bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulsus alternans induced by inferior vena caval occlusion in man
Authors: Bashore Thomas M. , Walker Stephen , Van Fossen Douglas , Shaffer Philip B. , Fontana Mary E. , Unverferth Donald V.
Published: March 2007

To assess the effect of rapid preload reduction on left ventricular performance in nonischemic cardiomyopathy, 11 patients were studied during inferior vena caval (IVC) balloon occlusion. Five developed sustained pulsus alternans.

During pulsus alternans, the strong beats demonstrated systolic performance characteristics similar to baseline values, despite a drop in both left ventricular (LV) enddiastolic diameter (66 ± 13 to 61 ± 13 mm; p < 0.05) and LV end‐diastolic pressure (21 ± 8 to 9 ± 6 mmHg; p < 0.05). In contrast, the weak beats demonstrated a reduction in peak systolic pressure (130 ± 36 to 109 ± 33 mmHg; p < 0.02), fractional shortening (20% ± 4% to 17% ± 9%; p < 0.05) and peak positive dP/dt (1,006 ± 224 to 921 ± 287 mmHg; p < 0.05).

Measures of diastolic performance (peak negative dP/dt, the time constant of LV relaxation, the length of diastasis, and LV end‐diastolic stress) were not different between baseline beats and the strong beats; and only LV end‐diastolic stress differed when baseline beats were compared to the weak beats.

When the strong beats were compared to the weak beats during induced pulsus alternans, significant differences were observed in peak systolic pressure, peak positive dP/dt, and fractional shortening, but no differences in any measured diastolic parameter was observed. A slight difference was noted in the left ventricular end‐diastolic diameters, with the weak beat consistently beginning at a slightly smaller diameter (61 ± 13 mm vs 59 ± 13; p < 0.05).

In summary, these data are consistent with an augmentation and deletion of intrinsic contractile forces in association with an alternation in preload on a beat‐to‐beat basis as best describing left ventricular performance during pulsus alternans.
Clinical trial of the disposable transducer catheter
Authors: Cha Se Do , Roman Cecelia F. , Maranhao Vladir
Published: March 2007

We compared the intracardiac and intravascular pressures obtained by a conventional strain gauge transducer (CT) with a recently developed disposable high‐fidelity transducer catheter (DT) during cardiac catheterization. CT was positioned at the patient's midchest level.

The pressure measurements obtained by DT compared favorably with those of CT. Femoral arterial pressures by the two methods showed no statistical difference. Right heart pressures were similar using both transducers. However, right ventricular pressures by DT in five of eight patients were lower than that from CT. Higher pulmonary arterial pressures were noted in two of seven patients and higher pulmonary capillary wedge pressures were seen in four patients using DT compared to CT. None of these differences were of statistical significance.

These pressure differences may be due to transducer position. Because the midchest position of CT does not precisely define the anatomic location of the cardiac chamber being studied, pressure measurements can be overestimated or underestimated. DT eliminates this problem, as well as overshooting and concern with air bubbles in the catheter system commonly associated with CT.

Therefore DT may provide accurate hemodynamic measurements. It would appear to be useful regardless of patient position and may be useful in ambulatory hemodynamic determinations.
Balloon valvuloplasty for pulmonic valve stenosis—two‐year follow‐up: Hemodynamic and doppler evaluation
Authors: Mullins Charles E. , Ludomirsky Achi , O'Laughlin Martin P. , Vick G. Wesley , Murphy Daniel J. , Huhta James C. , Nihill Michael R.
Published: March 2007

The purpose of this investigation was to evaluate the efficacy, technique, and follow‐up results of balloon dilation angioplasty for valvular pulmonary stenosis. Percutaneous dilation was performed on 63 patients with pulmonary stenosis (ages 3 months to 76 years, mean = 4.3 years). In 43 patients, a single balloon was used; in 20 patients two balloons were used simultaneously.

The pressure gradient across the pulmonary valve was determined with right ventricular and main pulmonary artery catheters. Pressure gradients simultaneously were estimated by continuous wave Doppler (CWD) during catheterization. The peak systolic ejection gradient was obtained by both techniques both pre‐ and postangioplasty. There was excellent linear correlation between the simultaneous catheter pressure gradient and the pressure gradient estimated by Doppler (r = 0.99). Follow‐up pressure gradient estimations by Doppler echocardiogram were obtained in 30 patients between 6 months and 30 months postcatheterization (mean = 13 months).

The mean preangioplasty gradient of 64 mm Hg (range 30–160 mm Hg) was reduced to 22 mm Hg (range 2–31 mm Hg). A significant reduction of transvalvular gradient (52–95%, mean 68%) occurred in each patient. A linear correlation was found between the predilation gradient and the pressure gradient drop (r = 0.92). Mean follow‐up gradient by Doppler was 20 mm Hg (range 0–31 mm Hg), and there was no significant difference between these gradients and the postdilation gradient. No important complications were noted. These data confirm that balloon dilation angioplasty for valvular pulmonary stenosis is safe and effective, and suggest that stenosis does not recur.
Anomalous origin of the circumflex coronary artery in association with the right superior septal artery
Authors: Callaham Peter , Shandling Adrian , Lang William , Feld Gregory K.
Published: March 2007

