bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurements of left‐to‐right intracardiac shunting in adults: Oximetric versus indicator dilution techniques
Authors: David Hillis L. , Winniford Michael D. , Jackson Jay A. , Firth Brian G.
Published: March 2007

Of the various techniques that are available to assess the presence and magnitude of intracardiac shunting, oximetry and indicator dilution are used most frequently. This study was performed to compare these methods in adult patients with pure left to‐right intracardiac shunting. In 27 patients [12 men, 15 women, aged 32 ± 12 (mean ±SD) years], shunt magnitude was assessed in close temporal proximity by both techniques. The oximetric percentage left‐to‐right shunt averaged 55 ± 16%, whereas the indocyanine green dye percentage shunt was significantly less (36 ± 14%, p < 0.001). The oximetric percentage shunt exceeded the indocyanine green dye percentage shunt in 26 and did so by >20% in 23 patients. Thus, there is a substantial difference in shunt magnitude between the oximetric and the indicator dilution techniques. In infants, indicator dilution yields results that are larger than those obtained with the oximetric method. Conversely, in adults, the indicator dilution technique gives results that are consistently smaller than those obtained with oximetry. As a result, the decision regarding therapy of an intracardiac shunt should be made with this in mind.
Arteriovenous shunt measured by bolus dye dilution: Reproducibility and comparison between two injection sites
Authors: Rocha Paulo , Kahn Jean‐Claude , Dongradi Gérard , Baron Bernard , Fendler Jean‐Pierre
Published: March 2007

Twenty‐eight brachial arteriovenous fistulae (AVF) flows were assessed by the Stewart and Hamilton method by bolus dye injection. These measurements were divided in two groups: a first group with dye injection into the AVF artery and a second group with dye injection into the efferent vessel of the AVF in close proximity. The increase and the decrease of dye concentration were regular and the circulation occurred very late in both groups. Reproducibility was assessed by the usual index: the mean of the differences between two successive measurements of each series related to the first of these two and expressed as a percentage, m(Qn ‐ Qn ‐ 1)/Qn%. In the two groups, the reproducibility index was at 10.1%, similar to the index applied to Grimby's results, measuring successive cardiac output by dye bolus injection at 9.8%. Theoretical criteria of validity of the Stewart and Hamilton method were checked for all measurements. Even when the duration of the measurement was very short, arteriovenous flow fulfilled the criteria of validity in the same way as cardiac output. Two AVF flows were measured successively at both injection sites with no difference between the obtained values. The same reproducibility of the efferent vessel injection site group suggests that an arterial puncture is not necessary for a correct assessment of AFV flow.
Percutaneous transluminal angioplasty of stenotic ductus arteriosus
Authors: De Lezo José Suárez , Lopez‐Rubio Fernando , Guzmán Juana , Galán Antonio , Herrera Norberto , Arizón Josá , Sancho Manuel , Pan Manuel , Franco Manuel , Fernández Raul , Zapatero Mercedes , Vallés Federico
Published: March 2007

This article describes our in vitro experience of balloon angioplasty of the ductus arteriosus (DA) in three post mortem human specimens, as well as an in vivo dilatation of a stenotic DA. The in vitro histologic observations revealed disruption of the intima and areas of pathologically fragmented and disorganized fibers at the media, with integrity of the ductal wall in all three DA. These findings led us to attempt percutaneous transluminal angioplasty (PTA) of a stenotic DA in a 2.3‐kg newborn infant with hypoplastic left heart syndrome in a very deteriorated clinical condition. A Rashkind septostomy was associated with PTA of the stenotic DA. Following this, the gradients across the DA and across the atrial septum disappeared and the ductal angiographic diameter increased. Although an improved clinical condition was observed during the following hours, he died 1 day after. At necropsy, we found integrity of the ductal wall with histological changes similar to that observed in vitro. We conclude that PTA of stenotic DA could represent an alternative for palliative treatment of DA‐dependent congenital heart disease.
Intra‐arterial monitoring during cardiopulmonary resuscitation
Authors: Pierpont Gordon L. , Kruse John A. , Nelson Donna Hamm
Published: March 2007

Because arterial cannulation assists in management of critically ill patients (pts), we assessed the utility of extending intra‐arterial monitoring to hospitalized patients suffering in‐hospital cardiopulmonary arrest outside of intensive care wards. A totally self‐contained, readily portable system for rapid insertion of emergency intra‐arterial lines was evaluated in 16 pts from 53 to 89 years old (mean = 66.5 years) undergoing cardiopulmonary resuscitation. Cannulation was successful in 14 pts (88% success rate). In 8 of 14 pts, cannulation was achieved rapidly and efficiently, whereas in six it was slightly delayed, once due to technical problems and five times due to difficulty cannulating the vessel. In addition to providing continuous pressure monitoring and ready access to arterial blood samples, direct feedback from the intra‐arterial pressure waveform frequently led to improved compression technique by the resuscitator performing external cardiac massage. We conclude that under selected circumstances emergency intra‐arterial monitoring has a potentially important adjuvant role during cardiopulmonary resuscitation.
Assessment of dimensions and image quality of coronary contrast catheters from cineangiograms
Authors: Reiber Johan H. C. , Kooijman Cornelis J. , Boer Ad Den , Serruys Patrick W.
Published: March 2007

