bluuebunny/crossref_metadata_2025 huggingface dataset:
Value and limitations of intracoronary adenosine for the assessment of coronary flow reserve
Authors: Zijlstra F. , Juilli Md Y. Ère , Serruys P. W. , Roelandt J. R. T. C.
Published: March 2007

An ideal coronary vasodilator for studying coronary flow reserve should rapidly produce a maximal hyperemic response, be short acting to permit repeated measurements, and not alter systemic hemodynamics. We measured with a Doppler tip balloon catheter, in 12 patients before and/or after percutaneous transluminal coronary angioplasty the hyperemic response following 12.5 mg intracoronary papaverine and following gradually incremental bolus injections of intracoronary adenosine, starting from 0.05 mg until a maximal hyperemic response or side effects. The mean dose (±SD) of adenosine needed to produce maximal hyperemia was 0.23 (±0.20 mg). Coronary blood flow velocity after adenosine increased to 1.6 ± 0.3 times resting coronary blood flow velocity, comparable in magnitude to the hyperemia following intracoronary papaverine. The time from injection to peak effect after adenosine was 7.4 (SD ± 2.2) sec and after papaverine 26 (SD ± 7) sec. Adenosine resulted in a bradyarrythmia in three patients. Intracoronary adenosine is a potent and very short acting vasodilator for studying coronary flow reserve, but the side effects and unpredictability of the dosage needed to produce maximal hyperemia may limit its applicability.
Double loop guiding catheter: A primary catheter for angioplasty of the right coronary artery
Authors: Arani Djavad T. , Bunnell Ivan L. , Visco John P. , Conley James G.
Published: March 2007

Double loop guiding catheters have been used for percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) in 42 consecutive cases. A catheter with a 90‐ degree primary curve was used when the proximal RCA had horizontal or inferior orientation. When the proximal segment of the RCA was oriented superiorly (shepherd's crook), the catheter with a 75‐degree primary curve was used. Catheters were fabricated with short (1.5 cm) or long (2.3 cm) (USCI, C.R. Bard, Inc., Billerica, MA) distal tips. Short‐tip catheters were satisfactory in the majority of cases. When the RCA had a complex course and more backup was necessary or when the ascending aorta was wide, long‐tip catheters were found to be the best choice.

Angioplasty of 49 lesions was attempted in 42 consecutive patients. In 39 patients successful dilatation was achieved (93%). In three patients the procedure was unsuccessful. In one patient, the lesion could not be crossed with the guidewire despite an excellent backup. In another patient, two of three stenoses were dilated successfully; the distal lesion was crossed with a guidewire but could not be crossed with the balloon catheter in spite of a good backup. The lack of a satisfactory engagement and inadequate backup were responsible for the failure in only one patient. There were no complications related to these guiding catheters. We conclude that double loop guiding catheters are safe and can be the primary choice in all right coronary angioplasties. These catheters provide an excellent backup with consequent high success rate.
Angiographic demonstration of atherosclerotic stenosis, arterial spasm, and thrombus formation in an infarct‐related coronary artery
Authors: De Marchena Eduardo J. , Trohman Richard G. , Palomo Andres R. , Myerburg Robert J. , Kessler Kenneth M.
Published: March 2007

Clinical, angiographic, and pathologic data support the contention that atherosclerosis, platelet aggregation, and coronary vasomotility work in unison to cause coronary thrombosis, which in turn leads to myocardial infarction. A patient is described in whom, 2 months after an acute myocardial infarction, inducible coronary artery spasm and a nonocclusive thrombus were angiographically demonstrated at the site of a minimal atherosclerotic narrowing in the infarction‐related vessel. This report, to the best of our knowledge, is the first time that these three pathophysiologic mechanisms have been shown, in vivo, to be occurring concomitantly in an infarct‐related vessel. Documentation of the unified occurrence of these phenomena support the current concept of the pathophysiology of myocardial infarction.
Percutaneous transluminal angioplasty for shepherd's crook right coronary artery stenosis
Authors: Gossman David E. , Tuzcu E. Murat , Simpfendorfer Conrad , Beck Gerald J.
Published: March 2007

Angiograms from 1,043 consecutive patients undergoing right coronary artery angioplasty were reviewed to determine the incidence of “shepherd's crook” origin of the right coronary artery. Primary results, complications, and technical difficulties were compared with a control group. Fifty‐one patients (4.9%) were found to have this anatomic variation. Compared with a control group, the primary success rate was lower (86% vs. 98%) and the incidence of procedural difficulties was higher (33% vs. 13%). Technical problems led to the use of more guiding catheters and more guidewires per patient than in the control group. Thus, coronary angioplasty of shepherd's crook right coronary artery imposes technical problems and is associated with less than an optimal primary success rate.
Chronic bundle branch block and use of temporary transvenous pacemakers during coronary arteriography
Authors: Gilchrist Ian C. , Md Airlie Cameron
Published: March 2007

