bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of an ionic versus a nonionic low osmolar contrast agent on the thrombotic complications of coronary angioplasty
Authors: Piessens Jan H. , Stammen Francis , Vrolix Matty C. , Glazier James J. , Benit Edouard , De Geest Hilaire , Willems Jos L.
Published: March 2007

An increasing body of evidence suggests that the potential for thrombotic complications is greater with nonionic than with ionic contrast agents. This is a particularly important consideration in the highly thrombogenic setting of percutaneous transluminal coronary angioplasty (PTCA). To explore this issue further, 500 consecutive patients undergoing PTCA were prospectively randomized to receive the low osmolality ionic ioxaglate or the nonionic agent iohexol. The number of acute thrombotic in‐laboratory events was significantly less in the ioxaglate than in the iohexol group (8 versus 18; P < 0.05), but there was no significant difference between the 2 groups as regards the number of out‐of‐laboratory acute rethrombotic events. With multivariate analysis, use of the nonionic agent rather than the ionic agent emerged as an independent predictor of acute in‐laboratory rethrombosis. These data suggest that, in the performance of PTCA, an ionic, rather than a nonionic, should be the preferred contrast agent. © 1993 Wiley‐Liss, Inc.
Prograde double balloon dilation of congenital aortic valve stenosis: A case report
Authors: O'Laughlin Martin P. , Slack Michael C. , Grifka Ronald , Mullins Charles E.
Published: March 2007

A new method for prograde balloon dilation of severe congenital aortic valve stenosis is described. Two TEGwire™ balloons were used prograde through bilateral femoral venous sheaths. Excellent hemodynamic results were achieved, without the need for retrograde left heart catheterization and femoral arterial sheath placement. © 1993 Wiley‐Liss, Inc.
Transcatheter closure of residual atrial septal defect following cardiac transplantation
Authors: O'Laughlin Martin P. , Bricker J. Timothy , Mullins Charles E. , Cabalka Allison K. , Gelb Bruce D. , Towbin Jeffrey A.
Published: March 2007

An almost 3‐year‐old boy had a residual atrial septal defect after cardiac transplantation. The patient was symptomatic and had arrhythmia and cardiac enlargement. An atrial septal defect occlusion device was employed to close the communication with excellent results. Transcatheter occlusion enabled the patient to avoid further surgery and did not interfere with follow‐up endomyocardial biopsies. © 1993 Wiley‐Liss, Inc.
The use of transesophageal echocardiography to avoid left atrial thrombus during percutaneous mitral valvuloplasty
Authors: Kamalesh Masoor , Burger Andrew J. , Shubrooks Samuel J.
Published: March 2007

During mitral balloon valvuloplasty, transesophageal echocardiography (TEE) has been employed for the accurate placement of the transseptal needle, guide wires, and balloon catheters and to provide an immediate evaluation of the results of the procedure. We describe a case demonstrating that TEE can be used to avoid a left atrial appendage thrombus during the placement of wires and catheters. With TEE guidance, we feel left atrial appendage thrombi are no longer an absolute contraindication to percutaneous mitral valvuloplasty. © 1993 Wiley‐Liss, Inc.
Rescue transcatheter embolectomy following complicated transluminal extraction atherectomy of a coronary vein graft
Authors: Gamra Habib , Ruiz Carlos E. , Zhang He Ping , Whittaker Peter
Published: March 2007

Transluminal extraction catheter atherectomy of a saphenous vein graft to the right coronary artery was performed in a 72‐year‐old female and was complicated by distal embolization. A successful transcatheter aspiration of the embolic plaque was achieved. The usefulness of this technique as a coronary intervention is discussed.
Restenosis following successful balloon valvuloplasty: Bone formation in aortic valve leaflets
Authors: Feldman Ted , Glagov Seymour , Carroll John D.
Published: March 2007

Restenosis after balloon aortic valvuloplasty is common, occurring in as many as half or more of patients in the first year. To gain understanding of the mechanisms of restenosis we examined results of second dilatations and the histology of restenosed valves excised during valve replacement for restenosis. Eleven patients with calcific aortic stenosis underwent second valvuloplasty for restenosis. The mean age was 82 ± 6 years. The interval between first and second dilatation was 14.7 ± 8.5 months. First valvuloplasty resulted in an increase in valve area from 0.63 ± 0.23 to 1.09 ± 0.32 cm2 (P<0.01). The valve area found after symptoms recurred was 0.56 ± 0.18 cm2, not significantly different from the prevalvuloplasty dimensions. Second dilatation resulted in a mean aortic valve area of 0.76 ± 0.22 cm2 (p = 0.011 vs results of first valvuloplasty). The change in valve area after first dilatation was 0.45 ± 0.17 vs 0.20 ± 0.13 cm2 after second dilatation (p<0.01). Multiple histologic sections from excised, restenosed valves from five additional patients showed zones of active capillary and cellular proliferation and fibrosis in crevices between calcific nodules in three cases. Associated foci of ossification were seen in two of these. Stenotic nonvalvuloplasty control valves (n = 19) showed no ossifications. In conclusion, histologic changes in restenosed valves differ from those seen initially in calcific aortic stenosis, with granulation tissue, fibrosis, and ossification being present. These findings may help to explain the limited results of second dilatations for restenosis.