In the quantitative assessment of coronary arterial dimensions from coronary cineangiograms, the contrast catheter is usually used as a scaling device, requiring the definition of the catheter contours by semi‐ or fully automated contour detection procedures. The image quality of the x‐ray radiated catheter is dependent on the catheter material, concentration of the contrast agent in the catheter, and kilovoltage of the x‐ray source. The effects of these variables on the image quality and accuracy of the size‐measurement of the filmed catheters were studied for four different catheter materials: woven dacron (wd), polyvinylchloride (pv), polyurethane (pu), and nylon. The following parameters were studied: measured size, image contrast, and average brightness gradient along the edges of the displayed catheters. The average differences of the angiographically measured size with the true size for the wd, pv, pu, and nylon catheters were +0.2, ‐ 3.2, ‐ 3.5, and + 9.8%, respectively. The image contrast at various fillings of the catheters was roughly identical for the wd, pv, and pu catheters, and significantly lower for the nylon catheter. Image gradient was highest for the wd catheter, followed by the pv and pu catheters, and lowest for the nylon catheter.

From these data it may be concluded that the woven dacron catheter is most suitable for quantitative coronary angiographic studies. The polyvinylchloride and polyurethane catheters perform about equally well but slightly less than the woven dacron catheter. The nylon catheter should not be used for such quantitative studies.
Percutaneous brachial approach using the femoral artery sheath for left heart catheterization and selective coronary angiography
Authors: Maouad J. , Hebert J. L. , Fernandez F. , Gay J.
Published: March 2007

A percutaneous method via the brachial artery for left heart catheterization and selective coronary angiography is described. The technique uses the sheath intended for the femoral artery, continuously infused and introduced following a particular technique. The procedure was performed with minimal complications over 18 months, with multipurpose “Schoonmaker” or preshaped catheters, in all the patients (37) in whom the femoral approach was contraindicated or failed. When a catheterization must be performed from the arm, this method, without cutdown and arteriotomy and allowing a good distal flow during the procedure, appears to have some advantages over the classical Sones technique or the percutaneous arterial axillary approach.
Neurologic sequelae of cardiac catheterization
Authors: Weissman Barbara M. , Aram Dorothy M. , Levinsohn Morris W. , Ben‐Shachar Giora
Published: March 2007

Neurologic complications are a known and at times tragic consequence of cardiac catheterization. During a four‐year period, 1,362 procedures were performed at our institution on children less than 15 years of age. Eighteen children, without prior nervous system disease, developed neurologic sequelae within 24 hours of cardiac catheterization (1.3%). Three presented with seizures only, ten with neurologic deficits, and five with both focal seizures and stroke. Computerized tomography scans (16 patients) demonstrated areas of nonhemorrhagic infarction in all but one. The 18 patients were studied retrospectively for possible factors contributing to the neurologic complications. They were matched to controls by age, cardiac lesion, and catheterization technique. Data examined included catheterization duration and approach, contrast agent, precatheterization urine specific gravity, pre‐ and postcatheterization hematocrit, blood loss, and intracatheterization events. Catheter and catheter sheath clots were noted in both patient groups. The neurologic complication group had 7/18 intracatheterization neurologic events versus only one in the controls and the change in hematocrit was greater in the complication group (t = 2.89, p<0.01). Due to this study's results and to prevent possible thromboembolic events, a heparinization protocol was instituted and patients were prospectively observed for neurologic complications. No neurologic complications have occurred over three years since the institution of this protocol.
Death from coronary air embolism during percutaneous transluminal coronary angioplasty
Authors: Bentivoglio Lamberto G. , Leo Louis R.
Published: March 2007

A patient undergoing percutaneous transluminal angioplasty of a critical proximal stenosis of his anterior descending coronary artery died as a result of coronary air embolism from a defective dilatation catheter. The probable mechanism responsible for this lethal complication is discussed. Simple precautions are described that will prevent its future occurrence.
Catheter‐induced left internal mammary artery bypass graft dissection
Authors: Farooqi Shafgat , Jain Abnash C. , O'Keefe Michael
Published: March 2007

The first reported case of a patient with left internal mammary artery bypass graft dissection secondary to selective coronary and graft arteriography is presented. The intimal tear and false lumen could not be seen with flouroscopy during catheterization. This later led to antero‐septal myocardial infarction.
Clinical success after percutaneous transluminal coronary angioplasty failure for unstable angina
Authors: Kern Morton J. , Lembo Nicholas J.
Published: March 2007

We report a patient who had an asymptomatic total occlusion of a left anterior descending coronary artery after PTCA for unstable angina. A clinical success with a negative maximal exercise test and absence of symptoms after PTCA can not be presumed to correlate with coronary patency.
Intravascular retrieval of broken guide wire from the ascending aorta after percutaneous transluminal coronary angioplasty
Authors: Steele Mbbs(Hons) Peter M. , Holmes David R. , Mankin Harold T. , Schaff Hartzell V.
Published: March 2007

Percutaneous coronary angioplasty of a proximal right coronary artery stenosis was attempted, but the guide wire broke. The distal portion remained in the right coronary artery and the proximal portion in the ascending aorta. A Dotter retrieval catheter was used to snare the wire, and the intra‐aortic portion was removed.
Selection of dilatation hardware for ptca‐1985
Authors: Topol Eric J. , Myler Richard K. , Stertzer Simon H.
Published: March 2007

