bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of intramyocardial hemorrhage using high‐field proton (1h) nuclear magnetic resonance imaging
Authors: Lotan Chaim S. , Miller Sandra K. , Bouchard Alain , Cranney Gregory B. , Reeves Russell C. , Bishop Sanford P. , Elgavish Gabriel A. , Pohost Gerald M.
Published: March 2007

Proton (1H) nuclear magnetic resonance (NMR) imaging has been used to define zones of myocardial infarction (MI), which appear as areas of relatively increased signal intensity (SI). However, zones of decreased SI have been observed within the areas of infarction and have been postulated to result from intramyocardial hemorrhage. To explore this phenomenon further, ex vivo spin‐echo 1H NMR imaging at 1.5 Tesla was performed in 17 dogs after 24 hr (n=9) and after 72 hr (n=8) of coronary artery occlusion.

In all dogs, a zone of increased SI (118 ± 9% compared with normal myocardium) was observed in the distribution of the occluded coronary artery. In 12 of the 17 dogs, zones of decreased SI (92 ± 8% compared with normal) were seen within or around the central zone of increased SI. Gross inspection and histological assessment of sliced myocardium usually disclosed hemorrhage in the regions of decreased SI. In three of the five dogs with no apparent zones of decreased SI on NMR. the infarct was small, and only minor hemorrhage was observed by gross inspection, whereas in the remaining two dogs no hemorrhage was seen. Myocardial flow in the hemorrhagic regions was significantly higher than in the necrotic core (59 ± 29% vs. 31 ± 24% compared with control, P< 0.05).

Image‐derived calculation of T2 relaxation times in the different infarcted regions revealed a significant shortening of T2 in the infarcted hemorrhagic zones with decreased SI compared with the infarct zones with increased SI (49 ± 8 msec vs. 66±8 msec, P< 0.05). This reduction in T2 in the hemorrhagic zone is consistent with the paramagnetic effects of the deoxyhemoglobin associated with intramyocardial hemorrhage.

These observations improve our understanding of the changes in NMR SI within the infarcted regions and provide a noninvasive method for the detection of intramyocardial hemorrhage. This should help to characterize further the myocardium in patients with myocardial infarction and to assess the effect of myocardial hemorrhage following reperfusion therapy.
Guiding catheter exchange during coronary angioplasty
Authors: Warren Stafford G. , Barnett J. Craig
Published: March 2007

A new technique to exchange one angioplasty guiding catheter for another with the guide wire in place and across a coronary artery stenosis has been developed to decrease the dangers of having to recross the stenosis with a guide wire. This technique utilizes a regular extended angioplasty guide wire and enables the exchange of guiding catheters during the angioplasty procedure. In 683 consecutive angioplasty procedures by one operator, this technique has been attempted 57 times in 43 patients (6.3%) and has been successful 51 times (90%). The only failures were when the second catheter had a large or open curve (left Amplatz II, 5/22 unsuccessful or multipurpose, 1/3 unsuccessful). There have been no complications. We conclude that exchange of a guiding catheter over a guide wire by the method described is safe and helpful in cases where different guiding catheters are needed for back‐up power once the lesion has been crossed with a guide wire.
Multi‐hospital Eastern Atlantic Restenosis trial: Design, recruitment, and feasibility
Authors: Hill James A. , Macdonald Robert G. , Jugo Ralph , Hirshfeld John W. , Goldberg Sheldon , Savage Michael P. , Vetrovec George , Cowley Michael , Bass Theodore A. , Margolis James R. , Whitworth Hall B. , Taussig Andrew S. , Bove Alfred A. , Pepine Carl J.
Published: March 2007

A randomized control trial was set up to examine factors that influence restenosis and determine the effects of corticosteroids on restenosis following successful PTCA. The rationale for the study agent chosen, design, recruitment, and feasibility, as well as initial patient demographic data and initial results are presented.
Klinefelter's syndrome with anomalous origin of left main coronary artery
Authors: Albazzaz Sabah J.
Published: March 2007

