bluuebunny/crossref_metadata_2025 huggingface dataset:
Intracoronary thrombolysis in evolving isolated right ventricular infarction
Authors: Fujita Masatoshi , Sasayama Shigetake , Sakurai Tsunetaro , Nonogi Hiroshi
Published: March 2007

In a 52‐year‐old man with severe chest pain of 3 hours duration and ST‐segment elevation in leads V1 and V2, a nondominant right coronary artery was recanalized by an intracoronary infusion of urokinase. Coronary cineangiography revealed a total occlusion of the nondominant right coronary artery and no significant narrowing of the left coronary artery. Hemodynamic studies during the acute phase of myocardial infarction demonstrated an increase of right atrial mean pressure in association with normal pulmonary capillary wedge pressure. Following the recanalization, chest pain disappeared and hemodynamic alterations were corrected. The purpose of this report is to document a case of isolated right ventricular infarction due to a nondominant right coronary artery occlusion.
Thromboembolic complications of percutaneous transluminal coronary angioplasty for myocardial infarction
Authors: Cameron James , Buchbinder Maurice , Wexler Lewis , Oesterle Stephen N.
Published: March 2007

To determine the incidence of thromboembolic complications of percutaneous transluminal coronary angioplasty (PTCA) in the setting of recent and acute myocardial infarction, the clinical sequelae and coronary angiographic findings were examined in a series of 13 patients who underwent PTCA either as acute intervention during the infarction or as treatment for recurrent myocardial ischemia that occurred soon after the initial completed infarction. In all cases, the angiographic appearance in the infarct‐related artery was that of thrombus in the setting of total or subtotal occlusion. Balloon dilatation, without antecedent thrombolytic therapy, was performed in 14 arteries and was successful in establishing reperfusion with reduction of the degree of intraluminal narrowing to less than 50% in all cases. Residual thrombus at the site of inflation was noted in two cases (15%), and embolization was noted in four cases (29%), for an incidence of complication of 44%. In five of six instances in which either residual thrombus or embolization were noted, the initial infarction had occurred greater than 24 h before. In only one of seven cases in which PTCA was used as acute intervention during infarction of less than 4 h duration was the presence of residual thrombus noted after PTCA. Therefore, these findings suggest that thromboembolic complications after PTCA in the setting of recent or acute myocardial infarction are uncommon when the syndrome is less than 4 h duration; however, complications are relatively frequent when infarction has occurred greater than 24 h before. PTCA as a primary intervention in this latter setting should be approached cautiously.
Immediate balloon inflation during ventricular fibrillation complicating coronary angioplasty — an alternative technique to angioplasty system withdrawal: Case reports and review
Authors: Ferguson David W. , Chambers Charles E.
Published: March 2007

Two patients are presented in whom ventricular fibrillation occurred during otherwise uncomplicated percutaneous transluminal coronary angioplasty. Rather than withdrawing the angioplasty dilatation system in place in the coronary vessel before instituting resuscitation procedures, immediate balloon inflation was performed while a defibrillator was charged. During balloon inflation, both patients were countershocked, and they recovered stable cardiac rhythm. Postresuscitation hemodynamic and angiographic analysis revealed successful angioplasty results. This report describes an alternative technique to immediate removal of the balloon dilatation system for cardiac arrest complicating coronary angioplasty. Theoretical advantages and potential disadvantages of this technique are discussed.
Diffuse coronary artery to left ventricular communications: An unusual cause of demonstrable ischemia
Authors: Duckworth Frederick , Mukharji Jhulan , Vetrovec George W.
Published: March 2007

Diffuse communications between both the left and right coronary arteries and the left ventricle were found in a 46‐year‐old man presenting with typical angina pectoris. Symptoms were reproducible on treadmill exercise and ST segment depression, and redistribution septal defects were documented on stress Thallium scintigraphy. Antianginal drugs were effective in treating the patient's symptoms. Only 13 patients with similar anatomy have been previously described. This report is the first to document reproducible objective evidence of ischemia in such patients. The literature is reviewed and possible mechanisms of ischemia and its treatment discussed.
Angiography of the internal mammary artery via the contralateral brachial artery
Authors: Dorros Gerald , Lewin Ruben F.
Published: March 2007

A new technique for angiography of the contralateral internal mammary artery via the brachial artery approach is described. A Simmons (sidewinder) catheter is maneuvered into the ascending aorta and is rotated as to assume its performed shape. The catheter is advanced into the contralateral subclavian artery beyond the internal mammary artery. With the aid of an exchange wire, the Simmons catheter is replaced with a preformed internal mammary angiographic catheter. The internal mammary artery is cannulated, and angiography is performed. Fifty patients were successfully studied by means of this technique without incident. In 20 cases, the ipsilateral internal mammary artery was subsequently visualized. Brachial angiographers may prefer to add this technique to their repertoire.
A modified hand injector for percutaneous transluminal coronary angioplasty
Authors: Weiner Ronald I. , Maranhao Vladir
Published: March 2007

This paper introduces a modified hand injector for percutaneous transluminal coronary angioplasty (PTCA). The new hand injector allows powerful injections to be performed through No. 8 or 9 French guiding catheters with little strain on the operator's hands. This device may reduce the time and cost of the procedure and would be useful in laboratories performing a high volume of PTCAs.
Percutaneous transluminal valvuloplasty in calcific aortic stenosis: The double balloon technique
Authors: Dorros Gerald , Lewin Ruben F. , King James F. , Janke Lynne M.
Published: March 2007

