bluuebunny/crossref_metadata_2025 huggingface dataset:
Aortic catheterisation via percutaneous left ventricular puncture
Authors: Wong Philip H. C. , Chow Joseph S. F. , Chen Walter W. C. , Miller Graham A. H.
Published: March 2007

When retrograde catheterisation and angiography of the ascending aorta from the brachial or femoral approach is not possible, this can be accomplished by direct percutaneous left ventricular puncture. The haemodynamic and angiographic information obtained was essential to surgical correction of aortic arch anomalies as illustrated in two patients.
Progression of coronary disease in candidates for transluminal coronary angioplasty
Authors: Morton B. C. , Higginson L. A. J. , Chambers R. J. , Beanlands D. S.
Published: March 2007

Five of our first 20 candidates for PTCA had unanticipated occlusion of the relevant coronary artery between the time of coronary angiography and PTCA. None had a change in symptoms or ECG to suggest coronary occlusion. We currently schedule PTCA within a month to help avoid this occurrence.
A case of normal coronary infarction after intracoronary thrombolysis with urokinase
Authors: Watabe Shinji , Uwatoko Masashi , Tsunekawa Atsushi , Izumi Shiro , Osugi Junichi , Takatsu Fumimaro , Ishikawa Hiroyasu , Nagaya Teruo
Published: March 2007

We report the case of a 50‐year‐old male who had classical ECG signs of inferior wall myocardial infarction. Intracoronary thrombolysis resulted in fragmentation of a thrombus in the lumen of the right coronary artery. Angiography 1 month later showed no abnormalities at the site of previous thrombus. Ergonovine stress did not produce spasm. We conclude that (1) a mild cardial infarction can occur with an occlusive thrombus arising in angiographically normal coronary arteries; (2) transient change in minimal atheromata or spasm may induce such thrombi; and (3) thrombolytic therapy may be able to expedite recanalization of the occluded artery and salvage the myocardium.
Transluminal coronary angioplasty: Comparison of brachial and femoral artery methods
Authors: Dorros Gerald , Stertzer Fsca Simon H. , Myler Fsca Richard K. , Kaltenbach Martin , Spring Fsca Donald A.
Published: March 2007

The brachial and femoral artery methods for (percutaneous) transluminal coronary angioplasty are compared. We attempted 901 angioplasties with 539 (59.8%) via the brachial and 362 (40.2%) via the femoral artery. The stenosis was crossed in 670 attempts (74%); in 410 (76%) via the brachial, and in 260 (72%) via the femoral artery. Successful angioplasty was achieved in 607 attempts (67%): in 370 (69%) via the brachial, and in 237 (65%) via the femoral artery. There was no difference between the techniques in crossing the stenosis or achieving a primary success. The left anterior descending artery stenosis was statistically more likely to be crossed than a stenosis in the right (p < 0.001), circumflex (p < 0.05), left main coronary artery (p < 0.05), or saphenous vein graft (p < 0.05); the left anterior descending artery stenosis was more likely (p < 0.05) to be successfully dilated if the lesion were crossed (410 of 445 cases, 92%) than a right coronary stenosis (117 of 136 cases, 80%). The brachial and femoral artery methods are comparable techniques. Interventional angiographers performing coronary angioplasty should utilize the angiographic approach with which they are most familiar.
Laminar flow due to venous valves masquerading as vein graft spasm
Authors: Singh Ram N. , Salvoza Manuel I.
Published: March 2007

Two cases of laminar flow at the venous valves were found to produce a tapered appearance of the vein grafts, similar to spasm, during angiography. This possibility should be kept in mind when considering the diagnosis of spasm in a vein graft during postoperative angiographic studies. In addition, the follow‐up of these cases suggests that valves may predispose to later stenosis or occlusion of the vein grafts.
Recent experience with transeptal catheterization
Authors: Lew Allan S. , Harper Richard W. , Federman Jacob , Anderson Stanley T. , Pitt Aubrey
Published: March 2007

We report our recent experience of 207 consecutive transeptal catheterizations performed in the following groups of patients: aortic valve disease in 152, mitral valve disease in 20, combined aortic and mitral valve disease in 11, hypertrophic obstructive cardiomyopathy in 11, assessment of prosthetic cardiac valves in nine, and four miscellaneous.

Transeptal catheterization failed in 20 patients. There was no attempt to advance the transeptal catheter from the left atrium into the left ventricle in 18 patients, and failure to advance the transeptal catheter from the left atrium into the left ventricle occurred in 13 patients. Transeptal catheterization was achieved in a mean time of 9.7 ± 4.6 SD min.