© 1993 Wiley‐Liss, Inc.
Implantation of half palmaz‐schatz stents in short aorto‐ostial lesions of saphenous vein grafts
Authors: Nordrehaug Jan Erik , Priestley Kim , Chronos Nicolas , Buller Nigel , Sigwart Ulrich
Published: March 2007

Two cases are presented in which a half Palmaz‐Schatz stent was implanted in a short lesion located in the ostium of a saphenous vein graft. Aorto‐ostial stenoses are a technical challenge for balloon angioplasty and stenting. Short stents may offer several advantages as regards deployment, positioning, thrombogenicity, and restenosis. © 1993 Wiley‐Liss, Inc.
Diagnosis of stenosis in a pulmonary valve‐conduit using an angioplasty guide and probing catheter
Authors: Wilentz James R. , Fratellone Patrick
Published: March 2007

A 42‐year‐old man who had undergone previous Blalock‐Taussig anastomoses and placement of a homograft aortic valve‐root conduit for tetralogy of Fallot presented with dyspnea at rest. Previous catheterization had shown homograft stenosis at the level of the pulmonic valve. Repeat catheterization necessitated the use of angioplasty guide and probing catheters to cross the stenosis, and pullback documented stenoses both across the homografted valve and within the homograft aortic root‐native pulmonary artery conduit. © 1993 Wiley‐Liss, Inc.
Endoluminal sealing of vascular wall disruptions with radiofrequency‐heated balloon angioplasty
Authors: Resar Jon R. , Wolff Matthew E. , Hruban Ralph H. , Brinker Jeffrey A.
Published: March 2007

Suboptimal luminal widening or acute closure secondary to arterial dissection remain significant risks of percutaneous transluminal balloon angioplasty. Non surgical techniques are often employed in an attempt to repair dissections either as temporary or definitive treatment. The aim of this study was to test the hypothesis that radiofrequency thermal balloon angioplasty at an operating temperature of 70°C and low inflation pressure could seal dissections and perforations in a model of severe arterial wall damage. Dissections and perforations were created in renal (n = 4) and carotid (n = 4) arteries in four mongrel dogs. Endoluminal sealing was then attempted with conventional balloon angioplasty or radiofrequency thermal balloon angioplasty (2 atm at 70°C). Contrast dye extravasation persisted in all cases following conventional balloon angioplasty but completely resolved with radiofrequency balloon angioplasty in all but one artery. Histologic examination of the arteries treated with radiofrequency balloon angioplasty showed extensive thermal injury, including transmural coagulation necrosis, flattening of the internal elastic lamina, and medial thinning. On the basis of these results, the utility of thermal balloon angioplasty for endoluminal sealing of dissections and perforations complicating angioplasty deserves further evaluation. © 1993 Wiley‐Liss, Inc.
Percutaneous left atrial to femoral arterial bypass pumping for circulatory support in high‐risk coronary angioplasty
Authors: Glassman Ephraim , Chinitz Larry A. , Levite Howard A. , Slater James , Winer Howard
Published: March 2007

Left atrial to femoral arterial bypass was evaluated as a means of supporting patients who were considered to be at high risk for the performance of percutaneous transluminal coronary angioplasty. A 20 French drainage catheter was inserted percutaneously into the left atrium via a modified transseptal technique. Blood was withdrawn from the left atrium and returned through a femoral arterial cannula using a roller pump. Thirteen patients were treated in this fashion with excellent circulatory support. Pump flows varied from 1.5 to 3 liters per minute and bypass time ranged from 27 to 106 min (mean 43±17). Aortic mean pressure was well supported during balloon inflation. No significant complications were encountered. Neither an oxygenator nor a perfusionist is required. The ability to obtain direct left ventricular decompression offers a major potential advantage. Further evaluation of this technique for the support of such patients is indicated.

© 1993 Wiley‐Liss, Inc.
Coronary angiography in cardiac myxomas: Findings in 19 consecutive cases and review of the literature
Authors: van Cleemput J. , Daenen W. , de Geest H.
Published: March 2007

We reviewed the coronary angiographic findings of 19 patients with a cardiac myxoma, who underwent cardiac catheterization before surgery. Seventeen myxomas were localized in the left atrium and seven had angiographically visible tumor vascularity emerging from atrial branches of the right coronary artery in four patients and the circumflex coronary artery in three. In one patient, we found significant coronary artery disease of the circumflex coronary artery and in another we saw a thrombus‐like lesion in the proximal third of the left anterior descending coronary artery. Our results are compared with the findings in two smaller groups of patients with cardiac myxoma who underwent coronary angiography preoperatively. We conclude that the major importance of coronary angiography in patients with cardiac myxomas is to exclude concomitant coronary artery disease before surgery. In a very small minority of patients, a selective coronary angiography is the clue to the diagnosis of cardiac myxoma. © 1993 Wiley‐Liss, Inc.
Anomalous connection between the sinus node artery and the A‐V node artery
Authors: Krauss Daniel , Carter James E. , Feldman Ted
Published: March 2007

Anomalous connection between the sinus node artery and A‐V node artery is an extremely rare coronary variant. Angiographic and clinical data from an adult with this finding are reported. Coronary embryogenesis and normal nodal arterial blood supply are reviewed. © 1993 Wiley‐Liss, Inc.
Successful prolonged local infusion of urokinase for the hypothenar hammer syndrome
Authors: Yakubov Steven J. , Nappi James F. , Candela Richard J. , George Barry S.
Published: March 2007

Ulnar artery thrombosis secondary to trauma, also known as the hypothenar hammer syndrome, has been most commonly been treated by surgical techniques. Applying concepts of local lysis of thrombotic occlusion used in cardiac and peripheral vascular intervention, we describe a method of correction of the hypothenar hammer syndrome by prolonged urokinase infusion. © 1993 Wiley‐Liss, Inc.
Sinus of valsalva aneurysms involving both coronary ostia
Authors: Tami Luis F. , Turi Zoltan G. , Arbulu Agustin
Published: March 2007