Klinefelter's syndrome is a rare entity. Even rarer is an anomalous origin of the Left Main Coronary Artery. For both conditions to occur in the same patient is hence exceedingly rare. Reported here is a never previously reported case of a coronary congenital anomaly in a patient with Klinefelter's syndrome together with the proper angiographic approach.
Retrograde Recanalization of an occluded posterior tibial artery by using a posterior tibial cutdown: Two case reports
Authors: Iyer Sriram S. , Dorros Gerald , Zaitoun Rafic , Lewin Ruben F.
Published: March 2007

Recanalization of two occluded posterior tibial arteries was successfully achieved by utilizing a retrograde approach via a posterior tibial artery cutdown at the level of the ankle. Both cases were previously unsuccessfully attempted by using an antegrade approach. Thus, the choice of access vessel (arterial entry site) becomes a crucial determinant of angioplasty success.
Percutaneous high‐speed rotational atherectomy (Rotablator™) of a restenosed ostial renal artery: A case report
Authors: Zaitoun Rafic , Dorros Gerald , Iyer Sriram S. , Lewin Ruben F.
Published: March 2007

This case report describes the feasibility and potential benefit of the use of a high‐speed rotational atherectomy device (the Rotablator™) in the treatment of renovascular hypertension in a patient with a recorded restenosis of an ostial renal artery lesion following standard balloon angioplasty.
Systemic heparinization does not prevent clot formation in coil embolization
Authors: Johnson Walter H. , Peterson Robyn K. , Howland Donna F. , Lock James E.
Published: March 2007

Therapeutic transcatheter closure with Gianturco‐type steel coils has been applied to a variety of vascular communications in children with congenital heart disease. Vessel closure depends upon successful thrombus formation around the coil. Since systemic anticoagulation with heparin is commonly used during catheterization and cardiac surgery, we studied the effect of systemic heparinization on the efficiency of vessel occlusion by coil emboiization in lambs. Catheters inserted in femoral arteries were used to arteriographically locate and size 36 systemic arteries in 9 lambs weighing 4.2 to 7.4 kg. Twenty‐four vessels were embolized prior to heparinization with 400 u/kg heparin, IV. Effective anticoagulation was demonstrated by post‐heparin activated clotting time (ACT) values greater than 300 sec. Seven vessels (29%) were not successfully coil‐embolized because of inadequate coil position or distant embolization of the coil; 17 (71%) of these vessels were shown to be successfully occluded by arteriography 6 to 77 min later. After a period of systemic heparinization ranging from 71 to 159 min, 9/17 arteries remained occluded, 7/17 could not be examined arteriographically due to early demise of the animal, and only 1/17 showed recanalization. A second group of 12 vessels were embolized after heparinization. Eight (75%) were successfully occluded, and 4 (25%) were not successfully coil‐embolized because of inadequate coil position or coil embolization to distant arteries. We conclude that systemic heparinization had no measurable effect on occlusion rates in coil‐embolized systemic arteries in the lamb. These data support the use of systemic heparinization, when indicated, during or following therapeutic coil embolization in children.
Simplified method for estimating true aortic valve mean gradient from simultaneous left ventricular and peripheral arterial pressure recordings
Authors: Folland Edward D. , Parisi Alfred F. , Comei Cynthia
Published: March 2007

Estimation of the aortic valve gradient by simultaneous recording of left ventricular and peripheral arterial pressures is subject to error due to delay and modulation of the arterial pressure contour as it propagates from the ascending aorta. This error can be corrected by averaging the mean gradients derived from unaltered and temporally aligned simultaneous left ventricular‐peripheral arterial pressure tracings. In 26 patients with aortic stenosis and simultaneous recordings of ascending aortic and femoral arterial pressure we compared this method with a simplified approach in which the peripheral arterial pressure is partially aligned by advancing it against the left ventricular pressure by 50% of the time delay of the simultaneously recorded upstrokes. Gradients measured this way predicted the true aortic valve gradients (left ventricular‐ascending aortic) with a mean difference of +1.1 mm Hg (range = +10 to −5 mm Hg). We recommend use of this simplified method of correction because it predicts true aortic valve gradient equally well as the averaging technique (r=0.977 vs. 0.979) and requires half the time and effort.
Experience with the use of coronary autoperfusion catheter during complicated angioplasty
Authors: Saenz Carlos B. , Schwartz Kerry M. , Slysh Sonya J. , Palanca Kim , Charles R. Curry
Published: March 2007