The double balloon technique for aortic valvuloplasty using a combined brachial and femoral artery approach with readily available angioplasty equipment is described. Online hemodynamic assessment of the patient during the procedure was provided by continuous, reflective spectorphotometric monitoring of the pulmonary artery mixed venous oxygen saturation and the arterial pressure in the femoral sheath. Successful valvuloplasty was achieved in 70 patients with the transaortic peak‐to‐peak systolic gradient reduced from 77.6 ± 28 to 27.8 ± 15 mmHg (P <0.001), the mean gradient from 62.0 24 to 26.0 ± 15 mmHg (P <0.0007), and the aortic valve area increased from 0.56 ± 0.3 to 1.03 ± 0.6 cm2 (P <0.05). No significant complications were encountered. The double balloon technique for aortic valvuloplasty is an acceptable alternative method to the single balloon technique.
Blood velocity in the coronary artery circulation: Relation to thromboxane A2 levels in coronary sinus in patients with angiographically normal coronary arteries
Authors: Di Donato Marisa , Fantini Fabio , Maioli Mauro , Prisco Domenico , Rogasi Pier Giorgio , Serneri Gian Gastone Neri
Published: March 2007

In the present study, we report the finding that some patients with spontaneous typical angina and angiographically normal coronary arteries present an abnormal cardiocoronary capacity to produce thromboxane A2, both in basal conditions and after sympathetic stimulation. The levels of thromboxane A2 in coronary sinus are significantly correlated to the rate of clearance of contrast medium in coronary circulation. Such a finding might be useful in better understanding the interesting syndrome of angina with normal coronary arteries.
Three‐wire technique: A unique approach to percutaneous transluminal coronary angioplasty of a trifurcation lesion
Authors: Hartzler Geoffrey O.
Published: March 2007

A unique three‐wire technique was utilized for dilatation of a complex “trifurcation” lesion within the proximal left anterior descending coronary artery.
Partial dehiscence of a porcine prosthesis in association with aortic annular separation producing a false aneurysm of the ascending aorta
Authors: Come Patricia C. , Carl Lisa V. , Leeman David , Abelmann Walter H. , Weintraub Ronald M.
Published: March 2007

A 44‐year‐old man developed intermittent left bundle branch block followed by complete heart block 18 months after aortic valve replacement, and aortic insufficiency and hemolytic anemia 5 years postoperatively. These abnormalities were associated with operative findings (7 years after aortic valve replacement) of total disruption of the aorta at the level of the aortic annulus. Echocardiographic findings of an enlarged and unusually shaped “aortic root” and angiographic findings of abnormally high origin of the coronary arteries relative to the valve ring, which should have suggested the diagnosis 2 years prior to successful surgical repair, are presented.
Lack of postextrasystolic potentiation in a normal heart
Authors: Ilia Reuben , Rudnik Leonid , Gueron Moshe
Published: March 2007

Lack of postextrasystolic potentiation in a normal heart is described. The phenomenon might be attributed to calcium channel blocker treatment. We could not find a previous description of such a phenomenon in the English literature.
Pseudonormalization of T‐waves during coronary angioplasty
Authors: Zack Paul M. , Aker Umit T. , Kennedy Harold L.
Published: March 2007

Myocardial ischemia has been reported occasionally to produce transient T‐wave normalization in certain patients. We present a case of “pseudonormalization” of T‐waves occurring in the setting of coronary angioplasty. This case illustrates the potential of the transient coronary occlusion which occurs during coronary angioplasty as a model for understanding acute myocardial ischemia.
Angled tip of the steerable guidewire and its usefulness in percutaneous transluminal coronary angioplasty
Authors: Voda Jan
Published: March 2007

Theoretical analysis and clinical evaluation of single and multi‐angled guidewires as an alternative to widely used J‐wires suggested that the major determinants of the wire function are the shortest distance between the tip and a long axis of the wire‐reaching distance (RD), angulation of the tip, and the length of the angled arm. Their relationship can be characterized by a fomula; reaching distance = sin β × length of the arm. The two clinically most useful multiple angulations—double and triple angles—were evaluated in 54 patients in whom commercial J‐wire failed to pass the lesion in 120 s. This value was compared with an average time of 57.90 ± 3.9 s needed to pass an angled, individually shaped guidewire from the tip of the guiding catheter through the lesion. (P < < than 0.001 or highly significant.) All patients had tortuous vessels, sharply angled branches, and the largest diameter of the stenosed vessel less than 50% of the largest diameter of the left main coronary artery. Thirty‐seven lesions were in the obtuse marginal arteries and 17 in the diagonal arteries. The study suggested that angled guidewires shaped according to described guidelines have superior success to commercial, unshaped J‐wires in instrumentation of the tortuous vessels with angled branches and markedly varying diameter.
Endomyocardial biopsy with a disposable bioptome: A modified technique
Authors: Lew Brian T. , Olivari Maria Teresa , Levine T. Barry
Published: March 2007

Right ventricular endomyocardial biopsy can be obtained successfully with a manually shaped flexible disposable bioptome introduced in the right jugular vein. Introduction of a curve at the tip provides better control of the bioptome so that a short introducer sheath can be used and the right ventricular sampling site can be varied.
Use of 5 French catheters for cardiac catheterization and coronary angiography: A critical review
Authors: Brown Robert I. G. , MacDonald A. Craig
Published: March 2007