The presence of anomalous coronary arteries is observed infrequently during routine coronary angiography. However, their identification is crucial to the management of the patient with associated coronary artery disease. A case is described in which concomitant anomalous origin of the circumflex coronary artery from the right coronary artery, and a right superior septal coronary artery with a separate ostium occurred in association with severe three‐vessel coronary artery disease requiring bypass graft surgery. Clues to the presence of the anomalous vessels were (1) their visualization during left ventriculography and (2) their presence or absence during injection of the normally originating vessels. This particular association of anomalous vessels was previously unreported.
Vasospastic coronary occlusion associated with a myocardial bridge
Authors: Ciampricotti R. , El Gamal M.
Published: March 2007

A 53‐year‐old woman was admitted with unstable angina. Acute coronary angiography showed myocardial bridging and total occlusion of the left anterior descending artery in the middle one‐third of its course. The occlusion was completely relieved by intracoronary administration of nitroglycerin. The occurrence of coronary spasm may explain angina and myocardial infarction in symptomatic patients with myocardial bridges.
The balloon on a wire device: A new ultra‐low‐profile coronary angioplasty system/concept
Authors: Myler Richard K. , Mooney Michael R. , Stertzer Simon H. , Clark David A. , Hidalgo Benito O. , Fishman Jodi
Published: March 2007

A new ultra‐low‐profile coronary angioplasty device, a “balloon probe,” is presented. This device consists of a balloon on a coronary guidewire and is the lowest profile dilatation system presently available. The balloon material is polyethylene terephthalate, a new polymer with high inflation pressure limits and very low compliance. This report discusses this device and its usage in coronary artery disease.
Use of a balloon‐tipped catheter to guide placement of the bioptome sheath in right ventricular percutaneous endomyocardial biopsy
Authors: Johnson Dennis E. , Vacek James L. , Dunn Marvin
Published: March 2007

A common problem during biopsy of the right ventricular septum using the flexible King's bioptome is the difficulty of accurately directing the tip of the long biopsy sheath against the septal surface. This can be important in that inadvertent biopsy of the more delicate ventricular free wall may lead to perforation and pericardial tamponade. An alternate method of sheath placement is presented. This involves the use of a No. 5 or 6 French balloon‐tipped catheter within the long bioptome sheath in order to facilitate sheath passage and positioning. Catheter positioning is readily accomplished when documented by bioplane fluoroscopy, with alternate or additional two‐dimensional echocardiographic position check as desired. Balloon‐guided positioning for right ventricular septal biopsy appears to be a simple and safe technique that may be especially useful for relatively inexperienced operators and for patients with abnormal cardiac anatomy for whom endomyocardial biopsy (EMB) might normally be technically difficult.
Coronary reperfusion with a new catheter in six patients with acute occlusion after angioplasty
Authors: Werter C. , El Gamal M. , Bonnier H. , Michels R. , van Gelder L. , Krieken A. V. D.
Published: March 2007

A new catheter was used in an attempt to re‐establish coronary flow in six patients with acute occlusion after angioplasty and prior to emergency coronary artery bypass surgery. All patients suffered from severe chest pain, and the electrocardiogram showed signs of acute transmural ischemia. A reperfusion catheter manufactured by Advanced Cardiovascular Systems (ACS) has 36 side holes spirally arranged along the distal 10 cm. It is introduced over an exchange wire. After the catheter was positioned across the occlusion, five patients had complete relief of chest pain, and another patient had partial relief. The electrocardiogram normalized in all six patients (in one only initially). Two patients developed a limited myocardial infarction, but four did not. The time between introduction of the reperfusion catheter and aorta cross clamping varied between 1.5 and 6.5 hours, and there were no complications related to its use. We conclude that the ACS reperfusion catheter is useful in re‐establishing coronary blood flow after failed angioplasty and prior to emergency coronary artery bypass surgery.
Assessment of global and regional left ventricular function in ischemic heart disease using ultrafast computed tomography
Authors: Macmillan Robert M. , Rees Michael R. , Weiner Ronald , Maranhao Vladir
Published: March 2007

Contrast‐enhanced ultrafast computed tomography (CT) of the left ventricle was done in the long axis and short axis within one day of cardiac catheterization in 14 males with ischemic heart disease and a mean age of 58 years. Imaging was R wave‐triggered at 58‐msec intervals (13/level). Left ventriculography was performed in 30° right anterior oblique (RAO) and 60° left anterior oblique (LAO) caudal 12°. CT left ventricular ejection fraction was measured using a modified Simpson's reconstruction of end‐systolic and end‐diastolic slices. Catheterization left ventricular ejection fraction was measured by area‐length method. Six left ventricular segments (septal, apex, anterior, lateral, inferior, and posterior) were scored by different paired observers as follows: dyskinesis (−1), akinesis (0), moderate‐severe hypokinesis (1), mild hypokinesis (2), and normal (3). Correlations of left ventricular ejection fraction for catheterization vs. long‐axis CT and short‐axis CT were r =.83 and r =.86, respectively. Seven of eight patients with transmural myocardial infarction were identified on CT by akinetic/dyskinetic segments. Eighty‐four segments were scored. There was agreement (normal vs. abnormal) in 76 (90%). CT detected 47 normal segments vs. 51 by catheterization (92%), 11 akinetic/dyskinetic segments (92%), and 14 hypokinetic segments vs. 21 (67%). Wall motion scores between CT and catheterization differed by > 1 in 6 of 84 segments (7%). Therefore, ultrafast CT can accurately assess global and regional left ventricular function.
Comparison of gated cardiac magnetic resonance imaging and two‐dimensional echocardiography for the evaluation of right ventricular thrombi: A case report with autopsy correlation
Authors: Johnson Dennis E. , Vacek James , Gollub Steven B. , Wilson David B. , Dunn Marvin
Published: March 2007

