bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcatheter occlusion of ventricular septal defect
Authors: O'Laughlin Martin P. , Mullins Charles E.
Published: March 2007

The patent ductus arteriosus occlusion device (Rashkind‐USCI) was employed to occlude a residual ventricular septal defect after Fontan procedure in a patient with hypoplastic right ventricle, ventricular septal defect, and pulmonary stenosis. There was significant right‐to‐left shunting across the ventricular septal defect, with cyanosis exacerbated by exercise. After placement of the 17 mm occlusion device, the right‐to‐left shunt was markedly diminished, and the cyanosis resolved. Occlusion of ventricular septal defects in patients with complex congenital heart disease may be performed with the patent ductus arteriosus occluder in selected instances.
Mitral balloon valvuloplasty using a retrograde transventricular approach via the brachial artery
Authors: Zureikat Harran Y. , Karsheh Issa E. , Naber Natalia M. , Najjar Sakeb M. , El‐Dibs Nayef R. , Salch Suhayl S.
Published: March 2007

Mitral balloon valvuloplasty was performed successfully in two patients with moderately severe mitral stenosis by using a retrograde transventricular arterial approach. This technique is less costly and less time consuming as compared with the transseptal technique. It avoids the creation of an atrial septal defect, which can result in significant left to right shunt that can make interpretation of haemodynamic data difficult. The major drawback with this technique is the size of the balloon catheters in current use, which can make their introduction into the brachial artery difficult. This paper discusses technical aspects of retrograde crossing of the mitral valve.
Transseptal left heart catheterisation in infants, children, and young adults
Authors: Ali Khan M. A. , Mullins C. E. , Bash S. E. , Al Yousef S. , Nihill M. R. , Sawyer W.
Published: March 2007

Over a 5 yr period, from October 1983 to September 1988, transseptal left heart catheterisation, using Mullins long‐sheath technique, was performed in 217 infants, children, and young adults, with various forms of congenital or acquired heart disease. The mean age was 50 ± 45 months, (range 1 mo to 21 yr). The procedure was successful in 215 (99%) patients. Pericardial puncture occurred in three patients (1.4%), though without tamponade or sequelae. There was no mortality or morbidity. Transseptal left heart catheterisation is a safe procedure for studying the left side of the heart. In addition, and of increasing importance, it allows the performance of interventional procedures on the left side of the heart and avoids the use of retrograde catheterisation through the femoral arteries.
Measurement of coronary sinus flow by thermodilution: Observations on the effect of respiration and a review of the potential sources of error
Authors: Stewart J. T. , Gray H. H. , Camm A. J.
Published: March 2007

In a series of experiments involving measurement of left ventricular blood flow by thermodilution in the coronary sinus, a consistent, but unexpected, variation in calculated coronary sinus flow, related to respiration, was seen. In some patients the variation was small, but in others it was as much as 300%. To discover its cause, five patients were investigated prospectively with continuous right atrial pressure monitoring during coronary flow measurement and respiratory manoeuvres. In three, ice‐cold saline was injected into the right atrium during respiratory manoeuvres while coronary sinus temperature was monitored continuously and the position of the catheter was monitored fluoroscopically. The cause was found to be movement of the catheter such that thermistor approached the right atrium, and the variation was therefore spurious. We report these findings and discuss other known causes of inaccurate coronary flow measurement using the thermodilution technique.
Probe angioplasty of total coronary occlusion using an intracoronary probing catheter™
Authors: Little Thomas , Richard Augusto D. , Lindsay Joseph
Published: March 2007

Coronary angioplasty (PTCA) of total coronary occlusion is limited by the inability of guidewires and conventional dilating catheters to cross all such lesions. We have therefore developed a technique for PTCA of chronic total coronary occlusions using the ultralow profile “balloon‐on‐a‐wire” Probe™. An intracoronary Probing Catheter™ is used to facilitate crossing the stenosis with a guidewire and then to deliver a Probe into the obstruction for balloon dilatation. This technique was used in 13 patients including six in whom other dilating systems had failed to cross the occlusion. Successful dilatation was performed in nine patients (67%). Among the six patients in whom other dilating systems had failed, dilatation was performed in five using the Probing Catheter technique with a successful outcome acieved in four (67%).

The Probing Catheter technique offers a promising new method to apply “balloon‐on‐a‐wire” technology to the dilatation of chronic total coronary occlusions. This method may allow successful dilatation when other dilating systems fail.
Adverse reactions to indocyanine green: A case report and a review of the literature
Authors: Benya Richard , Quintana Joseph , Brundage Bruce
Published: March 2007

Indocyanine green is a dye used primarily in cardiac output determinations, and in ophthalmic angiography. It has a low incidence of side effects; however, they occur and have included death. We report a case of anaphylactoid reaction to indocyanine green and review the literature on these reactions.
Accelerated aortic stenosis
Authors: Graham Susan P. , Nath Amar
Published: March 2007

A 56 year‐old woman presented in congestive heart failure 4 weeks after cardiac catheterization. By repeat catheterization, the mean gradient across the native aortic valve had progressed from 10 mm Hg to 51 mm Hg. In patients with calcific‐degenerative valvular disease, the rapid worsening of aortic stenosis should be considered in the differential diagnosis of recurrent heart failure.
Complex multiple percutaneous transluminal coronary angioplasties with vortex oxygenator cardiopulmonary support in the community hospital setting
Authors: Freedman R. J. , Wrenn R. C. , Godley M. L. , Knoepp J. D. , Smith Curt , LaCroix C.
Published: March 2007