With the number of outpatient cardiac catheterizations increasing, much attention has recently been focused on the use of 5 French catheters for cardiac catheterization and selective coronary angiography. However, there are few reports in the literature regarding the technical aspects of their use or the quality of cineangiograms obtained. We reviewed our experience with these catheters in our first 100 consecutive cases. All cineangiograms were diagnostic, though 9% were deemed only of fair quality (incomplete luminal filling in some frames) by two experienced observers. Technical problems encountered with the use of these catheters included instability of the right Judkin's catheter in the right coronary ostium owing to high torquability, streaming of contrast during left coronary injections, and difficulty entering the left ventricle with a pig‐tail catheter.
Catheter entrapment in a Bjöurk‐Shiley prosthesis in aortic position
Authors: Kober Gisbert , Hilgermann Reinhard
Published: March 2007

This report describes a lethal complication which occurred during retrograde catheterization of the left ventricle across a Björk‐Shiley prosthesis. The authors were called upon to testify as experts in malpractice proceedings in this case.

After an 8F Sones catheter had been passed through the small side orifice of the prosthesis and three ventriculograms had been carried out, it was apparent that the movement of the tilting disc valve was considerably impaired and that the catheter had become irreversibly trapped. As a consequence the patient died of irreversible left heart failure before an operation could be performed.

Consequently passing a tilting disc valve can no longer be considered as completely safe. This procedure should only be used under exceptional circumstances requiring very strict indication. If such an intervention is necessary, then it should only be performed by experienced cardiologists, who should take all possible precautions to reduce risks.
Acute percutaneous transluminal coronary angioplasty complicated by embolism to a coronary artery remote from the site of infarction
Authors: Saenz Carlos B. , Harrell R. Ronnie , Sawyer Iii James A. , Hood William P.
Published: March 2007

Percutaneous transluminal coronary angioplasty has emerged as a mode of treatment in patients with both chronic and acute coronary syndromes. Among the recognized complications of coronary angioplasty is coronary embolism. This case report describes a case of acute anterior myocardial infarction which was treated with angioplasty of the left anterior descending coronary artery. Postdilation angiography revealed obstruction of the posterior descending artery (in a left dominant system). The use of thrombolytic therapy previous to angioplasty is briefly discussed.
Endomyocardial diagnosis of cardiac lipomatosis
Authors: Cladellas Mercè , Abadal Maria Lluisa , Ballester Manel , Obrador Damià , Crexells Carles , Matias‐Guiu Xavier , Bordes Ramàn , Bonnin Oriol
Published: March 2007

A patient with severe isolated right‐sided cardiac failure of unknown origin is presented in whom three right ventricular endomyocardial biopsies obtained in different bioptome positions disclosed a yellowish material which was confirmed at histological examination as fat. At operation, a complete replacement of atrial and ventricular myocardium by fat was noted. This previously unreported use of endomyocardial biopsy is emphasized, especially when the differential diagnosis of isolated right‐sided heart failure is considered.
complex coronary angioplasty: Use of extended and angled balloon catheters
Authors: Slack John D. , Pinkerton Cass A.
Published: March 2007

Certain anatomical features of coronary artery stenoses are recognized to be associated with a high risk of acute closure during percutaneous transluminal coronary angioplasty. Balloon catheters with extended balloon lengths were developed and tested in nonsegmental stenoses and multiple stenoses in series. Balloon catheters with acute angulation were also designed and tested in stenoses located in tortuous, angulated arterial segments. Clinical experience with these unique balloon configurations is presented.
Translumbar coronary and brachiocephalic arteriography using a modified Desilets‐Hoffman sheath
Authors: Marcus Robert , Grollman Julius H.
Published: March 2007

A translumbar sheath is described that is suitable for performance of selective coronary and brachiocephalic arteriography when the extremity arteries are blocked. The sheath has been adapted to a needle and catheter, which are introduced as a unit into the aorta at the T‐12 level. With the needle and catheter removed, the sheath can be used safely to exchange catheters for left ventriculography and selective studies of branches of the thoracic aorta without excessive retroperitoneal bleeding.
Quantitative analysis of coronary arteriograms by microprocessor cinevideodensitometry
Authors: Silver Kevin H. , Buczek Jo Ann , Esser PhD Peter D. , Nichols Allen B.
Published: March 2007

A rapid microprocessor technique for mesuring the cross‐sectional area, diameter, and relative percentage stenosis of coronary atherosclerotic lesions by cinevideodensitometric analysis was developed and validated. Video images of projected 35‐mm coronary arteriographic cine frames were analyzed from cinevideodensitometric profile curves recorded for the catheter shaft, normal artery, and stenotic segment. In radiographic phantom studies of calibrated, contrast‐filled, plexiglass cylinders, cinevideodensitometric measurements correlated linearly with percentage relative stenosis (r = 0.98; SEE = 4.1%), diameter (r = 0.99; SEE = 0.12 mm), and cross‐sectional area (r = 0.99; SEE = 0.32 mm2). In postmortem studies of two patients dying after coronary arteriography, cross‐sectional areas of arterial segments measured by cinevideodensitometry correlated well (r = 0.99; SEE = 0.71 mm) with areas of acrylic resin casts of the coronary arteries. Intraobserver variability (r = 0.99; SEE = 2.6%) and interobserver variability (r = 0.96; SEE = 5.3%) of cinevideodensitometric measurements of coronary arteriograms were low. Additionally, percentage relative stenosis measured in the right anterior oblique projection correlated well with measurements in the left anterior oblique projection (r = 0.98; SEE = 0.11 mm2) of patients with eccentric stenotic lesions. Lastly, cinevideodensitometric measurements were significantly (p < 0.05) more reproducible than caliper measurements. This inexpensive dedicated microprocessor system provides rapid cinevideodensitometric measurements of coronary arterial dimensions, without requiring manual tracing of arterial segments or the major expense of a mainframe computer system.
Massive hemoptysis associated with isolated peripheral pulmonary artery stenosis
Authors: Matsumoto Alan H. , Delany David J. , Parker Leonard A. , Ney Kathryn A.
Published: March 2007