There were no deaths, two major and four minor complications. We conclude that transeptal catheterization remains a useful technique that in experienced hands is both rapid and safe.
A method for inserting two catheters, pulmonary arterial and temporary pacing, through a single puncture into a subclavian vein
Authors: Jacob Andrew S. , Schweiger Marc J.
Published: March 2007

A method for inserting two catheters into a subclavian vein, using a single puncture, is described. Ten patients are reported in whom pulmonary arterial and temporary pacing catheters were inserted by this method. Similar techniques are discussed.
Brachial artery catheterization employing a side arm sheath
Authors: Folland Edward D. , Kemper Andrew , Bloomfield Peter , Parisi Alfred F.
Published: March 2007

A major complication of left heart catheterization via the brachial artery is occlusion at the cutdown site. This is particularly a problem when patients with severe atherosclerosis are catheterized in laboratories where the brachial approach is not routinely used. A method of brachial artery catheterization is described which employs a continuously flushed side arm sheath in order to minimize local trauma to the artery from catheter exchange and manipulation. In 15 consecutive atherosclerotic patients catheterized by this method there were no complications, and all arteriotomies were closed easily with immediate restoration of a good radial pulse. This contrasts with the preceding 33 consecutive brachial catherizations employing standard technique in similar patients in whom four patients required surgical repair, and an additional six patients required more than one closure attempt and/or catheter thrombectomy to restore a good pulse. In our laboratory the brachial sheath technique has facilitated arterial repair and reduced local complications.
Incidence of new focal pulmonary emboli after routine cardiac catheterization comparing the brachial to the femoral approach
Authors: Gowda Siddhesh , Bollis A. M. , Haikal M. , Salem B. I.
Published: March 2007

The incidence of pulmonary perfusion defects after routine cardiac catheterization was assessed in 56 patients by comparing ventilation–perfusion (V/Q) lung scans obtained before and 1 day after catheterization. Patients were prospectively randomized in two groups, one in which the brachial approach was performed using an antecubital cutdown procedure, and one in which the percutaneous femoral approach was used. None of the patients with the brachial approach had any ventilation–perfusion mismatch on the V/Q scan; however, three patients (8.3%) with the femoral approach did. These two groups did not differ significantly in clinical characteristics, duration of catheterization, and hemodynamic variables. The data suggest that pulmonary emboli postcardiac catheterization is more frequent in the femoral than the brachial approach. Furthermore, since those pulmonary emboli are mostly asymptomatic, their clinical recognition would be underestimated.
Left main coronary artery stenosis: A possible complication of transluminal coronary angioplasty
Authors: Graf Ray H. , Verani Mario S.
Published: March 2007

Coronary transluminal angioplasty is a new alternative modality for the treatment of specific lesions of coronary artery disease. Although numerous complications have been recognized, this represents the first report of development of a severe left main coronary artery stenosis following left anterior descending artery angioplasty.
Sotalol‐induced torsade de pointes
Authors: Rakovec Peter , Cercek Bojan , Rode Primoz , Brucan Andrej , Horvat Matija
Published: March 2007

A case of sotalol‐induced polymorphous ventricular tachycardia (torsade de pointes) is presented. The patient had moderately prolonged Q‐T interval before medication with sotalol with further prolongation after application of this drug. Electrophysiological study during rechallenge with sotalol demonstrated a uniform ventricular tachycardia with a somewhat polymorphous onset; whether or not this tachycardia represented replication of the patient's spontaneous arrhythmia is questionable. Without antiarrhythmic drugs and during medication with pindolol ventricular tachycardia was not inducible.
Distal coronary artery injury following successful percutaneous transluminal coronary angioplasty
Authors: Schweiger Marc J. , Meeran M. K. , Gianelly Ralph E.
Published: March 2007

A 65‐year‐old woman underwent successful percutaneous transluminal coronary angioplasty of a right coronary artery stenosis. Shortly thereafter, she developed chest discomfort and repeat angiography demonstrated a new area of stenosis distal to the area of original angioplasty. An attempt at a second angioplasty resulted in vessel occlusion with subsequent successful bypass surgery. The etiology of the new distal lesion is discussed.
Balloon inflation caused by contrast injection through the guiding catheter: An unusual observation during coronary angioplasty
Authors: Van Gelder L. M. , Van Der Krieken A. M. , El Gamal M. I. H. , Bonnier J. J. R. M. , Michels H. R.
Published: March 2007

Balloon inflation caused by contrast injection through the guiding catheter has been observed during several angioplasty procedures. The phenomenon is observed when employing an 8F USCI guiding catheter in combination with an ACS dilatation catheter. Two cases demonstrating the phenomenon are described in detail, together with an in vitro experiment that illustrates and quantifies the mechanism.
Intravenous versus intracoronary streptokinase for acute transmural myocardial infarction
Authors: Blunda Michael , Meister Steven G. , Shechter Jay A. , Pickering Nancy J. , Wolf Nelson M.
Published: March 2007

In order to compare the thrombolytic efficacy of selective versus systemic administration of streptokinase, we gave this drug by either the intracoronary or intravenous routes to 25 patients during the first 6 hours of acute myocardial infarction. All patients had total occlusion of the infarct‐related vessel, unresponsive to intracoronary nitroglycerin. Twelve patients received intravenous streptokinase and 13 received intracoronary administration of the drug. Angiograms were taken prior to and during streptokinase administration. Reopening was achieved in 11 of 13 intracoronary patients and 8 of 12 intravenous patients (P = Ns). Time to reopening was longer (54 minutes) in the intravenous patients than in the intracoronary patients (26 minutes) (P < 0.05). In this study, intravenous streptokinase reopened infarct‐related vessels nearly as often as intracoronary streptokinase, but it took longer. Given the limited access and time to prepare for intracoronary infusion and the ease of intravenous administration, further study of intravenous streptokinase is justified.
Clinical and angiographic findings in a patient with vasospasm in an anomalous coronary artery
Authors: Schulman Peter , Ferree Joel W. , Del Mastro Patrick R.
Published: March 2007