A retrospective analysis of 217 consecutive patients with chronic bundle branch blocks undergoing cardiac catheterization was done to evaluate the need for temporary transvenous pacing during coronary arteriography. In patients without temporary right ventricular pacemakers (n = 185), only one episode of high‐grade atrioventricular block occurred during coronary arteriography which required the urgent use of temporary pacing. All other bradyarrhythmias, including five episodes of transient asystole (greater than 3‐sec pause) and four episodes of artioventricular block (second degree or higher), were successfully managed without pacemaker utilization. Patients with prophylactic right ventricular pacemakers (n = 32) had a greater prevalence of ventricular fibrillation than those without pacing electrodes located in the right ventricle (2% vs. 9% respectively; P < 0.05). These findings suggest that routing phrophylactic pacemaker insertion during coronary arteriography in patients with chronic bundle branch block is not warranted and may place the patient at risk for developing iatrogenic ventricular arrhythmias.
Unstable angina secondary to left main coronary thrombus extending from prosthetic aortic valve
Authors: Avanindra Jain  , Mazanek Greg J. , Armitage John M.
Published: March 2007

Embolic complications due to prosthetic heart valves are common. The present report documents a left main coronary artery thrombus extending from a Starr Edward's aortic ball valve prothesis 22 years after its placement. It resulted in unstable angina and a small myocardial infarction. This rare complication illustrates the importance of adequate anticoagulation
Percutaneous radial artery approach for coronary angiography
Authors: Campeau Lucien
Published: March 2007

Percutaneous entry into the distal radial artery and selective coronarography using a French 5 sheath and preshaded catheters were attempted in 100 patients with a normal Allen test. Cannulation of the radial artery was not possible in ten patients, and selective catheterization of the coronary arteries was unsuccessful in two. Manipulation of catheters presented no problem, and arterial spasm was rarely observed, only before the use of a 23‐cm‐long sheath. Only two complications without symptoms were observed: arterial dissection of the brachial artery in one patient and occlusion of the radial artery in another. With experience, this approach may become as effective and possibly safer than the transbrachial entry.
Search and retrieval of a radiolucent foreign object
Authors: McLvor Michael E. , Kaufman Stephen L. , Satre Richard , Porterfield James K. , Brinker Jeffrey A.
Published: March 2007

Successful percutaneous removal of an intravascular foreign body requires precise localization of the object so that retrieval devices can be properly positioned. Here we report the successful search for and retrieval of a catheter embolus lost in the ascending aorta during PTCA whose localization was complicated because it was radiolucent.
Role of angioplasty in patients with previous coronary artery bypass surgery
Authors: Cooper Ian , Ineson Neil , Demirtas Ertan , Coltart John , Jenkins Stephea , Webb‐Peploe Michael
Published: March 2007

Fifty‐nine patients with previous coronary artery bypass surgery (CABG) underwent coronary artery or vein graft angioplasty following a recurrence of symptoms, 141 lesions were attempted in 70 procedures. The overall angiographic success rate was 77%. Some angiographic success was achieved in 83% of patients. Complications included myocardial infarction in three (4.3%), death in one (1.4%), and iliac artery thrombosis in one (1.4%). No patients were referred for urgent surgery. Twenty‐eight patients have undergone repeat coronary arteriography after 7.5 ± 2.6 months (mean ± SD), and 31% of lesions have recurred. Fifty‐eight percent of patients without recurrence at follow‐up continue to have improved symptoms. Treadmill exercise time was significantly prolonged in patients in whom all attempted lesions had been successfully dilated and in those in whom only some lesions were dilated. Our experience suggests that approximately 29% of patients with recurrence of angina following CABG may be suitable for angioplasty.
Use of the internal mammary artery guiding catheter for percutaneous transluminal coronary angioplasty of the shepherd's crook right coronary artery
Authors: Kulick Daniel L.
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) of shepherd's crook right coronary arteries presents a difficult technical challenge. Presented here are two cases demonstrating the use of an internal mammary guiding catheter for PTCA of shepherd's crook right coronary arteries. The advantages of this guiding catheter, a short tip with an acute distal angle, are emphasized.
Coronary artery bypass grafts: New universal markers
Authors: Hoffman Richard B. , Po Jonathan B.
Published: March 2007

This report describes a new system to facilitate the identification of coronary artery bypass grafts during repeat coronary angiography. Geometric markers (square, triangle, circle, hexagon) are placed over the aortic end of the graft, with each geometric shape designating the target vessel of the graft, e.g. square, right coronary; triangle, anterior descending. This system significantly simplifies cannulation of the postoperative patient and also allows immediate recognition of specific vessels bypassed by mere perusal of the chest film.
Dissecting intramyocardial hematoma masquerading as a pseudoaneurysm of the left ventricle
Authors: Meyers David G. , Lund Gunnar B. , Moulton Anthony L. , Robinson Lary A.
Published: March 2007

This report presents a case of left ventricular intramyocardial dissection masquerading as a ventricular pseudoaneurysm, as documented by echocardiography, magnetic resonance imaging, and angiography with subsequent confirmation at operation.
Percutaneous balloon valvuloplasty for mitral stenosis complicated by fatal pericardial tamponade in a patient with extreme pulmonary hypertension
Authors: Berland J. , Gerber L. , Gamra H. , Boussadia H. , Cribier A. , Letac B.
Published: March 2007

A case of left ventricular perforation by straight‐tipped balloon catheter during double‐balloon mitral valvuloplasty with fatal outcome is presented. Technical considerations to prevent this complication are discussed.
Simultaneous left ventricular and ascending aortic pressure measurements via single artery access for assessment of aortic stenosis
Authors: Nath Amar , Vetrovec George W. , Mukharji Jhulan , Cole Sharon , Lewis Stephen A. , Disciascio Germano , Cowley Michael J.
Published: March 2007