A fatal case of massive hemoptysis in a patient with isolated peripheral pulmonary artery stenosis is described. Such patients are predisposed to developing pulmonary artery aneurysms. When hemoptysis develops, erosion of an aneurysm into an adjacent bronchus should be considered and aggressive diagnostic evaluation undertaken.
Approach to reduction of vascular complications of percutaneous valvuloplasty
Authors: Cole Patricia L. , Krone Ronald J.
Published: March 2007

The large‐bore arterial sheaths required for balloon valvuloplasty and intraaortic balloon pumps may be associated with substantial morbidity when introduced into the superficial femoral artery in elderly people, especially women and those with peripheral atherosclerosis. We report a total occlusion of the superficial femoral artery by a large intravascular sheath requiring subsequent surgical intervention. A femoral arteriogram using less than 10 cc of contrast through a 5F catheter can assure placement of the puncture into the common femoral artery prior to introducing the large sheath or catheter, thus reducing morbidity.
Semicircular curve catheter for pulmonary artery catheterization
Authors: Miller Gordon Chason
Published: March 2007

Catheters with a distal curve consisting of a half circle of 7.5 cm diameter have been found to markedly facilitate pulmonary artery catheterization from either arm in adults. The full semicircular curve holds the tip off the lateral wall of the right ventricular outflow tract facilitating its passage, reducing arrhythmias, and reducing the chance of perforation. The curve was factory‐formed into both end‐hole type catheters for pressures, pulmonary wedging, and blood sampling and formed into side‐hole catheters with a closed‐end, as the NIH, for pulmonary angiograms. In 179 of 182 procedures, it was observed clearly to facilitate, to make more gentle, and to speed pulmonary artery catheterization as compared to catheters with lesser curves.
Postextrasystolic potentiation of systolic gradient in valvular aortic stenosis: Clinical usefulness and analysis of hemodynamic factors
Authors: Domingo Enric , Angel Juan , Alvarez Amparo , Anivarro Inocencio , Soler‐Soler J.
Published: March 2007

To analyze the behavior of aortic valve gradient (AVG) after ventricular extrasystole (VE), we studied 36 pure valvular aortic stenoses (AS) free of coronary artery disease and obstructive hypertrophic cardiomyopathy, in whom basal (B) (74 ± 32 mm Hg) and catheter‐induced post‐VE (110 ± 50 mm Hg) AVG were obtained. In all 26 cases with valve area <0.70 cm2, the post‐VE AVG was ≥70 mm Hg. In 19 cases AVG after two or more consecutive VE were also obtained. Maximal post‐VE AVG was obtained after multiple VE (19 cases) and/or after one VE causing a post‐VE pause equal or longer than 1.7 basal cardiac cycles (post‐VE RR ≥1.7B RR) (9 cases). Basal and postsingle VE AVG, up to a post‐VE RR ≥ 1.7 B RR, were a linear function of previous RR (r≥0.90), regression line slope increasing with AS severity (P =.05). Inotropic state measured by PEP/LVET only increased after multiple VE, P <.01. AVG after multiple VE was independent of post‐VE RR. Thus, (1) post‐VE potentiation of AVG may be seen with fixed valvular AS without obstructive cardiomyopathy; (2) post‐VE AVG is a function of compensatory pause after single VE and of increased inotropism after multiple VE; (3) analysis of maximal post‐VE AVG generated as described is reliable and useful for assessing AS severity (post‐VE AVG ≥ 70 mm Hg meaning an aortic valve area <0.70 cm2) and may supplement valve area calculations.
Progression of left main coronary artery stenosis following left anterior descending coronary artery angioplasty
Authors: Harper J. Michael , Shah Yogesh , Kern Morton J. , Vandormael Michel G.
Published: March 2007

Although recent clinical experience indicates a high success rate, percutaneous transluminal coronary angioplasty (PTCA) is still associated with serious complications which usually occur during or shortly after the procedure and are principally related to the lesion or segment of vessel being dilated. We report 2 cases of subacute progression within months of left main stenosis following successful, uncomplicated left anterior descending (LAD) coronary PTCA. Identification of left main trunk involvement may mandate earlier follow‐up or intervention.
Percutaneous transluminal coronary angioplasty of anomalous left circumflex coronary artery
Authors: Kimbiris Demetrios , Lo Eric , Iskandrian Abdulmassih
Published: March 2007

We present our experience of percutaneous transluminal coronary angioplasty in two patients with an anomalous left circumflex coronary artery with severe stenosis. In the first case, the anomalous vessel originated from the first portion of the right coronary artery, and in the second case it originated from the right sinus of Valsalva. Cannulating the anomalous vessel with the guiding catheter can be difficult. The right Judkins‐type catheter, with a posteriorly directed tip, is the most appropriate catheter for cannulating the anomalous circumflex artery when the vessel originates from the first portion of the right coronary artery, and the left Amplatz‐type 1 is most appropriate when the vessel originates from the right sinus of Valsalva.
A new technique for angioplasty of occluded coronary arteries and bypass grafts, not associated with acute myocardial infarction
Authors: De Swart J. B. R. M. , van Gelder L. M. , van der Krieken A. M. , El Gamal M. I. H.
Published: March 2007