We report the case of a 58‐year‐old man with coronary vasospasm that occurred within an anomalous coronary artery. The rapidly progressive clinical course and the dramatic treadmill test result preceeded the diagnostic cardiac catheterization. Combination therapy with isosorbide, beta blocker, and nifedipine resulted in complete resolution of symptoms.
Aberrant origin of the right ventricular coronary artery: A report of two cases
Authors: Vacek James L. , Stock Peter D. , Davis William Ross
Published: March 2007

Aberrant origin of coronary arteries is a not uncommon entity found on cardiac catheterization, at the time of surgery, and on post mortem examination. We present two cases of origin of a right ventricular (or atypical large conus) branch of the right coronary artery originating from a separate ostium in the right coronary cusp, which to our knowledge has been only rarely previously described. We feel that this may be a relatively frequent coronary varient that has important implications regarding patient assessment and care.
Reproducibility and accuracy of left ventricular ejection fraction and wall motion determinations using gold‐195m: A new ultrashort‐lived radionuclide for cardiac studies
Authors: Narahara Kenneth A. , Mena Ismael , Maublant Jean C. , Brizendine Marianne , Thompson Craig J. , Criley J. Michael
Published: March 2007

Gold‐195m has a halflife of 30.5 sec. Its ultrashort halflife and low radiation exposure (240 mrads to the kidney from a 20‐mCi injection) make it an ideal agent for sequential first‐transit studies of cardiac function. The reproducibility of ejection fraction and wall motion determinations were assessed from two gold‐195m first‐pass angiograms performed 3 min apart in 38 subjects. The accuracy of these evaluations was assessed by performing another first‐transit study using technetium‐99m.

The correlation of the ejection fraction between the two gold‐195m angiograms was 0.95 (standard error of the estimate (SEE) = 0.049) over an ejection fraction range of 20–78. The correlation of the ejection fraction using technetium‐99m versus gold‐195m was 0.95; SEE = 0.050. Only six minor discrepancies were noted when wall motion was evaluated in the gold‐195m angiograms and compared with the technetium‐99m study.

We conclude that gold‐195m can provide repeated, accurate, and reproducible ejection fraction and wall motion determinations with conventional imaging equipment at a substantially lower radiation exposure than with technetium‐99m.
Selective coronary arteriography by percutaneous transaxillary approach
Authors: Valeix B. , Labrunie P. , Jahjah F. , Collet F. , Monassier J. P. , Guarino L. , Puel J. , Roux J. J. , Heibig J. , Levy S. , Gerard R.
Published: March 2007

Coronary angiography by the percutaneous femoral approach is widely used. This technique is potentially dangerous or impossible in patients with advanced arterial disease of the lower limbs, whether or not surgically treated. In these cases, percutaneous left or right axillary approach is an alternative to brachial approach.

In this article, we report our multicenter experience involving 120 patients. The left axillary artery was used in 94 cases (78%) and the right in 26 cases (22%). We used preformed coronary catheters usually associated with the femoral approach. The left axillary artery was used preferentially since this avoids catheterization of the innominated trunk and allows easier catheterization of the coronary ostia and aortic ends of aorto‐coronary bypass grafts. The routine use of a sheath (arterial introducer) avoided arterial compression during catheterization, prevented hemorrhagic suffusion when the catheters were exchanged, and reduced the risk of thrombosis or laceration of the axillary artery. There were no failures in the catheterization of the axillary artery and no complication was observed during or after the procedure.

Axillary percutaneous technique appears to have the following advantages over the brachial arteriotomy: (1) Investigation time is equivalent to the time needed for the femoral percutaneous approach. (2) There is the possibility of lateral and simultaneous bi‐plane angiograms. (3) Arterial puncture is preferable to arteriotomy.

The axillary approach could also be used for percutaneous transluminal coronary angioplasty.
Experience with a technique for coronary angioplasty of bifurcational lesions
Authors: Zack Paul M. , Ischinger Thomas
Published: March 2007

To decrease the risk of iatrogenic side branch occlusion during coronary angioplasty of bifurcational lesions, we evaluated a technique in which two over‐the‐wire dilatation systems are positioned within the stenosed coronary artery and the side branch in jeopardy. The technique was used in eight patients undergoing angioplasty for a lesion in the left anterior descending or circumflex artery located near a large side branch. Successful dilatation of the major vessel lesion was achieved in all eight patients, and dilatation within the side branch was successful in all three patients whose lesion involved the side branch ostium. In one patient, dilatation within the major vessel led to partial closure of the side branch and the prepositioned guide wire facilitated prompt dilatation of the iatrogenic closure. There were no complications associated with use of the additional dilatation system. The technique appears to provide an efficacious method to perform safe coronary angioplasty in selected patients with bifurcational lesions.
Unusual nodular pulmonary lesions associated with thrombolytic therapy
Authors: Carmody Thomas James , Wergowske Gilbert L. , Joffe C. David
Published: March 2007

The occurrence of solitary nodular pulmonary lesions associated with thrombolytic therapy is reported in two patients. Resolution was spontaneous in each patient. Multiple thin needle aspiration biopsies in one case revealed only red blood cells. This unusual entity should be included as one of the potential complications associated with the use of thrombolytic agents.
Thresholds for transesophageal atrial pacing
Authors: Dick MacDonald , Campbell Robert M. , Jenkins Janice M.
Published: March 2007