Between February and July of 1989, 22 patients underwent the use of the Stack autoperfusion catheter following acute occlusion or obstructive dissection during coronary angioplasty; in 20 cases conventional balloon was used in an attempt to correct the angiographic appearance followed by the use of Stack catheter when results were sub‐optimal. Only 1 patient (4.5%) required surgical revascularization. Although our study is not prospective or randomized, our observations suggest a significant impact in decreasing the need for emergency surgical revascularization after complicated coronary angioplasty with the use of this approach.
Acquired lutembacher syndrome or mitral stenosis and acquired atrial septal defect after transseptal mitral valvuloplasty
Authors: Sadaniantz Ara , Luttmann Christopher , Shulman Richard S. , Block Peter C. , Schachne Jay , Thompson Paul D.
Published: March 2007

Critical mitral stenosis in selected patients may be treated successfully with percutaneous mitral valvuloplasty. Complications of this procedure, particularly an atrial septal defect following transseptal approach, are generally of minor clinical significance.

We describe a woman who initially underwent a successful percutaneous double‐balloon mitral valvuloplasty via the transseptal approach. Three months later she presented with right‐sided heart failure. Color Doppler echocardiography and cardiac catheterization demonstrated an atrial septal defect (ASD) as well as restenosis of the mitral valve.

We conclude that significant ASDs may occur following transseptal mitral valvuloplasty with appearance of right ventricular failure and that color Doppler imaging aids in the diagnosis of this new variant of the classical Lutembacher syndrome.
Myocarditis simulating acute transmural myocardial infarction
Authors: Chakko Simon , Woska David , de Marchena Eduardo , Morales Azorides R. , Castellanos Agustin
Published: March 2007

A patient with cardiogenic shock had typical electrocardiographic findings of acute anterior transmural myocardial infarction. Cardiac catheterization revealed normal coronary arteries and severe biventricular failure. Postmorten examination confirmed normal coronary arteries; acute myocarditis, but no evidence for infarction, was found. Electrocardiographic changes of myocarditis may be indistinguishable from acute transmural infarction. In suspected cases, cardiac catheterization should be considered prior to thrombolytic therapy.
Misplacement of a swan‐Ganz catheter after insertion through the left internal jugular vein
Authors: Unger P. , Stoupel E. , Berkenboom G.
Published: March 2007

We report a case of perforation of the left brachiocephalic vein after insertion through the left internal jugular vein. Entrapment of air in the balloon occurred, possibly due to high surrounding tissue pressure at its base, preventing deflation. We emphasize the potential hazards of catheterization via the left internal jugular vein.
Percutaneous valvuloplasty in a patient with mitral stenosis following surgical annuloplasty
Authors: Saenz Carlos B. , Nocero Michael A. , Weaver Curtis J.
Published: March 2007

A case is described in which a patient with a Carpentier‐Edwards annuloplasty ring developed mitral stenosis and was treated with percutaneous mitral valvuloplasty. Possible mechanisms for the development of mitral stenosis are briefly discussed.
Salvage from cardiogenic shock by atherectomy after failed emergency coronary artery angioplasty
Authors: Smucker Mark L. , Sarnat William S. , Kil Diane , Scherb Daniel E. , Howard Paul F.
Published: March 2007