We describe a new technique for angioplasty of totally occluded coronary arteries and bypass grafts in the absence of acute myocardial infarction. We used a guiding catheter, a coronary infusion catheter, and a relatively stiff steerable guide wire to perforate the occlusion. Angioplasty of the recanalized vessel was subsequently performed. The procedure was attempted in nine patients; it was successful in eight. There were no complications. The advantages of this technique are discussed.
Does intracoronary papaverine dilate epicardial coronary arteries? implications for the assessment of coronary flow reserve
Authors: Zijlstra F. , Reiber J. H. C. , Serruys P. W.
Published: March 2007

Intracoronary papaverine is used as a means to induce a strong and short‐lasting hyperemia in several recently developed methods to measure coronary flow reserve. Changes in stenosis geometry from papaverine would influence the measured coronary flow reserve. Therefore, we investigated the influence of intracoronary papaverine on stenosis geometry with quantitative analysis of the coronary angiogram and assessed the influence of papaverine on pressure‐flow characteristics of the stenosis and coronary flow reserve. The cross‐sectional areas (mean ± SD) of the stenosis increased 18% ± 7% after papaverine. The normal proximal and distal parts of the coronary artery dilated 5% ± 2% after papaverine. This results in a decrease of the calculated pressure drop over the stenosis varying from 20% to 30%. Coronary flow reserve of a flowlimiting epicardial stenosis is overestimated by 16% when papaverine is used to induce hyperemia. These papaverine‐induced changes can nevertheless be circumvented by maximal vasodilation of the major epicardial coronary artery with 3 mg intracoronary isosorbidedinitrate prior to the investigation of the coronary flow reserve with papaverine.
Double‐wire angioplasty of the right coronary artery bifurcational stenosis
Authors: Nath Amar , Vetrovec George W. , Cowley Michael J. , Newton Mark , Disciascio Germano , Mukharji Jhulan , Lewis Stephen A.
Published: March 2007

Two cases of distal right coronary artery (RCA) bifurcational stenoses involving ostia of the posterolateral (PLA) and the posterior descending (PDA) branches in patients who underwent successful coronary angioplasty using a double‐wire technique are reported. A single guiding catheter and sequential balloon inflations were utilized in one, and two guiding catheters and simultaneous balloon inflations in the other. The indications, techniques, and outcomes are described.
Percutaneous balloon valvuloplasty and coronary angioplasty for the treatment of calcific aortic stenosis and obstructive coronary artery disease in an elderly patient
Authors: Vandormael Michel , Deligonul Ubeydullah , Gabliani Gregory , Chaitman Bernard , Kern Morton J.
Published: March 2007

An 81‐year‐old man with severe calcific aortic stenosis and coronary artery disease who refused surgical therapy was treated with sequential percutaneous balloon aortic valvuloplasty (PBAV) and percutaneous transluminal angioplasty. Before percutaneous balloon valvuloplasty, the mean aortic gradient was 76 mmHg, and the aortic valve area was. 45 cm2. The aortic valve was dilated using 15‐mm and 18‐mm balloons. The mean gradient decreased to 40 mmHG, and the aortic valve area increased to.62 cm2. Percutaneous transluminal coronary angioplasty (PTCA) was performed 2 weeks later, and an 85% proximal left circumflex stenosis was successfully dilated to 20%. No complications were noted during either procedure. At 6‐month follow‐up, the patient had returned to normal activities and was asymptomatic. Thus, combined therapy with PBAV and PTCA is technically feasible in selected elderly patients with calcific aortic stenosis and anatomically suitable coronary artery disease. This nonsurgical therapeutic approach may be useful in the treatment of selected patients who refuse or who are deferred from cardiac surgery.
Hemodynamic effects of contrast media during coronary angiography: A comparison of three nonionic agents to Hypaque‐76
Authors: Piao Zhen En , Murdock David K. , Hwang Ming H. , Raymond Richard M. , Scanlon Patrick J.
Published: March 2007

Coronary angiography with standard ionic contrast media is associated with marked alterations in cardiac hemodynamics because of the depressant effects of the contrast media on cardiac contractility. Nonionic contrast media have been reported to produce less hemodynamic alteration than standard ionic contrast media. However, there is no information on how one nonionic media compares to another. Thus we compared the hemodynamic effects of three nonionic contrast media, lopamidol (IOP), lohexol (IOH), and loversol (IOV) to each other as well as to the standard ionic contrast media Hypaque‐76 (H76). In 20 closed‐chest anesthetized dogs, we recorded the maximal change in left ventricular systolic pressure (LVSP), mean aortic pressure, left ventricular diastolic pressure (LVDP), and left ventricular dp/dt during 10‐cc left main coronary artery injections of H76, IOP, IOH, and IOV. The mean aortic pressure and LVSP decreased 36 ± 17 mm Hg and 46 ± 21 mm Hg with H76 but only 5 ± 5 mm Hg and 6 ± 5 mm Hg with IOP, 5 ± 4 mm Hg and 6 ± 6 mm Hg with IOH, and 5 ± 4 mm Hg and 7 ± 6 mm Hg with IOV (P < 0.001). The LVDP increased 6 ± 5.0 mm Hg with H76 out only 0.2 ± 0.5 mm Hg with IOP, 0.2 ± 0.3 mm Hg with IOH, and 0.5 ± 1.0 mm Hg with IOV (P < 0.001). The LV dp/dt decreased 545 ± 261 mm Hg/sec with H76 but increased 886 ± 477 mm Hg/sec with IOP, 910 ± 96 mm Hg/sec with IOH, and 473 ± 335 mm Hg/sec with IOV (P < 0.001). Whereas each nonionic agent produced significantly less hemodynamic abnormalities than H76, there was no significant difference between any of the nonionic agents on any hemodynamic parameter. Thus, as compared to H76, these nonionic contrast media produced only trivial alterations in hemodynamics and LV dp/dt. These agents may be preferable in patients with LV dysfunction.
Balloon inflation following injection of contrast material through the distal lumen of the USCI balloon catheter
Authors: McEniery Paul T. , Grigera Fernando , Chambers James , Franco Irving , Hollman Jay
Published: March 2007