To determine the thresholds for transesophageal atrial capture, as well as factors that may influence the thresholds, we measured the minimal current and pulse width required to pace the atria through transesophageal bipolar lead systems in 12 patients, ranging in age from 1 day to 19 years, during 19 episodes of reentrant supraventricular tachycardia. Depending on the patients' age and size several electrode catheters were used. The protocol called for 1‐msec step‐wise increments in pulse width. At each pulse width the current was increased by 1 mamp until capture was achieved. The mean minimal pulse width and mean minimal current required for capture were 5.8 msec and 13.6 mamp, respectively. Atrial capture was achieved in 75% of attempts at a pulse width and current equal to or less than 6.5 msec and 17.5 mamp, respectively. No correlation between current and pulse width on the one hand and age, height, weight, or body surface area on the other was detected. Likewise neither electrode type nor existence of structural heart disease influenced the threshold required for capture. We conclude that atrial capture can be readily achieved through transesophageal electrodes and is not influenced by the subject's age or size.
Determinants of outcome following left ventricular aneurysmectomy
Authors: Nestico Pasquale F. , Hakki A‐Hamid , Iskandrian Abdulmassih S. , Hakki A‐Hadi , Kay Harold , Mundth Eldred D.
Published: March 2007

The determinants of outcome after left ventricular aneurysmectomy are not well understood. We analyzed preoperative follow‐up information on 38 patients who had undergone left ventricular aneurysmectomy. At a mean follow‐up of 39 months (range 6 to 68), 25 patients (66%) improved by at least one functional class (New York Heart Association) (Group I), and 13 patients (Group II) either died (n: 8) or had persistent congestive heart failure (n: 5). Patients in Group I had significantly higher left ventricular ejection fraction before surgery than patients in Group II (38 ± 12% vs. 29 ± 14% P < 0.04). The volume of the aneurysm at end‐diastole was smaller among patients in Group I than Group II (42 ± 32 ml vs. 73 ± 47 ml, P < 0.04).

The contractile indices of the nonaneurysm segment, contractile segment ejection fraction, basilar half ejection fraction, and basilar fractional area shortening were not significantly different between the two groups. There was no difference between the two groups in the preoperative left ventricular end‐diastolic pressure, cardiac index, pulmonary artery wedge pressure, pulmonary artery pressure, extent of coronary artery disease, number of bypass grafts inserted, or aortic cross‐clamp times.

Conclusion: (1) The ejection fraction and volume of the aneurysm are more important predictors of outcome after left ventricular aneurysmectomy than the contractile indices of the nonaneurysmal left ventricle and (2) symptomatic improvement occurs in 66% of patients after left ventricular aneurysmectomy.
Regulation of cardiac output during upright exercise in patients with aortic regurgitation
Authors: Iskandrian Abdulmassih S. , Hakki A‐Hamid , Amenta Angelo , Mandler Jeffrey , Kane Sally
Published: March 2007

The change in cardiac output during upright exercise in patients with aortic regurgitation (AR) is not well known. We measured left ventricular (LV) ejection fraction (EF) and volume, regurgitant fraction (RF), total cardiac output and forward cardiac output at rest, and peak upright exercise by means of radionuclide angiography in ten normal subjects and 15 patients with AR.

In the normal subjects, there was no significant change in the end‐diastolic volume but there was a significant decrease in the end‐systolic volume (p = 0.0001) and a significant increase in EF (p = 0.0001). The increase in cardiac output during exercise was due to increases in both stroke volume and heart rate.

In patients with AR, there was a significant decrease during exercise in RF (53 ± 15% at rest, and 45 ± 15% during exercise; p = 0.03), and in end‐diastolic and endsystolic volume (p = 0.02, and p = 0.003, respectively). The EF increased during exercise (p = 0.003). The total stroke volume did not change (68 ± 19 ml/m2 at rest, and 67 ± 14 ml/m2 during exercise; p, NS).

Thus, in patients with AR, individual changes in EF, RF, and volume are quite variable, but as a group a decrease in RF and an increase in heart rate contribute to the increase in forward flow. The total stroke volume may not increase during exercise, despite an increase in EF and a decrease in end‐systolic volume because of a concomitant decrease in end‐diastolic volume.
Combined fluid‐filled and micromanometer‐tip catheter system for high‐fidelity pressure recordings in infants
Authors: Colan Steven D.
Published: March 2007

Investigation of pressure‐derived indices of systolic and diastolic function in infants and young children has been limited, in part due to difficulty in obtaining high‐fidelity pressure recordings. Standard fluid‐filled catheter‐manometer systems have a frequency response which is inadequate for this purpose, whereas high‐frequency response micromanometer‐tip catheters systems are difficult to use in this age group. Therefore, a system was investigated whereby a micromanometer‐tip catheter (Millar) was connected directly to a standard pigtail catheter. The frequency response of this combined system was defined using 3.2 Fr pigtails of 40, 50, and 65 cm, 4.0 Fr pigtails of 50, 65, and 80 cm, and 5.0 Fr pigtails of 80 and 100 cm.