Selection of the proper dilatation hardware in performing coronary angioplasty will facilitate the procedure, minimize its cost, and enhance its safety. Over the past 3 years, there has been an acceleration of growth in PTCA catheter and wire technology. We evaluated all currently approved dilatation systems as well as some investigational equipment and herein discuss their relative merits and disadvantages. To aid in operator selection of equipment, the concept of a risk:benefit ratio of potential for intimal trauma vs maximal back‐up support is introduced. This information combined with objective data may be helpful in choosing the optimal dilatation equipment, which must be highly individualized for operator preferences and for each patient and his respective coronary anatomy.
A new catheter for angioplasty of the right coronary artery and aorto‐coronary bypass grafts
Authors: Arani Djavad T.
Published: March 2007

We have developed a new guiding catheter for angioplasty of the right coronary artery (RCA) and venous bypass grafts (VG). This catheter is easy to manipulate, provides a good „backup”︁, and is unusually helpful in angioplasty of the RCA with a usual as well as a complex course. The catheter is equally successful in angioplasty of bypass grafts. We have used this guiding catheter for angioplasty of the RCA and VG in 27 consecutive cases. In 22 patients (81%), successful dilatation was achieved. Inadequate „backup”︁ was responsible for two of the five unsuccessful angioplasties; therefore, the catheter provided a good „backup”︁ in 25/27 (93%) cases. No major complication occurred in this group of patients.
Transient visual disturbance during cardiac catheterization with angiography
Authors: Vik‐Mo Harald , Todnem Kari , Følling Magne , Rosland Gunnar A.
Published: March 2007

The occurrence of visual disturbances following cardiac catheterization with angiographies was studied in a prospective study of 2,006 consecutive adult patients. The overall incidence of visual disturbances was 1.0% and of complete blindness 0.2%. Women had higher incidence than men (2.0 versus 0.6%, p < 0.01) and patients with a history of angina pectoris with normal coronary arteries had higher incidence than those with coronary artery stenosis (3.7 versus 0.8%, p < 0.02). Thirteen of twenty patients also had signs of mental confusion. An abnormal electroencephalogram was found in 8 of 13 patients studied. Other neurological findings were observed in one patient only. All patients had complete recovery within 24 hours. Thus, the incidence of visual disturbances is found to be higher than earlier reported, but the visual loss is transient with a benign course.
Inadvertant balloon extrusion through a side hole in a guiding catheter
Authors: van Gelder L. M. , van der Krieken A. M. , El Gamal M. I. H. , Bonnier J. J. R. M. , Michels H. R.
Published: March 2007

A patient presented with an acute inferior myocardial infarction. Coronary angiography in the acute stage revealed total occlusion of the right coronary artery. Reperfusion was obtained after intracoronary infusion of 250,000 units of streptokinase. Angioplasty was subsequently performed because of a high grade residual stenosis. An 8‐French right Judkins guiding catheter with a single side hole (USCI), a 3.0 mm balloon dilatation catheter (ACS), and a 0.018 high torque floppy guide wire (ACS) were used. After successful angioplasty angiography was repeated with the guide wire in the RCA, but the balloon was withdrawn into the guiding catheter. After injection of contrast, it was impossible to withdrawn the balloon catheter out of the guiding catheter. Fluoroscopy revealed extrusion of the balloon through the side hole in the guiding catheter.
Left atrial myxoma: Diagnosis by digital subtraction intravenous angiography
Authors: Tamari Israel , Goldberg Harvey L. , Moses Jeffrey W. , Fisher Jeffrey , Borer Jeffrey S.
Published: March 2007

Digital subtraction intravenous angiography (DSIVA) represents an important technical advance in angiographic diagnosis. Herein we present three patients with left atrial myxoma assessed by DSIVA. We review the role of DSIVA in evaluation of patients with suspected cardiac tumors and the importance of careful atrial‐phase scrutiny in examinations obtained for other purposes (ie, pulmonary angiography and assessment of ventricular function).
Isolated coronary ostial stenosis
Authors: Miller Graham A. H. , Honey Michael , El‐Sayed Hassan
Published: March 2007

We have examined 5 patients with typical angina pectoris and found them to have left coronary ostial stenosis without evidence of any other coronary arterial disease and without evidence of aortic disease (Takayasu aortitis, syphilitic aortitis, or familial hypercholesterolaemia). All five patients were female aged between 38 and 53 years, a striking difference from the normal 7:1 male:female ratio for atherosclerotic coronary artery disease. It may be that these patients represent a rare but distinct syndrome. The angiographic diagnosis can be difficult but a pressure drop as the catheter tip engages the ostium and lack of spill‐over of contrast into the sinus of Valsalva are findings that should lead the angiographer to suspect ostial stenosis.
Right ventricular inflow and outflow obstruction due to adrenal cell carcinoma
Authors: Carlin Brian W. , Dianzumba Sinda B. , Wendel Christopher , Joyner Claude R.
Published: March 2007

A 48‐year‐old man with surgically removed adrenal cell carcinoma presented with shortness of breath and fatigue. Physical examination revealed neck vein distention and a new systolic murmur. Echocardiography showed a right ventricular mass causing inflow and outflow tract obstruction. These findings were confirmed at surgery.
A newly designed directionally controlled guidewire
Authors: Wholey Mark H.
Published: March 2007

A directionally controlled, 1:1 torque ratio flexible. 035 guidewire has been developed for angioplasty procedures being done in the peripheral, renal, subclavian, and visceral circulation. A torque‐controlling device is incorporated with the wire in order to negotiate the stenotic or ulcerative atherosclerotic site without damage to the intimal plaque. The increased selectivity of the wire has also found application in subselective examinations within the peripheral, visceral, and extracranial circulation. Four designed configurations are described

Now manufactured by Advanced Cardiovascular Systems, Inc., Mountain View, CA.