With the support of a Bard percutaneous cardiopulmonary bypass pump system, multiple complex percutaneous transluminal coronary angioplasties (PTCAs) were performed successfully in four patients previously declined for surgery or intervention because of prohibitive risks.
Large coronary artery angioplasty
Authors: Calick Arthur
Published: March 2007

Angioplasty of a large coronary artery required two side‐by‐side balloon catheters. Angioplasty was performed using a single recently developed large lumen guide catheter in a vessel that was difficult to cannulate.
Systolic compression of the right coronary artery by a pseudoaneurysm following mitral valve replacement
Authors: Minami Kenneth T. , Fergusson David J. G.
Published: March 2007

A patient who developed a pseudo‐, or false, aneurysm following mitral valve replacement is presented here with the unique angiographic finding of systolic compression of the right coronary artery by the pseudoaneurysm. Clinical and angiographic features of this case along with a discussion of pseudoaneurysms and the significance and causes of systolic compression of coronary arteries are presented.
Staged thrombolysis and percutaneous transluminal coronary angioplasty for unstable and postinfarction angina
Authors: Hurley Dominic V. , Bresnahan Dennis R. , Holmes David R.
Published: March 2007

The precise timing of intravenous thrombolysis and coronary angioplasty continues to be evaluated for patients who have coronary thrombosis and unstable angina or postinfarction angina. Coronary angioplasty is effective for these patients but is associated with thromboembolic coronary occlusion in 24% to 29% of cases. After adjunctive intravenous thrombolysis and oral antiplatelet therapy to improve the success rate and to decrease the risk of acute occlusion, deferred angioplasty was successful in three patients with intracoronary thrombus and unstable angina or postinfarction angina. Staged thrombolysis and deferred angioplasty is feasible for selected patients with these acute coronary syndromes.
Repeat balloon aortic valvuloplasty for aortic valve restenosis
Authors: Ross Terence C. , Banks Alan K. , Collins Tyrone J. , Ramee Stephen R. , White Christopher J. , Moore John W.
Published: March 2007

Effective balloon aortic valvuloplasty (BAV) is limited by restenosis. After aortic valve restenosis six patients underwent repeat BAV. In spite of the use of larger balloons there was a trend toward a less satisfactory result after repeat BAV (0.98 ± .26 cm2 vs. 1.2 ± .26 cm2), which did not reach statistical significance, P = .14. Mortality of the patients at 6 months was 50%. Repeat BAV may be less efficacious than the original procedure.
Spontaneous cyclic severe mitral regurgitation
Authors: Engel Peter J. , Wayne Donald
Published: March 2007

Two patients are described with spontaneous wide fluctuations in the size of pulmonary capillary wedge pressure V waves thought to be related to cyclic spontaneous variations in the degree of mitral regurgitation over very short periods of time. The findings are thought to represent a hemodynamically distinct syndrome intermediate between chronic severe and acute severe mitral regurgitation.
Percutaneous brachial coronary angioplasty utilizing a standard side arm sheath introducer system
Authors: Korr Kenneth S. , Januski Victoria
Published: March 2007

A percutaneous approach via the brachial artery for coronary angioplasty is described. The technique employs a standard side arm sheath introducer system routinely intended for the femoral artery. Initial experience in ten cases shows this to be a relatively easy and safe alternative to conventional brachial arteriotomy, with some distinct advantages. It is less time consuming, permits the use of a variety of standard preformed guiding catheters, is associated with less patient discomfort, and the sheaths may be left in place for many hours if the angioplasty is complicated and/or long‐term anticoagulation is desirable. Complications were limited to the female patients in this series. This technique is most suited to those operators who employ the brachial approach infrequently and only out of necessity in patients with severe peripheral vascular disease.
Complex coronary angioplasty: Use of a new microprobe balloon catheter
Authors: Mayo Joseph R. , Candela Richard J. , Zimmerman Connie , George Barry S.
Published: March 2007

Since the introduction of coronary angioplasty by Gruntzig et al. (Circulation [Suppl II] 56:84,1977), a key determinant to overall success has been advancement in equipment technology. Major advances have been made in the availability of low‐profile catheters in the last 5 years that have facilitated penetration of high‐grade distal and complex lesions. The USCI Probe TM catheter is an example of a low‐profile catheter that has shown favorable applicability in dilating high‐grade stenoses. Preliminary data indicate that this device has good trackability and an extremely low profile, which allows penetration of stenoses where other current low‐profile catheters have failed.
Optimal display of the coronary arterial tree with an upscan 1,023‐line video display system
Authors: Holmes David R. , Wondrow Merrill A. , Reeder Guy S. , Gray Joel E. , Fellows James L. , Julsrud Paul R.
Published: March 2007

Differences of opinion exist as to whether visualization of the coronary arterial tree is better with 525‐line or 1,023‐line video imaging systems. The 1,023‐line acquisition has been associated with image degradation; 525‐line display, however, has prominent raster lines that may also degrade the image. For evaluation of this issue, identical coronary arterial images were obtained with 525‐line acquisition and then displayed with either 525‐line or 1,023‐line display. The 525‐line acquisition with digital upscan 1,023‐line display had superior image quality compared with 525‐line display. With the use of 525‐line acquisition and 1,023‐line display, video images were similar to or slightly better than the identical cineangiographic images.
Adequate heparinization during PTCA: Assessment using activated clotting times
Authors: Ogilby J. David , Kopelman Harry A. , Klein Lloyd W. , Agarwal Jai B.
Published: March 2007