In order to determine the reliability of a single arterial access technique for hemodynamic assessment of aortic stenosis, data obtained from this method was compared with that from dual arterial access in 13 patients. A 59 cm long, 8 Fr. Mullins Transseptal Sheath (MTS) was placed in the ascending aorta (AA) and a 5 Fr. pigtail catheter advanced through the MTS (using a hemostatic “Y” adapter) into the left ventricle for simultaneous pressure recordings. Another 5 Fr. pigtail catheter (PTC) was advanced in the AA from the contralateral femoral artery. Peak pressures, AA pressure‐tracing characteristics, mean gradients, and the aortic valve area using tracings from the MTS and the PTC were compared. Peak pressures 120 ± 8 vs. 119 ± 8 mmHg (r = .998), “T” time .16 ± .01 vs. .15 ± .01 sec. (r = .913), “U” time .36 ± .02 vs. .36 ± .02 sec. (r = .983), mean gradients 38.4 ± 6.1 vs. 39.6 ± 6.9 mmHg (r = .990) and the AV area .78 ± .08 vs. 79 ± .08 cm2 (r = .994) were similar. Therefore, this single arterial technique provides data comparable to the traditional dual access system for hemodynamic assessment of aortic stenosis.
Precordial ST elevation with acute conus branch occlusion
Authors: Matthews Ray V. , Oesterle Stephen N.
Published: March 2007

A 70‐year‐old man developed anterior precordial ST elevation during coronary angiography in the presence of a normal left coronary artery. Injection of a proximally totally occluded right coronary artery caused occlusion of the conus branch. The electrocardiographic findings are shown, and the pathogenesis is discussed.
Permanent cerebral blindness after cardiac catheterization
Authors: Thomas Timothy Darrell , Troost B. Todd
Published: March 2007

Cerebral blindness is usually a transient event that can complicate cardiac catheterization. The neurologic deficit clears in 1–3 days. We present a patient who developed permanent cerebral blindness after undergoing transfemoral cardiac catheterization. Bilateral hemorrhagic occipitotemporal infarcts were demonstrated on magnetic resonance imaging (MRI). The patient also demonstrated denial of blindness and had transient memory disturbances due to occipitotemporal lobe infarct. The probable source of the emboli was cardiac.
Relative efficiency and risk of endomyocardial biopsy: Comparisons in heart transplant and nontransplant patients
Authors: Anastasiou‐Nana Maria I. , O'Connell John B. , Nanas John N. , Sorensen Sherman G. , Anderson Jeffrey L.
Published: March 2007

Right ventricular endomyocardial biopsy remains the gold standard for the diagnosis of acute rejection of the cardiac allograft. Among 704 consecutive procedures performed in 39 transplant recipients (2,842 myocardial samples), endomyocardial biopsy by either the right internal jugular (n = 661) or the femoral venous (n = 43) approach was compared with 243 consecutive procedures performed in nontransplant patients (n = 149 and n = 94, internal jugular and femoral approach, respectively). The internal jugular vein could not be located In only 0.61% (4/661) of heart transplant versus 5% (7/149) of nontransplant procedures (P < 0.001). Vascular access plus sufficient myocardial sampling was obtained in all but 0.61% (4/661) internal jugular procedures performed in heart transplant patients and in all but 7% (11/149) of those performed in nontransplant patients (P < 0.0001). (Vascular access was achieved in all femoral venous procedures performed in both transplant and nontransplant patients; sampling was successful after vascular access in all heart transplant recipients and all but two [2.1%] nontransplant procedures.) Cardiac complications occurred in nontransplant patients after one internal jugular procedure (cardiac perforation with tamponade) and after one femoral venous procedure (pericardial effusion). No cardiac complications occurred in transplant recipients, but 2 other complications were observed: One local abscess and one superior vena caval perforation with hemothorax associated with hypotension, both after an internal jugular approach. The overall efficiency (no safety problem; vascular access and adequate sample) was higher among transplant than nontransplant procedures (99% vs 93%, respectively, P < 0.0001). These observations continue to support routine application of endomyocardial biopsy for monitoring rejection in cardiac transplant patients. Safety and effectiveness of a single transvenous biopsy procedure in nontransplant patients, although still high, may not be equal to that predicted by the experience in transplant patients. These observations plus the more controversial nature of biopsy indications for nontransplant applications suggest greater caution in its use in nontransplant patients.
Effect of balloon aortic valvuloplasty on the dynamics of left ventricular ejection
Authors: Ferguson James J. , Bush Howard S. , Riuli Edward P.
Published: March 2007

To evaluate the effect of balloon aortic valvuloplasty on left ventricular ejection dynamics, simultaneous left ventricular and aortic pressures were obtained by use of a micromanometer catheter in nine patients before and after the procedure. Ejection times, stroke volumes (thermodilution), ejection rates, and pressure gradients were measured. For each parameter, ejection was then divided into two components: accelerative (onset systole to peak gradient) and decelerative (peak gradient to end systole).

After valvuloplasty, there was (1) a decrease in overall ejection time and in mean and peak pressure gradients; (2) an increase in overall ejection rate; (3) no change in stroke volume or heart rate; (4) an increase in both accelerative and decelerative ejection rates and a decrease in the decelerative ejection time (expressed as a percentage of the R–R interval); and (5) a decrease in the time for the ejection of the final 25% of stroke volume (P < 0.01) and time occupied by the final 25% of the gradient.