In a patient who died of complications of severe pulmonary hypertension, right ventricular failure, and sepsis, antemortem two‐dimensional (2‐D) echocardiography and magnetic resonance imaging (MRI) studies demonstrated a right ventricular mass which at autopsy proved to be thrombus. The diagnostic features of this mass as imaged by these two methods are compared. This case was complicated in that the patient had a history of right atrial myxoma that had been successfully removed three years previously, and a history of several prior pulmonary emboli. Gated MRI depicted the size, shape, and surface characteristics of the mass more clearly than 2‐D echocardiography because MRI provided better contrast and spatial resolution. Both techniques were useful in localizing the mass and showing if it was fixed or mobile. Depiction of tumor attachment was unclear with echocardiography but very clear with MRI. MRI also showed a left pulmonary artery thrombus that was not visualized by 2‐D echocardiography. Both techniques provided chamber dimension measurements showing enlargement of the right atrium and ventricle. This case demonstrates that gated MRI provides high‐quality images of cardiac anatomy and masses. Gated cardiac MRI should be considered at least complementary and potentially superior to two‐dimensional echocardiography in the evaluation of intracardiac masses in certain patients.
Differential hemodynamic effects of hypaque‐76 and renografin‐76 during coronary angiography: The role of calcium‐binding additives
Authors: Hwang Ming H. , Murdock David K. , En Piao Zhen , Gries William J. , Scanlon Patrick J.
Published: March 2007

Hypaque‐76 (H76) and Renografin‐76 (R76) are nearly identical ionic contrast media, except that R76 binds more calcium than H76 because of the presence of sodium citrate and EDTA in R76. To determine whether the calcium‐binding additives in ionic contrast media contribute to the hemodynamic effects of contrast media during coronary angiography, left coronary angiography was performed in anesthetized dogs. In nine closedchest dogs, 10 cc of H76 and R76 were injected in each dog in a blinded, randomized fashion. The effect of H76 and R76 on left ventricular systolic pressure (LVSP) and left ventricular diastolic pressure (LVDP), on mean aortic pressure (MAP), and on left ventricular (LV) dp/dt was recorded. Compared with H76, R76 produced a greater decrease in the LVSP (77 ± 25 mmHg vs 48 ± 17 mmHg P < .05), MAP (72 ± 24 mmHg vs 38 ± 18 mmHg P> .01). and LV dp/dt (747 ± 87 mmHg/sec vs 460 ± 81 mmHg/sec P> .01). In nine additional open‐chest dogs, left coronary angiography was performed 1 hour after occlusion of the proximal LAD coronary artery. Seven cc R76 produced a 35 ± 15 mmHg decrease in LVSP, compared with 20 ± 9 mmHg with H76 (P> .01). The LV dp/dt decreased 720 ± 387 mmHg/sec with R76, compared with 462 ± 222 mmHg/sec with H76 (P> 0.05). Thus, R76 produces significantly greater hemodynamic abnormalities than H76. Contrast media lacking calcium‐binding agents may be preferable for coronary angiography.
Cortical blindness after left internal mammary artery to left anterior descending coronary artery graft angiograph
Authors: Henzlova M.J. , Coghlan H.C. , Dean L.S. , Taylor J.L.
Published: March 2007

We describe a case of transient cortical blindness following internal mammary artery to left anterior descending coronary artery graft angiography. This dramatic, infrequent, and self‐limiting complication so far has not been described in the cardiovascular literature

In the present era of internal mammary artery use for the left coronary artery grafting, the angiographer should be familiar with the diagnosis, prevention, and management of complications previously seen mostly during the posterior cerebral circulation angiography.
Percutaneous double‐balloon angioplasty of a stenotic modified fontan aortic homograft conduit
Authors: Pelikan Peter , French William J. , Ruiz Carlos , Laks Hillel , Criley John Michael
Published: March 2007

A 28‐year‐old woman with pulmonary atresia underwent a modified Fontan procedure that utilized a valved aortic homograft; she developed stenosis of the distal anastomosis between the homograft and the pulmonary artery. Because of the increased risk of reoperation, balloon angioplasty of this stenotic lesion was performed successfully. In the subsequent 11 months she has remained asymptomatic. Balloon angioplasty was a successful alternative to reoperation in this patient.
An unusual case of guide wire fracture during percutaneous transluminal coronary angioplasty
Authors: Md Matty Vrolix , Md Johan Vanhaecke , Md Jan Piessens , Md Hilaire De Geest
Published: March 2007

We report a case of guide wire fracture during percutaneous transluminal coronary angioplasty, using one of the newer catheter systems. The broken free end of the guide wire remained within the coronary tree, and surgical removal was necessary. Entrapment and overcoiling of the guide wire can cause fracture; in our case excessive bending in a tortuous coronary tree resulted in this unusual complication. An excessive tensile load to the guide wire may result from anatomical peculiarities and can cause wire fracture.
Percutaneous balloon mitral valvuloplasty in a pregnant woman with mitral stenosis
Authors: Safian Robert D. , Berman Aaron D. , Md Benjamin Sachs , Diver Daniel J. , Come Patricia C. , Baim Donald S. , Bsn Linda McKay , Md William Grossman , McKay Raymond G.
Published: March 2007