.
Characterization of left ventricular chamber distortion: Alterations in cavity shape and orientation in mitral stenosis
Authors: Gault James H. , Gentzlerm Richard D. , Cooper Matthew M. , Reed J. C.
Published: March 2007

Distortion of the left ventricular (LV) chamber silhouette was identified in 28 patients with mitral stenosis (MS) by disparity between normally identical chamber volumes calculated independently from the frontal(AP) and lateral (LAT) views of biplane cineangiograms( AP end diastolic volume 157.8 ± 10.0 ml, LAT end diastolic volume 115.6 + 7.2 ml, p <.001). Similar systematic disparity was observed in estimates of end systolic volume in these views. While no directional difference in ejection fraction was found, identical (± 10%) AP and LAT measurements were obtained in only 36% of patients, indicating poor reproducibility of the estimate of LV function between single radiographic views.

A technique was also devised for determining the spatial orientation of the LV long axis (mid mitral valve to apex) from biplane cineangiograms; this axis was shown to intercept the frontal plane at an angle of 50.9 ± 2.4° in 12 subjects with normal LV anatomy and 36.1 ± 4.5° in seven patients with MS, indicating that the long axis was rotated posteriorly toward alignment with the frontal plane in the latter group. The presence and magnitude of LV chamber distortion was clearly related to the degree of angiographically estimated right ventricular dilatation. Implications of these observations, particularly with reference to the estimation of single plane LV volume characteristics in patients with MS, are discussed.
Torsades de pointes immediately following right coronary arteriography
Authors: Goldfinger Tedd M. , Hoekenga David E.
Published: March 2007

Selective coronary angiography with ionic contrast agents produces delayed myocardial repolarization with prolongation of the QTc interval on EKG. Torsade de Pointes, an unusual polymorphic ventricular tachycardia, has been causally linked to delayed myocardial repolarization. We present a case of Torsade de Pointes resulting from selective right coronary arteriography.
A new catheter design for use in patients with critical aortic stenosis
Authors: Agarwal Jai B. , Klein Lloyd W.
Published: March 2007

A new catheter that facilitates catheterization in patients with severe aortic stenosis is described. The catheter design is capable of high‐pressure injections for left ventriculography, but it maintains maneuverability and has an end hole for use with a guide wire in traversing tightly stenotic valves. Experience with this catheter in 23 patients confirmed that good‐quality ventriculograms are obtained after left ventricular entry. Twenty‐two of 23 patients with aortic stenosis were studied entirely with this catheter; in only one case were attempts to cross the valve unsuccessful, both with this and other catheters. In conclusion, this new catheter is recommended for routine use in patients with suspected severe aortic stenosis.
Changing trends of congenital heart disease in adults: A catheterization laboratory perspective
Authors: Flanagan Michael F. , Leatherman George F. , Carls Alexa , Keane John F. , Selwyn Andrew P. , Lock James E.
Published: March 2007

Advances in cardiac surgery now enable many children with congenital heart disease (CHD) to survive to adulthood. The influence of such advances on the frequency of various lesions among adult patients undergoing cardiac Catheterization (CC) has not previously been addressed. This retrospective analysis of 329 adults with CHD undergoing CC at an adult and at a pediatric referral center demonstrates that when compared to 20 years ago, adults with CHD who now undergo CC are more likely to have complex cardiac disease, and more have had prior surgery. In addition, despite more aggressive surgical management, ventricular dysfunction and dysrhythmias are now commonly encountered residua of CHD in adults who require diagnostic CC. Premature coronary artery disease appears uncommon. These changing characteristics of adults with CHD require consideration in the planning of future health care for these patients.
Paucity of subtle myocardial injury after angioplasty delineated with MB CK
Authors: Spadaro James J. , Ludbrook Philip A. , Tiefenbrunn Alan J. , Kurnik Peter B. , Jaffe Allan S.
Published: March 2007

To determine the extent to which PTCA elicits subtle myocardial ischemic injury, 28 patients were studied prospectively. The presence of myocardial injury was assessed by analysis of frequent (q4 hours) serial samples of MB CK, a sensitive and specific marker of myocardial injury. Immediately prior to angioplasty, baseline 12‐lead ECGs and blood samples for evaluation of total CK and MB CK were obtained. Additional ECGs were obtained immediately after the procedure and on the following morning, and serial samples for total and MB CK were obtained at 4‐hour intervals for 24 hours. Patients requiring cardiac surgury within 24 hours after PTCA were excluded. Samples (n = 203) were assayed by the glass bead method. Total CK rose by more than 20 IU/L in only five patients, four of whom had received intramuscular premedication. Mean MB CK was 3.4 77± 6.1 IU/L at 12 hours and 4.1 ± 4.7 IU/L at 24 hours compared to 3.1 ± 1.7 IU/L prior to angioplasty. Only one patient with obvious infarction had a value for MB CK above the normal range. Thus, uncomplicated PTCA is not accompanied by objectively detectable subtle myocardial injury.
Vertical left ventricular angulation assessed by thallium 201 myocardial perfusion imaging in patients with mitral valve prolapse
Authors: Arora Rohit R. , Horowitz Steven F. , Machac Josef , Goldman Martin E.
Published: March 2007

