bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary balloon angioplasty through diagnostic 6 french catheters
Authors: Villavicencio Ramon , Urban Philip , Muller Thierry , Favre Josiane , Meier Bernhard
Published: March 2007

We investigated the use of ultralow profile balloon catheters (Scimed ACE, USCI Probe, Cordis, Orion) for coronary angioplasty through 6 French diagnostic catheters (Schneider, Cordis). Contrast injection was assisted with a Hercules pump (Cordis) in all cases. During 21 procedures, angioplasty of 27 lesions in 20 selected patients was attempted (1.3 lesion/procedure). Twelve lesions were in the right, 10 in the left anterior descending, and 5 in the left circumflex coronary artery. Balloon size varied between 2.5 and 3.5 mm. Twenty lesions could be successfully dilated (74%) through the 6 French catheter and 7 lesions required an exchange to a 7 French angioplasty guiding catheter. For 5 cases, another balloon was also necessary to complete the procedure. The final overall success rate was 100% per patient and per lesion and there were no major complications. Despite the small internal catheter lumen (1.22 mm) coronary visualization was adequate, and mechanical support was good. Failures of 6 French catheters were attributed to insufficient torque control and excessive friction when the balloon crossed the tapered end of the diagnostic catheter.

Coronary angioplasty through a diagnostic 6 French catheter is feasible and may represent a reasonable alternative for simple cases that are done during the same session as the diagnostic angiography. Once available, 6 French high flow angioplasty guiding catheters without a tapered tip should improve success while retaining the advantage of a small femoral puncture site.
Preliminary experience with 5 and 6 french diagnostic catheters as guiding catheters for coronary angioplasty
Authors: Kern Morton J. , David Talley J. , Deligonul Ubeydullah , Serota Harvey , Aguirre Frank , Gudipati Chalapathirao , Ring Michael , Joseph Abraham , Yussman Zoe Ann , Kulick Daniel , Salinger Michael
Published: March 2007

With the reduction in profile of balloon dilation catheters, until recently, it has been the internal dimensions and performance of the guiding catheter that has mandated the use of 7,8 or 9 French (F) systems for the performance of percutaneous transluminal coronary angioplasty (PTCA). A new 5F catheter design (Sherwood Medical Co., St. Louis, MO) provided a large inner lumen (0.46″) permitting use of 0.20–0.22″ fixed‐wire PTCA balloon catheters with good coronary visualization. Potential advantages include reduced coronary artery ostial trauma and catheter induced damping and enhanced patient comfort. We report our initial experience in 14 patients undergoing PTCA with a 5 and 6F guide/fixed‐wire system. Mean age was 63 ± 10 (43–78 years). PTCA indications: Cardiogenic shock (1), post‐myocardial infarction angina pectoris (2), grade III angina (5) and unstable angina pectoris (6). Vessel attempted: Left anterior descending (3), circumflex (4), obtuse marginal (2), diagonal (1), right coronary artery (3), and internal thoracic artery (1). Twelve patients had femoral approach; two brachial approach. The USCI Probe® (USCI Division, Billerica, MA) was used in 8 lesions and SCIMED ACE® (SCIMED Life Systems, Maplegrove, MN) catheter in 7 lesions. Successful 5 or 6F guide/fixed‐wire dilations reduced the stenosis (77 ± 14 to 37 ± 30%) and were successfully performed in 79% (11/14). One 5F patient required 8F guiding catheter and was dilated with 2.0 fixed‐wire balloon. A second failed 5F PTCA could not be dilated with any larger conventional system. A third total occlusion could not be crossed with a guidewire or fixed wire balloon. No patient had a complication. Difficulty in retracting the deflated fixed‐wire balloon into the 5 and 6F guide catheter was encountered in fixed‐wire balloons sized >2.5mm.

This preliminary experience suggests that, in selected patients, large lumen 5 and 6F diagnostic catheters can be used as a satisfactory guiding catheter system for fixed‐wire PTCA.
Anatomic and machine projection angles of various radiographic imaging systems used for cardiac angiography
Authors: Burge Christopher , Sanders William , Alderman Edwin L.
Published: March 2007

Quantitation of coronary artery dimensions in serial angiographic studies requires an awareness of the variety, complexity, and implications of radiographic imaging equipment used for coronary arteriography. Recognition of the geometric complexities inherent in angiographic imaging systems is important in understanding complex image rotations and ensuring identity of projections when serial comparison is desired. Tables, figures, and formulae are provided to permit translation of machine angles into patient reference angles and vice versa.
Vasospasm in a coronary artery aneurysm
Authors: Gutowski Ted , Tannenbaum Alan K. , Moreyra Abel E.
Published: March 2007

Coronary artery aneurysms are not believed to have enough intact smooth muscle to generate significant vasoconstriction. A case is presented illustrating vasospasm of a large fusiform aneurysm of a right coronary artery during angioplasty. Pathophysiology of aneurysms is discussed.
Vascular entrapment of intra‐aortic balloon after short‐term balloon counterpulsation
Authors: Schechter David , Murali Srinivas , Uretsky Barry F. , Reddy P. Sudhakar , Makaroun Michel , Dekker Andrew
Published: March 2007

Prolonged, continuous intra‐aortic balloon (IAB) counterpulsation for several weeks can result in balloon entrapment secondary to thrombus formation in the balloon lumen. In this report, we describe a patient who developed IAB entrapment, early (1 wk) after initiation of counterpulsation. A trace amount of blood was noted in the tubing connecting the balloon catheter to the console for 3 days prior to IAB malfunction and vascular entrapment. We suggest that the balloon catheter be removed immediately when blood is detected in the external connecting tubing even if the IAB is functioning satisfactorily.
Nondiagnosed left main ostial stenosis partly due to the use of 5 french coronary angiographic catheters
Authors: Colle Jean‐Pierre , Delarche Nicolas , Bourdeaud'Hui Alain , Laborde Nadine
Published: March 2007