A 39‐year‐old woman with symptomatic mitral stenosis underwent percutaneous mitral valvuloplasty at the end of her first trimester of pregnancy. Balloon dilatation utilizing a double 18–20 mm balloon technique resulted in improvement in mean mitral gradient (16 to 7 mmHg) and in calculated mitral valve area (1.4 to 2.4 cm2), without significant complications and with an estimated radiation exposure to the fetus of less than 0.2 rads. The procedure resulted in disappearance of symptoms of congestive heart failure and allowed for discontinuation of diuretics. The subsequent course of gestation was uncomplicated and a normal baby boy was delivered in the 36th wk. We conclude that percutaneous mitral valvuloplasty may produce successful palliation of symptoms in patients with mitral stenosis during pregnancy.
Development and application of transseptal left heart catheterization
Authors: Weiner Ronald I. , Md Vladir Maranhao
Published: March 2007

The recent interest in transseptal left heart catheterization affords an opportunity to review the development and application of this procedure. This review briefly follows the history of right and left heart catheterization to the development of the transseptal procedure. A detailed description of the technique of transseptal catheterization is provided, as well as the indications and contraindications to its use. A learning curve is associated with this technique and is inversely related to the complication rate of the transseptal approach. Physicians working in high volume catheterization laboratories may gain the experience to safely perform transseptal left heart catheterization on carefully selected patients.
Preservation of left ventricular function in patients with total occlusion of the left anterior descending coronary artery and wide‐caliber distal vessel filling by collateral vasculature
Authors: Sedlis Steven P. , Cohen Kenneth H. , Sequeira Jeffrey M. , El‐Sherif Nabil
Published: March 2007

The segmental ventricular function of 76 patients with total occlusion of the left anterior descending coronary artery (LAD) was analyzed to establish the relationship between ventricular function and the presence and angiographic appearance of the collateral circulation. The relationship between function and collateral supply was found to be significant (P < .01). The only angiographic feature of the collateral vasculature that was associated with preserved function was the caliber of the distal LAD. Wide‐caliber vessels were more likely to be associated with preserved ventricular function than thin vessels (P < .01). In contrast, both rapidly filling collateral arteries and slow filling vessels were associated with preserved ventricular function. Collateral supply maintenance was significantly associated with preserved ventricular function, even when the collaterals arose from stenotic coronary arteries. Furthermore, despite marked differences in ventricular function between the base and apex of the heart, there was a true relationship between preserved ventricular function and the presence of collateral vessels for all segments of the anterior wall. These findings may be relevant to clinical decision making and to proper interpretation of studies of ventricular function following LAD occlusion.
Use of mechanical devices for distal hemoperfusion during balloon catheter coronary angioplasty
Authors: Md Jacques Heibig , Md Paolo Angelini , Leachman D. Richard , Beall Madeline M. , Beall Arthur C.
Published: March 2007

Previous attempts to protect the dependent myocardium during balloon catheter coronary angioplasty in animals and humans have had generally unsatisfactory results. This paper summarizes the authors' experience in investigating commercially available mechanical pumps for distal coronary hemoperfusion during balloon angioplasty. Both roller and piston pumps can attain adequate distal perfusion without significant side effects in the majority of patients. Our goal was to suppress angina for at least 5 min to prolong balloon inflation in awake patients. Minor T‐wave changes without concomitant angina pectoris can be expected when the distal coronary bed is perfused with hypothermic blood. Side branch occlusion by the inflated balloon prevents effective protection of the corresponding part of the dependent myocardium during distal hemoperfusion, which may result in persistent angina and ST‐T changes uncorrected by increasing the hemoperfusion rate. Distal coronary diffuse spasm, rare and transient, was the only immediate complication of this procedure. It is suggested that intense local wall stimulation could occur with a higher flow rate (jet effect). Improved balloon catheter pressure/flow characteristics and on‐line continuous mechanical pumps should soon make distal coronary hemoperfusion through balloon catheters an accepted clinical technique.
Percutaneous transluminal angioplasty of a stenosis at the origin of the left internal mammary artery graft: A case report
Authors: Md Visuit Vivekaphirat , Yellen Steven F. , Md Alberto Foschi
Published: March 2007

A case of percutaneous transluminal angioplasty of a high‐grade stenosis at the origin of the left internal mammary graft is presented. An investigational angled‐balloon dilating catheter was used.
Anomalous origin of the right coronary high above the left sinus of valsalva
Authors: Thatcher Jackson L. , Miller William P.
Published: March 2007

Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is exceedingly rare and previously has been reported to be associated with congenital aortic valve disease. We report a case of the right coronary artery arising from the mid ascending aorta, high above the left sinus, with a clinically and angiographically normal aortic valve.
Use of a conductance (volume) catheter and transient inferior vena caval occlusion for rapid determination of pressure‐volume relationships in man
Authors: Kass David A. , Md Mark Midei , Phd Willard Graves , Brinker Fsca Jeffrey A. , Md , Maughan W. Lowell
Published: March 2007