Immediately following balloon aortic valuloplasty, there is a decrease in ejection time and in increase in ejection rate. Balloon aortic valvuloplasty has a significant effect on the dynamics of left ventricle ejection, with changes primarily expressed in late systole. By improving the mobility of calcified leaflets, balloon aortic valvuloplasty may reduce the forces opposing forward blood movement during the decelerative phase of ejection.
Coronary spasm masquerading as progressive exertional angina with normal coronaries
Authors: Houghton Jan Laws , Frank Martin J.
Published: March 2007

A case of typical exertional angina secondary to chronic focal vasospasm with normal coronary arteries and the role of vasospasm in typical angina are briefly discussed. Recommendations are made regarding evaluation of patients with normal coronaries and angina.
Probe “balloon on a wire” ultra‐low‐profile coronary catheter: Results of ptca in 107 patients
Authors: Martinez Alejandro , Pichard Augusto , Little Thomas , Lindsay Joseph
Published: March 2007

A new low‐profile “balloon‐on‐a‐wire” angioplasty catheter, the Probe™ (USCI), was used in 107 patients over a 4‐month period. Twenty‐nine patients had stable angina, 59 had unstable angina, and 19 had had myocardial infarction (Ml) 3 to 15 days prior to the procedure; 71 patients had single‐vessel and 36 had multi‐vessel disease. In this series, 57 lesions were defined as complex. Successful dilatation was defined as a residual stenosis of <30%.

Of 132 non‐total obstructions, 127 (97%) were successfully dilated. Two distal lesions could not be reached, two lesions could not be crossed by the balloon, and a distal lesion dilatation resulted in acute closure in one case. Of 19 total obstructions, 16 (84%) were successfully dilated (mean residual stenosis 23%). The wire tip was unable to cross the lesion in the three unsuccessful procedures.

Seven complications occurred in the series, all involving non‐total obstructions: closure of a distal vessel and a side branch caused no clinical symptoms or EKG changes; three local dissections were tacked back with repeat dilatation; and two longitudinal dissections caused no apparent reduction in luminal diameter.

The Probe's low‐profile and exceptional trackability enabled it to cross very tight lesions with minimal trauma to the vessel wall. The high degree of conformability of the PET balloon minimizes vessel straightening or sheer forces and appears to reduce the potential for dissection. The device may therefore extend the indications and ease of PTCA while reducing complications of the procedure.
Rapid lysis of life‐threatening pulmonary thromboembolism following recent abdominal surgery using a modified systemic infusion of rt‐pa
Authors: Wysham Douglas G. , Ulstad Valerie K.
Published: March 2007

A case of pulmonary thromboembolism in a young woman three days status post‐abdominal surgery is treated successfully with a low‐dose infusion rate of tissue plasminogen activator (10 mg/hr over 10 h). Clinical improvement is rapid and there are no bleeding complications.
Emergency cardiopulmonary bypass support in patients with cardiac arrest in the catheterization laboratory
Authors: Shawl Fayaz A. , Domanski Michael J. , Wish Marc H. , Davis Mark , Punja Sudhakar , Hernandez Tomas J.
Published: March 2007

Cardiac arrest in the catheterization laboratory is fatal if unresponsive to advanced cardiac life support (ACLS). Seven patients not responding to ACLS following cardiac arrest in the catheterization laboratory underwent percutaneously instituted cardiopulmonary bypass support. Cardiac arrest occurred following abrupt closure postcoronary angioplasty in three patients, during cardiogenic shock in three patients, and during diagnostic angiography in one patient. Cardiopulmonary bypass was instituted 10–45 min (mean, 21 min) following the onset of cardiac arrest. Flows on bypass ranged from 4.0 to 5.2 liter/min. Mean blood pressure ranged from 70 to 110 mm Hg on bypass. Six of the seven patients regained consciousness after the institution of bypass. Acid‐base balance was normalized in all patients. Coronary bypass surgery was subsequently performed in three patients and coronary angioplasty in two. Four patients survived. One patient died following coronary bypass surgery. Two patients, who were not suitable candidates for revascularization, expired. Total bypass time was 1.5–8.5 hr (mean, 2.7 hr). At a mean follow‐up of 6 months, all four survivors are alive and asymptomatic or NYHA class 1. We conclude that cardiopulmonary bypass support 1) can stabilize patients following cardiac arrest in the catheterization laboratory, 2) can facilitate emergency coronary angioplasty or transfer to the operating room for coronary bypass surgery, and (3) can improve survival in patients unresponsive to ACLS when instituted early following cardiac arrest in the catheterization laboratory.
Anomalous aortic origin of the left anterior descending coronary artery with dilated cardiomyopathy
Authors: Okura Takafumi , Sekiya Michihito , Sumimoto Takumi , Mukai Mikio , Hamada Mareomi , Hiwada Kunio
Published: March 2007

Serious complications such as angina pectoris and myocardial infarction in patients with anomalous origin of a coronary artery have been documented. However, this anomaly with dilated cardiomyopathy is very rare. We present the first case of anomalous origin of the left anterior descending coronary artery with dilated cardiomyopathy.
Peripheral transluminal angioplasty of the subclavian and innominate arteries utilizing the brachial approach: Acute outcome and follow‐up
Authors: Dorros Gerald , Lewin Ruben F. , Jamnadas Pradip , Mathiak Lynne M.
Published: March 2007