Two cases have been reported in which the use of 5 F angiographic catheters is associated with a failure to diagnose an ostial stenosis of the left main coronary artery (LMCA). In both cases, the erroneous diagnosis led to an inappropriate indication for percutaneous transluminal coronary angioplasty (PTCA) on other stenosed vessels, and the ostial left main lesion was unexpectedly discovered when using 8F guiding catheters. It is supposed that the ability of preformed 5F catheters to pass easily through an ostial lesion makes detection of such proximal stenosis much more difficult. We suggest that the choice of 5F catheters must be approached with caution when left main disease is potentially expected from the clinical features.
Percutaneous balloon pericardial window for patients with malignant pericardial effusion and tamponade
Authors: Palacios Igor F. , Murat Tuzcu E. , Ziskind Andrew A. , Younger Jerry , Block Peter C.
Published: March 2007

We performed percutaneous balloon pericardial window (PBPW) in 8 patients (age 40 to 70 yrs; 4 men, 4 women) with malignant pericardial effusion and tamponade. Pericardial window was indicated because they continued to drain >100 ml/day of pericardial fluid through the pigtail catheter for >/3 days.

A 0.038 inch guidewire was advanced through the pigtail catheter into the pericardial space and then the catheter was removed. A 20 mm diameter, 3 cm long balloon dilating catheter was advanced to straddle the parietal pericardium. Manual inflations were performed until the waist produced by the pericardium disappeared. All patients tolerated the procedure well with minimal discomfort and with no complications. A left or bilateral pleural effusion occurred in all patients after PBPW. No patient developed recurrent pericardial tamponade at a mean follow‐up of 6 ± 2 months. Thus, PBPW is a useful and safe technique to avoid surgery in patients with malignant pericardial effusion and tamponade.
Radiographic contrast agents and platelet function: A quenched‐flow study
Authors: Taylor Marc A. , Angello Debra A. , Ayers Carlos R. , Gear Adrian R. L.
Published: March 2007

Radiographic contrast media (RCM) may alter platelet behavior at concentrations achieved during cardiac angiography. We used quenched‐flow aggregometry coupled to single‐particle counting to study the influence of RCM on the kinetics of platelet aggregation (< 5.0 sec) induced by adenosine diphosphate (ADP, 2.86 μM). At a concentration in platelet‐rich plasma (PRP) of 5 per cent RCM by volume, platelet aggregation was inhibited by diatrizoate, iopamidol and ioxaglate either directly or following incubation of each contrast agent with PRP for 20 minutes. Diatrizoate inhibited more than did iopamidol or ioxaglate (56 ± 6, versus 39 ± 3 and 40 ± 9 per cent respectively; P<0.003, P<0.009, n = 20 normal subjects). A small reduction (about 16 per cent) in aggregation velocity occurred within 5 seconds of exposure of PRP to all 3 RCM and the onset time (t) or lag period before aggregation begins was significantly prolonged by diatrizoate (P<0.03). The RCM vehicles alone (iodinated moiety removed, osmolality readjusted) had no effect on the ADP‐induced aggregation. Platelet counts fell significantly after incubation with diatrizoate (12%; P = 0.04). Our data therefore show that early platelet aggregation was inhibited by 3 commonly‐used ionic and nonionic contrast agents. Inhibition was apparently caused by the iodinated contrast molecule, began within seconds of platelet‐RCM contact and was independent of vehicle composition. Since diatrizoate inhibited aggregation more than iopamidol or ioxaglate, its use may be of additional value during angi‐ographic procedures in clinical situations involving enhanced platelet activation.
Multicenter evaluation of a new fixed‐wire coronary angioplasty catheter system: Clinical and angiographic characteristics and results
Authors: Talley J. David , Joseph Abraham , Killeavy Eugene S. , Garratt Kirk N. , Hodes Z. I. , Linnemeier T. J. , Yussman Zoe Ann , Brier Michael E. , Kupersmith Joel
Published: March 2007

Coronary angioplasty is increasingly used as an attempt to revascularize patients with severe coronary artery disease. To determine the efficacy of such treatment, a new fixed wire angioplasty catheter was evaluated by a multicenter group in a non‐randomized fashion in 50 patients, average 58 ± 11 years (± 1SD), 58% men. Forty‐four percent had a prior revascularization procedure (28% angioplasty, 16% coronary bypass surgery), 38% had a prior Q‐wave myocardial infarction, 43% had grade 4 angina, and 60% multiple vessel disease. Angioplasty was attempted in 63 lesions which were located in a mid to distal location in 69%, with a proximal tortuosity score of 1.8 (2 = 45–60° entrance angle), and lesion angulation of 1.4 (1 = 45° lesion bend). In 88%, the device was the primary catheter used and in 6%, it was chosen when another system failed. The balloon was able to successfully cross 94% of all lesions attempted. Six lesions were crossed and dilated but significant residual stenoses remained. There were no significant device malfunctions, or angiographic or clinical complications.