In three different catheters of each diameter and length, minimal variation in response was seen. The 3.2 Fr‐40‐cm system demonstrated a flat line (100%) response to 90 Hz with a resonant frequency of 130 Hz. This is certainly adequate for determination of pressure derivatives for heart rates up to 120 beats per minute. The longer 3.2 Fr catheters demonstrated a poorer frequency response. The 4.0‐Fr‐50‐cm system was flat line to 60 Hz, rising to 175% response at the resonant frequency of 85 Hz. This is adequate for determination of pressure derivatives at heart rates up to 120 beats per minute. Increasing the diameter or length of the pigtail catheter resulted in further deterioration of the frequency response. Thus, this system provides high‐fidelity tracings suitable for assessment of pressure‐derived indices of systolic and diastolic function in infants and young children.
The use of pigtail catheters for retrieval of foreign bodies from the cardiovascular system
Authors: Auge J. M. , Oriol A. , Serra C. , Crexells C.
Published: March 2007

Snare retrieval of foreign bodies is a common procedure but in certain cases, location of the foreign body requires another system. We present three cases in which only the use of a pigtail catheter gave a good grip for gentle traction and removal or repositioning of the foreign body. A careful review of the world literature up to December 1982 gave rise to two previous similar reports. Both our experience and that found in the literature seem to suggest that in cases where there are no free ends to snare, pigtail catheters may be the first instrument used to start retrieval.
Late progression of an asymptomatic intimal tear to occlusive coronary artery dissection following angioplasty
Authors: Zack Paul M. , Ischinger Thomas
Published: March 2007

Symptomatic coronary artery dissection is a recognized complication of coronary angioplasty that is usually associated with immediate adverse consequences. In contrast, the asymptomatic angiographic finding of an “intimal tear” following otherwise successful angioplasty has been considered clinically unimportant. A case is reported of a primarily successful coronary angioplasty with intimal tear that progressed to occlusive coronary artery dissection requiring coronary bypass surgery at 4 weeks postangioplasty. This case demonstrates that an asymptomatic intimal tear following successful coronary angioplasty is not always an innocuous angiographic finding.
Absence of left anterior descending coronary artery associated with anomalous origin of left circumflex coronary artery from the right coronary artery: A case report and review
Authors: Ferguson David W. , Henkle Joseph Q. , Haws Charles W.
Published: March 2007

In this report we present a case of a 30‐year‐old female patient with a single coronary artery, which consisted of a right coronary artery from which there was an anomalous origin of the left circumflex coronary artery. There was no left anterior descending coronary artery. The clinical and other noninvasive diagnostic features of this rare angiographic variant are described and compared to other known varieties of coronary anomalies. The absence of objective evidence of ischemia or left ventricular functional impairment and analysis of the angiographic data suggest that this is another benign variant of coronary anatomy.
Balloon dilatation for superior vena caval obstruction after the senning procedure
Authors: Benson L. N. , Yeatman L. , Laks H.
Published: March 2007

A 3‐month‐old infant is presented who developed acute superior vena caval obstruction after atrial surgery for transposition of the great arteries. Balloon dilation angioplasty resulted in a decrease in caval‐atrial gradient. The application of balloon angioplasty in this setting is discussed.
Hemodynamic evaluation of stenotic cardiac valves: II. Modification of the simplified valve formula for mitral and aortic valve area calculation
Authors: Angel Juan , Soler‐Soler J. , Anivarro Inocencio , Domingo Enric
Published: March 2007

Since the introduction by Gorlin and Gorlin [1] of the hydraulic formulae for calculating valve area, it has become the best parameter for quantitating valve stenosis. Recently Hakki et al [3] proposed a simplified formula for valve area calculation that does not take into account either heart rate (HR) or left ventricular filling or ejection time. The purpose of this study was to analyze the validity of Hakki's formulae under different physiological conditions and to propose an easy correction to improve its accuracy. Our study suggests: (1) that an easy correction for heart rate in certain cases, dividing by 1.35 when HR < 75 beats per min in mitral stenosis and when HR > 90 beats per min in aortic stenosis, significantly improves the accuracy and validity of Hakki's formulae (p < 0.02 and p < 0.05); (2) the instantaneous valve gradients (peak gradient for aortic stenosis and average of instantaneous early, middle, and late diastolic gradients for mitral stenosis) are as valid as mean planimetric gradients for valve area calculation. Thus the simplified formulae proposed in this study allow mitral and aortic valve area calculations by means of instantaneous gradients, cardiac output, and heart rate.
Factory fixation of an ARC curve into brachial coronary artery catheters of the manipulative type: A new curve for sones' type catheters
Authors: Miller Gordon C.
Published: March 2007

Advantage was found in factory fixing an approximation of the curve that has long been hand‐formed at the tableside by angiographers using the manipulative type brachial‐coronary technique. It consists of a 7 cm arc of a circle of 10 cm diameter. Used in 68 different patients, it was found to definitely facilitate and speed selective cannulation of the coronary artery ostia as compared to previous curves.
Spontaneous regression of coronary artery obstructions: Incidence in 313 consecutive repeat angiograms
Authors: Moise Alain , Goulet Claude , Théroux Pierre , Taeymans Yves , Lespérance Jacques , Bourassa Martial G.
Published: March 2007

We studied the incidence of reversibility of coronary obstructions in a consecutive series of 313 patients with nonoperated coronary artery disease catheterized twice 3 to 118 (mean 38) months apart. Recanalization was observed in three patients and regression from an initial < 100% obstruction in six patients. Progression in a different location occurred in six of the nine patients who demonstrated one recanalized or one regressive lesion. We conclude that true regression is an infrequent event in the natural history of medically treated patients with coronary artery disease; moreover, the pathophysiology and clinical relevance of angiographic regression remain poorly defined.
Left main coronary thrombolysis
Authors: Cox William R.
Published: March 2007