Determination of left ventricular pressure‐volume relationships in situ ideally requires both a method for easy measurement of multiple pressure‐volume loops and a rapid and reversible means of altering load. We report a technique, previously used in animals, that combines conductance catheter volumes and rapid inferior vena caval occlusion to permit routine measurement of calibrated P‐V relationships in man for the first time. An 8F volume catheter with a 3F micromanometer tipped pressure catheter placed through its lumen was advanced to the left ventricular apex through a femoral artery. A thermodilution output catheter was placed through a 9F femoral venous sheath and later replaced with an IVC balloon occlusion catheter, through which a 2.5F bipolar wire was advanced for atrial pacing. A specialized data system facilitated collection, editing, and data analysis at the time of cardiac catheterization. Absolute volume calibration required cardiac output measurement and injection of hypertonic saline. IVC occlusion decreased peak left ventricular pressure by 42 ± 17 (SD) (P < .001) mm Hg in 15 patients. Endsystolic pressure‐volume relationships (ESPVR) were determined with 5–8 cardiac cycles with an average of r2 of 0.94 ± 0.05 and were generally reproducible. The slope of the ESPVR demonstrated consistency among a group of normal patients (n = 6), and was significantly lower than the slope derived from a group of patients with ventricular hypertrophy (n = 9). We conclude that left ventricular pressure‐volume relationships can be easily and repeatedly determined as part of a routine cardiac catheterization in man.
Monitoring of ischemia during percutaneous coronary angioplasty: Influence of guidewire, balloon placement, and lead selection
Authors: Md Shereif Rezkalla , Md Bassam Moushmoush , Connors Brad C. , Turi Zoltan G.
Published: March 2007

We examined the sensitivity of the surface 12‐lead electrocardiogram (ECG) for detecting ischemia during guidewire and deflated balloon passage as well as during balloon inflation in proximal epicardial stenoses during percutaneous transluminal coronary angioplasty (PTCA) of 55 patients. Ischemia (ST change ⩾ 0.1 mV) by 12‐lead ECG was detected in 28% of patients after guidewire passage, in 50% after deflated balloon passage, and in 76% during balloon inflation vs. 17%, 14%, and 50%, respectively, by limb lead monitoring alone. The best single lead for detecting ischemia during PTCA was V2 for left anterior descending and circumflex and III for right coronary artery inflations. The addition of a selected second precordial lead further enhanced ischemia monitoring. We conclude that ischemia is common during PTCA even during wire and deflated balloon passage, that the 12‐lead ECG is more sensitive for monitoring ischemia during PTCA than conventional techniques, and that laboratories can optimize their ability to detect ischemia during PTCA by selecting appropriate leads.
Percutaneous transluminal angioplasty of anomalous right coronary artery
Authors: Mooss Aryan N. , Heintz Mary H.
Published: March 2007

Angioplasty of anomalous coronary arteries can be technically challenging because of difficulty in selectively cannulating the aberrant vessel. We present our experience with angioplasty of an anomalous right coronary artery. A Judkins‐type left coronary catheter with an eccentric tip, the FL4‐G type catheter was used to obtain stable position in the right coronary artery and angioplasty was performed.
Angiography of right gastroepiploic artery for coronary artery bypass graft
Authors: Tanimoto Yoshinori , Matsuda Yasuo , Fujii Banyo , Kobayashi Yurio , Hayashi Kenji , Takashiba Kiyoshi , Hamada Yoshio , Hanazono Shigemi , Ando Keijiro , Hashimoto Takashi
Published: March 2007

We describe the angiographic technique of grafting the right gastroepiploic artery to the coronary artery. With the femoral approach, our specially devised catheter was placed in the common hepatic artery or gastroduodenal artery. The gastroepiploic artery and graft to the coronary artery were visualized satisfactorily by manual injection of contrast media.
Percutaneous transluminal angioplasty for innominate artery stenosis and total occlusion of subclavian artery in takayasu's‐type arteritis
Authors: Staller Bernard J. , Maleki Massoud
Published: March 2007

Previous reports describe high success rates achieved by dilating subclavian artery stenoses. Attempts at angioplasty for total occlusions have been uniformly unsuccessful. No previous case successfully recanalizing total subclavian artery occlusion was found after an extensive literature search. Modified guidewire technique facilitated safe crossing of the occlusion.
Intercoronary and intracoronary communications in four cases of vasospastic angina
Authors: Takatsu Fumimaro , Osugi Junichi , Sugiishi Munetaka , Suzuki Akira , Nagaya Teruo
Published: March 2007

Persistent intercoronary and intracoronary communications were observed on cineangiograms in four patients having vasospastic angina without significant coronary narrowings. On provocation of coronary spasm using ergonovine maleate, these communications seemed to protect myocardium from ischemia, at least partially.
Aortic annular tear after valvuloplasty: The role of aortic annulus echocardiographic measurement
Authors: Lewin Ruben F. , Dorros Gerald , King James F. , Seifert Paul E. , Schmahl Terence M. , Auer James E.
Published: March 2007

Following percutaneous transluminal aortic valvuloplasty, 2/100 patients (2%) developed significant aortic insufficiency as a result of an aortic annular tear. Both patients underwent emergency aortic valve replacement and survived the operation. One patient died 4 weeks postoperatively from sepsis and multiorgan failure, and the other patient had a benign postoperative course. In both cases, the balloon area significantly exceeded the aortic annular area and caused the complication. Review of the balloon area‐aortic annular area ratio in our series showed that a value of < 1.2 was not associated with this complication.
Severe aortic regurgitation complicating percutaneous aortic valve valvuloplasty
Authors: Dean Larry S. , Chandler Jerry W. , Saenz Carlos B. , Baxley William A. , Bulle Thomas M.
Published: March 2007