Heparinization during PTCA is often done empirically with an initial 10,000 unit bolus of heparin and subsequent additional boluses as deemed necessary to prevent thrombus formation and fibrin deposition. However, the initial 10,000 unit bolus may not result in adequate systemic anticoagulation in every patient, exposing some patients to risk of thrombus at the angioplasty site and subsequent reocclusion. In this non‐randomized study, we assessed systemic coagulation during PTCA by retrospectively analyzing activated clotting times obtained in 108 consecutive patients. All patients had normal baseline prothrombin times and activated partial thromboplastin times. Patients who were on heparin prior to PTCA were excluded. Based on data from studies on heparinization during extracorporeal bypass an activated clotting time (ACT) of greater than 300 seconds was required. Twelve patients (11 %) were observed to have activated clotting times of below 300 seconds after an initial 10,000 unit bolus of heparin. These patients required an additional 3,000‐10,000 units of heparin to have systemic anticoagulation during PTCA. Symptoms of stable or unstable angina had no significant effect on heparin requirement, although there was a trend toward greater heparin resistance in unstable angina.

We conclude that it is important to monitor the status of anticoagulation during PTCA, for 11 % of patients undergoing PTCA require additional initial heparin bolus to achieve an ACT greater than 300 seconds and to be effectively anticoagulated. Careful monitoring of heparinization during PTCA may reduce the incidence of thrombosis.
Side branch occlusion during coronary angioplasty: Incidence, angiographic characteristics, and outcome
Authors: Arora Rohit R. , Raymond Russell E. , Dimas Alexios P. , Bhadwar Kavita , Simpfendorfer Conrad
Published: March 2007

Side branch occlusion (SBO) during percutaneous transluminal coronary angioplasty is a well‐recognized complication. The purpose of the present study was to analyze the incidence, angiographic characteristics, and sequelae of side branch occlusion. Data from coronary angiograms of 4,800 consecutive patients from January 1981 to December 1987 was retrospectively analyzed, and 167 patients (3%) involving 181 lesions, with side branch occlusion, were identified. Only arteries with occlusion of side branches >1 mm were evaluated. There were 65 (36%) diagonal, 49 (27%) septal, 40 (22%) left circumflex, and 27 (15%) right coronary branch occlusions. Most side branch occlusion occurred in branches with disease (66%: 120 of 181) or branches originating within the primary arterial lesion (72%: 130 of 181).

Although the incidence of side branch occlusion is uncommon, it is associated with a significant incidence of myocardial infarction (14%). Attempts to reopen the occluded branch were successful in 27 of 36 cases (75%). With improvement in balloon angioplasty technology, the risks of side branch occlusion have declined, and many occlusions can be successfully reopened, suggesting that side branch involvement in a primary lesion is not a limitation to balloom angioplasty.
Late hemodynamic results after orthotopic heart transplantation in early infancy
Authors: Kanakriyeh Mohammad S. , Mullins Charles E. , Parisi Francesco , Petry Eugene L. , Bailey Leonard L.
Published: March 2007

To study the late hemodynamic results after infant orthotopic heart transplantation, five late survivors, as of October 1988, underwent right and left cardiac catheterization and endomyocardial biopsy. Mean age at transplantation was 1.4 ± 1.5 months. Mean post‐transplantation period was 17 ± 5.6 months. All patients were on maintenance immunotherapy. The systemic and mixed venous saturations were normal, with no intracardiac shunt. The atrial and pulmonary artery anastomoses were widely patent. Three patients had coarctation of the aorta with a respective gradient of 24, 26, and 30 mm Hg; two were successfully treated by balloon angioplasty. The right‐side hemodynamics were normal in all patients. Left ventricular pressures were elevated only in the patients with coarctation. The ventricular ejection fraction was normal. The right ventricular endomyocardial biopsy revealed no evidence of rejection. The mean cardiac index was 4.7 liter/min/m2 (range, 3.68–5.9). These data indicate excellent hemodynamic results and support orthotopic heart transplantation as therapy for selected neonates and infants with incurable heart disease.
Treatment of coronary artery stenosis and coronary arteriovenous fistula by interventional cardiology techniques
Authors: Nguyen Khiem , Myler Richard K. , Hieshima Grant , Ashraf Mohammed , Stertzer Simon H.
Published: March 2007

Complications associated with coronary arteriovenous fistulae (CAVF) include congestive heart failure, bacterial endocarditis, fistula rupture, and angina secondary to the “coronary steal” phenomenon. Traditional treatment of large CAVF is surgical ligation. In this report, we describe a modified microcoil embolization and guidewire technique for percutaneous closure of CAVF.
Intracoronary thrombectomy: A new approach to total occlusion
Authors: Kipperman Robert M. , Feit Alan S. , Elnhorn Arnold M. , Co John A.
Published: March 2007

After initial failure with conventional angioplasty of a total right coronary artery occlusion, we were successful in obtaining patency using a combination of intracoronary thrombectomy and thrombolysis. This represents the first report of this technique in the therapy of total right coronary occlusions.
Balloon entrapment in a coronary artery: Potential serious complications of balloon rupture
Authors: Colombo Antonio , Skinner Joan M.
Published: March 2007

We report a case of balloon catheter rupture with subsequent entrapment during percutaneous transluminal coronary angioplasty. The presence of a calcified, distal lesion is believed to have prevented withdrawal of the broken catheter. A nonsurgical retrieval technique, using a second dilation system, was used to free the catheter.
Coronary artery dissection caused by angioplasty balloon rupture
Authors: Rothschild Richard , Voda Jan
Published: March 2007