Sinus of Valsalva aneurysms are a rare cause of angina or myocardial infarction. We describe a patient with unstable angina and massive unruptured aneurysms of both coronary sinuses causing severe distortion of both coronary ostia, to our knowledge not previously reported. This unusual patient underwent aortic valve replacement, ascending aortic repair, and coronary artery bypass. At 11‐year follow‐up, she had developed severe mitral stenosis and prosthetic aortic valve stenosis. Review of the literature reveals 30 reported cases of Sinus of Valsalva aneurysm complicated by coronary insufficiency or infarction, involving either the left (20 cases) or the right coronary sinus (10 cases). We emphasize the poor outcome of these patients, especially if treated conservatively. © 1993 Wiley‐Liss, Inc.
Guidelines for training, credentialing, and maintenance of competence for the performance of coronary angioplasty: A report from the interventional cardiology committee and the training program standards committee of the society for cardiac angiography and interventions
Authors: Cowley Michael J. , Faxon David P. , Holmes David R.
Published: March 2007

This report suggests updated guidelines for training, credentialing, and maintenance of proficiency in coronary angioplasty and for the newer, more advanced interventional techniques; and recommends establishment of a subspecialty examination for certification of special competencies in international cardiology.© 1993 Wiiey‐Liss, Inc.
Percutaneous transluminal coronary angioplasty of a right coronary artery arising from the left main coronary artery
Authors: Gibbs Harry H. , Spokojny Artur M. , Molloy Thomas J. , Kamen Mazen O. , Sanborn Timothy A.
Published: March 2007

Angioplasty of anomalous coronary arteries presents unique technical challenges. Correct guiding catheter selection is important to ensure adequate access to the anomalous vessel and to provide support to cross the lesion. A case of successful PTCA of a lesion in an anomalous right coronary artery arising from the left main coronary artery is presented. © 1993 Wiiey‐Liss, Inc.
Double left anterior descending artery originating from the left and right coronary artery: A rare coronary artery anomaly
Authors: Voudris Vasilis , Salachas Anastasios , Saounotsou Maria , Sionis Dimitris , Ifantis George , Margaris Nikolaos , Koroxenidis Gabriel
Published: March 2007

A case of double left anterior descending coronary artery is presented. The double artery originated from the left main stem and the right coronary artery. There were no stenoses on these two arteries. This anomaly of coronary arteries seems to be very rare. © 1993 Wiiey‐Liss, Inc.
Transcatheter management of pulmonary venous pathway obstruction with atrial baffle leak following mustard and senning repair
Authors: Hosking Martin C. K. , Alshehri Mohammed , Murdison Kenneth A. , Teixeira Otto H. P. , Duncan Walter J.
Published: March 2007

Two patients presenting with pulmonary venous baffle obstruction following Mustard or Senning repair of transposition of the great arteries were successfully treated with percutaneous balloon dilatation. At the time of baffle dilatation, a significant systemic to pulmonary venous Mustard baffle leak was successfully closed with a Rashkind ductal occluder device. Specific features pertaining to the morphology of the baffle defect that allowed successful catheter occlusion are discussed and compared to that found in a Senning patient. The important adjunctive role of transoesophageal echocardiography within the catheterization laboratory is emphasized. © 1993 Wiiey‐Liss, Inc.
Clinically guided closure of femoral arterial pseudoaneurysms complicating cardiac catheterization and coronary angioplasty
Authors: Agarwal Rajiv , Agrawal Subodh K. , Roubin Gary S. , Berland Lincoln , Cox David A. , Iyer Sriram S. , Dean Larry S. , Baxley William A.
Published: March 2007

Femoral artery pseudoaneurysm formation is a significant problem in patients undergoing cardiac catheterization and interventional cardiac procedures. It is especially more common with the use of anticoagulant and antiplatelet therapy and the use of intracoronary stents. We describe our initial experience with clinically guided bedside compression of femoral pseudoaneurysms in such patients.

Eleven patients, 10 undergoing coronary angioplasty (including 3 with intracoronary stents) and 1 undergoing diagnostic cardiac catheterization, developed a femoral pseudoaneurysm. All patients had a femoral bruit and 9 had an expansile groin hematoma. The diagnosis was confirmed in each case by Doppler ultrasound. Seven patients were receiving heparin while 4 were on oral anticoagulants at the time of detection of the pseudoaneurysm. These patients underwent clinically guided graded external compression to close the pseudoaneurysm neck while maintaining femoral arterial flow.

External compression for 104.1 ± 63 min resulted in successful clinical resolution of pseudoaneurysm in all patients without complications. The results were confirmed by Doppler ultrasound at least 12 hr later.

Bedside compression of femoral pseudoaneurysms guided by clinical clues is simple and appears to be an effective and safe technique to manage this iatrogenic problem. © 1993 Wiiey‐Liss, Inc.
Correct positioning for cardiac angiography: Insights from mri
Authors: Hartnell George G. , Bradley Francis M.
Published: March 2007

The recommended angiographic projections for optimally demonstrating various cardiac structures vary, and do not always achieve their aim. To determine the most appropriate radiographic projections to optimally demonstrate cardiac structures, we reviewed the orientations of major cardiac structures and the associated great vessels, as demonstrated by axial MRI.