An 88‐year‐old patient undergoing percutaneous aortic balloon valvuloplasty of a tricuspid aortic valve is described. The patient had mild aortic regurgitation prior to the procedure but developed severe aortic regurgitation after balloon dilatation of the valve. At the time of surgery there was no anatomic disruption of the valve or supporting structures. Development of severe aortic incompetence following balloon valvuloplasty has not been previously reported.
Right to left interatrial shunting following balloon mitral valvuloplasty
Authors: Goldberg Neil , Roman Cecelia F. , Cha Se Do , Weiner Ronald , Maranhao Vladir , Eldredge Jay , Fernandez Javier
Published: March 2007

A complication of balloon mitral valvuloplasty is development of left‐to‐right interatrial shunt. This report describes right‐to‐left interatrial shunting following balloon mitral valvuloplasty in a patient with mitral stenosis, tricuspid regurgitation and pulmonary hypertension.
Inadvertent Swan‐Ganz catheter placement in the left pericardiophrenic vein
Authors: McLellan Bruce A. , Jerman Michael R. , French William J. , Criley J. Michael , Pelikan Peter C. D.
Published: March 2007

Placement of flow‐directed Swan‐Ganz catheters without fluoroscopic guidance occasionally results in placement in positions other than the pulmonary artery. In the case presented, the inadvertent placement of such a catheter into the left pericardiophrenic vein was probably facilitated by distortion of the right heart and systemic venous anatomy.
Single coronary artery from the left sinus of valsalva
Authors: Vassanelli Corrado , Turri Marco , Morando Giorgio , Menegatti Giuliana , Zardini Piero
Published: March 2007

A patient with chronic exertional angina and electrocardiographic signs of myocardial ischemia at exercise stress test had recent onset of rest chest pain and underwent coronary arteriography. Besides severe atherosclerotic coronary disease (which was probably responsible for clinical presentation), a single coronary artery arising from the left sinus of Valsalva was discovered. This is an exceptional finding, and its in‐life diagnosis may be relevant for surgical treatment.
A wire technique to cross the congenitally stenotic aortic valve
Authors: Adatia I. , Benson L. N. , Freedom R. M.
Published: March 2007

We describe a double‐catheter “rendezvous” technique that allows the successful placement of a balloon valvotomy catheter retrogradely across a congenitally stenotic aortic valve when traditional single‐catheter retrograde methods fail. An important therapeutic procedure that might otherwise be abandoned can be completed with only the additional procedure of a transseptal atrial puncture and a second arterial entry.
Dilating guide wire: Use of a new ultra‐low‐profile percutaneous transluminal coronary angioplasty system
Authors: Rizzo Thomas F. , Ciccone John , Werres Roland
Published: March 2007

The following case reports represent two examples using the newly released Dilating Guide Wire. The balloon‐wire system is specifically designed to be used as a steerable percutaneous transluminal coronary angioplasty (PTCA) guide wire. It can be utilized as a predilatation device in combination with a standard PTCA dilating balloon or as a free‐standing dilatation catheter. As applied to the following situations, predilatation proved to be an effective time‐ and step‐saving approach when confronting severely stenosed coronary artery lesions.
An improved catheter design for crossing stenosed aortic valves
Authors: Feldman Ted , Carroll John D. , Chiu Y. Christopher
Published: March 2007

Retrograde catheterization of the left ventricle in patients with aortic valve stenosis is commonly performed using a pigtail or coronary arterial catheter. This approach, although usually ultimately successful, may be highly tedious. To overcome the limitations of these conventional catheter shapes, we have designed a catheter specifically for crossing stenotic aortic valves. In a group of 17 patients, mean aortic valve area 0.75 cm2, the average time to cross the aortic valve was 2 minutes 45 seconds and the median time 30–40 seconds. Once the proper size catheter was selected, the average time to cross was 59 seconds. The success of this catheter is based on the operator's ability to “scan” or interrogate the surface of the valve thoroughly by manipulating the catheter and a moveable core straight tip guidewire.
Transluminal balloon embolization of an inadvertent aorto‐to‐coronary venous bypass to the anterior cardiac vein
Authors: Jost Stefan , Simon Rüdiger , Amende Ivo , Herrmann Gunhild , Reil Gert‐Hinrich , Lichtlen Paul R.
Published: March 2007

Therapeutic embolization of blood vessels by means of hardly steerable devices (e.g. metal coils, gel foam) can result in displacement of the emboli in the circulation. The embolization of an ACVB‐graft erroneously implanted to the anterior cardiac vein was performed, applying a catheter system with a detachable silicone rubber balloon.
High‐Frequency rotablation of occluded coronary artery during heart catheterization
Authors: Erbel R. , O'Neill W. , Auth D. , Haude N. , Nixdorf U. , Rupprecht H. J. , Dietz U. , Meyer J.
Published: March 2007

High‐frequency rotation atherectomy of an occluded left circumflex coronary artery was performed in a 45‐year‐old man. Over a 0.009 inch flexible tip steel wire a diamond‐coated brass burr fasten to a flexible drive shaft that rotates and tracks was advanced. The drive shaft was connected to a turbine and driven by compressed air with 150,000 rpm. After rotablation of the posterior lateral branch over 3 cm with a 1.5 mm burr and rotablation with a 1.75 mm burr of the posterior branch of the left circumflex coronary artery the vessel was reopened with a smooth surface without perforation and dissection. 24 h control and 6 mo control revealed an open coronary vessel.