This feasibility evaluation of this new fixed wire system yielded excellent angiographic results. Although not a comparative study, this analysis suggests that this new generation of angioplasty catheter may improve the safety and efficacy of complex coronary angioplasty.
Coronary angioplasty in octogenarians: Comparisons to coronary bypass surgery
Authors: Myler Richard K. , Webb John G. , Nguyen Khiem P. V. , Shaw Richard E. , Anwar Azam , Schechtmann Norberto S. , Bashour Tali T. , Stertzer Simon H. , Zapolanski Alex
Published: March 2007

Coronary angioplasty was performed in 74 patients 80 years of age and older (mean 83±3). Single vessel coronary disease was present in 34% and multivessel coronary disease in 66%. Angioplasty of a single vessel was performed in 51 patients (69%), while 23 (31%) had angioplasty of multiple vessels.

Angioplasty was successful in 59 of 74 patients (80%). Angioplasty was unsuccessful but uncomplicated in 12 (16%) due to (unyielding) calcified lesions or (impassable) old occlusions. Of these 12, 8 were discharged on medical therapy and 4 underwent elective uncomplicated bypass surgery prior to discharge. Three (4%) patients required emergency coronary bypass surgery due to abrupt vessel closure during the angioplasty procedure, with one hospital death (1.4%).

Follow‐up (mean 24±22 months) was obtained in all patients. Of the 59 successful angioplasty patients, late mortality was 10% (cardiac 7% and non‐cardiac 3%). Survival and survival without myocardial infarction were both 90%; survival without either infarction or bypass surgery was 86%. Actuarial 3‐year survival was 91% and 3‐year freedom from death, infarction or bypass surgery was 87% by life‐table analysis. Repeat angioplasty for restenosis was performed in 7 patients (12%) without complications.
Successful percutaneous closure of a complex coronary‐to‐pulmonary artery fistula using a detachable balloon: Benefits of intra‐procedural physiologic and angiographic assessment
Authors: Doorey Andrew J. , Sullivan Kevin L. , Levin David C.
Published: March 2007

A 48‐yr‐old woman presented with a loud continuous precordial murmur and symptoms of fatigue. Color‐flow doppler imaging and nuclear magnetic resonance imaging failed to show the cause of the murmur. Diagnostic catheterization showed a large left anterior descending coronary artery to pulmonary artery fistula with impaired left ventricular wall motion. Two detachable balloons were deployed in the fistula with complete abolition of flow in the main fistula channel. A small parallel channel of the fistula, previously not appreciated due to vessel overlap, remained patent but had trivial flow as assessed by green‐dye and oximetric techniques. The patient had immediate resolution of her symptoms and return of normal ventricular wall motion.
Concurrent double balloon valvotomy for combined rheumatic mitral and tricuspid stenosis
Authors: Sharma Satyavan , Loya Yunus S. , Daxini Bipin V. , Sundaram Usha
Published: March 2007

We expanded the application of percutaneous balloon valvotomy (PBV) to 4 adults (age 14 to 30 years, average 22.2 years) with combined rheumatic mitral and tricuspid stenosis. Double balloon dilatation reduced the transmitral gradient from 17.36 ± 3.54 to 5.52 ± 0.89 (P<0.025) and transtricuspid gradient from 12.65 ± 2.67 to 3.67 ± 0.95 (P<0.025). Mitral and tricuspid valve area increased from 0.73 ± 0.20 to 2.57 ± 0.67 (P<0.005) and from 0.77 ± 0.24 to 2.67 ± 0.24 cm2 (P<0.005), respectively. The procedures were well tolerated, with no significant increase in valvular regurgitation or left to right shunt across the atrial septum. The excellent symptomatic and haemodynamic benefits are sustained at 3–24 months follow‐up.

It is concluded that combined dilatation of stenotic valves by double balloon technique can emerge as an alternative to surgery in selected patients with polyvalvar rheumatic heart disease.
A new technique for right heart catheterization with a swan‐ganz balloon catheter via femoral vein in the patient with dilated right heart chambers, utilizing a modified transseptal‐type sheath
Authors: Lee Hongpyo H. , Mahrer Peter R.
Published: March 2007

Right heart catheterization with a Swan‐Ganz balloon catheter via femoral vein in the patient with dilated right atrium and ventricle is frequently difficult due to excessive catheter coiling in the dilated atrium. A new technique is described in this situation. By using a modified transseptal‐type sheath positioned counterclockwise in right atrium as an introducing sheath, a balloon catheter can be easily advanced to the distal pulmonary artery by smooth counterclockwise direction and secure support from this sheath.
Simplified formula for the calculation of mitral valve area: Potential inaccuracies in patients with tachycardia
Authors: Brogan Walter C. , Lange Richard A. , Hillis L. David
Published: March 2007

A simplified formula (cardiac output/[transvalvular pressure gradient]1/2) has been proposed as an alternative to the Gorlin equation for determining valve area in patients with mitral stenosis. This study was done (a) to assess the relationship between the results of the simplified formula and those of the Gorlin equation in patients with mitral stenosis and (b) to determine the clinical characteristics most likely to be associated with a disparity between the 2 formulae. In 96 patients with mitral stenosis, the disparity between the 2 formulae was>0.2 cm2 in 43 (45%) and ≥ 0.35 cm2 in 21 (22%). The results of the simplified formula were especially likely to be disparate from those of the Gorlin equation in those whose heart rates were>100 beats/minute. Thus, in the patient with mitral stenosis, the simplified formula should be used with caution and cognizance of its potential inaccuracy, particularly if the patient is tachycardic.
Rapid thrombus dissolution by continuous infusion of urokinase through an intracoronary perfusion wire prior to and following PTCA: Results in native coronaries and patent saphenous vein grafts
Authors: Chapekis Anthony T. , George Barry S. , Candela Richard J.
Published: March 2007