Mitral valve prolapse has been associated with septal to aortic root angle abnormalities determined by echocardiography. Thallium 201 imaging in the anterior view permits visualization of the left ventricular long axis. In the present study, the vertical angle was defined as the angle formed by the long axis of the left ventricle and a horizontal line. The vertical angle was determined in 25 patients who had 201 TL stress testing and M‐mode echocardiography. Group I (11 patients) had mitral valve prolapse and group II (14 patients) did not have mitral valve prolapse. The vertical angle and ultrasound were read blinded to each other. Height, weight, and body surface area were compared for the two groups, and receiver operator curve analysis performed.

Vertical angle measured by TL 201 was significantly more vertical in patients with mitral valve prolapse. Receiver operator curve analysis showed that an angle of >30° successfully identified 9/11 patients with mitral valve prolapse, with a sensitivity of 82% and a specificity of 79%. There were no significant differences in height, weight, or body surface area between the two groups. Thus, patients with mitral valve prolapse have more vertically positioned hearts than patients without mitral valve prolapse, independent of body habitus. The different appearance of a vertically oriented heart may contribute to false‐positive readings of TL 201 images.
Left main coronary artery dissection during percutaneous transluminal coronary angioplasty
Authors: Slack John D. , Pinkerton Cass A. , Vantassel James W. , Orr Charles M.
Published: March 2007

Acute dissection of the left main coronary artery during diagnostic cardiac catheterization with selective coronary arteriography is an uncommon but recognized complication of the procedure. That similar dissection may occur during percutaneous transluminal coronary angioplasty is less well recognized. This report describes two cases of left main coronary dissection resulting in acute occlusion that occurred during percutaneous transluminal coronary angioplasty and demonstrates that survival with essentially complete functional recovery may result if immediate surgical intervention is undertaken. Recognition and treatment of this potentially catastrophic complication of angioplasty is described.
Trefoil balloon for percutaneous valvuloplasty
Authors: Meier Bernhard , Friedli Beat , Oberhaensli Ingrid , Belenger Jacques , Finci Leo
Published: March 2007

A new balloon (Trefoil balloon) was developed to avoid complete interruption of blood flow during percutaneous balloon valvuloplasty. It consists of three identical 2‐ to 4‐cm‐long angioplasty balloons mounted in a parallel fashion on a single catheter. Filled simultaneously, they assume the cross section of a rosette, allowing for continued blood flow. Trefoil balloons of various sizes were tested in five dogs (aorta and aortic valve). They created a gradient ranging from 5 to 40 mmHg where conventional, single balloons of comparable size were completely obstructive. In three consecutive patients with congenital pulmonary stenosis, Trefoil balloons were used successfully and without significant complications. Continued transvalvular blood flow during the actual dilatation process was documented in all cases. The Trefoil balloon is a promising new device for percutaneous valvuloplasty and, perhaps, coronary angioplasty.
Salvage coronary angioplasty for symptoms refractory to medical therapy
Authors: Feldman Robert L. , Macdonald Robert G. , Hill James A. , Carmichael Michael J.
Published: March 2007

Coronary angioplasty was used without surgical back‐up in eight patients with angina refractory to medical therapy. After careful evaluation, none of these patients was felt to be a candidate for elective or emergent bypass surgery. Angloplasty provided a reasonable means of coronary revascularization. In each patient, extenuating clinical circumstances and reduced left ventricular function led to this approach. Angioplasty was angiographically and clinically successful in each patient.
Risk of preangioplasty occlusion and myocardial infarction in one‐vesseldisease patients scheduled for percutaneous transluminal coronary angioplasty
Authors: Robert Jacques , Bourassa Martial G. , Moise Alain , Kouz Simon , Crepeau Jacques , Bonan Raoul , Chaitman Bernard R. , David Paul Robert , Salamon Roger
Published: March 2007

Coronary occlusion or myocardial infarction occurred in 50 of 394 (13%) one‐vesseldisease patients awaiting percutaneous transluminal coronary angioplasty (PTCA). To identify risk factors for these events, we first matched the 37 patients whdemonstrated occlusion on the immediate preangioplasty repeat angiogram with 37 patients who did not. Matching was based on the time interval between angiograms, the date of the procedure, and the site of the lesion. Preangioplasty occlusion patients did differ from controls by age (47 ± 11 vs 54 ± 8 years, P< <.01), smoking status (34/37 vs 24/37, P <.01), and angina class (2.6 ± 1.0 vs 2.3 ± 0.7, P < .10) at the time of the first angiogram. Second, we pooled the data of the 37 preangioplasty occlusion patients with those of the 13 patients with preangioplasty myocardial infarction. The 50 cases with complication (coronary occlusion or myocardial infarction) were younger (47 ± 12 vs 54 ± 8 years, P < .01), more often smokers (42/50 vs 24/37, P <.05), and more symptomatic (2.7 ± 0.8 vs 2.3 ± 0.7, P <.05) than the 37 controls. This study suggests that young smokers with severe angina are at high risk of preangioplasty occlusion and/or myocardial infarction; prompt management of these patients, when considered for PTCA, seems advisable.
Papavine: The ideal coronary vasodilator for investigating coronary flow reserve? A study of timing, magnitude, reproducibility, and safety of the coronary hyperemic response after intracoronary papaverine
Authors: Zijlstra F. , Serruys P. W. , Hugenholtz P. G.
Published: March 2007