Measurements were made from 187 MRI examinations of the heart. These measurements confirmed that the optimum angiographic projections for various cardiac structures are at variance with a number of the recommended views. Recommendations for the angiographic projections most likely to provide optimum display of various cardiac structures and associated great vessels in different patient populations are presented. © 1993 Wiiey‐Liss, Inc.
Percutaneous balloon valvuloplasty in mirror‐image dextrocardia and rheumatic mitral stenosis
Authors: Raju Raghava , Singh Shailender , Kumar Padma , Rao Srinivasa , Kapoor S. , Raju B. S.
Published: March 2007

A 28‐year‐old woman with mirror‐image dextrocardia and severe rheumatic mitral stenosis underwent successful percutaneous balloon mitral valvuloplasty (PBMV). Standard technique was altered to include transseptal catheterization via the left femoral vein and inter‐atrial septal puncture with the transseptal needle rotated to a 7 o'clock position. The predilatation transmitral gradient (mean) of 16 mmHg decreased to 5 mmHg following PBMV. The valve area improved from 1.0 cm2 to 2.6 cm2. There were no complications. This case illustrates that transseptal catheterization can be accomplished safely in patients with unusual cardiac anatomy and mitral valvuloplasty can be performed in patients with mirror‐image dextrocardia and rheumatic mitral stenosis. © 1993 Wiiey‐Liss, Inc.
Use of an intracoronary stent to control intrapericardial bleeding during coronary artery rupture complicating coronary angioplasty
Authors: Thomas M. R. , Wainwright R. J.
Published: March 2007

Coronary artery rupture is a rare complication of percutaneous transvenous coronary angioplasty (PTCA) usually requiring urgent cardiac surgery and often resulting in a poor outcome including death. We report, for the first time, the use of an intracoronary stent to control intrapericardial bleeding following the development of a coronary artery rupture during PTCA. Cardiac surgery was avoided and the patient was discharged well 1 week after the procedure. © 1993 Wiley‐Liss, Inc.
Experience with u‐shaped catheters in angiography and angioplasty of the left coronary artery
Authors: El Gamal M. , Bracke F. , Bonnier J. , El Biltagiu S. , Peels C. , Pijls N. , van Gelder L.
Published: March 2007

We developed a U‐shaped diagnostic and guiding catheter for left coronary angiography and angioplasty. Angiography with a 6 French (F) diagnostic U‐shaped catheter was attempted in 101 patients (pts). Primary use in 82 pts; all successful. Secondary use after failure of 6 F left Judkins diagnostic catheters to intubate the left main coronary artery in 19 pts; 17 successful. An 8 F U‐shaped guiding catheter was used for percutaneous transluminal coronary angioplasty (PTCA) of left coronary artery branches in 102 pts [left anterior descending (LAD), 48 pts; circumflex (CX), 54 pts]. Stable cannulation of the left coronary artery was achieved in 96 pts (94%), but PTCA was successful in 90 pts (88%). Primary use in 70 pts (LAD, 27 pts; CX, 43 pts). PTCA was successful in 60 pts. Secondary use after failure of left Judkins and Amplatz guiding catheters in 32 pts (LAD, 21 pts; CX, 11 pts). PTCA was successful in 30 pts. No complications were seen. In conclusion, U‐shaped diagnostic and guiding catheters increased the success rate of (1) left coronary angiography after failure of left Judkins diagnostic catheters; and (2) PTCA of the left anterior descending and circumflex arteries after failure of left Judkins and Amplatz guiding catheters
© 1993 Wlley‐Liss, Inc
Variations in acoustical beam properties of intracoronary doppler catheters
Authors: Roth Thomas , Erbel Raimund , Brennecke RÜDiger , Rupprecht Hans JÜRgen , Meyer JÜRgen , Seelen Werner V.
Published: March 2007

The limitations of coronary angiography in assessing the functional significance of coronary obstructions is well known. While the critical variable of coronary blood flow cannot be readily measured, intraluminal Doppler sonography offers useful related functional information on blood flow velocity. In order to fully evaluate Doppler signals it is essential to have exact knowledge of the transducer transmission characteristics and of the ultrasound beam topology. In an experimental set‐up, the transmitter‐receiver characteristics of five commonly used Doppler catheters were investigated. In comparing the beam characteristics we found inhomogeneities in the lateral beam spread. At a penetration depth of 3.0 mm the beam shape varied from a minimum of 1.25 mm up to a maximum of 3.5 mm. The mean was 2.25 mm. The different beam profiles of the investigated Doppler transducers cause an error in measuring the blood flow velocity. The blood flow velocity tends to be underestimated the more the vessel diameter and the blood flow velocity increase. Contrary to transducer design optimized for imaging, for spectral analysis of the Doppler signal it would be advantageous to have as broad a beam as possible in order to illuminate the entire vessel lumen © 1993 Wlley‐Liss, Inc
Collagen plug hemostatic closure of femoral arterial puncture sites following implantation of intracoronary stents
Authors: Webb John G. , Carere Ronald A. , Dodek Arthur A.
Published: March 2007

Recently a new adjunct to achieving arterial hemostasis has been developed. The device consists of a purified bovine collagen plug which when inserted adjacent to the arterial wall induces the formation of a hemostatic cap directly over the arterial puncture. We have utilized collagen plug hemostasis in 32 patients on 35 occasions undergoing implantation of intracoronary stents while attempting to maintain continuous full anticoagulation. Initial hemostasis was successfully achieved in all patients. Moderate sized (5 to 10 cm) hematomas were noted in 4 patients and large hematomas (>10 cm) in 3, of whom 2 required vascular repair and transfusion. One patient developed a purulent discharge from the puncture site which resolved with a brief course of antibiotics. No patient suffered femoral arterial occlusion, distal embolization, or venous thrombosis. There were no long term access site problems at a mean follow up of 6 months. Repeat catheterization utilizing the same femoral artery was performed in 16 patients without difficulty. In five of these patients angiography was performed early after stent implantation without discontinuation of full anticoagulation and collagen closure was utilized a second time. Collagen plug hemostasis is feasible after coronary stenting, may allow more aggressive anticoagulation than might otherwise be achieved, and may facilitate angiographic restudy early after stenting without the need to discontinue anticoagulation.© 1993 Wlley‐Liss, Inc
Use of the porous balloon in porcine coronary arteries: rationale for low pressure and volume delivery
Authors: Santoian Edward C. , Gravanis Michael B. , Schneider Joel E. , Tarazona Norman , Cipolla Gustavo D. , Robinson Keith A. , King Spencer B.
Published: March 2007