In this case report of a patient undergoing angioplasty for cardiogenic shock during acute myocardial infarction, recurrent occlusion resulted in recurrence of shock. Atherectomy reestablished lasting patency and reversed the patient's hemodynamic collapse. Atherectomy deserves further investigation as a means to salvage vessel patency during unsuccessful coronary angioplasty.
Regression of infundibular pulmonary stenosis after successful balloon pulmonary valvuloplasty in adults
Authors: Fawzy M. E. , Galal O. , Dunn B. , Shaikh A. , Sriram R. , Duran C. M. G.
Published: March 2007

Between July 1985 and March 1988,22 adult patients with congenital pulmonary stenosis underwent balloon pulmonary valvuioplasty. There were 10 males and 12 females aged 16‐45 (average 25 ± 9.9) years. All patients had additional mild to severe infundibular stenosis; 16 were restudied 6‐36 (mean 12.6) months later by repeat Catheterization. Student's t‐test was used for comparison of data.

Right ventricular (RV) systolic pressure before dilatation was 84–196 (mean 129 ± 32.3) mm Hg, and the peak pulmonary gradient (PPG) was 60–176 (mean 111 ± 33.2) mm Hg immediately after dilatation. The RV systolic pressure dropped to 32–140 (mean 59.2 ± 27) (P<0.001); and PPG dropped to 10–113 (mean 37.8 ± 26.4) (P<0.001), and the infundibular gradient ranged from 8 to 113 (mean 35.1 ± 25.8) mm Hg. The infundibular diameter, before dilatation, ranged from 2 to 15 (mean 9.5 ± 4) mm Hg. At repeat catheterization, the RV systolic pressure dropped further to 33–66 (mean 42.8 ± 9.7) mm Hg and the PPG was reduced to 0–48 (mean 18.4 ± 10.9) mm Hg (P<0.001). The infundibular gradient regressed to 0–34 (mean 15 ± 8.8) mm Hg (P< 0.001). The infundibular diameter Increased to 8–25 (mean 15.8 rt 5.4) (P<0.001). It is concluded that moderate to severe lnfundibular stenosis, in adults, can regress after successful pulmonary valvuloplasty.
Death at cardiac catheterization: Coronary artery embolization of calcium debris from lonescu‐shiley bioprosthesis
Authors: Walley V. M. , Giannoccaro P. , Beanlands D. S. , Keon W. J.
Published: March 2007

The case described is a death due to emboliration of calcium debris from a bioprosthesis, dislodged at cardiac catheterization. As more bioprosthetic valves are implanted, and more of them fail long‐term with calcification, such complications of the lnvasive study of these valves may be expected.
Percutaneous aspiration of thrombus occluding a saphenous vein graft
Authors: Adatte Jean Jacques , Villavicencio Ramon , Meier Bernhard
Published: March 2007

Bypass graft occlusion by a thrombus 30 min before elective coronary angiography was treated by percutaneous thrombus aspiration, followed by an angioplasty with a good follow‐up result.
Coronary angioplasty of anomalous coronary arteries: Notes on technical aspects
Authors: Topaz On , Disciascio Germano , Goudreau Evelyne , Cowley Michael J. , Nath Amar , Kohli Ravinder S. , Vetrovec George W.
Published: March 2007

Five patients with significant atherosclerotic lesions of anomalous coronary arteries underwent coronary angiopiasty of the anomalous vessel. Four patients had anomalous circumflex artery and 1 had an anomalous right coronary artery. Angiographic and clinical success was achieved in all 5 patients. To ensure adequate equipment selection special consideration should be given to angiographic characteristics of these vessels, such as the orifice configuration, exit angulation, the route the artery traverses and the location of the stenotic lesions. Major determinants for successful angioplasty in these patients are guiding catheter selection and advancement of the balloon catheter to the very proximal portion of the anomalous vessel to subsequently facilitate guide wire advance ment. This data indicates that balloon angioplasty can be successfuily utilized in patients with significant atherosclerotic disease of anomalous coronary arteries.
Probe™ angioplasty of total coronary occlusion using the probing catheter™ technique
Authors: Little Thomas , Rosenberg Joel , Seides Stuart , Lee Benjamin , Lindsay Joseph , Pichard Augusto D.
Published: March 2007