Even with aspirin and heparin therapy, thrombus present prior to or forming after percutaneous transluminal coronary angioplasty (PTCA) results in significant complications. We report on 33 patients who were treated with continuous infusion of Urokinase through an intracoronary perfusion wire for 24 hr because of visible intracoronary thrombus. Seventeen native vessels (9 pre‐PTCA and 8 post‐PTCA) and sixteen saphenous vein grafts (12 pre‐PTCA and 4 post‐PTCA) were treated. All vessels were patent at the time of perfusion wire placement. Complete thrombus resolution, successful PTCA and sustained patency was seen in 31 of 33 patients. One native vessel treated post PTCA (originally occluded) re‐occluded. One saphenous vein graft treated prior to PTCA showed improvement in thrombus but distal embolization with balloon inflation occurred. No significant complications related to the intracoronary infusion technique were observed.

In conclusion, rapid lysis of intra‐coronary thrombus can be accomplish safely using this technique and can result in improved PTCA outcome.
Coronary focal ectasia formation following percutaneous transluminal angioplasty
Authors: Semler Herbert J.
Published: March 2007

Focal ectasia of the right coronary artery developed following percutaneous transluminal angioplasty. Operative intervention was not deemed necessary. No restenosis was found on repeat coronary angiography. Five‐yr follow‐up was associated with a benign course.
Congestive heart failure secondary to an arteriovenous fistula from cardiac catheterization and angioplasty
Authors: Sy Alexander O. , Plantholt Stephen
Published: March 2007

Arteriovenous (AV) fistulae are well known to cause high output cardiac failure. AV fistulae from cardiac catheterization are as rare as 0.01% in the transfemoral approach. We describe here what we believe is the first reported case of high output cardiac failure from an AV fistula due to percutaneous transluminal coronary angioplasty (PTCA). The patient had reversal of the congestive heart failure with surgical correction of the fistula.
Effects of intracoronary administration of contrast media on coronary hemodynamics in a canine post ischemic reperfusion model
Authors: Sheu Sheng H. , Hwang Ming H. , Piao Zhen E. , Hariman Robert J. , Loeb Henry S. , Scanlon Patrick J.
Published: March 2007

Hemodynamic changes due to intracoronary injections of nonionic contrast medium Omnipaque‐350 (OM), ionic dimer Hexabrix (HB), and ionic contrast medium Renografin‐76 (R76) were compared at baseline and during reperfusion after a 30‐minute left anterior descending coronary artery (LAD) occlusion. In 11 open chest, anesthetized, and atrially paced dogs, 4 ml of either OM, HB, R76, or 0.9% NaCI were injected into the carotid‐LAD bypass system. Coronary blood flow (CBF) and coronary vascular resistance (CVR) were measured before, during and after the intracoronary injection. The maximal hyperemic change (in percentage) from the preinjection value of CBF and CVR were calculated. The results at baseline and during reperfusion for CBF were: 104±14% vs. 85±10% for OM (NS); 76±11% vs. 39±9% for R76 (p<0.05); 57±8% vs. 33±5% for HB (p<0.05); and 30±7% vs. 9±4% for 0.9% NaCI (p<0.05). Consequently, the hyperemic changes of CVR at baseline and during reperfusion were: −49±3 vs. −42±4% for OM (NS); −44±3% vs. −24±6% for R76 (p<0.01); −36±3% vs. −24±4% for HB (p<0.05); and −18±4% vs. −7±3% for 0.9% NaCI (p<0.05). Thus, ischemia and reperfusion significantly dampened the coronary hemodynamic and vascular response to R76, HB, and 0.9% NaCI but not to OM. The preserved coronary vascular reserve with high flow in this canine post‐ischemic reperfusion model may explain the advantage of nonionic over ionic contrast media used in emergency coronary angiography following thrombolysis.
Congenital atresia of left main coronary artery: Proposed mechanism for severe disabling angina in a patient with non‐atherosclerotic single right coronary artery — A case report
Authors: Ruiz Carlos E. , Lau Francis Y. K.
Published: March 2007

A patient with progressive disabling angina was found to have a single right coronary artery with atresia of the left main coronary artery, and absence of any obstructive coronary disease. The patient required aortocoronary by‐pass surgical reconstruction of a left main coronary artery to control her angina. Possible mechanisms for the development of her anginal pain are briefly discussed.
Evaluation of a theoretical doppler index to noninvasively estimate peak dp/dt using continuous wave doppler ultrasound of ascending aortic flow in man
Authors: Hunt A. C. , Chow S. L. , Escaned J. , Perry R. A. , Seth Mb A. , Shiu M. F.
Published: March 2007

A theoretical formula for calculation of peak dP/dt was derived using parameters obtained from continuous wave Doppler echocardiography signals of aortic blood flow. The direct proportional relationship between the main variables of this formula and invasively measured peak dP/dt was validated in 20 patients undergoing routine diagnostic cardiac catheterization.

Doppler signals of aortic flow were obtained simultaneously to invasive pressure recordings with a 2 MHz continuous wave transducer via the suprasternal echocardiographic window. The Doppler signals were recorded on magnetic tape and measurements were made with digital calipers by two independent, blinded observers.

The following parameters were measured: peak velocity (V) and time from onset of ejection to peak velocity (T). V2/T, the variable of the derived formula, was calculated for each of the observer's measured parameters and showed a very high interobserver correlation. The two observers' measurements of each parameter were averaged for each patient and the resulting mean was used in calculating the V2/T and mean acceleration.