Three cases of coronary angioplasty balloon rupture complicated by coronary artery dissection are described. Factors that may predispose to this previously undescribed and potentially devastating complication are discussed.
False coronary dissection with the new Monorail angioplasty balloon catheter
Authors: Esplugas Enrique , Cequier Angel R. , Sabaté Xavier , Jara Francisco
Published: March 2007

During percutaneous transluminal coronary angioplasty, the appearance of persistent staining in the vessel by contrast media suggests coronary dissection. We report seven patients in whom a false image of severe coronary dissection was observed during angioplasty performed with the new Monorail balloon catheter. This image emerges at the moment of balloon inflation, is distally located to the balloon, and disappears with balloon catheter deflation. No complications were associated with the appearance of this image.
Angioplasty of recent total coronary occlusions: Cardiac death can occur in “low‐risk” cases
Authors: Butman Samuel
Published: March 2007

Revascularization by angioplasty of total coronary artery occlusions is generally thought to be relatively safe in experienced hands. Although success rates are lower than with diseased but patent vessels, reasonable success can be expected. In this report, different events led to a sudden and fatal outcome in two patients with total coronary occlusions subtending recently infarcted, but still viable, areas of myocardium. The cases and procedural details are presented.
Percutaneous balloon valvuloplasty of a stenosed mitral bioprosthesis
Authors: Fernandez Jose J. , Desando C. James , Leff Richard A. , Ord Mark , Sabbagh Adib H.
Published: March 2007

A 62‐year‐old woman with disabling mitral prosthetic stenosis underwent percutaneous balloon valvuloplasty. The transvalvular gradient preoperatively was 22 mm Hg and was reduced to 6 mm Hg after the valvuloplasty. The valve area was increased from an initial value of 0.77 cm2 to 1.53 cm2. No complications occurred related to the procedure. Further studies are necessary to ascertain the indications and long‐term results of percutaneous valvuloplasty on bioprosthesis in the mitral position.
Single coronary artery associated with annuloaortic ectasia and ventricular septal defect
Authors: Kallikazaros John E. , Gavaliatsis Isidoros P. , Tentolouris Costas A. , Merkouris Costas S. , Liasides Christakis E. , Kourouklis Costas B. , Toutouzas Pavlos C.
Published: March 2007

A 60‐year‐old man with a single left coronary artery associated with an annuloaortic ectasia and a ventricular septal defect is described. He presented with severe heart failure and underwent open‐heart surgery during which all these entities were confirmed.
Comparison of 5F and 7/8F catheters for left ventricular and coronary angiography
Authors: Hui William K. K. , Klinke W. Peter , Kubac George , Talibi Talip
Published: March 2007

Fifty‐two patients were randomized into two groups of 26 to the use of either 5 or 7/8F catheters for their first left heart cardiac catheterization. Clinical characteristics for the two groups were similar. 5F catheters were significantly inferior to 7/8F catheters in terms of torque control (P<.001), ease of engaging coronary ostia (P<.001), and quality of angiograms (P<.05). Nine patients in the 5F group required a change to 7/8F catheters for completion of the procedure. There was no difference in procedure time or fluoroscopy time between the groups. Time to haemostasis was significantly shorter in the 5F group (P<.01), but there was no difference between groups with respect to haematoma formation or rebleed after haemostasis. We conclude the slight advantage of 5F catheters in terms of haemostasis is outweighed by many disadvantages. Their routine use in cardiac catheterization, at least at this time, cannot be recommended.
Isolated unruptured sinus of Valsalva aneurysm producing right ventricular outflow obstruction
Authors: Haraphongse Mant , Na Ayudhya Rapeephon Kunjara , Jugdutt Bodh , Rossall Richard E.
Published: March 2007

An unusual case of right ventricular outflow obstruction and right heart failure due to an isolated unruptured congenital sinus of Valsalva aneurysm originating from the right coronary sinus in a 75‐year‐old‐man is described. The diagnosis was made by twodimensional echocardiography and cardiac catheterization. Successful surgical resection of the aneurysm resulted in dramatic symptomatic improvement.
Management of complicated coronary angioplasty by intracoronary urokinase and immediate re‐angioplasty
Authors: Verna Edoardo , Repetto Sergio , Boscarini Mauro , Onofri Marco , Qing Lu Guo , Binaghi Giovanni
Published: March 2007

Percutaneous transluminal coronary angioplasty was complicated by acute coronary occlusion, dissection of the arterial wall, or angiographic evidence of intraluminal thrombosis in 33 high‐risk patients from 153 consecutive angioplasty procedures (21.5%). Ten patients (group I) were managed with nitroglycerin (0.2 to 0.4 mg i.c.) and repeated attempts at mechanical guide wire recanalization or dilation, but they did not receive thrombolytic therapy. In the remaining 23 patients (group II), intracoronary urokinase (100,000 to 360,000 U.I.) was administered over 15–20 min after onset of coronary occlusion or thrombosis and continued during attempts at repeated dilation of the stenosis. The incidence of sudden coronary artery occlusion was 70% in group I patients and 52% in group II. The angiographic evidence of thrombus formation was observed in a higher, but not significant, proportion of group II patients (65%) as compared with group I(30%). The incidence of intimal tearing or dissection was similar in the two groups of patients (40 vs. 34.7%). The overall final success rate of the complicated angioplasty series was 48% (6/33). However, the success rate was lower (10%) in group I than in group II patients (10 vs. 65%; P < 0.005), and the frequency of emergency coronary artery bypass grafting was lower in group II patients (13 vs. 60%; P = 0.01), suggesting that thrombolytic therapy with urokinase may be effective in the management of acute coronary occlusion and thromboembolic complications of coronary angioplasty.
Effectiveness of the Arani double‐loop guiding catheters in angioplasty of aorto‐coronary vein grafts
Authors: Arani Djavad T. , Visco John P. , Conley James G. , Bunnell Ivan L.
Published: March 2007