High frequency rotating coronary angioplasty seems to be a promising alternative method to PTCA in opening totally occluded coronary arteries.
Percutaneous transluminal angioplasty of stenotic saphenous vein right coronary bypass grafts utilizing a peripheral balloon dilatation catheter without a guiding catheter
Authors: Arafah Mohammed , Aldridge Harold E. , Schwartz Leonard
Published: March 2007

Effective angioplasty of stenosed saphenous vein coronary bypass grafts may be impossible with the standard‐size coronary dilatation catheters because the large diameter of these grafts results in unacceptable balloon‐to‐vessel ratios. We avoided this problem by using a peripheral arterial dilatation catheter with an inflation diameter of 6 mm and obtained a satisfactory short‐ and long‐term result in two patients in whom previous attempts with the largest coronary dilatation catheter (4 mm) had failed. This technique, which precludes the use of a guiding catheter, is suitable only for right bypass grafts.
Comparison of iced and room temperature injectate for thermodilution cardiac output
Authors: Bourdillon Patrick D. V. , Fineberg Naomi
Published: March 2007

Cardiac output estimation by thermodilution is carried out using room temperature or iced injectate, but the accuracy and variability of the two methods is not well documented. Room temperature and iced injectate were compared in 21 patients undergoing diagnostic cardiac catheterization. Dextrose injectate (10 ml) was administered in prefilled syringes left to stand either in iced water or in room air. Four injections were made sequentially with room temperature and iced injectate. Cardiac output by room temperature and iced injectate were not significantly different (4.70 ± 1.22 for room temperature and 4.90 ± 1.37 for iced injectate, n = 21, P = 0.155). There was a significant difference in the variance of the estimations by the two methods (room temperature = 0.296, iced = 0.120, P < 0.005). From this variance the calculated number of measurements needed to estimate cardiac output to ± 0.5 L/min with 95% confidence is seven for room temperature and four for iced injectate. For five patients with cardiac output < 4.00 L/min with room temperature injectate, cardiac output with iced injectate was significantly higher (3.33 ± 0.34 for room temperature vs. 3.69 ± 0.49 for iced injectate, P = 0.05). Thus room temperature injectate generally gives a satisfactory cardiac output estimation but with significantly greater variability than iced injectate. Sample size for accurate cardiac output estimation must be greater with room temperature injectate. Iced injectate may overestimate output when cardiac output is low.
Clinical experience with the use of the angled‐balloon dilatation catheter
Authors: Vivekaphirat Visuit , Zapala Catherine , Foschi Alberto E.
Published: March 2007

A special balloon catheter has been developed for use in coronary angioplasty. The balloon portion has a 135°–145° angle at its mid portion. It is designed for stenosis located at an angle of the coronary artery.

We investigated the use of this catheter in 39 patients who underwent percutaneous transluminal coronary angioplasty (PTCA): 29 men and 10 women. PTCA was attempted in 43 stenotic sites. Thirty‐two stenoses were located at the angled portion of the dilated arteries. Eleven stenoses were located at the side branches of the acutely angled bifurcations. Twenty stenoses were in the right coronary artery distribution. Twenty‐two stenoses were in the left coronary artery distribution. One stenosis was at the origin of the left internal mammary artery. Forty‐one stenoses were angioplastied successfully (95.4%). No angiographic evidence of intimal tear or dissection was noted in all of the dilated vessels. Acute closure was not observed. The mean follow‐up period was 239.5 days. Six patients (15.4%) were found to have restenosis. We conclude that the use of the angled‐balloon dilatation catheter provides the potential benefit of reducing intimal trauma and dissection during PTCA of certain coronary anatomies–stenosis at the angled portion or at the takeoff of the side branch of a bifurcation.
Analysis of aortic valve gradients by transseptal technique: Implications for noninvasive evaluation
Authors: Gordon John B. , Folland Edward D.
Published: March 2007

The peak instantaneous aortic valve gradient derived from Doppler echocardiography is commonly used to predict the severity of aortic stenosis. Peak instantaneous gradient should not be equated with the mean gradient or “peak to peak” gradient measured at cardiac catheterization. The primary purpose of this study is to assess the relationship between the aortic valve gradients, using a two‐catheter transseptal technique in 102 patients with aortic stenosis, mixed aortic stenosis and regurgitation, and following aortic valve replacement. These cases were drawn from a series of 111 consecutive transseptal procedures for patients with isolated aortic valve disease. No major complications occurred, and the most common reason for technical failure was inability to engage the atrial septum in postoperative patients.

Although the peak instantaneous gradient correlates well with the mean gradient in aortic stenosis (r = .94, P < .001), mixed stenosis and regurgitation (r = .95, P < .001), and after aortic valve replacement (r = .86, P < .001), it systematically overestimates both the mean gradient and the peak to peak gradient. Neither the peak instantaneous nor the mean gradient correlates highly with aortic valve area in aortic stenosis (r = −.48, P < .01 peak; r = −.58, P < .001 mean gradient), mixed aortic stenosis and regurgitation (r = −.39, P NS peak; r = −.42, P NS mean gradient) or following aortic valve replacement (r = −.26, P NS peak; r = −.53, P < .01 mean gradient). Systolic time intervals also were analyzed from the simultaneous left ventricular and ascending aortic pressure tracings. The systolic ejection period, time to peak gradient, time to peak left ventricular pressure, and time to peak aortic pressure correlated poorly with aortic valve area.