Percutaneous transluminal angioplasty (PTA) of the subclavian and innominate arteries was performed in 27 patients at 33 sites (30 subclavian, 3 innominate). All procedures were successful angiographically and clinically and were without complication. The ipsilateral arm was utilized in all cases. Indications for the procedure included claudication (ten patients), neurological symptoms (seven patients), to gain vascular access for other interventions (eight patients), and scheduled coronary bypass surgery with internal mammary utilization (two patients). There were 22 stenoses and 11 occlusions. Thrombi was retrogradely recovered through the arteriotomy site in three patients with vessel occlusions. No early or late episode of neurological deficit was seen. Follow‐up was obtained in 22 patients (82%) at a mean time of 28 months (range, 2–73 months). The cumulative patency rate was 95%. The three restenosed sites were treated with successful repeat PTA. Angioplasty of stenotic or occluded subclavian or innominate arteries should be the procedure of choice in symptomatic patients.
Tissue‐type plasminogen activator: Intracoronary applications
Authors: Tiefenbrunn Alan J.
Published: March 2007

Intracoronary tissue‐type plasminogen activator (t‐PA) was employed successfully before, after, or in place of coronary artery angioplasty in four patients referred for emergency cardiac catheterization during evolving myocardial infarction. The potential roles of intracoronary thrombolysis, dose considerations for intracoronary t‐PA, factors influencing the choice of plasminogen activator, and safety issues are discussed.
Use of propranolol for severe dynamic infundibular obstruction prior to balloon pulmonary valvuloplasty (a brief communication)
Authors: Thapar Mohinder K. , Rao P. Syamasundar
Published: March 2007

A case of severe pulmonary valvar stenosis and infundibular obstruction has been reported Infundibular obstruction was so severe that no catheter could be advanced into the pulmonary artery. Propranolol, 0.5 mg given intravenously, reduced the obstruction and allowed the balloon dilatation of the pulmonary valve to be carried out without complication. Subsequently oral propranolol helped to remove the infundibular obstruction. We strongly recommend the use of propranolol when infundibular obstruction is present prior or after the balloon pulmonary valvuloplasty.
Experimental argon laser thermal angioplasty as an adjunct to balloon angioplasty in peripheral arteriosclerotic disease
Authors: Stroh Jack A. , Sanborn Timothy A. , Haudenschild Christian C.
Published: March 2007

Laser thermal recanalization has been used clinically as an adjunct to balloon angioplasty in the treatment of peripheral arteriosclerotic disease, with improved initial success rates in total peripheral occlusions and greater 1 yr vessel patency suggested, as compared to balloon angioplasty alone. However, the morphological effects of laser‐assisted balloon angioplasty are unknown. Therefore the goals of the present study were to evaluate 1) the angiographic and nistologic effects of laser thermal recanalization followed by balloon angioplasty and 2) the hypothesis that balloon‐catheter‐induced neointimal fracture could be sealed by subsequent laser thermal angioplasty in an experimental rabbit iliac artery atherosclerotic model.

In Group 1(7 vessels), a 1.5 mm metal capped argon laser fiberoptic was introduced via femoral arteriotomy and 10 W of thermal power was applied to the iliac artery stenosis for 5 sec while maintaining constant back‐and‐forth motion. Thereafter, balloon angioplasty was performed in the same vessel segment with a 2.5 mm balloon catheter inflated 3 times at 5 atm for 30 sec each. Mean angiographic luminal diameter increased from 1.1 mm to 2.0 mm after both procedures, and mean final post balloon dissection grade was 0.6 on a scale of 0,1 +, and 2 +. Perforation occurred once with the laser probe and once with the balloon catheter. Histologic examination of these vessels was characterized by irregular thermal erosions with minimal reactive thrombosis.

In Group 2 (10 vessels), the sequence was reversed, with laser thermal angioplasty following balloon dilation. Mean angiographic luminal diameter improved from 1.2 mm to 1.8 mm after both procedures. The mean post laser thermal angioplasty dissection grade was 1.3, which was twice that of Group 1. Perforation occurred once with the balloon catheter and twice with the laser probe. In only 1 of the 10 vessels was there histologic evidence suggestive of neointimal sealing.

In conclusion, laser thermal recanalization prior to balloon angioplasty appears to decrease the degree of angiographic dissection. Histologically, the thermal effect may be eccentric, and thrombosis appears to be limited. However, laser thermal sealing was not found to be feasible with the current 1.5 mm metal‐capped fiberoptic after dilation with a 2.5 mm balloon catheter. This is possibly due to inadequate contact of the probe with the vessel wall. There may also be anincreased tendency towards laser probe perforation following the fracture and dissection which results from balloon dilation.
Left‐sided inferior vena cava draining into the coronary sinus via persistent left superior vena cava: Case report and review of the literature
Authors: Brickner M. Elizabeth , Eichhorn Eric J. , Netto Dymphna , Cigarroa Ricardo G. , Brogan Walter C. , Simonsen Randall L. , Grayburn Paul A.
Published: March 2007

A case of a left‐sided Inferior vena cava draining into the coronary sinus via a persistent left superior vena cava is described and the pertinent literature reviewed.
A new complication of coronary arteriography
Authors: Raphael M. J. , Donaldson R. M.
Published: March 2007

The introduction of a sharply angulated catheter through an arterial sheath for percutaneous coronary arteriography was associated in 7 cases with dissection of the iliac arteries; this extended to the lumbar aorta at the level of the coeliac axis. The catheter tip should be introduced gently and preferably straightened out with a good length of guide wire to avoid this complication.
Method of measurement of the cardio‐thoracic ratio
Authors: Hoeffel J. C. , Harmand D. , Worms A. M.
Published: March 2007