Using agents administered systemically, attempts to control the restenotic myoproliferative response associated with angioplasty have been unsuccessful. The porous balloon has the advantage of achieving high local concentrations by directly infusing agents into the arterial wall. The purpose of this study is to identify any acute and chronic morphological changes in swine coronary arteries infused with normal saline through the porous balloon at different driving pressures. In order to establish the safety of local arterial wall infusion through the porous balloon, swine underwent porous balloon infusion of 3,6, or 10 ml of saline at 5 atmospheres, or infusion of 3 ml of normal saline delivered at either 2, 5, or 10 atmospheres of pressure into the normal left anterior descending and left circumflex arteries. To assess the histopathologic alterations induced by the porous balloon, sized 1.1 to 1 with respect to the artery, animals were sacrificed either immediately after porous balloon infusion or 14 days later. Acute vessels were evaluated for the presence of medial injury, disruption and/or dissection, whereas chronic vessels underwent morphometric analysis measuring the residual luminal area (Lumen area/Intimal area + Lumen area) and the maximal intimal thickness. Adequate adventitial penetration was confirmed by infusing as little as 2–3 ml of methylene blue at 2 atmospheres of pressure. Infusion of 3 ml of normal saline at 2 atmospheres resulted in minor focal medial edema and disorganization, detected both acutely and 14 days after porous balloon infusion. At delivery pressures of 5 or 10 atmospheres, proportionally more acute injury was noted and measurable neointimal lesions were observed 2 weeks after infusion. These data indicate that porous balloon infusion of 3 ml of normal saline at 2 atmospheres was safe and resulted in only minimal medial edema of normal swine coronary arteries. Higher pressure or volume delivery proportionally increased the degree of injury and contributed to the development of neointima.© 1993 Wlley‐Liss, Inc
Mobile cardiac catheterization registry: Report of the first 1,001 patients
Authors: Bersin Robert M. , Elliott Charles M. , Elliott Allison V. , Fedor John M. , Gallagher John J. , Jordan Lisa , Simonton Charles A. , Svenson Robert H. , Wilson B. Hadley , Zimmern Samuel H.
Published: March 2007

The purpose of this study was to evaulate prospectively the efficacy and safety of mobile cardiac catheterization. Mobile cardiac catheterization was introduced into clinical practice in 1989, but there has been no systematic study of its performance and safety. A registry was established in 1989 to monitor outcomes with mobile cardiac catheterization and is reported here.

Patients were screened for eligibility for mobile cardiac catheterization using the joint AHA/ACC criteria for outpatient angiography. Eligible patients underwent mobile catheterization at eight hospitals within 120 miles of the base tertiary center. Helicopter evacuation services were available at each mobile site. The indications, findings, dispositions, and complications of mobile cardiac catheterization were recorded by means of a checklist, telephone follow‐up and chart review.

A total of 1,001 consecutive patients were entered into the registry in the first 20 months of operation, including 436 females and 565 males aged 22 to 84 years. Angina (Canadian Classes II–IV) was the most frequent primary indication for catheterization (46.4%), followed by atypical chest pain (36.9%), or a positive exercise stress test (25.6%). Infrequent indications for catheterization included a history of myocardial infarction (5.6%), congestive heart failure (7.1%), arrhythmias (4.1%), and valvular heart disease (0.7%). Catheterization was accomplished in 99.9% of patients. Angiographically normal studies were observed in 22.8%, and mild (≤50%) coronary artery disease in 13.6% of patients. Significant one, two, and three vessel coronary artery disease was observed in 19.7, 16.0, and 18.0% respectively, and left mainstem disease was seen in 4.7% of patients. Only 27% required further referral to a tertiary site for additional diagnostic procedures, interventions, or surgery. Urgent referral for clinical instability was necessary in 0.9%, and major complications occurred in only 0.6% of patients. There were no deaths.

When the joint AHA/ACC screening criteria for outpatient catheterization are used, a low risk population of patients can be appropriately identified for mobile cardiac catheterization. Mobile catheterization can be accomplished with a high procedural success rate and few complications. Most patients do not need further referral to a tertiary site for additional procedures. Mobile cardiac catheterization thus appears to be a safe and effective means of diagnostic angiography.
Creation and healing of severe coronary dissection by the use of oversized balloon for the treatment of restenosis after an initially successful angioplasty
Authors: Rozenman Yoseph , Gilon Dan , Nassar Hisham , Gotsman Mervyn S.
Published: March 2007

We describe two patients who underwent successful coronary angioplasty with a balloon that matched the normal size of the artery. Both patients returned for a second angioplasty because of restenosis. The morphology of the restenotic lesion was very similar to that of the original lesion. In the second angioplasty a larger balloon was used, and in both cases severe dissection occurred. Repeat angiography 3 months later demonstrated an open artery with clinically insignificant residual stenosis. We believe that in these two cases the initial angioplasty stretched the artery and it recoiled slowly to its original dimensions. A larger balloon size was necessary to crack atherosclerotic plaque and cause a successful long‐term outcome.
Unusual tear in inoue balloon during percutaneous balloon mitral valvuloplasty in a patient with calcific mitral stenosis
Authors: Kerkar Prafulla G. , Vora Amit M. , Sethi Jagmeet P. , Kale Purushottam A. , Dalvi Bharat V.
Published: March 2007