Double‐loop guiding catheters have been used for angioplasty of aorto‐coronary vein grafts (VG) or grafted arteries through the VG in 31 cases. A catheter with a 90° primary curve was usually the best choice for angioplasty of the VG to the right coronary artery (RCA). For angioplasty of the VG to the left coronary artery branches (LCA), a 90° primary curve was used when the proximal segment of the VG was oriented horizontally and a 75° (USCI, C.R. Bard, Inc., Billerica, MA) was used when the proximal segment was directed superiorly.

Angioplasty of 32 lesions was attempted in 31 patients. These catheters provided good “back‐up” in angioplasty of 30 lesions (94%). The lesions were crossed with balloon catheters in 29 cases (91%). There was one acute VG occlusion requiring coronary artery bypass graft (CABG) surgery, a complication not attributed to the guiding catheter. We conclude that Arani guiding catheters provide strong back‐up, are helpful in angioplasty of the vein grafts, and could be used as the primary choice for VG angioplasties.
Swan‐Ganz catheter‐induced rupture of the pulmonary artery: Successful early management by transcatheter embolization
Authors: Jondeau Guillaume , Lacombe Pascal , Rocha Paulo , Rigaud Michel , Hardy Anne , Bourdarias Jean‐Pierre
Published: March 2007

An 84‐year‐old patient with severe aortic valve stenosis suffered Swan‐Ganz catheterinduced massive pulmonary hemorrhage. Immediate therapeutic embolism of the segmental artery by using a liquid, tissue‐adhesive, occlusive agent (isobutyl‐2‐cyanoacrylate) controlled bleeding.
Estimation of coronary flow reserve by intracoronary doppler flow probes and digital angiography
Authors: Graham Susan P. , Cohen Mark D. , Hodgson John McB.
Published: March 2007

This prospective study investigated two different methods used clinically to estimate coronary flow reserve during cardiac catheterization. First, the relationship between simultaneous digital angiography and intracoronary Doppler velocity measurements was determined in 61 patients. The correlation coefficient for 233 simultaneous pairs of papaverine‐induced flow reserve was 0.70 (Doppler = 0.41 digital + 0.93, P<0.0001). Repeated basal flow determinations showed little variability (Doppler: 2 ± 5% (mean ± 95% confidence intervals); digital: 3 ± 10%). Repeated hyperemic flow estimates by the Doppler technique were more reproducible (10 ± 2%) than those by the digital method (26 ± 6%).

Second, estimates of coronary flow reserve by side‐mounted and end‐mounted Doppler catheters were compared in vitro and in patients. In vitro measurement of blood velocity was linear for both catheter designs and was highly correlated with volume flow determined by electromagnetic flow meter (r = 0.99 side‐mounted; r = 0.96 end‐mounted). In patients (n=20), average coronary flow reserve for the side‐mounted Doppler crystal was 2.64 ± 0.15 and for the end‐mounted Doppler crystal was 2.40 ± 0.14 (P0.02). When flow reserve was determined twice for each catheter, there was greater variability in repeated measurements using the side‐mounted Doppler crystal (21 ± 10%, n = 14) than using the end‐mounted Doppler crystal (12 ± 4%, n = 32). When the two catheters were placed sequentially in the same patient, measurements of flow reserve varied by 19.0 ± 5.5% (n =20). A specially constructed catheter with both side‐ and end‐mounted crystals on the same shaft was evaluated in five patients. Coronary flow reserve was similar for both crystals (side: 2.54 ± .68, end: 2.60 ± .20) but variation between crystals remained high (19.8 ± 4.4%).
Total inferior vena cava thrombosis following coronary artery bypass surgery
Authors: Rama Bhola N. , Salem Bakr I. , Haikal Maged , Mera Ronald , Ortbals David , Gowda Siddhesh
Published: March 2007

A 44‐yr‐old male presented with abdominal and back pain following coronary bypass surgery (CABG). Total inferior vena cava (IVC) thrombosis was then documented by computed tomography as well as IVC contrast cineangiography. Furthermore, the patient developed multiple pulmonary emboli.

This presentation with severe abdominal and back pain with lack of early peripheral edema without apparent hepatic or renal dysfunction and with extreme elevation of erythrocyte sedimentation rate seems rather unusual.