4. A good correlation of V2/T with invasively measured peak dP/dt was obtained. Our derived index of left ventricular function showed a higher correlation with peak dP/dt compared to other Doppler indices of ventricular function. V2/T may provide a noninvasive method for estimating peak dP/dt.
Short and long term outcome of percutaneous transluminal coronary angioplasty in unstable versus stable angina pectoris: A report of the 1985–1986 nhlbi ptca registry
Authors: Bentivoglio Lamberto G. , Holubkov Richard , Kelsey Phd Sheryl F. , Holmes David R. , Sopko George , Cowley Michael J. , Myler Richard K.
Published: March 2007

In a cohort of 1,720 consecutive patients from the National Heart, Lung, and Blood Institute, Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry (August 1985–May 1986), we compared 768 patients (45%) with stable angina and 952 patients (55%) with unstable angina pectoris. Unstable angina patients exhibited at least one of the following characteristics: new onset angina, rapidly progressing angina, angina at rest, angina refractory to medication, variant angina, acute coronary insufficiency, or angina recurring shortly after an acute myocardial infarct.

The distribution of single‐ and multi‐vessel disease was similar among stable and unstable angina patients; multi‐vessel disease predominated. Average severity of stenosis and incidence of tubular and diffuse stenosis morphology were higher among patients with unstable angina (both p<0.001). Patient success rates were similar in stable and unstable patients. However, on a per lesion basis, overall angiographic success rate and average reduction of severity of stenosis in successfully dilated lesions were significantly higher among patients with unstable angina (both p<0.001). Incidence of major patient complications (p<0.01) and of emergency coronary bypass surgery (p<0.05) were also higher in patients with unstable angina but consistent with their more precarious clinical condition and stenosis morphology.

During a two year follow‐up, the cumulative distributions of death, myocardial infarct, repeat PTCA, and coronary bypass surgery were not significantly different in patients with stable angina compared to patients with unstable angina.

Comparison of the current PTCA Registry cohort with the cases reported in the 1979–1982 Registry revealed a 19% higher success rate for both stable and unstable angina patients. Major complication rates decreased between time periods for stable but not for unstable angina patients. Incidence of emergency bypass surgery decreased more for stable than for unstable angina patients.

Coronary angioplasty is indicated in properly selected patients with unstable angina and both single‐and‐multi‐vessel coronary disease.
Blade atrial septostomy: Experience with the first 50 procedures
Authors: Khan M. A. Ali , Bricker J. Timothy , Mullins Charles E. , Yousef Saad Al , Nihill Michael R. , Vargo Thomas A.
Published: March 2007

We have performed 50 blade and balloon atrial septostomies in 46 patients with diagnoses of transposition of the great arteries‐32 patients; mitral atresia or stenosis‐10 patients; total anomalous pulmonary venous drainage‐2 patients; tricuspid atresia‐1 patient; and pulmonary valve atresia with hypoplastic right ventricle‐1 patient. The patients' age ranged from 1 day to 72 months (median=8 months) and weights ranged from 2.7 to 14.5 kg. In patients with transposition the systemic saturation increased from an average of 62% to 74.6% (p <0.001) and the inter‐atrial mean pressure gradient was reduced from 7.74 ± 5.3 to 1.4 ± 2.04 mm Hg. Patients with mitral atresia had no significant increase in systemic arterial saturation but a significant decrease in the mean inter‐atrial gradient from 19.6 ± 12.4 to 3.8 ± 5.3 mm Hg. In three patients the blade septostomy was unsuccessful for technical reasons and the condition of the patient. Complications included one death due to atrial laceration, blood loss requiring transfusion in 5 patients, transient CVA in one patient, and failure of the blade to close in one patient. We have found the palliative use of the blade catheter in conjunction with balloon atrial septostomy to be an effective and safe procedure.
Ventricular fibrillation complicating endomyocardial biopsy of a cardiac allograft
Authors: Oldham Nancy , Ott Richard A. , Allen Byron A. , Fopiano Patria , Dwyer Marylynn
Published: March 2007

Transvenous endomyocardial biopsy remains the most useful diagnostic aid in assessing rejection in the transplanted heart. Although invasive, the complications associated with endomyocardial biopsy are few, and the procedure is generally regarded as safe. We report a case of apparent ventricular fibrillation complicating transvenous endomyocardial biopsy. Histologic section revealed evidence of moderate acute rejection. This case represents the first report of a life threatening ventricular dysrhythmia following routine endomyocardial biopsy in a cardiac transplant recipient.
Balloon valvuloplasty for mild mitral stenosis
Authors: Pan Manuel , Medina Alfonso , De Lezo Jose Suarez , Romero Miguel , Hernandez Enrique , Segura Jose , Melian Francisco , Pavlovic Djordje , Jimenez Francisco , Vivancos Ricardo , Montero Anastasio , Valles Federico
Published: March 2007

Of a total number of 288 patients with mitral stenosis treated by percutaneous balloon valvuloplasty, 21 patients had a basal mitral area equal to or greater than 1.5 cm2, as measured hemodynamically. The immediate hemodynamic results of this particular group of patients with mild mitral stenosis are described, as well as the clinical and echo doppler findings at follow‐up (22 ± 12 mo). Patients with mild mitral stenosis (group I) had more pliable valves (p < 0.01), as assessed by echo, and higher incidence of sinus rhythm (p < 0.02) than that observed in the remaining 267 patients (group II). After valvuloplasty the valve area increased in group I from 1.7 ± 0.2 to 3.1 ± 0.7 cm2 (p < 0.0001). This mean final area was significantly different (p < 0.0001) than that observed in group II (1.98 ± 0.6 cm2). No patients with mild mitral stenosis developed progression of mitral regurgitation, and none had any other major complications. Most of them reached a grade I final functional status. At echo doppler follow‐up studies we did not observe significant changes in the mean mitral gradient as compared with the immediate hemodynamic results.