A patient with acute occlusion of the left main coronary artery in whom streptokinase thrombolysis was successful in reestablishing antegrade flow is reported. A discussion of factors influencing survival and a review of the literature is presented.
Resolution of congestive failure, mitral regurgitation, and angina after percutaneous transluminal coronary angioplasty of triple vessel disease
Authors: Reinfeld Howard B , Samet Philip , Hildner Frank J
Published: March 2007

Congestive heart failure, unstable angina, and moderate mitral regurgitation improved after double‐vessel angioplasty in a 41‐year‐old woman who was considered inoperable because of high risk of bypass surgery. With the concomitant use of balloon counterpulsation, angioplasty reduced the cross‐sectional stenosis in the left anterior descending coronary artery from 98 to 20% and in the left circumflex coronary artery from 90 to 0%. The right coronary artery was completely occluded and angioplasty was not attempted. The ejection fraction was 17% prior to angioplasty and 50% 2 months later at follow‐up.
Applicability of percutaneous transluminal coronary angioplasty to patients with recombinant tissue plasminogen activator mediated thrombolysis
Authors: Topol Eric J. , Eha Jaan E. , Brin Kenneth P. , Shapiro Edward P. , Weiss James L. , Riegel Mary B. , Gottlieb Sidney O. , Brinker Jeffrey A.
Published: March 2007

To test the utility and safety of percutaneous transluminal coronary angioplasty (PTCA) after recombinant tissue plasminogen activator (t‐PA), we performed the procedure in all suitable candidates with acute myocardial infarction (MI) who had successful t‐PA mediated coronary thrombolysis. Twenty consecutive patients with MI received t‐PA after coronary angiographic conformation of total occlusion. Successful recanalization with t‐PA was achieved in 13 patients, leaving a residual obstruction of 84 ± 6% in the nine patients for whom PTCA was attempted at a mean of 21.6 h. Success was achieved in seven patients, leading to a residual lesion of 29 ± 7%. In the two patients for whom PTCA was unsuccessful, total reocclusion occurred prior to the attempt despite therapy with heparin, aspirin, dipyridamole, and nifedipine. All PTCA procedures were uncomplicated. Serial two‐dimensional echocardiography at 10 days, compared to admission, demonstrated infarct zone wall motion index improvement in the patients with successful PTCA (group A, 0.83 ± 0.36 to 1.46 ± 0.49) as compared to the 13 patients without thrombolysis or successful PTCA (group B, 0.61 ± 0.26 to 0.66 ± 0.39), (P < 0.05). One patient of group A sustained a massive stroke at 2 weeks after hospital discharge. In the remaining six patients, follow‐up exercise testing and/or coronary arteriography demonstrated a negative treadmill test and/or patent infarct vessel, respectively. After successful PTCA, no patient had clinical signs of reocclusion, reinfarction, postinfarction angina, or congestive heart failure. At 9.4 ± 2 months, all six patients are asymptomatic and have returned to work. Thus, sequential PTCA after t‐PA can be performed safely and successfully in patients with MI and this approach may be associated with improved regional function and a favorable post‐MI course.
Coronary angiography and intracoronary thrombolytic therapy in the coronary care unit: An alternative approach
Authors: Gottlieb Sidney O. , Guzman Pablo A. , Brin Kenneth P. , Walford Gary D. , Brinker Jeffrey A.
Published: March 2007

The feasibility, safety and efficacy of performing left heart catheterization, coronary angiography, and intracoronary thrombolytic therapy in the coronary care unit setting were examined in 17 patients with acute ischemic syndromes presenting at a time when routine catheterization facilities were not available. In all cases, cardiac catheterization and coronary angiography were performed in the coronary care unit without difficulty using a portable image intensifier and a portable video recording system, and selective intracoronary streptokinase was safely administered in 13 patients with a total coronary occlusion, with successful thrombolysis in seven patients (54%). No adverse effects attributable to the performance of these procedures in the coronary care unit were observed. This approach might allow for a more prompt response and wider availability of intracoronary thrombolytic therapy for patients presenting with acute myocardial infarction.
Quantitative assessment of left ventricular function after myocardial infarction using the minnesota Q‐QS codes for resting electrocardiograms
Authors: Karnegis James N. , Matts John , Tuna Naip , Amplatz Kurt , Moore Richard B. , Buchwald Henry
Published: March 2007

The electrocardiogram as a quantitative predictor of left ventricular systolic function was investigated in subjects with one myocardial infarction. The first 509 consecutive subjects to enter the Program of Surgical Control of Hyperlipidemia were studied by selective left ventriculography. Electrocardiograms taken during a prior hospitalization of the subjects for acute myocardial infarction were classified according to the Minnesota Q‐QS codes. This study showed that the lower (ie, the more significant) Q‐QS codes were highly correlated with reduced left ventricular function as measured both by a lower ejection fraction and by a greater number of left ventricular segments showing abnormal systolic motion. In addition, the location of segmental wall motion abnormalities correlated with the electrocardiographic site of the Q‐QS code.
The role of intravenous streptokinase in acute arterial occlusions after cardiac catheterization
Authors: Gagnon Roger‐Marie , Goudreau Evelyne , Joyal France , Morissette Martin , Roussin André
Published: March 2007

Arterial occlusions after cardiac catheterization are usually treated surgically. We report four patients with femoral thrombosis or distal emboli that developed after cardiac catheterization. Each patient was treated successfully with intravenous streptokinase.