We report on four patients in whom we observed inflation of the balloon following injection cf contrast material into the distal lumen during percutaneous transluminal coronary angioplasty. This is a rare technical problem. However, inadvertent balloon inflation may cause transient occlusion of the proximal coronary artery and in one case was associated with acute occlusion of a vessel that had been dilated. Management involves prompt deflation of the balloon.
Acute total aortic occlusion during cardiac catheterization associated with polycythemia vera
Authors: Zinn Philip , Applegate Robert J. , Walsh Richard A.
Published: March 2007

We present a case of acute total aortic occlusion at the time of cardiac catheterization in a 62‐yr‐old female with an acute myocardial infarction and newly diagnosed polycthemia vera. Despite normalization of serum viscosity and red cell mass by phlebotomy, her predisposition to thrombosis persisted. Caution is advised when considering cardiac catheterization in patients with this disease.
Transpancreatic catheterization of the right hepatic artery for chemoembolization using a new infusion system
Authors: Quinn Michael F. , Lundell Caroline J. , Daniels John R. , Vegh Gabriel B. , Engelson Erik T.
Published: March 2007

The right hepatic artery was catheterized for chemoembolization in a patient with liverdominant metastatic breast carcinoma and occlusion of the celiac artery by tumor compression. This was accomplished by use of a new coaxial infusion catheter‐steerable guidewire system passed through the superior mesenteric artery and posterior pancreatic arcade.
Transfemoral coronary arteriography via a prosthetic aortic bifurcation graft
Authors: Smith Douglas C. , Willis William H.
Published: March 2007

Angiographers may inappropriately avoid the transfemoral access route when a prosthetic aortic bifurcation graft exists. An aortofemoral graft will necessitate overdilatation of the femoral puncture site to allow adequate manipulation. If the puncture transverses both walls of the femoral limb of the graft into the native artery, further withdrawal of the catheter will allow reentry into the graft. When an aorta‐to‐external‐iliac, end‐to‐side graft is present, transfemoral catheterization will frequently result in the guide wire or catheter tip terminating in the occluded common iliac artery. By choosing the proper catheter, entrance into the distal limb of the proximally communicating graft may be achieved. For the unwary operator, these confusing situations may result in failure to properly catheterize the graft. The methods of successfully overcoming these problems are discussed and illustrated.
Technical consideration for a new X‐ray video progressive scanning system for cardiac catheterization
Authors: Wondrow Merrill A. , Bove Alfred A. , Holmes David R. , Gray Joel E. , Julsrud Paul R.
Published: March 2007

The widespread growth of interventional angiographic procedures has expanded the use of X‐ray video systems. Reduced radiation exposure to the patient and staff has been recently reported by implementing a new pulsed progressive scanning video system. We have shown that this system, which enables the pulsing of the X‐ray generator at 30 pulses per second, results in a 50% reduction in radiation exposure. The technical parameters and implementation of a progressive scanning video system are discussed. Image quality, temporal and spatial resolution, and signal‐to‐noise ratio (SNR) were assessed using conventional interlaced and progressive video scanning. These comparisons documented improved resolution, no degradation of ejection fraction measurements, improved clinical images, and a 1.0‐dB improvement in the SNR with the progressive scanning. Progressive scanning video systems reduce radiation exposure and provide an objective improvement in image quality over conventional scanning video systems.
Hemodynamic and electrocardiographic consequences of high‐ and low‐osmolality contrast agents for left ventricular angiography
Authors: Vik‐Mo Harald , Rosland Gunnar A. , Følling Magne , Danielsen Ragnar
Published: March 2007

The cardiovascular effects of two nonionic contrast agents with low osmolality (iohexol and metrizamide) were compared with one standard ionic, high‐osmolality contrast agent (metrizoate) used for left ventricular (LV) angiography in patients with coronary heart disease. Metrizoate induced a marked elevation of LV end‐diastolic pressure and LV systolic pressure and an increase in cardiac output after a delay of a few minutes. All these changes were significantly less severe with iohexol and metrizamide. Hypotension occuring 30 sec after LV angiography was observed only with use of metrizoate. All agents increased heart rate, but the increase after metrizoate was significantly more pronounced and prolonged. The PQ and QT interval was prolonged only by metrizoate. The subjective symptoms were significantly more marked with metrizoate than with the two other agents. Thus the new nonionic contrast agent iohexol and metrizamide produced markedly less hemodynamic and electrocardiographic disturbance than the ionic agent metrizoate.
Unusually long inflation times during percutaneous transluminal coronary angioplasty
Authors: Palazzo Angela M. , Gustafson Gregory M. , Santilli Eugene , Kemp Harvey G.
Published: March 2007