These findings suggest that early mitral balloon valvuloplasty could be an alternative in trying to favorably Influence the natural course of the rheumatic mitral disease in selected patients.
Allograft vasculopathy and death in a cardiac transplant patient with angiographically normal coronary arteries
Authors: Johnson Thomas H. , McDonald Kenneth , Nakhleh Raouf , McGinn Andrew L. , Wilson Robert F. , Olivari Maria Teresa , Kubo Spencer H.
Published: March 2007

A cardiac transplant patient died of severe left ventricular dysfunction 2 weeks after coronary anglography demonstrated normal coronary arteries. Post mortem examination showed significant and diffuse allograft vasculopathy. Coronary angiography may have limited sensitivity In detecting allograft vasculopathy.
Early ostial vein graft stenosis: Management by atherectomy
Authors: Kuntz Richard E. , Piana Robert , Schnitt Stuart J. , Johnson Robert G. , Safian Robert D. , Baim Donald S.
Published: March 2007

During the initial perioperatfve period (1 mo to 1 yr) after saphenous vein coronary grafting, early stenosis and occlusion occurs In 5–8% of grafts due to intimal hyperplasia. We report a patient who developed ostial stenosis within 4 mo of bypass surgery at the aortotomy site of two vein grafts. Balloon angioplasty of the elastic stenoses did not provide significant luminal enlargement, but successful treatment of the lesions was obtained using directional atherectomy. Histological examination demonstrated intimal hyperplasia. Directional atherectomy may be an excellent technique for treatment of elastic ostial vein graft stenoses in lieu of conventional balloon dilatation.
Coronary artery pseudo‐occlusion associated with the use of an active hemoperfusion system during ptca
Authors: Grill Howard P. , Dowger Barbara A. , Brinker Jeffrey A.
Published: March 2007

We describe the phenomenon of coronary artery “pseudo‐occlusion,” which may occur when active hemoperfusion devices are utilized during percutaneous transluminal coronary angioplasty (PTCA). In such cases, contrast injected via the guiding catheter fails to opacity the coronary artery distal to the tip of the dilating catheter, thereby giving the angiographic appearance of coronary occlusion. When active hemoperfusion is terminated, contrast opacifies the vessel in a normal fashion. The cause of this observation is likely multifactorial and includes obstruction to flow by the dilating catheter, high distal pressure delivered by the dilating catheter during hemoperfusion competing with the flow of contrast infected via the guiding catheter, and wash‐out of contrast at the tip of the dilating catheter by non‐contrast containing blood being pumped through the system. This phenomenon must be recognized if potentially deleterious repeat dilatations are to be avoided.
Angioplasty in ulcerative coronary artery disease: Acute results and early follow‐up
Authors: Brack Martin , Mooney Jodi Fishman , Huber Michael S. , Pedersen Wes R. , Van Tassel Robert A. , Mooney Michael R.
Published: March 2007

The safety and efficacy of percutaneous transluminal coronary angioplasty (PTCA) for stenoses involving ulcerative lesions were retrospectively studied. Seventy‐seven patients (62 men and 15 women, mean age 62 ± 10 years) representing 3.4% of 2,250 patients treated with PTCA during the period January 1, 1988 and June 30, 1990, had pre‐PTCA stenoses defined as ulcerated. Twenty‐eight (36%) of the stenoses were localized in the left anterior descending coronary artery, 9 (12%) in the left circumflex and 40 (52%) in the right coronary artery. During angioplasty, percent diameter stenosis was reduced from 73 ± 14% to 22 ± 13% and transstenotic gradient decreased from 48 ± 18 to 12 ± 6 mm Hg. Clinical success (freedom from angina at discharge without coronary bypass surgery, infarction or death) was achieved in 70 patients (90.9%). There were seven unsuccessful cases: three underwent elective coronary bypass surgery, one was managed medically, and three developed a major flow interrupting dissection during the procedure requiring emergency coronary bypass surgery. There were no deaths. At mean follow‐up of 7.6 months, 45 of 61 patients (73.7%) remained asymptomatic. One patient needed an elective coronary bypass surgery and five patients had a successful repeat PTCA. In conclusion, PTCA for an ulcerated stenosis can be performed safely with a high primary success rate and a favorable early clinical course.
Double wire technique for additional guiding catheter support in anomalous left circumflex coronary artery angioplasty
Authors: Das Gladwin S. , Wysham Douglas G.
Published: March 2007

This case report presents an example of the use of the double wire technique for additional guiding catheter bracing support in percutaneous transluminal coronary angioplasty (PTCA) of a stenosis in an anomalous circumflex (CX) artery arising within the ostium of the right coronary artery (RCA). It illustrates the ease of this technique in comparison to conventional guiding catheter cannulation, which may be more difficult and yield poor backup support in this unusual anatomic situation.
Prognosis of culprit lesion PTCA in acute myocardial infarction for multi versus single vessel disease
Authors: Vacek James L. , Rosamond Thomas L. , Robuck Wayne , Kramer Paul H. , Beauchamp Gary D.
Published: March 2007