An unusual tear in an Inoue balloon during dilatation of calcific mitral stenosis is presented and its mechanisms discussed. An abnormal sequence of inflation indicates a possible tear.
Intracerebral hemorrhage complicating urokinase infusion into an occluded aortocoronary bypass graft
Authors: Taylor Marc A. , Santoian Edward C. , Aji Janah , Eldredge W. Jay , Cha Se Do , Dennis Charles A.
Published: March 2007

Selective infusion of urokinase into occluded coronary bypass vein grafts is effective in restoring patency. We report the occurrence of intracerebral hemorrhage complicating an intra‐graft urokinase infusion protocol. The patient had known cerebral vascular structural pathology without recent clinical complications. Caution with the use of thrombolysis in this setting is suggested.
Influence of intraballoon pressure on development of severe mitral regurgitation after percutaneous transvenous mitral commissurotomy
Authors: Yamabe Takashi , Nagata Seiki , Ishikura Fuminobu , Md Kohji Kimura , Miyatake Kunio
Published: March 2007

To evaluate the influence of intra‐balloon pressure on the development of severe mitral regurgitation (≥grade 3 + ), we measured intraballoon pressure during percutaneous transvenous mitral commissurotomy (PTMC) in 62 patients using the Inoue balloon catheter. The peak intraballoon pressure was 2.29 ± 0.55 kg/cm2. Severe mitral regurgitation as a result of leaflet tear occurred in 7 patients (11%). Patients were divided into two groups those with (n = 7) and those without (n = 55) severe mitral regurgitation. Intraballoon pressure had been significantly higher in those with vs. those without severe mitral regurgitation (2.76 ± 0.31 kg/cm2 vs. 2.23 ± 0.55 kg/cm2, P < 0.01). Multiple logistic regression analysis revealed that the occurrence of severe mitral regurgitation was related to only the peak intraballoon pressure. These data suggest that a high intraballoon pressure is a risk factor for severe mitral regurgitation as a result of leaflet tear.
Multicystic aneurysmal dilatation of bilateral coronary artery fistula
Authors: Takahashi Masafumi , Sekiguchi Hiromichi , Fujikawa Hideyuki , Mito Hideaki , Eto Masato , Hojo Yukihiro , Chiba Yoshizo , Kitamura Satoshi , Shimada Kazuyuki
Published: March 2007

Bilateral coronary artery fistula constitutes an uncommon subgroup of coronary artery fistulas that may have a distinct embryologic origin. Coronary artery fistulas usually show a tortuous arrangement upon coronary angiography, but aneurysmal dilatation is rare. We report here an extremely rare case of coronary artery fistula originating from both coronary arteries, which showed multicystic aneurysmal dilatation.
Transcatheter embolization of an internal mammary artery bypass graft sidebranch causing coronary steal syndrome
Authors: Ayres Richard W. , Lu Chien‐Tai , Benzuly Keith H. , Hill Gregory A. , Rossen James D.
Published: March 2007

We describe a 66‐yr‐old man with angina after internal mammary artery‐coronary bypass grafting due to coronary artery steal by a sidebranch of the mammary artery. Myocardial ischemia was successfully treated by transcatheter embolization of the sidebranch.
Contrast‐induced nephrotoxicity in patients undergoing cardiac catheterization
Authors: Tommaso Carl L.
Published: March 2007

Contrast‐induced nephrotoxicity (CIN) is a common concern among angiographers. The causes of CIN are not well understood and the identification and preparation of patients at risk are important. This report reviews the literature concerning the causes and identification of patients at risk and documents the studies that are available to improve the safety of cardiac catheterization and cardiac interventions by reducing the risk of CIN.
New guiding catheter configuration for aortocoronary vein graft angioplasty
Authors: Warren Stafford G.
Published: March 2007

A new family of four guiding catheters (8 French and 9 French) has been developed for angioplasty of aortocoronary vein grafts and native coronary arteries beyond vein graft insertions. In 67 consecutive grafts and native vessels dilated through the grafts in 54 patients, the procedural success rate was 97%. The G‐1 standard catheter was employed for the majority of the procedures (66%), but the G‐3 catheter was better for high anterior grafts and the G‐4 catheter was better for high left grafts. The G‐2 catheter was better for lower right grafts, especially in dilated aortas. Balloon angioplasty alone using 8 French catheters was performed in 60 procedures, and excimer laser with adjunctive balloon angioplasty using 9 French catheters was performed in 7 procedures.

These unique guiding catheters provide an attractive alternative to existing vein graft guides by their improved seating and backup support. They may be the primary choice for vein graft angioplasty and may have future application in stent deployment and transluminal extraction catheter (TEC) atherectomy.
High incidence of renal artery stenosis in patients with coronary artery disease
Authors: Jean William J. , Al‐Bitar Issam , Zwicke Dianne L. , Port Steven C. , Schmidt Donald H. , Bajwa Tanvir K.
Published: March 2007

The incidence of renal artery stenosis (RAS) in patients with coronary artery disease (CAD) has not been well documented. Over a 9‐month period, 196 patients who underwent coronary angiography because of clinically suspected CAD had routine nonselective renal cine or digital subtraction angiography. There were 68 females and 128 males with a mean age of 63 years (range 35–85). Angiographically significant CAD was present in 152 patients (78%). Of the total patient cohort, 29 patients (15%) had mild RAS (<50%), and 36 patients (18%) had significant RAS (≥50%). In patients with normal coronary arteries, only three patients (7%) had RAS. Thirty‐three patients (92%) with severe RAS also had CAD. Of these 33 patients, 45% had hypertension, 30% had hyperlipidemia, 24% had diabetes mellitus, 24% had renal insufficiency (creatinine ≥1.5), and 51% were smokers. In addition, it was noted that 20 of these patients (61%) had two or more of the above‐listed clinical parameters. However, univariate analysis using the chi‐square test revealed that only CAD (22% P<0.03) and renal insufficiency (29%P<0.15) were reliable clinical predictors of RAS.