This study indicates that the mean gradient, which is consistently smaller than the peak instantaneous gradient, can be estimated by a simple regression formula: mean gradient = 0.70 peak instantaneous gradient. The mean gradient, which is usually less than the peak to peak gradient over 58 mm Hg and greater than the peak to peak gradient under 58 mm Hg, can be estimated by: mean gradient = 0.71 peak to peak gradient + 17 mm Hg. The limitations of isolated gradients in predicting aortic valve area indicate the importance of accurate flow measurements for optimal determination of the severity of aortic valve obstruction.
Myocardial infarction and sudden death after sport: Acute coronary angiographic findings
Authors: Ciampricotti Renzo , El Gamal Mamdouh I. H. , Bonnier Johannes J. , Relik Theodorus H. F. M.
Published: March 2007

Thirteen patients, seven with acute myocardial infarction and six survivors of sudden death after sport, underwent coronary angiography within a mean of 104 min after the onset of symptoms. The admission electrocardiogram showed transmural myocardial ischemia in all patients.

The ischemia‐related vessel was occluded in all cases of sudden death and in three cases of acute myocardial infarction. Reperfusion was achieved in eight vessels: after intracoronary streptokinase in three, after intracoronary nitroglycerin in three, and mechanically in two. Coronary spasm was demonstrated in three vessels, and coronary thrombi, in four. The coronary lesion was described as either concentric in two or eccentric with irregular borders in eight. There was a high incidence of eccentric lesions consistent with ruptured plaques.

The acute coronary angiographic findings of acute myocardial infarction and sudden death after sport are similar. Physical exercise can provoke myocardial infarction and sudden death probably by inducing plaque rupture that can evoke coronary spasm, thrombosis, or both.
Percutaneous aspiration of a thromboembolus
Authors: Dorros Gerald , Jamnadas Pradip , Lewin Ruben F. , Sachdev Naveen
Published: March 2007

Percutaneous aspiration of a thromboembolus was successfully performed in 12 out of 13 patients with in situ thrombosis (4 patients), distal embolization (7 patients), or both (2 patients). The flow was improved from TIMI 0 (10 patients, no flow) or TIMI 1 (2 patients, impaired flow) to TIMI 3 (10 patients, normal flow) or TIMI 2 (2 patients, normal but slower flow). A custom‐made 8 F Teflon‐coated sheath was introduced in the superficial femoral and proximal below‐the‐knee arteries to aspirate the debris. Distal embolization in below‐the‐knee arteries was concomitantly treated with short‐term intraarterial Urokinase in nine patients. Complications included one in‐hospital (not procedure related) death, two patients with below‐the‐knee amputations (above‐the‐knee amputation averted), and one transmetatarsal amputation (prior established gangrene present and below‐the‐knee amputation avoided). The remaining nine patients left the hospital with improved limb status and peripheral pulses. This technique is a rapid, reliable, and efficient method to treat in‐situ clot or procedure‐related distal embolization as an adjuvant or complement to lytic treatment.
Effect of respiration on angiographic assessment of saphenous vein graft stenoses
Authors: Laramee Louise A. , Hartzler Geoffrey O.
Published: March 2007

Coronary angiography in two patients, one 11 yr and the second 15 yr following coronary bypass surgery demonstrated striking focal decrease in vein graft diameter related to the inspiratory phase of the respiratory cycle. The pathophysiology, potential role of mechanical traction, and the clinical implications of this observation are discussed.
Improved method for transcatheter retrieval of intracoronary detached angioplasty guidewire segments
Authors: Serota Harvey , Deligonul Ubeydullah , Lew Brian , Kern Morton J. , Aguirre Frank , Vandormael Michel
Published: March 2007

A transcatheter technique using a probing catheter and 0.014 wire to form a loop snare was used percutaneously to safely retrieve segments of retained guidewire fragments in mid‐ and distal coronary arteries in three patients.
Valve injury and repair in balloon aortic valvuloplasty
Authors: Farb Andrew , Moses Jeffrey W. , Wallerson Donald C. , Gold Jeffrey P. , Subramanian Valavanur A.
Published: March 2007

Aortic valves 0.5, 2.0, and 4.5 months after successful percutaneous balloon aortic valvuloplasty (BAV) were examined. BAV caused macroscopic and microscopic fractures in calcific deposits. An inflammatory response was identified that may lead to valvular scarring. This process may be an important factor in the development of restenosis after BAV.
False detection of left atrial thrombus by the angiographic sign of “neovascularity”
Authors: Chow Wing‐Hing , Tai Yau‐Ting , Cheung King‐Loong
Published: March 2007

“Neovascularity” in the region of the left atrial appendage was demonstrated by coronary arteriography preoperatively in five patients with mitral valve disease and was attributed to the presence of thrombus in the left atrium. Subsequently, they underwent surgery, but thorough inspection of the left atrium did not reveal thrombus in any of the five patients. The presence of neovascularity without apparent thrombosis or false detection may be a result of tissue reaction and organization in an effort to resorb the thrombus.