To our knowledge, such massive IVC thrombosis has not been reported following CABG. Thrombolytic and anticoagulant therapy was utilized with good recovery.
Foreign body retrieval using a simple snare device
Authors: Bogart Douglas B. , Earnest James B. , Miller John T.
Published: March 2007

We report three patients who had intravascular catheter fragments removed using an easily made snare device fashioned from a 0.038 inch movable‐core J‐wire and a multipurpose catheter. The device is easily manipulated and facilitates safe removal of embolized catheters.
Retrieval of a fractured USCI probe tip from a diseased coronary artery using another fixed‐wire balloon catheter, the Cordis Orion
Authors: Feldman Robert L. , Trice William A. , Hennemann Willard W. , Furst Ariel
Published: March 2007

We report a novel technique for removing an intracoronay wire fragment using a fixedwire steerable angioplasty balloon catheter, the Cordis Orion.
Left ventricular pressure effects on right ventricular pressure and volume outflow
Authors: Damiano Ralph J. , Cox James L. , Lowe James E. , Santamore William P.
Published: March 2007

Massive destruction of the right ventricular free wall has been shown to cause only mild hemodynamic alterations. Further, the derivative of right ventricular (RV) pressure (P) is broad or double peaked, with one peak occurring coincidentally with peak left ventricular (LV) dP/dt. Both observations suggest a direct LV assistance to RV function. Since the ventricles contract nearly simultaneously, the relative contribution of LV to RV pump function has been difficult to determine. This LV assistance was quantified in six canine experiments using a unique electrically isolated RV preparation. While on total cardiopulmonary bypass, the RV free wall was electrically isolated from the remainder of the heart. This preparation allowed for wide variations in the timing interval between RV and LV contractions. Double‐peaked waveforms for RVP and pulmonary flow (RVF) occurred over a wide range (0 to 300 ms) of pacing intervals between the RV and LV. One derivative peak always followed RV contraction for RVP and RVF (r = 0.971 ± .011, P 0.01: r = 0.972 ± .012, p < 0.01; respectively). The second derivative peak was unrelated to the RA‐RV pacing interval (r = 0.297 ± .191, P > 0.5 RVP; 4 = 0.237 ± .278, P > 0.5 RVF), but corresponded to the maximal LVP rise. Additionally, the magnitude of the two derivative peaks was similar when the ventricles contracted synchronously. When RV contraction preceded or followed LV contraction, the derivative peak associated with LV contraction was significantly greater (P < 0.05, range 2.1 ± 0.6 to 6.7 ± 1.6 for RVP; P ± 0.05 range 1.9 ± 0.4 to 6.7 ± 1.5 for RVF) than the derivative associated with RV contraction. These data demonstrate a normally present, large LV assistance to RV contraction and may help to explain the RV response to myocardial infarction.
Probe exchange catheter used for angioplasty of total coronary artery occlusions
Authors: Kiemeneij F. , Suwarganda J. S. M. , van der Wieken L. R.
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) for total occlusions frequently fails, because the guidewire fails to pass the occlusion. With the use of the Probe exchange catheter (PEC), however, stiffness of the guidewire is increased and a higher pushability is obtained in order to manipulate the guidewire beyond the lesion. Once the guidewire has passed, the PEC is advanced and a non‐over‐the‐wire dilatation catheter can be introduced through the PEC. This paper describes the technique in a representative case. The results of this technique in 19 consecutive patients with class III‐IV/IV(NYHA) angina due to an occluded coronary artery are presented. In 16 patients the PEC reached the lesion (84%) and in all these patients the guidewire could pass the occlusion. A successful PTCA was performed in 14 patients (74%).
Detection and quantification of aortic regurgitation during aortic valvuloplasty
Authors: Lopez J. F. , Khouri M.
Published: March 2007

The degree of aortic regurgitation, before and after balloon aortic valvuloplasty, was assessed in 32 patients, using double indicator dilution curves: a) the forward curve was obtained by dye injection into the left ventricle and sampling in the aorta; b) the regurgitant curve was obtained by dye injection in the aorta and sampling in the left ventricle. A regurgitant index (RI) was calculated by obtaining the ratio of the areas of the triangles from regurgitant and forward curves. Eight‐five percent of the patients were 70 years or older. After valvuloplasty, aortic valve area increased from 0.5±t 0.3 cm2 to 0.7 ± 0.3 cm2 (P = 0002) while left ventricular to aortic gradient decreased from 77 ± 32 to 51 ± 24 (P=.0001). RI did not significantly change in 58% of patients, increased in 25%, and decreased in 15.2%. We conclude that in most patients undergoing aortic valvuloplasty, regurgitation does not change after the procedure. In some patients it may increase significantly, and in a few it may even decrease. Indicator dilution curves technique seems to provide a sensitive, accurate, and reproducible method to detect and quantify aortic incompetence before and after valvuloplasty.
Internal mammary angiography: A review of technical issues and newer methods
Authors: Kuntz Richard E. , Baim Donald S.
Published: March 2007

Up to 90% of coronary bypass operations in some centers now include at least one IMA graft. In parallel with the increased use of IMA grafts, our catheterization laboratory records for 1986‐7–8 demonstrate a progressive increase in IMA angiography, both absolutely (11, 28, 48 cases/yr) and as a percent of restudy procedures performed after prior bypass (14, 25, 43%). Unfortunately, these records also show that cannulation of the right and left IMAs may involve substantial technical hurdles, resulting in a mean time of 19 ± 19 min from catheter insertion toselective IMA angiography.