Coronary angioplasty (PTCA) of total coronary occlusion is limited by the inability of guidewires and conventional dilating catheters to cross all such lesions. A new technique was therefore prospectively evaluated for PTCA of these lesions using the ultra‐low‐profile Probe™ “balloon on a wire” device. An intracoronary Probing Catheter™ was used to facilitate crossing the stenosis with a guidewire and then to deliver a Probe™ Into the obstruction for balloon dilatation. This technique was utilized in 64 consecutive patients with “absolute” coronary occlusions demonstrating no angiographically detectable antegrade coronary flow. Successful dilatation was achieved in 47 (73%). Among 33 occlusions of less than 3 mo duration 31 (94%) were successfully dilated whereas only 16 of 31 more chronic occlusions were dilated (P<.01). Chronic occlusions with a tapered morphology and those located more than 1 cm from a branch point were more frequently dilatable. There were no Serious complications including no vessel perforations with this technique.

The Probing Catheter™ technique offers a safe and effective method for the dilatation of recent coronary occlusions by using balloon on a wire technology.
Physical examination and echo doppler study in the assessment of femoral arterial complications following cardiac catheterization
Authors: Cohen Gerald I. , Chan Kwan‐Leung
Published: March 2007

Femoral arterial complications following cardiac catheterization have been well recognized. The development of an inguinal mass in these patients can represent a simple hematoma, a pseudoaneurysm, or an arteriovenous fistula. The utility of the physical examination in diagnosing these complications was assessed by using the echo Doppler study for comparison. This study shows that any single clinical sign should not be used in isolation, but a constellation of physical findings can suggest the correct diagnosis.
Inflation pressure requirements during coronary angioplasty
Authors: Kahn Joel K. , Rutherford Barry D. , McConahay David R. , Hartzler Geoffrey O.
Published: March 2007

To examine the balloon inflation pressures required for successful percutaneous transluminal coronary angioplasty (PTCA), the maximal inflation pressure required for 477 coronary lesions in 200 consecutive patients was determined retrospectively. When graded balloon infaltions just sufficient to achieve full expansion were used, the maximal inflation pressure used was ≤8 atm in 412 stenoses (86%) and was ≤10 atm in 463 stenoses (97%). Successful PTCA was achieved in 98% of lesions with a 3.5% major procedural complication rate. In a second group of 100 patients studied prospectively, the inflation pressure required to achieve full balloon expansion was ≤8 atm in 214 of 232 stenoses (92%) and ≤10 atm in 228 stenoses (98%). Thus, PTCA of coronary stenoses can be achieved with high success rates and low complication rates when graded inflations to pressures just sufficient to achieve full balloon expansion are performed. Most coronary stenoses will respond to pressures ≤8–10 atm.
Evaluation of catheters and metallic catheter markers as calibration standard for measurement of coronary dimension
Authors: Leung Wing‐Hung , Demopulos Peter A. , Alderman Edwin L. , Sanders William , Stadius Michael L.
Published: March 2007

Measurement of coronary dimension requires an accurate and reproducible dimensional reference. Angiographic catheters are frequently used for this purpose. We measured the angiographic diameters of a broad range of diagnostic and angioplasty guiding catheters by using two commonly used edge‐detection algorithms. Angiographic diameters are significantly less than true catheter outer diameter. Therefore the use of contrast‐filled catheters as a dimensional reference may lead to considerable error in vessel measurement with overestimation of absolute dimension. Tables of reference values for multiple catheters are included. We also evaluated the suitability of a metallic‐tipped “marker” catheter as calibration standard, tested under a variety of angiographic conditions. The metallic‐tipped marker was found to have a better degree of reproducibility than catheters. These findings have implications for studies employing serial measurements of coronary artery dimension and for the clinical practice of estimating vessel diameter for choice of balloon size during angioplasty.
Standby percutaneous transluminal coronary angioplasty for coronary artery bypass surgery
Authors: Schieman Gregory , Cohen Barry M. , Buchbinder Maurice
Published: March 2007