In conclusion, RAS is a frequent finding in patients with CAD, particularly when renal insufficiency is also present. © 1994 Wiley‐Liss, Inc.
Use of the left internal jugular vein approach in endomyocardial biopsy
Authors: Hauptman Paul J. , Selwyn Andrew P. , Cooper Christopher J.
Published: March 2007

Endomyocardial biopsy is conventionally performed by accessing the right internal jugular vein. The alternative approach is via the femoral veins. We describe the safe and effective use of the left internal jugular vein with a standard Caves‐Schulz bioptome. © 1994 Wiley‐Liss,Inc..
Myocardial perforation in the cardiac catheterization laboratory: incidence, presentation, diagnosis, and management
Authors: Friedrich Steven P. , Berman Aaron D. , Baim Donald S. , Diver Daniel J.
Published: March 2007

The introduction of balloon valvuloplasty and new devices for coronary intervention has increased the incidence and changed the site and clinical presentation of cardiac perforation. We reviewed all cases of cardiac perforation that occurred during 11,845 consecutive catheterization procedures during a 6‐yr period (1986–91). Fourteen cardiac perforations (overall incidence 0.12%) occurred as a result of the following procedures: mitral valvuloplasty 7 of 150 (4.7%), aortic valvuloplasty 4 of 260 (1.5%), pericardiocentesis 1 of 90 (1.1%), temporary pacer 1 of 1,660 (0.06%), and diagnostic left heart catheterization 1 of 6,965 (0.01%). Perforation was recognized in the catheterization laboratory in 11 patients, within 1 hr of leaving the laboratory in two patients, and 15 hr later in one patient. Hemodynamic evidence of tamponade developed in 13 patients and was confirmed by fluoroscopy (immobile heart borders) or echocardiography. Pericardiocentesis is definitive therapy in nearly half of the cases; the remaining patients require pericardiocentesis plus surgical repair of the perforation. © 1994 Wiley‐Liss,Inc..
Recoil following wiktor stent implantation for restenotic lesions of coronary arteries
Authors: Jaegere Peter De , Serruys Patrick W. , Es Gerrit‐Anne Van , Bertrand Michel , Wiegand Volker , Marquis Jean Francois , Vrolicx Matthias , Piessens Jan , Valeix Bernard , Kober Gisbert , Rutsch Wolfgand , Uebis Rainer
Published: March 2007

The purpose of this study was to determine acute recoil of the vessel wall immediately after Wiktor stent implantation in native coronary arteries of 77 consecutive patients and to assess whether there was compression or “late recoil” of the stent itself at long‐term follow‐up. Furthermore, the relationship between recoil and a number of clinical, angiographic, and procedural variables was studied in addition to the relation between acute recoil renarrowing or restenosis was assessed. All angiograms were analyzed with the Cardiovascular Angiography Analysis System using automated edge detection. Acute recoil was defined by the difference between the mean diameter of the fully expanded balloon on which the stent was mounted and the mean diameter of the stented segment. Late recoil was calculated by comparing the mean diameter of the stent itself immediately after implantation and at follow‐up without opacification of the vessel.

Acute recoil amounted to 0.25 ± 0.32 mm or 8.2%. Multivariate analysis identified sex (coefficient = –0.20, p = 0.04) and stent/artery ratio (coefficient = 0.99, p = 0.0001) as the only independent predictors of acute recoil. “Late recoil” of the stent itself was not observed. The overall difference between the mean diameter of the stent itself immediately after implantation and at follow‐up was –0.15 ± 0.33 mm, suggesting an overall increase in diameter of 5.0%. There was no relation between acute recoil and late restenosis. On the contrary, there was a trend towards a greater degree of recoil in patients without restenosis. Moreover, linear regression analysis disclosed a weak but negative correlation between acute recoil and a loss in minimal luminal diameter (coefficient: –0.55, p = 0.04).

The Wiktor stent effectively scaffolds the instrumented vessel. Only a minimal amount of acute recoil was noted, which did not contribute to late luminal renarrowing or restenosis. In addition, no late compression of the stent itself was observed. These data suggest that tissue ingrowth into the lumen of the stented segment is the main cause of late luminal renarrowing after stent implantation. © 1994 Wiley‐Liss,Inc..
Perforations after percutaneous coronary interventions: clinical, angiographic, and therapeutic observations
Authors: Ajluni Steven C. , Glazier Sue , Blankenship Lisa , O'Neill William W. , Safian Robert D.
Published: March 2007

