.
Published: March 2007

The maximum inflated diameters of standard percutaneous transluminal coronary angioplasty (PTCA) balloon catheters can be insufficient if stenoses in oversized venous grafts are to be dilated. As an alternative to the recently described “hugging balloon” technique [1], it seems feasible to use a standard peripheral angioplasty (PTA) catheter with a balloon diameter that is matching to the vessel. Such a procedure calls for a free long‐wire exchange and may be hampered by the stiffness of a PTA catheter. We report a case where this technique, used in an emergency procedure, resulted in a satisfactory angiographic result without causing complications.
Sinus of valsalva aneurysm presenting with complete heart block
Authors: Clark Vivian L. , Hawkins Earl T. , Wendt David J.
Published: March 2007

An elderly woman presented with sudden unresponsiveness and complete heart block and subsequently expired. Postmortem examination revealed an aneurysm of the right sinus of Valsalva impinging on the cardiac conducting tissue. Only a few cases associated with complete heart block have been previously reported.