We studied 417 patients undergoing single vessel culprit lesion percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction to determine the impact of disease in other vessels. Group A (189 patients, 45%) had coronary artery disease (>70% stenosis) in at least 1 additional vessel while Group B (228 patients, 55%) did not. The groups were similar in sex distribution (A = 75% male, B = 76%), number of lesions in the single culprit vessel dilated (1 lesion in 83% A, 80% B), and PTCA success (A = 92%, B = 94%) (all p = NS). Group A patients were older (63 ± 10 vs. 56 ± 11 years) and had more prior myocardial infarctions (27% vs. 7%), and more prior coronary artery bypass grafting (15% vs. 0.4%) (all p < .01). Group A patients were more likely to have repeat catheterization (48% vs. 32%, p < .005) although restenosis of the infarct‐related vessel was similar (A = 24%, B = 16%) (p = NS). Group A was more likely to need angioplasty in a 2nd vessel (23% vs. 8%) and to need coronary artery bypass grafting (20% vs. 8%) (both p < .001). Cumulative mortality was higher in Group A at 1 month (10% vs. 5%), 1 year (11% vs. 6%), and long‐term (13% vs. 7%). This difference appeared to be due to the impact of lower mean ejection fraction in Group A.

Conclusion: Treatment of acute myocardial infarction by direct PTCA of the culprit lesion can be performed with a high likelihood of success in patients with or without multivessel coronary artery disease. Patients with multivessel disease are identified as a high risk group for whom subsequent interventional therapy may be required after the acute event. Mortality, however, is affected more by left ventricular function than by the presence of multivessel disease.
Elevated left atrial pressure does not cause left‐to‐right shunting after mitral balloon valvuloplasty
Authors: Watson K. R. , Chisholm R. J. , Azpiri J. R. , Armstrong P. W.
Published: March 2007

To assess the hemodynamic factors affecting left‐to‐right shunting following balloon mitral valvuloplasty we studied 10 patients at 3 points during the procedure: pre‐septal dilation, post‐septal dilation pre‐valvuloplasty, and post‐valvuloplasty. Hemodynamic parameters were recorded and an oximetry run was obtained at each stage.

Mitral valvuloplasty was successful in 8 and unsuccessful in 2 patients. No patient had a significant oxygen step‐up at any stage, including the 2 patients with unsuccessful valvuloplasty. Significant left‐to‐right shunting through the atrial septal puncture in mitral valvuloplasty is infrequent, even before successful balloon valvuloplasty when left atrial pressure is maximally elevated.
Urokinase infusion of chronically occluded femoropopliteal gortex™ bypass grafts via the popliteal approach
Authors: Dorros Gerald , Hall Patrick , Iyer Sriram S.
Published: March 2007

Thrombolysis of two occluded above‐knee femoropopliteal Cortex™ bypass grafts utilizing the popliteal approach for catheter placement was successfully performed without complication. In both cases, the proximal anastomoses of the graft could not be identified. A percutaneous popliteal approach was used for catheter placement and delivery of urokinase. Angioplasty was performed on the unveiled stenoses that, presumptively, led to graft closure. Selective thrombolysis via catheter placed from popliteal approach is a new technique for recanalizatlon of occluded femoropopliteal bypass grafts and warrants further investigation.
Comparison of the hydrophilic guidewire in double‐ and single‐wall entry needles: Potential hazards
Authors: Reagan Kathleen , Matsumoto Alan H. , Teitelbaum George P.
Published: March 2007

Using an in vitro model, the potential hazard of using a new plastic‐coated guidewire directly through both beveled, single‐wall and nonbeveled, double‐wall arterial puncture needles was assessed. Guidewire withdrawal directly through both types of needles resulted in either scraping and/or shearing of the plastic coating of the guidewire, leading to potential embolic debris. This problem was more significant when the guidewire was withdrawn through the beveled needle, in comparison to the nonbeveled type.

Extreme caution should be used when using plastic‐coated guidewires directly through metallic arterial entry needles.
Transseptal left heart catheterization: Usefulness of the intracavitary electrocardiogram in the localization of the fossa ovalis
Authors: Bidoggia Hector , Maciel Juan P. , Alvarez Jose A.
Published: March 2007

One of the major difficulties in left heart Catheterization through the interatrial septum is to ensure that the Brockenbrough needle tip is correctly laid on the fossa ovalis floor (FOF), which is the only area where the puncture must be done. The difficulties may be enhanced in patients with atrial enlargement and subsequent distortion of the anatomical structures.

In order to reduce the hazards of the septal puncture, an electrocardiographic mapping of the right atrial endocardium was performed using the Brockenbrough needle as an exploratory electrode in a group of 20 patients. When the tip of the needle was laid against the FOF, the endoatrial electrocardiogram (EAE) registered a slight or no injury curve, even when the pressure was tight enough to perforate the septum. On the contrary, the pressure on any other area of the muscular septum or atrial walls elicited a bizarre monophasic injury curve.