Coronary perforation is a rare, but potentially catastrophic, complication of percutaneous coronary intervention. A retrospective review of the Cardiology Quality Assurance Database was performed for all percutaneous coronary interventions (n = 8,932) at William Beaumont Hospital from October 1988 to December 1992. Coronary artery perforation was reported in 35 patients (0.4%), including after percutaneous transluminal coronary angioplasty (PTCA, 11/7,905, 0.14%), transluminal extraction coronary atherectomy (TEC, 6/420, 1.3%), directional coronary atherectomy (DCA, 1/249, 0.25%), and excimer laser coronary angioplasty (ELCA, 5/242, 2%); and none after high‐speed mechanical rotational atherectomy with the Rotablator (MRA, 0/116, 0%). Perforations were classified by coronary angiography as free perforations (n = 10), contained perforations (n = 17), or other types of perforation (n = 8). Although perforation was apparent in 32 (91%) of 35 angiograms, delayed cardiac tamponade occurred in 3 patients (9%), despite the absence of angiographic evidence for perforation at the time of the procedure. Causes of perforation were the guidewire in 7 (20%), an interventional device in 26 (74%), and indeterminate in 2 (6%). Complex B2 or C lesions accounted for 83% of perforations. Final treatment included conservative therapy (reversal of anticoagulation and/or PTCA) in 22 (63%) and surgical intervention (with or without bypass surgery) in 13 (37%). Serious clinical complications included cardiac tamponade in 6 (17%), blood transfusion in 12 (34%), myocardial infarction in 9 (26%), and death in 3 (9%). © 1994 Wiley‐Liss,Inc..
Myocardial infarction and polycythemia vera: how should we treat it?
Authors: Venegoni Paolo , Schroth George
Published: March 2007

Little is known about the management and treatment of coronary thrombosis in polycythemia vera (PV) [1]. We describe a case of acute myocardial infarction in a patient with recently diagnosed PV and thrombocytosis. The patient underwent emergency catheterization with intracoronary thrombolysis and angioplasty of the left anterior descending coronary artery. © 1994 Wiley‐Liss,Inc..
Percutaneous transluminal coronary angioplasty of the left internal thoracic artery graft: a case report in a child
Authors: Kawata Tetsuji , Hasegawa Junichi , Yoshida Yoshitsugu , Yoshikawa Yoshiro , Kawachi Kanji , Kitamura Soichiro
Published: March 2007

A 9‐year‐old girl who had undergone previous coronary artery bypass surgery at the age of 3.5 years for stenoses of the left anterior descending and right coronary arteries resulting from Kawasaki disease presented with recurrent exertional angina. Stenosis was found at the anastomosis of the left internal thoracic artery to the left anterior descending artery. Percutaneous transluminal coronary angioplasty was successfully performed. This is the first reported case of percutaneous transluminal coronary angioplasty of an internal thoracic artery graft in a child. © 1994 Wiley‐Liss,Inc..
Internal mammary artery collateral to the external iliac artery: an angiographic consideration prior to coronary bypass surgery
Authors: Parashara Deepak K. , Kotler Morris N. , Ledley Gary S. , Yazdanfar Shahriar
Published: March 2007

The role of routine selective angiography of the internal mammary artery prior to myocardial revascularization is controversial. We report a patient with coronary artery disease and peripheral vascular disease in whom the left internal mammary artery supplied blood flow to the left external iliac artery via a collateral network. Thus, selective angiography of the internal mammary artery did play a major role in the proper management of this patient who required coronary bypass surgery. A major potential postoperative complication of left lower extremity ischemia may have been prevented. © 1994 Wiley‐Liss,Inc..
Absent left circumflex coronary artery
Authors: Ilia Reuben , Jafari Jamal , Weinstein Jean Marc , Battler Alexander
Published: March 2007

This is the first reported case of a coronary artery anomaly in which the left circumflex artery was absent. The lateral and posterior aspects of the left ventricle were supplied by a large diagonal artery and a very long right coronary artery which continued along the atrioventricular groove. © 1994 Wiley‐Liss,Inc..
Comparative study of the angiographic morphology of coronary artery lesions treated with PTCA, directional coronary atherectomy, or high‐speed rotational ablation
Authors: Stertzer Simon H. , Pomerantsev Eugene V. , Shaw Richard E. , Boucher Ralph A. , Millhouse Felix , Zipkin Robert E. , Hidalgo Benito O. , Murphy Mary C. , Hansell Heidi N. , Myler Richard K.
Published: March 2007

To evaluate trends in morphology‐based intervention selection, series of 110 consecutive procedures of each of three devices, percutaneous transluminal balloon coronary angioplasty (PTCA), directional coronary atherectomy (DCA), or high‐speed rotational ablation (HSRA), were reviewed. PTCA was used mainly in discrete, concentric, smooth, ACC/AHA type A and B1 lesions. PTCA was used less frequently on a bend, branching points or in calcified lesions. Using PTCA as a reference, DCA was used more often for the treatment of discrete, proximal, eccentric, and noncalcified lesions, often complicated with thrombus and located on straight segments. HSRA was used more frequently in diffuse, calcified multiple complicated and B2 + C type lesions with frequent side branches and bend points. These results suggest that directional atherectomy and rotational ablation may be helpful in expanding the capacity of the operator to approach prognostically unfavorable lesions. © Wiley‐Liss, Inc.
Prolonged intracoronary infusion of streptokinase: An alternative pharmacologic approach to extensive thrombus in native coronary artery
Authors: Kjellgren Olle , Wilentz James R. , Kaganovsky Lazar , Sherman Warren
Published: March 2007

Several reports suggest that pretreatment of intracoronary thrombus with fibrinolytic agents may reduce the risk for complications during subsequent balloon angioplasty. We report a case, for the first time, of successful lysis of an extensive thrombus in a native coronary artery by administering a prolonged intracoronary infusion of streptokinase to facilitate subsequent angioplasty and discuss the management strategy when intracoronary thrombus is encountered. © Wiley‐Liss, Inc.