A potent, short‐acting vasodilator that induces a maximal hyperemic response of the coronary vascular bed is needed to determine coronary flow reserve. In 12 patients, we measured coronary sinus blood flow by thermodilution over a period of 2 min during which a bolus of 10 mg papaverine was given into the left main coronary artery. This was repeated after 5 min to assess the reproducibility of the changes. The maximal hyperemic response lasted from 24 until 37 sec after papaverine administration. There was no significant difference between the two consecutive hyperemic responses (Student's t‐test for paired observations). The mean difference between first and second hyperemic responses at 30 sec was 7.0% (SD ± 6.2%).

In conclusion, 10 mg of intracoronary papaverine is a short‐lasting and reproducible means of inducing a maximal hyperemic response in the coronary vascular bed and therefore appears to be the ideal agent for investigating coronary flow reserve.
Guidewire snap causing left main coronary occlusion during coronary angioplasty
Authors: Keltai Mátyás , Bartek Iván , Biró Veronika
Published: March 2007

The case of a 34‐year‐old female patient is presented. During attempted left anterior descending coronary angioplasty, the exchange guidewire (0.018 inch, 300 cm) snapped and the distal 20 cm of the wire caused immediate thrombotic occlusion of both the left anterior descending and circumflex arteries. The resulting complication was treated by emergency bypass surgery.
Anomalous origin of the right coronary artery from the left sinus of valsalva: A case report
Authors: Kucera Richard F. , Bowden William D. , Thomas Harry M. , Blue Peter W.
Published: March 2007

The rare anomalous origin of the right coronary artery from the left sinus of Valsalva has recently been shown to be associated with myocardial ischemia and sudden death. A patient is presented with overwhelming evidence of myocardial ischemia corrected by a single‐vessel bypass of the right coronary artery.
Clinical evaluation of soft‐tipped catheters for coronary angiography
Authors: Finci Leo , Meier Bernhard , Steffenino Giuseppe , Rutishauser Wilhelm
Published: March 2007

New soft‐tipped Judkins catheters for coronary angiography were compared with conventional femoral catheters for coronary angiography in a randomized, controlled fashion with cross‐over exchange of catheters when problems occurred. The problems encountered with a first generation of soft‐tipped catheters (n = 113) versus conventional catheters (n = 103) were as follows: difficult introduction 27% versus 1% (p < 0.01), difficult placement 13% versus 8% (not significant), difficult aspiration 4% versus 0% (p < 0.05), wedging 5% versus 0% (p <0.05), spasm 3% versus 0% (not significant), overselectivity 7% versus 2% (not significant), cross‐over necessary and successful 18% versus 1% (p < 0.01). Problems with a second generation of soft‐tipped catheters (n = 200), modified according to the experience gathered from the first generation, versus conventional catheters (n = 194) were as follows: difficult placement 10% versus 7%, difficult aspiration 2% versus 0.5%, wedging 2% versus 1%, spasm 1% versus 0%, overselectivity 3% versus 2%, ventricular fibrillation 1.5% versus 0%, cross‐over necessary and successful 3% versus 2%. None of the differences attained statistical significance. The performance of soft‐tipped catheters for coronary angiography was inferior for the first generation but comparable for the second generation to that of conventional catheters. In terms of safety, soft‐tipped catheters were not superior on the basis of our criteria.
Hemodynamic correlates of arterial compliance
Authors: Ferguson James J. , Randall Otelio S
Published: March 2007

There is at present no good understanding of the exact clinical correlates of arterial compliance. The purpose of this study was to establish which hemodynamic variables are most strongly associated with compliance. Hemodynamic measurements were performed on 41 patients undergoing diagnostic cardiac catheterization. Cardiac outputs were determined by thermodilution, and pressures were measured in the ascending aorta with a catheter‐tip manometer. Compliance was calculated from a mono‐exponential fit of diastolic decay pressures. Pulse pressure(PP), stroke volume(SV), age, systolic blood pressure(SBP), and cardiac output(CO) were significantly related to compliance. The quotient SV/PP was a good estimate of compliance, as was a first‐order function of both SV and PP. There appear to be specific clinical correlates of arterial compliance, as well as ways to estimate arterial compliance on the basis of conventional hemodynamic measurements when direct calculations are not possible.
“Isolength” postextrasystolic potentiation as a predictor of functional restoration following surgical revascularization for myocardial ischemia
Authors: Stanton Michael W , Cooper M. Wayne , Voda Jan , Lust Robert , Lutherer L. O. , Feola Mario
Published: March 2007