The peculiar electrocardiographic response of the FOF to the pressure exerted by the Brockenbrough needle tip was a valuable aid to identify the area where the transseptal puncture must be done. In addition, the sudden changes in the P wave morphology immediately after the septal perforation, provided the first clue that the left atrium has been reached.
Pneumococcal pericarditis successfully treated with catheter drainage and intravenous antibiotics
Authors: Kocheril Abraham G. , Luttmann Christopher , Sadaniantz Ara
Published: March 2007

Bacterial pericarditis is commonly a disease of children for which the primary treatment is surgical drainage. We report the case of a 19‐yr‐old patient presenting with pneumococcal pericarditis and tamponade treated successfully with intrapericardial catheter drainage and intravenous antibiotics. The technical aspects are discussed.
Balloon angioplasty of chronic total coronary artery occlusions: What does it cost in radiation exposure, time, and materials?
Authors: Bell Malcolm R. , Berger Peter B. , Menke Kristina K. , Holmes David R.
Published: March 2007

Coronary angioplasty of chronic total occlusions is known to have a lower success rate and higher frequency of restenosis than angioplasty of subtotal stenoses, but there are no data describing the additional time, resources, and radiation exposure associated with this procedure. The purpose of this study was to compare these features in 90 consecutive patients who underwent angioplasty of a total occlusion (group 1) to those of 100 consecutive patients who underwent angioplasty of a subtotal stenosis (group 2). Angioplasty was successful in 60% of group 1 and in 94% of group 2 patients. Procedures were longer in group 1 and significantly more guide catheters, angioplasty balloon catheters, and guide wires were required per patient compared to group 2. The volume of contrast media used in each group was similar. Estimates of radiation entry exposure, calculated from fluoroscopy exposure times and using data from phantom studies, were 53 R (roentgen) per patient in group 1 vs. 34 R in group 2. These procedures were performed using pulsed progressive fluoroscopy; radiation exposure would be considerably higher using conventional fluoroscopic systems. Cineangiographic radiation exposures were similar for each group and accounted for an average additional exposure of 14–22 R for each procedure. Total radiation exposure was reduced in both groups when the angioplasty procedure was combined with the diagnostic angiogram. These observations should be considered when dilation of a total occlusion is planned. Efforts to reduce the amount of radiation exposure should remain a priority in interventional catheterization laboratories.
Balloon pulmonary valvuloplasty in the management of cyanotic congenital heart defects
Authors: Rao P. Syamasundar , Wilson Allen D. , Thapar Mohinder K. , Brais Maurice
Published: March 2007

Twenty‐three children with cyanotic congenital heart defects, aged 3 days to 11.5 years, weighing 2.9 to 30 kg, underwent percutaneous balloon pulmonary valvuloplasty to improve pulmonary oligemia. The patients were divided into two groups: group I with intact ventricular septum and group II with ventricular septal defect. In 12 group I patients, there was an increase of systemic arterial oxygen saturation [83 ± 8% (mean ± SD) vs. 94 ± 5%, P < 0.001] and pulmonary‐to‐systemic flow ratio (0.7 ± 0.1 vs. 1.0 ± 0.2, P < 0.001). Peak systolic pressure gradient across the pulmonary valve decreased (P > 0.001) from 105 ± 48 to 25 ± 18 mm Hg. In 11 group II patients, arterial oxygen saturation (67 ± 13 vs. 83 ± 13%, P < 0.01) and pulmonary‐to‐systemic flow ratio (0.7 ± 0.4 vs. 1.2 ± 0.5, P < 0.02) increased following valvuloplasty. Peak systolic pressure gradient across the pul‐monic valve (52 ± 16 vs. 32 ± 22 mm Hg, P < 0.05) decreased while infundibular and total pulmonary outflow tract gradients were unchanged (P > 0.1). Immediate surgical intervention was avoided in all cases in both groups. On follow‐up, 1 to 36 months after valvuloplasty, arterial oxygen saturation, pulmonary‐to‐systemic flow ratio, and pulmonary valve gradients remain improved in both groups. However, in group I, repeat balloon valvuloplasty was required in two children. In group II, six children with tetralogy of Fallot (TOF) underwent successful total surgical correction 4 months to 2 years after valvuloplasty. Two children with transposition of the great arteries required Blalock‐Taussig shunts 6 and 18 months after valvuloplasty for further improvement of hypoxemia. Demonstrable increase in pulmonary artery diameter occurred in several children. These data suggest that pulmonary valvuloplasty offers an excellent relief of pulmonary valve obstruction in the intact ventricular septum group and palliation of pulmonary oligemia in the ventricular septal defect group. In the latter group, avoiding immediate surgical shunts in all patients and achieving growth in pulmonary arterial size in many patients, thus making them suitable for further surgical palliation or correction, are additional advantages.
Right internal mammary artery graft angioplasty through a right brachial artery approach using a new custom guide catheter: A case report
Authors: Brown Robert I. G. , Galligan Luke , Penn Ian M. , Weinstein Larry
Published: March 2007

Angioplasty of right internal mammary artery grafts may present problems because of the variable origin of the mammary artery and its angulation from the subclavian artery. We report a case of successful angioplasty using a custom designed guide catheter, after failed attempts using conventional guide catheters.
Arteriographic demonstration of both kinking at the origin and compression between the great vessels of an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of valsalva
Authors: Grollman Julius H. , Mao Song Shou , Weinstein Steven R.
Published: March 2007

Angled angiographic views demonstrated two areas of significant systolic narrowing in an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of Valsalva: (1) an ostial stenosis due to kinking as the anomalous artery turned sharply to the right after its origin from the aorta; (2) compression of the proximal segment as it coursed between the aorta and pulmonary artery. Appropriate angiographic studies to evaluate the presence of these changes may help to elucidate their significance.
Intramyocardial hemorrhage due to prolonged intracoronary infusion of urokinase into a totally occluded saphenous vein bypass graft
Authors: Bedotto John B. , Rutherford Barry D. , Hartzler Geoffrey O.
Published: March 2007

A 0.038 inch perfusion wire was used to selectively administer a 24‐hr infusion of urokinase into the occluded saphenous vein bypass graft of a 69‐yr‐old woman. Immediately following subsequent reperfusion by balloon angioplasty, she developed a hemorrhagic myocardial infarction.