Therapy was initiated 1–60 hr after the procedure. The duration of infusion lasted 4–42 hr (mean 27 hr). Pulses were restored 4–19 hr (mean 10 hr) after the beginning of infusion. There was no major hemorrhagic complication, even in patients with very early streptokinase infusion.

Thus intravenous streptokinase may be an alternate choice to surgery for arterial occlusions after invasive procedures.
Cardiac tamponade following percutaneous transluminal coronary angioplasty: Four case reports
Authors: Goldbaum Thomas S. , Jacob Andrew S. , Smith Douglas F. , Pichard Augusto , Lindsay Joseph
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) has had complications related to dilating catheters and guide wires such as coronary artery dissection, spasm, rupture, and perforation. This report describes four patients who developed cardiac tamponade following PTCA, presumably from right ventricular (RV) perforation. All four received large doses of heparin during PTCA and three received antiplatelet therapy. In three cases, cardiac tamponade occurred several hours after PTCA. All patients did well following operative intervention and no patient required repair of a cardiac perforation. We postulate that impaired hemostasis in the presence of an otherwise inconsequential RV perforation causes tamponade. Three alternatives to provide standby pacing are proposed.
Coronary artery vasospasm during treatment with intravenous nitroglycerin
Authors: Hom Gerald A. , Brent Bruce N.
Published: March 2007

We present a case of coronary artery vasospasm occurring during cardiac catheterization, which occurred while the patient was receiving substantial doses of intravenous nitroglycerin. Continued coronary artery vasospasm despite resolution of chest pain and response of vasospasm to intracoronary nitroglycerin are important clinical points.
Can total coronary occlusions be predicted from a previous coronary arteriogram?
Authors: Halon David A. , Sapoznikov Dan , Gotsman Mervyn S. , Lewis Basil S.
Published: March 2007

We studied the site, severity, and coronary angiographic morphology of coronary lesions and their ability to predict progression of coronary narrowing and obstruction of coronary arteries. Twenty‐six patients who had 94 lesions at the time of first angiography were followed for a mean of 29 ± 17 (SD) months. Progression of disease jor obstructions of vessel occurred in 11 lesions (12%): eight new total obstructions (8.5%) and three subtotal (3%). Narrowings of >75% of the luminal diameter were more likely to become totally obstructed than less severe narrowings (P = 0.01), but three total occlusions occurred at sites where mild disease had been present previously. Lesions in patients with double or triple vessel disease showed a marginally greater tendency to become totally occluded than in patients with single vessel disease (P < 0.1). We found no relationship between new total obstructions and the angiographic morphology of the lesion (smooth or irregular) nor with its length or position in the artery or the extent of atheroma in the vessel.
Aberrant main left coronary artery in a patient with unstable angina
Authors: Vega Manuel , Hamby Robert I.
Published: March 2007

A patient with significant obstructive coronary artery disease in an anomalous left main coronary artery arising from the right coronary artery is reported. The combination of this coronary anomaly with main left atherosclerotic disease is noteworthy and presented no surgical technical problem.
Heart rate influence on the systolic gradient across the stenotic aortic valve: Theoretical evaluation and implications
Authors: Rozenman Yoseph , Gotsman Mervyn S.
Published: March 2007

Peak systolic gradient across the aortic value, measured invasively or noninvasively is used in many laboratories for estimation of the severity of the stenosis (=actual valve area). This study shows that when cardiac output is normal the gradient across the valve is influenced by heart rate (HR) apart from valve area. A rate‐corrected peak systolic gradient (PSGc) is defined by the formula √PSGc = 0.041 √PSG HR (0.442–0.0014 HR) and its importance for clinical decision making is demonstrated. The significance of bradycardia in the pathogenesis of syncope in aortic stenosis is discussed.
The training for and practice of percutaneous transluminal coronary angioplasty: Results of two surveys
Authors: Scanlon Patrick J.
Published: March 2007

In order to gain understanding of how percutaneous transluminal coronary angioplasty (PTCA) is taught and practiced in the United States, two questionnaires were devised to survey all adult cardiology training programs and all adult cardiac catheterization laboratories in this country. Of the 184 programs that responded to the training questionnaire, 102 (55%) teach PTCA, usually in the form of fellowship training and especially as a specialized year, and less commonly in the form of a preceptorship. Though many programs expose trainees to an adequate number of cases as defined by the program directors, at least 37% do not. Of 388 laboratories responding to the practice questionnaire, 74% perform PTCA. The total number of PTCA's in this country seems to be doubling yearly, but many laboratories do relatively few cases per year, and 79% of physicians doing PTCA do fewer than one case per week. Average laboratory success rate for PTCA is in the range of 80–85%. Though there is now a proliferation of PTCA training programs, 93% of those practicing angioplasty are self‐ or preceptor‐trained, and have not learned the procedure as part of a fellowship.
The use of dextran‐40 during percutaneous transluminal coronary angioplasty: A report of three cases of anaphylactoid reactions—one near fatal
Authors: Brown Robert I. G. , Aldridge Harold E. , Schwartz Leonard , Henderson Mark , Brooks Esther , Coutanche Monica
Published: March 2007