The authors describe the use of a table for rapid measurement of the cardlo‐thoracic ratio on a standard PA chest film. The method is free of calculations.
Severe mitral insufficiency post‐balloon valvuloplasty: The late changes found in a disrupted mitral valve
Authors: Black M. D. , Campagna M. , Bedard P. , Marquis J.‐F. , Walley V. M.
Published: March 2007

The case of a 45‐yr‐old woman who had balloon valvuloplasty for rheumatic mltral stenosis is presented. An anterior mitral leaflet tear occurred as a complication of the procedure. Both partlal healing of the anterior mitral leaflet and gradual dilatation of the left atrium occurred which allowed the damaged valve to remain in situ for several months. Some of the late changes which occur after such a complicated valvuloplasty are illustrated here, as this patient eventually required surgery and valve excision for deflnitive repair.
Angioplasty of occluded coronary arteries: Use of thin shaft balloon over‐the‐wire system without pre‐dilatation
Authors: Gilchrist Ian C. , Clemson Barry S.
Published: March 2007

A retrospective review was done on 13 consecutive patients who underwent PTCA of totally occluded coronary arteries using a recently released thin shaft balloon over‐the‐wire angioplasty system. Balloon size was determined by the closest fit to the arterial size and used without predilatation techniques. This technique was initially successful in 12 patients with only 2 clinically insignificant episodes of distal embolization and one probable early reclosure. Using thin shaft angioplasty systems, balloon dilatation of totally occluded coronary arteries can be done safely with a single balloon in many caws resulting In simplified procedures and economic benefits.
Percutaneous popliteal approach for angioplasty of superficial femoral artery occlusions
Authors: Zaitoun Rafic , Iyer Sriram S. , Lewin Ruben F. , Dorros Gerald
Published: March 2007

Angioplasty using the percutaneous popliteal approach was utilized in 50 patients (PTS) to recanalize 59 occluded superficial femoral arteries which had been unsuccessfully canalized by using the antegrade approach because of either a flush origin occlusion or inability to maintain the guide wire in the true lumen. All PTS had claudication; 8 had rest pain; 3 had non‐healing ulcers. The laser Probe™ was used in 17 cases and the Rotablator™ in 3 cases. Occlusion length varied between 1 and 40 cm: 7 lesions were <10 cm (group 1); 9 were between 10 and 20 cm (group 2); and 43 were >20 cm (group 3). An angiographic success was obtained in 48/59 lesions (81%): 14/16 (87%) in groups 1 and 2 and 34/43 (79%) in group 3. Three PTS needed complementary common femoral endarterectomy and one required percutaneous aspiration of a thromboembolus. Complications included: arterial perforation and/or dissection (without clinical sequelae) in 11 and a popliteal hematoma in 1 PT. One patient with a severely ischemic leg underwent successful emergency vascular surgery, while another limb salvage patient required belowknee amputation. There was no worsening of limb ischemia from any popliteal approach attempt. At discharge, 39 patients (78%) whose outcome would have been unsuccessful with the traditional antegrade approach were clinically improved after utilizing the popliteal approach to achieve a successful angioplasty procedure.
Rib compression of the coronary arteries
Authors: Cascade Philip N. , Armstrong Marsha C.
Published: March 2007

This report describes the finding of coronary artery narrowing caused by compression by an overlying rib in two patients with cardiomegaly. There is probably no clinical significance to this finding. The primary differential diagnostic entity is myocardial bridging.
Left ventricular mid‐cavitary obstruction after balloon dilation in isolated aortic valve stenosis in children
Authors: Ludomirsky Achi , O'Laughlin Martin P. , Nihill Michael R. , Mullins Charles E.
Published: March 2007

A hyperdynamic left ventricle can lead to post‐dilation mid‐cavitary obstruction in the absence of any preballoon mid‐cavitary obstruction in children with aortic valve stenosis. The purpose of this study was to define the incidence and course of post‐dilation midcavitary obstruction. We reviewed the catheterization and echocardiographic data of 35 patients, ages 3 days to 18 years (mean + 7.9 years), with isolated aortic valve stenosis who underwent balloon dilation with a fall in aortic valve gradient to less than 20 mm Hg. Post‐dilation mid‐cavitary obstruction was suspected from post‐dilation left ventricular angiogram and was quantitated by echocardiographic and Doppler examinations performed immediately after dilation and in a 1–3 month follow‐up period. Continuous wave Doppler directed by color flow Doppler was used for evaluation and differentiation of post‐dilation mid‐cavitary obstruction and residual aortic valve stenosis. Three children (3/35 [9%]) all under 2 years of age developed post‐dilation mid‐cavitary obstruction immediately after dilation. The obstruction within the cavity resolved spontaneously in all three patients.