Unusually prolonged balloon inflations (PBI) during percutaneous transluminal coronary angioplasty (PTCA) have been utilized in 26 consecutive patients to establish adequate coronary perfusion after shorter inflation times resulted in severe residual stenosis (N = 15), early arterial closure (N = 5), or extensive dissection (N = 6). Inflations lasted 1.5 to 15 min and 23/27 stenoses were successfully dilated. The average reduction in stenosis was 67% (90%–33%). Chest pain occurred in 34% vs. 7% (P < 0.01), and ST changes occurred during 66% vs. 57% (NS) of PBI vs. short inflations.
Thromboembolic complications in coronary angiography associated with the use of nonionic contrast medium
Authors: Grollman Julius H. , Liu Chi Kong , Astone Robert A. , Lurie Mark D.
Published: March 2007

Thromboembolic complications occurred during diagnostic coronary arteriography in three patients in spite of systemic heparinization. These mishaps were associated with the use of a nonionic contrast medium, which is known not to have a significant protective effect on coagulation pathways. If nonionic contrast media are to be used in angiographic studies of critical organs, meticulous technique is imperative, and adequate systemic heparinization is recommended.
Percutaneous femoral transluminal angioplasty of a right brachial artery occluded after sones coronary angiography
Authors: Maouad Joseph , Guermonprez Jean Léon
Published: March 2007

A case of percutaneous transluminal angioplasty (PTA) from the groin to a 7‐cm right brachial artery occlusion in a 41‐year‐old man, having previously undergone Sones coronary angiography 2 months earlier, is presented. The post‐PTA angiogram shows near‐normal reconstitution of the total obstruction, persisting after 6 months with complete loss of collateral circulation. In a case of total obstruction of the brachial artery, femoral PTA should be considered before resorting to surgical treatment.
Clinical experience with the Monorail balloon catheter for coronary angioplasty
Authors: Finci Leo , Meier Bernhard , Roy Paul , Steffenino Giuseppe , Rutishauser Wilhelm
Published: March 2007

The Monorail balloon catheter is distinctly different from other current balloon catheters: the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the guiding catheter. Monorail coronary angioplasty was attempted in 61 patients on 73 lesions with balloons from 2.0 to 3.7 mm. Angiographic success was obtained in 66 lesions (90%). For 15 lesions, balloon exchanges were needed. In three lesions, the Monorail balloon failed to cross the lesion, while a standard balloon succeeded; two lesions could not be crossed with any balloon. Vessel occlusion occurred in four patients: two had emergency surgery without infarct (one died suddenly 4 days later and one had a stroke 1 day later), one was recanalized with a standard balloon, and one had a myocardial infarct. Continuous infusion of urokinase was used until patient 3 in whom problems with the delivery system led to cardiocerebral air embolization (with complete recovery). No thrombotic complications were observed in the subsequent 58 patients with only a bolus of 10,000 U of heparin. The Monorail balloon facilitates contrast injections and balloon exchanges but appears more difficult to pass through tight lesions. Omission of the previously recommended infusion with a thrombolytic agent proved safe.
Percutaneous mitral valvuloplasty: Retrograde, transarterial double‐balloon technique utilizing the transseptal approach
Authors: Babic Uros U. , Dorros Gerald , Pejcic Petar , Djurisic Zoran , Vucinic Mihailo , Lewin Ruben F. , Grujicic Sreten N.
Published: March 2007

Between February 1985 and May 1987, 72 patients with mitral stenosis (MS) underwent percutaneous transluminal mitral valvuloplasty (PTMV). The retrograde transarterial double‐balloon technique was used on 54/72 patients (75%); 16 males, 38 females; mean age: 39 ± 11 years. Transseptal catheterization was used to place two 0.035″, 350‐cm exchange wires into the ascending aorta in order to be snared, retrieved, and exteriorized, each through a femoral artery. Over these wires, the balloon dilation catheters were advanced through the femoral artery, retrogradely, across the mitral valve, for PTMV. The transmitral mean gradient fell [18 ± 4 to 9 ± 5 mmHg (P < 0.001)]; the cardiac output increased [5.1 ± 0.8 6.1 ± 0.8 L/min (P < 0.001)]; the hemodynamically calculated valve area increased [1.2 ± 0.2 to 2.3 ± 0.6 cm2 (P < 0.001)]; and the short axis two‐dimensional echocardiographic valve area increased [1.1 ± 0.3 to 2.2 ± 0.7 (P < 0.001)]. PTMV was unsuccessful in two patients (4%), due to the inability to maintain the inflated balloons in the mitral position. Significant complications were encountered in two patients: two strokes (3.7%) and one mortality from the stroke (1.4%). Significant mitral regurgitation occurred in two patients (3.7%); no post‐PTMV hemodynamically significant atrial septal defects were detected. Follow‐up (mean time: 11 ± 6 months) of 43 patients showed a persistent improvement in echocardiographic findings in 27 (63%) and hemodynamically measured mitral valve area in the 16 patients in which cardiac catheterization was repeated. The retrograde, transarterial double‐balloon technique can successfully accomplish PTMV with good results and an acceptable low morbidity and mortality.
Pulsed doppler evaluation of regurgitation in mitral valve prostheses
Authors: Azuma Steven S. , Abbasi A. S. , Fraser Allan , Hebel Laura L. , Bernstein William L. , Decristofaro Dominic
Published: March 2007