Urgent PTCA of a distal anastomotic stenosis in a saphenous vein aortocoronary bypass graft was successful in relieving recurrent ischemia within 24 h of CABG surgery.
Correction of subclavian artery stenosis by percutaneous angioplasty
Authors: Gershony Gary , Basta Lofty , Hagan Arthur D.
Published: March 2007

Subclavian artery stenosis is an infrequently recognized cause of left‐sided chest and arm pain that can mimic the signs and symptoms of angina pectoris. In addition, more proximal subclavian artery stenoses can be associated with cerebrovascular symptoms in the “subclavian steal syndrome.” This article reviews the clinical experience in four patients who presented with different manifestations of subclavian artery stenosis and who were all successfully treated by percutaneous angioplasty. Their clinical presentation, angiographic findings, and post‐angioplasty results are documented. In conclusion, it is felt that nonsurgical correction of critical subclavian artery stenosis, using current angioplasty techniques, is the preferred method of treatment.
Influence of low osmolality contrast media on electrophysiology and hemodynamics in coronary angiography: Differences between an ionic (loxaglate) and a nonionic (lohexol) agent
Authors: Vik‐Mo Harald , Følling Magne , Barth Philippe , Nordrehaug Jan Erik , Bjørkhaug Aud , Rosland Gunnar A.
Published: March 2007

It has recently been suggested that the addition of sodium to low osmolality contrast media may reduce the incidence of ventricular fibrillation and conduction disturbances during coronary angiography. In a randomized, double blind study of 30 patients undergoing coronary angiography we therefore examined the electrophysiological and hemodynamic effects of the two low osmolality contrast media—ioxaglate (with sodium) and iohexol (without sodium). Standard ECG, aortic blood pressure, and His bundle electrocardiogram were recorded.

The contrast media were well tolerated and no serious arrhythmias were observed. Both induced a transient decrement in systolic blood pressure and reduction in heart rate 10 s following contrast injection (all P<0.01). Ioxaglate prolonged the QT interval at 10 s (P<0.01) and also when analysed for the whole observation period (120 s) (P<0.05), whereas iohexol did not cause any significant changes in the QT‐interval. The AH‐interval was prolonged by ioxaglate at 10 s (P<0.01), but not altered by iohexol.

Thus, other factors than osmolality and sodium content might contribute to QT prolongation, since only the contrast agents with sodium (ioxaglate) induced QT prolongation in this study.
Postoperative angiographic evaluation of gastroepiploic artery grafts: Technical considerations and short‐Term patency
Authors: Isshiki Takaaki , Yamaguchi Tetsu , Nakamura Masato , Saeki Fumihiko , Itaoka Yoshinori , Nagahara Toshihiro , Furuta Yuko , Ikari Yuji , Wanibuchi Yasuhiko , Suma Hisayoshi
Published: March 2007

Follow‐up angiography was performed in 37 patients with right gastroepiploic artery (GEA) grafts at 27 ± 32 days postoperatively. By the femoral approach, a 5F cobra or twist catheter was advanced selectively into the gastroduodenal artery (GDA) over a plasticcoated guidewire. In 29 patients, the GDA was successfully catheterized, and the GEA grafts were clearly visualized by the injection of 3–7 ml of contrast medium. GDA catheterization was unsuccessful in 8 patients, but in 4 of them the grafts were well visualized when 15–20 ml of contrast was injected. In the other 4 patients, visualization of the GEA grafts was poor, but the distal portions were outlined by retrograde perfusion from the native right coronary arteries. A total of 34 GEA grafts were patent (92%), and the diameters of these grafts were adequate when compared with respective recipient coronary arteries (2.8 ± 0.9 and 2.3 ± 0.6 mm, respectively; P <.05). No complications were noted except for transient vasospasm (3 patients) in the GEA, hepatic artery, or both, which was relieved by the intra‐arterial injection of isosorbide dinitrate (2.5 mg). Thus, the overthe‐wire technique allows simple and safe GDA catheterization, which is essential for obtaining good visualization of GEA grafts.
Mitral valve disruption following percutaneous balloon valvuloplasty
Authors: Ramondo Angelo , Chirillo Fabio , Dan Maurizio , Sorbara Carlo , Fracasso Alberto , Mazzucco Alessandro , Rampazzo Carlo , Isabella Giambattista , Chioin Raffaello
Published: March 2007