A previously developed method of programmed postextrasystolic potentiation (PESP) was assessed in eight patients with medically refractory unstable angina, as a predictor of functional restoration resulting from surgical revascularization. Prior to coronary arteriography, left ventricular segmental wall motion was determined during ventricular pacing and the first postextrasystolic beat following an extrasystole. The postextrasystole was induced at an interval calculated to occur at a time where ventricular preioad was identical to the regular paced beat (isolength interval). The left ventricular wall was divided into six segments, each subscribing one area of the ventriculogram, and correction for rotation during systole was made. Of 48 segments, 21 were considered “jeopardized,” due to greater than 70% reduction in cross‐sectional lumen of the serving coronary arteries. Fifteen of these 21 responded to PESP, increasing their segmental area ejection fraction from 44 ± 5 (paced “normal” beat) to 56 ± 6 (postextrasystolic beat) (p < 0.05). Following surgical revascularization, these segments showed an improvement in their baseline area ejection fraction from 44 ± 6 to 58 ± 5 (p < 0.05). Six jeopardized segments that failed to respond to PESP prior to revascularization showed functional deterioration after revascularization. The 27 nonjeopardized segments (which were not revascularized) also showed functional improvement, suggesting improved collateral flow. This study demonstrates that isolength postextrasystolic potentiation obtained with a standardized pacing protocol may be used to predict the potential for improvement in cardiac function following surgical revascularization. Our results also show that lack of PESP predicts loss of left ventricular myocardial function following revascularization.
Coronary artery variation in a native Iraqi population
Authors: Kurjia Huda Z , Chaudhry M. Siddique , Olson Todd R
Published: March 2007

The variation and distribution of the coronary arteries were studied in 119 hearts of individuals, 4 fetal months to 40 years old, who died from noncardiovascular causes. All individuals included in this study were natives of the Mosul area of northern Iraq. The coronary arteries were examined by injection‐corrosion and unaided dissection. Almost all (90%) of the anomalies observed were in the right coronary artery. Nine hearts (8% of total sample) possessed ectopic ostia in the right coronary sinus for the right coronary and conus arteries. The occurrence of a separate conus artery appears to be anomalous rather than ubiquitous as widely reported in the literature. One specimen had separate origins for the left circumflex and anterior descending arteries from the left coronary sinus. The patterns of coronary artery distribution were classified as left (14%) and right (46%) preponderant, and balanced (40%), following Schlesinger [Schlesinger, Arch Pathol 30:403–415, 1940]. The present study adds to the growing body of data on intrapopulation frequencies of coronary artery variants among non‐Europeans and supports the contention that postpartum development may modify the pattern of coronary divergence from the aorta. As the number of non‐Caucasian patients undergoing surgical treatment for ischemic or valvular heart disease increases, additional comparative data on racial, sexual, and ontogenetic variation of the coronary arteries and their aortic ostia are required to improve the care of these patients.
Alterations in myocardial metabolism and function at rest in stable angina pectoris: Relations with the amount of exercise‐induced thallium‐201 perfusion defect
Authors: De Kock Martine , Melin Jacques A
Published: March 2007

The relation between the amount of exercise‐induced ischemia and alterations in left ventricular (LV) function and metabolism at rest was studied in 18 coronary patients with stable angina pectoris. An ischemic defect area score was computed from quantitative exercise thallium‐201 (Tl‐201) scintigraphy; this estimation of the amount of ischemic myocardium was used to classify the patients in group I (n = 8; score < 15%, mean 6.7 ± 2.5%) and II (n = 10; score > 15%; mean 27.2 ± 8.9%). Hemodynamics and metabolism were studied in basal state. No patient had anginal pain during the study, and the extent of anglographic coronary artery disease (CAD) was comparable in the two groups. Heart rate, aortic pressure, coronary blood flow, and myocardial oxygen uptake were also similar in both groups. However, ejection fraction was reduced in group II (51 ± 13 vs 63 ± 5%; p <0.01) and LV relaxation was impaired as shown by the increase in timeconstant of isovolumic pressure fall (55 ± 16 vs 44 ± 6 ms in group I; p <0.05); the LV end‐diastolic pressure was also increased in group II (19 ± 8 vs 10 ± 4 mmHg in group I; p <0.05). Furthermore, in group II, myocardial lactate uptake was reduced (4 ± 19 vs 3C ± 29 μ mole/min in group I; p <0.01) and the productions of alanine and glutamine were augmented (−7.5 ± 4.4 vs −4.6 ± 1.6 μ mole/min in group I; p <0.05). This study shows that in anginal patients with a similar extent of angiographic CAD, an increased size of perfusion defect during exercise is associated with an increased incidence in alterations of LV systclic and diastolic function and with signs of impairments in aerobic metabolism.
Unusual intra‐arterial communication in the normal right coronary tree
Authors: Goldner Branislav
Published: March 2007

Among 136 patients with a history of angina pectoris who underwent selective coronary arteriography, two patients (1.4%) with a normal right coronary artery were found to have angiographically demonstrated communications between the various branches of the same coronary artery. Such findings, unaccompanied by coronary artery disease, have been hitherto unknown and suggest a congenital variation in coronary anatomy rather than a clinically significant condition. The purpose of this report is to demonstrate that the angiographic appearance of the anastomotic vessels in such cases is entirely different from that which obtains in cases of obstructive coronary artery disease. The author notes the rarity of angiographic visualization of homocoronary communications in normal right coronary arteries and emphasizes the necessity of distinguishing these from the homocoronary collaterals found in atherosclerotic coronary artery disease.
Anomalous origin of the posterior descending artery from the first septal perforator
Authors: Errichetti Annmarie , Mills Roger M. , Mercadante Nicholas M , Lingley James F
Published: March 2007