Prosthetic mitral valve regurgitation was evaluated by both pulsed Doppler ultrasound and left ventriculography. Pulsed Doppler ultrasound was found to have only a 20% sensitivity in detecting prosthetic mitral valve regurgitation documented by left ventriculography. Possible reasons for this poor sensitivity include 1) an eccentric jet not identified by the small pulsed Doppler sample volume; 2) prothesis interference with the Doppler signal in the apical four chamber view; and 3) the large angle of incidence between the pulsed Doppler signal and the regurgitant jet. Mitral insufficiency, especially when not severe, may be missed by this technique. Care must be taken in interpreting negative results from a pulsed Doppler ultrasound evaluation of a prosthetic mitral valve.
Entrapment of an angioplasty balloon catheter: A case report
Authors: Rizzo Thomas F. , Werres Roland , Ciccone John , Karanam Ravi , Shah Shamji
Published: March 2007

This report presents a case in which an angioplasty balloon catheter became entrapped within the lumen of a coronary artery after rupture during percutaneous transluminal coronary angioplasty (PTCA). Prior to this report, balloon rupture had been considered a relatively benign occurrence. However, this case demonstrates that balloon rupture may lead to serious complications.
Saphenous vein graft rupture during percutaneous transluminal angioplasty
Authors: Namay David L. , Roubin Gary S. , Tommaso Carl L. , Warren Stafford G. , Douglas John S. , King Spencer B.
Published: March 2007

Three cases (one fatal) of a rare angioplasty complication, vein graft rupture, are presented with a review of the literature. Caution is suggested when oversizing balloons for vein graft dilatation.
Detection and treatment of high‐output cardiac failure resulting from a large hemodialysis fistula
Authors: Reis Gregg J. , Hirsch Alan T. , Come Patricia C.
Published: March 2007

Hemodialysis fistulas are a cause of high‐output congestive heart failure (CHF). A case is reviewed of a patient in whom surgical correction of an excessively high fistula flow led to resolution of CHF. Bradycardia induced by fistula occlusion (Nicaladoni‐Branham sign) was not present, but transient occlusion did produce a marked decrease in cardiac output.
Comparison of loxaglate with diatrizoate in angiography of the internal mammary artery
Authors: Davies Richard F. , Lemay Michel , Beanlands Donald S. , Morton Brian C. , Chambers R. Jane , Herbert Margaret , Larocque Bernard
Published: March 2007

To compare ioxaglate with the traditional agent diatrizoate, 44 patients scheduled to undergo coronary angiography that included internal mammary artery (IMA) visualization were entered into a randomized double blind‐parallel design protocol. Complete data were collected on 32 out of 44. Four patients were withdrawn because of angiographically normal coronary arteries; seven, because of unsuccessful IMA cannulation; and one, because of an anaphylaxis‐like reaction to ioxaglate. No other serious adverse effects were seen with either agent. The major endpoints were patient and physician assessments of discomfort, rated independently on a 4‐point scale. loxaglate caused significantly less discomfort (n = 17, median rating of “mild discomfort”) than did diatrizoate (n = 15, median rating of “severe discomfort”; P < 0.01); this effect was independent of patient sex, the number of injections, and the volume of dye injected. Radiographic quality was good with both agents. We conclude that ioxaglate is much better tolerated than diatrizoate during angiography of the IMA.
Effects of beta‐adrenergic blockade on nitroglycerin‐induced augmentation of regional coronary blood flow in patients
Authors: Miller John T. , Kern Morton J. , Henry Rodney L.
Published: March 2007

Although beta‐adrenergic blockade may increase coronary vascular resistance in some patients with severe ischemic heart disease, the effects of beta blockade on the nitroglycerin (NTG)‐induced augmentation of coronary blood flow have not been elucidated. Therefore, systemic hemodynamic and anterior left ventricular regional coronary bloodflow (thermodilution) data were measured during administration of NTG into the left coronary artery, before and 10 min after intravenous propranolol (0.1 mg/kg) in 22 patients. Six patients (Group 1) had normal left coronary arteries and nine (Group 2) had severe coronary artery disease with at least >70% narrowing of the left anterior descending artery. In seven additional patients (three without and four with >70% left anterior descending coronary artery disease), measurements were obtained with constant‐paced heart rates (Group 3). Before beta blockade, NTG (200 mcg) significantly increased anterior regional great‐vein flow [for Group 1, 84 ± 38% (81 ± 20 to 140 ± 60 ml/min); Group 2, 39 ± 41% (61 ± 26 to 83 ± 38 ml/min); and Group 3, 87 ± 55% (75 ± 36 to 144 ± 86 ml/min)]. In Groups 1 and 2, beta‐adrenergic blockade reduced heart rate 10% (p<0.01) but did not affect mean arterial or pulmonary artery pressures. After beta blockade, although control great cardiac vein flow was reduced only for Group 2 (58 ± 23 to 50 ± 15 ml/min, p<0.05), the hyperemic responses to NTG were unaffected (99 ± 47% 46 ± 23%, and 83 ± 73% for the three groups, respectively). These findings indicate that beta‐adrenergic blockade neither potentiates nor attenuates NTG‐induced increases in coronary blood flow and that the concomitant use of beta blockade does not appear to limit NTG‐induced vasodilatory responses in regions supplied by normal or diseased coronary arteries