Conclusions: 1) Post‐dilation left ventricular mid‐cavitary obstruction can occur in children under 2 years of age after balloon dilation of severe aortic valve stenosis, and 2) total regression of post‐dilation mid‐cavitary obstruction occurs spontaneously in all patients.
Determination of the anatomical size of ventricular septal defects on the basis of hemodynamic data and noninvasive assessment of pulmonary to systemic vascular resistance ratio rp/rs by doppler‐echocardiography
Authors: Rupprecht Thomas , Hofbeck Michael , Singer Helmut , Harms Dieter , Deeg Karl‐Heinz , Benson Lee
Published: March 2007

The pulmonary and systemic flow (Qp/Qs) and resistance ratios (RP/Rs) were determined in children with isolated ventricular septal defects (VSD) to derive an “effective defect resistance” (Rd/Rs) representing the ratios of the resistance of the defect to the systemic vascular resistance. The defect size (expressed as the ratio of the area of the defect to the cross‐sectional area of the ascending aorta) was related to the calculated “effective defect resistance,” where a significant (non‐linear) correlation was found. The effective resistance of the defect is a useful aid for estimation of the anatomical size of a ventricular septal defect. The close correlation between anatomical size and the hemodynamic parameter Rd/Rs allows one to calculate the ratio Rp/Rs with this concept using nonin‐vasive Doppler‐ultrasound and echocardiography. This was performed in 21 children with VSD who underwent cardiac catheterisation. The noninvasive calculated flow ratio Qp/Qs and the resistance ratio Rp/Rs showed a close correlation to the values measured at cardiac catheterisation.
Five‐Hour balloon inflation to resolve recurrent reocclusion during coronary angioplasty
Authors: Brenner Alan S. , Browne Kevin F.
Published: March 2007

A 63‐year‐old male presented with an acute inferior myocardial infarction with initial clinical reperfusion following thrombolysis. Due to recurrent reocclusion, emergency catheterization was performed, demonstrating a 90% stenosis in the mid right coronary artery. Angioplasty was complicated by multiple reocclusions, ultimately requiring 5‐h autoperfusion balloon inflation to maintain patency.
Arteriovenous fistula as a complication of temporary pacemaker insertion: Treatment with percutaneous embolization
Authors: Cooper Stanley G. , Lewis Jon , Pollak Jeffrey S. , Denny Donald F.
Published: March 2007

Arteriovenous fistula is a rare complication of central venous catheterization. We present a case of right internal mammary artery‐to‐right innominate vein fistula resulting from emergent insertion of a temporary pacemaker. Percutaneous management is discussed and the literature is reviewed.
Comparison of ionic and non‐ionic contrast agents in cardiac catheterization: The effects of ventriculography and coronary arteriography on hemodynamics, electrocardiography, and serum creatinine
Authors: Wayne Cooper M. , Reed P. J.
Published: March 2007

We compared two nonionic contrast agents (ioxaglate and iohexol) with an ionic agent (Renografin‐76) on the effects of ventriculography and coronary arteriography on the hemodynamics, electrocariography, and serum creatinine in one hundred consecutive patients. Patients were randomized to nonionic or ionic groups and were further evaluated regarding the effect of fluid loading prior to catheterization. The ionic agent more often produced subjective reactions (rash, nausea/vomiting). Following ventriculography, both ionic and non‐ionic agents produced an increase in left ventricular end diastolic pressure and this effect was undetermined by fluid loading. Nonionic agents decreased aortic diastolic pressure following ventriculography and this effect was unaltered by fluid loading. In contrast, the ionic agent produced profound hemodynamic changes (drop in both systolic and diastolic pressures) following coronary arteriography and these effects were blunted by prior fluid loading. The ionic agent produced significantly greater heart rate slowing and prolongation of the QT interval than the nonionic agents, suggesting that the latter are potentially less arrhythmogenic. Comparing the two non‐ionic agents, we found that both decreased aortic diastolic pressure and increased left ventricular end diastolic pressure following ventriculography. Iohexol produced greater heart rate slowing than did ioxagliate, though the increase was minor compared to the ionic agent. Neither nonionic agent appeared to significantly affect serum creatinine. In conclusion, the two nonionic agents appeared to offer significant advantages over the ionic agent in ventriculography and coronary arteriography.
Left main coronary artery aneurysm in association with severe atherosclerosis: A case report and review of the literature
Authors: Lenihan Daniel J. , Zeman Howard S. , Collins Gary J.
Published: March 2007

Aneurysms of the coronary arteries occur in from 0.3% to 4.9% of angiograms. Only 12 cases of left main artery (LMA) aneurysms have been reported. Of these, seven were associated with atherosclerosis in patients more than 56 years old. This report details the case of a 39‐year‐old patient with a large LMA aneurysm associated with atherosclerosis.
Cerebral ischemia: A complication of right ventricular endomyocardial biopsy
Authors: Adair John C. , Call Gregory K. , O'Connell John B.
Published: March 2007

During percutaneous transvenous endomyocardial biopsy, two cardiac transplant recipients developed symptoms of focal cerebral ischemia. Cerebrovascular injury has not been previously associated with endomyocardial biopsy. This procedure should be recognized as one of the causes of stroke following heart transplantation.
In vivo thrombus formation on a guidewire during intravascular ultrasound imaging: Evidence for inadequate heparinization
Authors: Grayburn Paul A. , Willard John E. , Brickner M. Elizabeth , Eichhorn Eric J.
Published: March 2007

We present a case in which thrombus formation on a guidewire was visualized during intravascular ultrasound imaging despite the administration of 10,000 units of heparin sulfate prior to the procedure. Gross thrombus formation was confirmed upon removal of the guidewire. The activated clotting time was found to be 191 s, suggesting heparin resistance. This report graphically illustrates the potential thrombogenicity associated with intravascular guidewire manipulation during procedures such as intravascular ultrasound imaging and percutaneous transluminal coronary angioplasty. Moreover, this case suggests that adequate heparinization should be routinely verified by measuring the activated clotting time prior to introducing a guidewire into the arterial system.
Cor triatriatum dexter: Recognition and percutaneous transluminal correction
Authors: Savas Vicky , Samyn Joseph , Schreiber Samyn Facc Theodore L. , Hauser Andrew , O'Neill William W.
Published: March 2007