Based on this experience, we review a standard technique for IMA angiography using preformedcatheters, and describe alternative methods (including use of PTCA guidewires with or without super‐selective catheters, and non‐selective angiography utilizing a specially designed balloon occlusion catheter).
Aortic valve tumor: An unusual cause of coronary obstruction during cardiac catheterization
Authors: Israel Douglas H. , Sherman Warren , Sharma Samin K. , Estioko Manuel R. , Ambrose John A.
Published: March 2007

Coronary artery obstruction during cardiac catheterization is a rare but serious complication that has been reported to occur in 0.15 to 0.5% of cases [1,2]. The most common causes of intraprocedural coronary occlusion include thromboembolism, air embolism, and coronary dissection. This report describes the angiographic findings of a patient who developed chest pain with electrocardiographic evidence of myocardial ischemia due to obstruction of the right coronary artery by an aortic valve tumor.
Hypothesis: Warfarin administered simultaneously with heparin infusion will prevent heparin‐discontinuance associated coronary Thrombosis
Authors: Craddock Lane , Miller Brian , Krumbach Barbara , Marmont Paula , Shander David
Published: March 2007

Recent studies have evidenced an association between the time of heparin discontinuance and coronary artery reocclusion. Some investigators have concluded that inadequate heparinization was responsible, and further heparin infusion or an increase in dose would have been indicated. However, several investigators (Rao: Thrombosis Research 24:181–186, 1981; Marciniak and Gockerman: Lancet September 17:581–584, 1977; Fisken et al.: Lancet December 10: 1231, 1977; Conard et al.: Thrombosis Research 22:507–511, 1981; Kakkar et al.: Lancet January 12:103–104; Green: Lancet February 16:374,375; Harborne and Nicolaides: Thrombosis Research 43:657–662, 1986; Bonen et al.: Thrombosis Research 27:123–124, 1982; Blomback et al.: Acta Physiologica Scandinavica 58:306–318, 1963; Holm et al.: Scandinavian Journal of Haematology 35:564–569, 1985; Andersson et al.: Thrombosis Research 34:333–340,1984) have demonstrated that antithrombin III levels are reduced in patients on intravenous heparin. Both reduced antithrombin III levels and reduced rate of antithrombin inhibition of thrombin at the time of heparin discontinuance may increase the risk of coronary rethrombosis. If this theory is correct, increasing heparin infusion may exacerbate this risk. We propose an investigation that will provide evidence for or against the decreased antithrombin III theory, and in doing so, test an experimental therapy designed to prevent coronary reocclusion upon heparin discontinuance. In a randomized, placebo‐controlled double‐blinded study, we will determine whether simultaneous administration of warfarin with heparin initiation provides more time to increase antithrombin III levels and prevent coronary reocclusion upon heparin discontinuance, compared to heparin without warfarin therapy.
Retrograde coronary angioplasty of isolated arterial segments through saphenous vein bypass grafts
Authors: Kahn Joel K. , Hartzler Geoffrey O.
Published: March 2007

Progression of native coronary artery disease proximal to the placement of saphenous vein grafts may leave arterial segments isolated by stenoses on either side. In 16 patients, we attempted coronary angioplasty in a retrograde direction through saphenous vein grafts to revascularize 17 isolated arterial segments. The retrograde dilatation was successful in 12 of 17 attempts (71%). Failure in 5 attempts was due to severe angulation between the graft insertion site and the retrograde proximal arterial limb. There were no major complications of these procedures. Symptoms and signs of myocardial ischemia were relieved following successful retrograde dilatation. Thus, retrograde dilatation through saphenous vein grafts provides another means of achieving complete revascularization using coronary angioplasty in patients with prior coronary bypass surgery.
Preliminary results utilizing a new percutaneous transluminal coronary angioplasty balloon catheter
Authors: Talley J. David , Joseph Abraham , Kupersmith Joel
Published: March 2007

We report our initial experience with a new percutaneous transluminal coronary angioplasty (PTCA) balloon catheter and compare it to a similar over‐the‐wire system in a retrospective, nonrandomized fashion. There was no statistical difference in pre‐PTCA angiographic indices and post‐PTCA angiographic and clinical success rates between the two groups. There was a trend toward a decrease in length of fluoroscopy (P = 08) and a significant decrease in the amount of contrast utilized (P = .007) with the new balloon catheter. Several new construction features of the new catheter account for this improvement and are discussed. The long‐term success of this balloon catheter remains to be investigated.
Successful resuscitation of a patient with critical aortic stenosis and cardiac arrest by peripheral cardiopulmonary support system
Authors: Pavlides Gregory , Cieszkowski John , Timmis Gerald C. , O'Neill William
Published: March 2007

Patients with critical aortic stenosis have an increased risk of complications during diagnostic cardiac catheterization, and those who arrest are particularly difficult to resuscitate. Recent advances in therapeutic techniques may change this unfavorable prognosis, as it is illustrated in the presented case. A 68 year‐old women with critical aortic stenosis sustained a cardiac arrest during diagnostic cardiac catheterization. Conventional cardiopulmonary resuscitation for 45 minutes failed to restore cardiac function and rhythm, which had degenerated to ventricular fibrillation, electromechanical dissociation, and asystole. Peripheral cardiopulmonary support system restored cardiac rhythm and blood pressure, with a subsequent successful aortic valve replacement.
Circumferential rupture and entrapment of a balloon‐On‐a‐wire device during coronary angioplasty
Authors: Nukta Emad , Meier Bernhard , Urban Philip , Muller Thierry
Published: March 2007

While attempting to dilate a distal lesion in a right coronary artery, using a balloonon‐a‐wire catheter, circumferential balloon rupture occurred with temporary entrapment of the balloon in the stenosis. The balloon was retrieved, and the dilatation completed, using an over‐the‐wireballoon catheter.
Accuracy of subjective and computer‐assisted assessments of angiographic left ventricular regional wall motion
Authors: Kussmaul William G. , Kleaveland J. Patrick , Zeevi Gary R. , Hirshfeld John W.
Published: March 2007