We describe a patient with an unusual coronary anatomic variant in which the first septal perforator gives rise to the posterior descending artery. The angiographic features and clinical recognition of this anomaly are reviewed.
Successful percutaneous removal of retained broken coronary angioplasty guidewire
Authors: Krone Ronald J
Published: March 2007

The use of a pigtail left ventriculography catheter to retrieve a coronary angioplasty guidewire that had become entrapped in a small coronary artery and broken off with the proximal end in the descending thoracic aorta is reported. A pigtail catheter was advanced to the ascending aorta and twirled, winding the wire around it, removing the wire from the small artery.
Catheter suction biopsy in diagnosis of an intrapulmonary artery tumor
Authors: Talley J. David , Franch Robert H
Published: March 2007

Unsuspected intracardiac masses are occasionally encountered when cardiac catheterization is performed in a patient with right ventricular or pulmonary artery occlusive disease. In one of two patients, suction biopsy of the mass has been successful in obtaining a histological diagnosis. The method and its contraindications are discussed.
Detection of right atrial myxoma by coronary cinearteriography
Authors: Levin Howard , Cha Se Do , Sumathisena  , Gonzalez‐Lavin Lorenzo , Gooch Alden S , Maranhao Vladir
Published: March 2007

During routine coronary cinearteriography, a large, right atrial myxoma was detected in a patient with angina pectoris. It was clinically unsuspected and was found at surgery to extend partially into the left atrium.
Tandem balloon catheter for coronary angioplasty
Authors: Finci Leo , Meier Bernhard , Steffenino Gluseppe , Rutishauser Wilhelm
Published: March 2007

The Tandem balloon catheter is a triple lumen steerable catheter for coronary angloplasty with two separately inflatable balloons of different diameters. Indications and results of 26 consecutive patients treated with a Tandem balloon catheter are reviewed. Adequate distal pressure measurements were obtained in 71% of the cases. In ten patients, the Tandem balloon catheter was selected for two stenoses in different segments of the same coronary artery. Angioplasty was successful for all lesions in five and for at least the strategic lesions in five patients (In one only after changing to a single‐balloon catheter). In the seven patients with stenoses in two different coronary arteries of various calibers, angioplasty was successful for both vessels in three and for one vessel in four patients. In the six patients with a very tight stenosis, where the Tandem balloon catheter was selected to predilate with the small balloon, the procedure was technically successful in all, but there was a myocardial infarction in one patient. In the three patients with a chronic total occlusion, where the stiffness of the Tandem balloon was the reason for selection, one recanalization was successful. The Tandem balloon catheter provides a handy tool for complex coronary angioplasty. It offers comparable ease in manipulation and pressure transmission and may save time, money, and radiation exposure by avoiding cathether exchanges.
A new technique for cannulation of the coronary sinus from the femoral vein
Authors: Dehmer Gregory J , Schmitz James M , Malloy Craig R
Published: March 2007

Previous techniques for cannulation of the coronary sinus have required entry into the right atrium from the superior vena cava. We describe a new technique for cannulation of the coronary sinus from the femoral vein using a standard, unmodified Simmons II catheter. This method was successful in 97% of the patients attempted. The method for using this catheter from the femoral route is described.
Anticoagulation with heparin during cardiac catheterization and its reversal by protamine
Authors: Dehmer Gregory J. , Haagen Donald , Malloy Craig R. , Schmitz James M.
Published: March 2007

The duration of effective anticoagulation with heparin during cardiac catheterization and angiography was determined in 201 patients. Effective anticoagulation was defined as prolongation of the activated partial thromboplastin time (APTT) by 2 or more times the upper limit of normal. When the procedure was completed within 40 min of heparin administration, all patients were anticoagulated adequately. The incidence of inadequate anticoagulation ranged from 9% to 25% as the time from heparin administration increased to 89 min. Procedures completed more than 90 min after heparin administration had a 58% incidence of inadequate anticoagulation. A protocol to estimate the appropriate protamine dose was developed based on experience accumulated in the first 78 patients and tested subsequently in 101 consecutive patients. Clotting studies returned to the normal range in 92% of the patients. The mean APTT decreased from 84.1 ± 19.4 to 27.4 ± 2.5 sec (p <.001) after protamine. Patients who did not correct to normal after protamine remained only 2.8 ± 1.4 sec (range 0.7–;–;5.5 sec) above normal. These data provide an estimate of the duration of anticoagulation during cardiac catheterization and angiography and demonstrate the feasibility of a simple and reliable method to reverse the effects of heparin.
Sequential dilatation of septal and left anterior descending artery: Single guiding catheter and double guide wire technique
Authors: Piscione Federico , Beatt Kevin , De Feyter Pim J. , Serruys Dr.Patrick W.
Published: March 2007

A new technique was used to dilate sequentially a bifurcation lesion involving the left anterior descending artery and the origin of a large septal branch. Two steerable long guide wires (300 cm) were advanced through a single guiding catheter and placed across each lesion. The balloon catheters were introduced into the target arteries for angioplasty one at a time over the pre‐positioned guide wires. After the septal branch had been successfully dilated, the balloon catheter was completely withdrawn from the manifold and a second balloon catheter positioned in the left anterior descending artery over the guide wire already placed across the stenosis. Such a technique is feasible and safe, and overcomes the potential risks of the conventional kissing balloon technique.