Cor triatriatum dexter is a rare congenital anomaly in which an obstructive membrane is located in the right atrium. The detection usually occurs after the sequelae of systemic congestion, coagulopathy, and hepatic dysfunction have set in, leading up to a high surgical risk. A percutaneous balloon correction of cor triatriatum dexter in a patient with advanced right‐sided congestive symptoms and hepatic dysfunction is presented. This efficacious method is an alternative to surgical correction and could be extended to the more common cor triatriatum sinistra.
Anomalous origin of the sinus nodal artery from left main artery
Authors: Kandalaft Naji , Ro Jae H. , Weiss Melvin B. , Herman Michael V.
Published: March 2007

This is the first case report of an anomalous origin of sinus nodal artery from the left main coronary artery.
Long‐term patency of arterialized cephalic vein used as a conduit for coronary artery bypass grafting
Authors: Mehta Sameer , Levine Steven , Margolis James R. , Martin Jose C. , Krauthamer Dan , Traad Ernest
Published: March 2007

We present long‐term angiographic follow‐up of a patient with an arterialized segment of cephalic vein used as a conduit for aortocoronary bypass grafting.
Relationship between coronary blood flow and perfusion pressure during reactive hyperemia: A case report in an awake unanesthetized woman with normal coronary arteries
Authors: Houghton Jan Laws , Carr Albert A. , Frank Martin J.
Published: March 2007

The linear relationship between coronary blood flow and mean arterial pressure during reactive hyperemia is presented for the first time in an awake unanesthetized woman with normal coronary arteries during systemic hypotension induced by pharmacologic vasodilation. This case demonstrates the critical dependence of coronary flow reserve on simultaneous perfusion pressure.
Percutaneous mitral valvuloplasty following surgical repair of sinus venosus atrial septal defect
Authors: Gerber Richard , Sedlis Steven P. , Tunick Paul A. , Chinitz Larry , Altszuler Henry , Gindea Aaron
Published: March 2007

Mitral valvuloplasty performed 5 y after repair of a sinus venosus ASD was difficult because of a thickened septum, but resulted in improved mitral valve opening and did not lead to ASD. Thus, prior repair of a sinus venosus ASD may not be an absolute contraindication to mitral valvuloplasty.
Brachial rotational atherectomy
Authors: Rosenblum Joseph , Stertzer Simon H. , Schechtmann Norberto S. , Hidalgo Benito , Baciewicz Peter A. , Myler Richard K.
Published: March 2007

The brachial approach adds a new dimension to rotational atherectomy. The two cases presented included a large ectopic right coronary artery and a right internal mammary graft where both outcomes were successful. These cases demonstrate that the brachial approach can facilitate rotational atherectomy when greater guide support is necessary.
Thrombolysis by rotational thrombectomy followed by tissue plasminogen activator: Evaluation by angioscopy
Authors: Johnson Christopher C. , Dewhurst Timothy A. , Vracko Rudolph , Auth David C. , Ritchie James L.
Published: March 2007

Thrombus removal using percutaneous rotational thrombectomy (PRT), followed by tissue plasminogen activator (t‐PA), was studied by contrast angiography and fiberoptic angioscopy in a canine femoral artery model of thrombosis. After thrombus induction and following each treatment, comparisons were made between angioscopy and angiography for the detection of thrombus and subintimal dissection. Angioscopic images were scored in a blinded fashion for lining, protruding, or occlusive thrombus (class 1, 2, or 3) as well as estimated wall coverage by thrombus. Angiograms were studied for percent diameter stenosis and the presence of flaps.

Following external forceps crush Injury of 18 arteries, two hour occlusion, and injection of thrombin, mean angiographic stenosis was 66%, thrombus coverage by angioscopy was 81%, and mean angioscopy class was 2.5. Following PRT, stenosis decreased to 27% (p < 0.008), thrombus coverage was reduced to 49% (p < 0.02), and angioscopy class dropped to 2.0 (p < 0.07). After t‐PA treatment, these values were further reduced to 25% (p = NS), 26% (p < 0.02), and 1.3 (p < 0.008), respectively. In comparison to angiography, subintimal dissection (seen as flaps) and thrombus (lining, protruding, or occlusive) were present significantly more often by angioscopy (p < 0.001).

It is concluded that PRT results in significant thrombolysis, apparent by angiography and angioscopy. Follow‐up t‐PA can produce additional, incremental thrombolysis, apparent only by angioscopy. A beneficial role for t‐PA following mechanical thrombolysis is suggested by this model. The superior sensitivity of angioscopy for detection of flaps and thrombus Is underscored by this study.
New option for balloon recanalization of total coronary occlusions
Authors: Hüpp H. W. , Franzen O. , Deutsch H. J. , Kux A. , Hilger H. H.
Published: March 2007

In 9 out of 12 patients with a total coronary occlusion but definite signs of viable myocardium a new approach for the recanalization procedure was successfully employed: Following recanalization using an on‐the‐wire 2.0 or 2.5 mm angioplasty catheter, a standard coronary guidewire was placed along the angioplasty catheter. After withdrawal of the catheter, over‐the‐wire angioplasty with an appropriately sized balloon was performed for final dilatation. Pending further studies in a larger patient population, this new method may offer an alternative approach for revascularization of total coronary occlusions.