To evaluate the accuracy of angiographic methods for analysis of left ventricular regional wall motion, we measured the ability of a carefully performed subjective analysis (three independent observers) and that of three computer‐assisted methods (centerline, radial, and area) to detect the presence of significant coronary artery disease. Normal ranges were established in 90 studies showing normal wall motion, and accuracy was tested in a second, consecutive series of 43 ventriculograms. The results show that the subjective method best separated those regions with from those without significant coronary disease. The subjective method also demonstrated sensitivity comparable to the centerline and radial methods. Among the computer‐assisted methods, the area method was least sensitive but most specific for both anterior and inferior region coronary disease. The centerline and radial methods were highly sensitive, but less specific. When coronary disease was defined by electrocardiographic Q‐waves, the area method had superior accuracy. Further analysis showed the following: 1) For the centerline and radial methods, long‐axis reregistration of the end‐systolic frame resulted in loss of sensitivity but increased specificity for anterior wall coronary disease, and little change in analysis of the inferior wall; 2) inclusion or exclusion of the apex had little effect on predictive accuracy for anterior wall coronary disease; 3) as expected, sensitivity and specificity results of all methods were dependent on the selection of a normal range cutoff value; but when performance was optimized, the subjective and area methods had a higher overall predictive accuracy than the centerline method; 4) It is likely that all three computer‐assisted methods could be calibrated to give indications of degrees of hypokinesis, as their results correlated well with subjective observers evaluations over the entire range of scores. These results should assist in selection of the optimal method for regional wall motion analysis in clinical and research applications. As currently applied, the area method is the most specific of the computer‐assisted methods tested; the centerline and radial methods have highest sensitivity and therefore are most suited to detection of mild degrees of hypokinesis.
Anomalous origin of the posterior descending artery from the obtuse marginal
Authors: Ilia Reuben , Gilutz Harel , Gussarsky Yehoshua , Gueron Moshe
Published: March 2007

We describe a patient with an unusual coronary anatomic variant in which the obtuse marginal gives rise to the posterior descending artery. The angiographic features and clinical recognition of this anomaly are reviewed.
Fractured and retained guide‐wire fragment during coronary angioplasty—unforeseen late sequelae
Authors: Doorey Andrew J. , Stillabower Michael
Published: March 2007

During a difficult coronary angioplasty, the tip of the guide wire became inadvertently wedged in a distal vessel, fractured, and retained in situ. Because of the otherwise successful nature of the angioplasty and the patient's great risk for cardiac surgery, it was elected to leave the wire fragment in place. Recurrence of symptoms led to recatheterization, which in addition to restenosis of the original angioplasty site showed diffuse narrowing of the arterial segment that contained the retained wire fragment. This occurred despite systemic anticoagulation with Coumadin in the interval between procedures. Thus retained guide wire fragments in patent coronaryarteries may cause arterial narrowing despite systemic anticoagulation.
Entrapment of a folded‐over introducer sheath in the lliofemoral artery: An unusual complication of PTCA guiding catheter exchange
Authors: Marsa Robert J. , Smith Douglas C. , Park Jeong S. , Jang G. David
Published: March 2007

An arterial introducer sheath became folded over in the iliac artery during PTCA. This probably resulted from withdrawal of a doubled over Judkins left coronary guiding catheter through the introducer sheath. Nonsurgical, atraumatic removal was accomplished after the acute bend of the introducer sheath had been withdrawn to the site of arterial entrance.
An alternative method for transcatheter retrieval of intracoronary angioplasty equipment fragments
Authors: Mintz Gary S. , Bemis Charles E. , Ali Unwala A. , Hadjimiltiades Stavros , Kimbiris Demetrios
Published: March 2007

A case is described of retrieval of the broken wire tip of a Probe balloon catheter from the distal right coronary artery with the help of a grasping forceps type of retrieval device.
Does percutaneous transluminal coronary angioplasty accelerate atherosclerotic lesions?
Authors: Nguyen Khiem P. V. , Shaw Richard E. , Myler Richard K. , Webb John G. , Stertzer Simon H.
Published: March 2007

Recent reports have suggested that angioplasty may cause or accelerate coronary arterial stenoses secondary to traumatic injury. Ninety‐four coronary angiograms performed in a 1 yr period were reviewed in patients who had successful coronary angioplasty 6 to 30 mo (mean 10.7) prior to restudy. Restenosis was found in 43 of 140 dilated lesions (31%) and in 41 of 94 patients (44%). Thirty‐three (35%) patients had new or progressive lesions outside the angioplasty site. New or progressive lesions occurred with similar frequency in the arteries that did not have angioplasty (23/155 = 15%) as in the arteries that did (13/127 = 10%; chi‐square n.s.). In the arteries which underwent angioplasty, new or progressive lesions occurred as commonly proximal to the PTCA site (7/14, 50%) as distal (6/13, 46%). New or progressive lesions occurred in 29% of patients with concomitant restenosis, and 40% of those without restenosis (chi‐square n.s.). No clinical, angiographic, or procedural factors distinguished patients with new and progressive lesions in target vessels from those without these lesions in target vessels. Patients with progressive lesions anywhere in the coronary tree were more likely to have had a shorter duration of anginal symptoms before angioplasty and a family history of coronary disease when compared with patients without progressive atherosclerosis. In conclusion, new and progressive lesions outside the angioplasty site occur after the procedure but appear unrelated to the restenosis process or traumatic injury by angioplasty instrumentation.