Successful percutaneous transluminal coronary angioplasty is achieved by fracture of the atheromatous plaque and perhaps dilatation of the arterial walls to increase the luminal diameter of the artery. Because this „controlled”︁ injury stimulates platelet adhesion on the subendothelial matrix, the use of dextran‐40 in addition to heparin has been advocated. The overall incidence of Dextran‐induced anaphylactoid reactions at our institution was 0.6% and of severe life‐threatening reactions, 0.2%. With the recent doubts cast on the efficacy of dextran‐40, the question arises regarding its routine use in PTCA.
Noninvasive determination of valve area in adults with aortic stenosis using doppler echocardiography
Authors: Holmvang Godtfred , McConville Briege , Tomlinson Charles W.
Published: March 2007

Doppler ultrasound has been used to determine the pressure gradient P1P2 across the valve in patients with aortic stenosis (AS), but since the gradient varies over time and may be deceptively low in patients with impaired cardiac output, the key parameter to obtain is the orifice area (A)

By calculating stroke volume (SV) from the modal flow velocity [vmode(t)] over the systolic ejection period (sep) or diastolic filling period (dfp(, wherever laminar flow exists in the heart across an area of known diameter D, (pulmonary artery or atrioventricular valves), and by substituting P1−P2 = 4Vmax2, (Vmax = peak velocity in the aortic jet), the Gorlin formula becomes:

where θ = flow intercept angle at D.

This approach was applied in nine adult patients with AS (age 64 ± 8 yearsrpar; in whom recent catheterization data was available for comparison. Close correlation was found between the calculated areas: A(Doppler) = 0.82 A(Cath) + 0.17 (r = 0.94, p < 0.001). Two patients with Doppler gradients of <40 mmHg were shown by this Doppler method nevertheless to have severely narrowed orifice areas of < 0g.78 cm2.

Although there is a tendency to overestimate slightly the valve area, Doppler ultrasound assessment using this technique adds valuable noninvasive information concerning the degree of aortic valve disease.
Portable intraaortic balloon counterpulsation: Clinical experience and guidelines for use
Authors: Gottlieb Sidney O. , Chew Paul H. , Chandra Nisha , Ouyang Pamela , Shapiro Edward P. , Bush David E. , Gottlieb Sheldon H.
Published: March 2007

Intraaortic balloon (IAB) Counterpulsation is a proven treatment for patients with refractory ischemia or cardiogenic shock; however its use has been largely limited to tertiary centers due to the difficulties and risks encountered in transporting patients with this device in place. We report our initial experience with 11 patients who underwent IAB Counterpulsation at a community hospital utilizing a portable transport IAB system. All 11 patients had successful IAB insertion, resulting in prompt stabilization. Immediate transportation during uninterrupted IAB Counterpulsation was successfully accomplished in each case using routine ambulance vehicles, allowing for the prompt initiation of further tertiary care. The role of portable IAB Counterpulsation in the community hospital and guidelines for the implementation of this portable IAB system are outlined.
Atypical phasic coronary artery narrowing
Authors: Angelini Paolo , Leachman Robert D. , Autrey Alonzo
Published: March 2007

Four unusual cases of phasic (occurring only in systole or only in diastole) coronary artery narrowing are reported. In two cases, diastolic compression of the left anterior descending coronary artery was due to tight pericardial adhesions in patients with aortic insufficiency; in the third case, systolic compression of two right ventricular coronary branches was associated with hypertrophic cardiomyopathy and a normotensive right ventricle; and in the fourth case, a large aneurysm of the inferior wall of the left ventricle caused systolic compression of the posterior descending coronary artery, which was epicardial. The diagnostic and pathophysiologic characteristics of each case are discussed.
Coronary artery spasm in a denervated orthotopic transplanted human heart
Authors: Goldenberg Irvin F. , Levine T. Barry
Published: March 2007

A case of catheter‐induced spasm in a 40‐year‐old male one year after orthotopic cardiac transplantation is presented. The fact that spasm can occur in this setting of total cardiac denervation demonstrates that other factors can play an important part in modifying the status of coronary artery patency.
Angioplasty at coronary bifurcations: Single‐guide, two‐wire technique
Authors: Oesterle Stephen N. , McAuley Bruce J. , Buchbinder Maurice , Simpson John B.
Published: March 2007

A technique is described for angioplasty at coronary bifurcations. This simple approach utilizes a single guiding catheter, an exchange wire, and a conventional dilatation catheter and guidewire. With this “protective” guidewire technique, side branches at risk from occlusion during dilatation of a primary coronary segment can be protected and dilated secondarily; continual access to the threatened side branch is maintained with a “standby” exchange wire in the branch vessel.
Use of pulmonary artery pressure and pacing catheter during PTCA
Authors: Jacob Andrew S. , Goldbaum Thomas S. , Richard Augusto D. , Lindsay Joseph
Published: March 2007

A balloon‐tipped pacing catheter capable of monitoring pulmonary artery pressure and providing standby right ventricular pacing was used in 20 percutaneous transluminal coronary angioplasties (PTCAs), without complication. The catheter was eily inserted in all cases (mean 85 sec) and achieved satisfactory pacing threshold in 17 patients (mean 7.5 ma). The design of this catheter theoretically reduces the risk of right ventricular perforation and tamponade, which may be increased during PTCA.