Two cases of massive mitral regurgitation due to mitral valve disruption following percutaneous balloon valvuloplasty are reported. This severe complication occurred in two elderly women with recurrent mitral stenosis after previous surgical commissurotomy. Due to their unstable hemodynamic and clinical condition, both patients underwent emergency valve replacement. At surgery, the commissures appeared fused and heavily calcified; the chordae tendineae thickened, shortened, and fused; and the leaflets presented a large tear with sheared edges. Because the technical aspects of both procedures were unremarkable, the anatomic features of the mitral valve seemed to affect the occurrence of severe mitral regurgitation. Percutaneous balloon valvuloplasty should be therefore applied carefully to patients with prior surgical valvotomy, in whom the structural alterations of the mitral apparatus may predispose to severe valvular damage.
Percutaneous balloon pulmonary valvuloplasty in sickle cell anemia: A case report
Authors: Muthusamy R. , Sriram R. , Dunn B.
Published: March 2007

Percutaneous balloon pulmonary valvuloplasty was performed on a 19‐year‐old female who had moderate pulmonary valve stenosis with sickle cell anemia. The patient developed sickle cell crisis resulting in occipital infarction, but she made a good recovery. We describe this case and the methods of reducing the risk of sickle cell crisis.
“Woven” Right coronary artery: Case report and therapeutic implications
Authors: Berman Aaron D. , Kim Ducksoo , Baim Donald S.
Published: March 2007

We report an unusual anomaly of the right coronary artery consisting of proximal branching of the artery and subsequent interweaving of the branches, referred to as a “woven” coronary artery. Implications and differential diagnosis are discussed.
Coronary stent implantation in acute vessel closure 48 hours after an unsatisfactory coronary angioplasty
Authors: Haude M. , Erbel R. , Straub U. , Dietz U. , Schatz R. , Meyer J.
Published: March 2007

We report the implantation of a balloon‐expandable stent in a patient with acute vessel closure in the state of evolving myocardial infarction following 48 hr after unsatisfactory coronary angioplasty. The stent was implanted after successful recanalization of an occluded left anterior descending artery, with repeated unsatisfactory results of balloon angioplasty. Adjunct thrombolytic therapy was contraindicated. No residual stenosis was documented in immediate control angiograms, or after 24 hr, 3 weeks, and 4 months.
Effect of heparin in nonionic contrast media on blood coagulation and its dose response curve
Authors: Hwang Ming H. , Piao Zhen En , Sheu Sheng Hsiung
Published: March 2007

To investigate the local effect of heparin on blood clot formation and partial thromboplastin time (PTT), blood was withdrawn into the catheters filled with iopamidol and heparin at 0, 1, 2, 3, 5, and 10 U per ml concentrations as debubbling. After 30 min incubation, blood clotting was observed in all 8 experiments with heparin concentrations of 0 and 1 U per ml; in 3 of 8 with 2 U per ml; and in none with ≥ 3 U per ml. PTT of blood and contrast mixture in catheters increased significantly when heparin concentrations were increased from 2 to 3 U per ml and reached a level of > 110 sec at 5 or more U per ml.

Thus, the addition of heparin to nonionic contrast media at concentrations of 5 U per ml may be an easy measure with which to prevent blood clotting and reduce thromboembolic complications during coronary arteriography.
Application of coronary angioplasty to the septal perforator arteries
Authors: Topaz On , Disciascio Germano , Vetrovec George W. , Goudreau Evelyne , Sabri Nagui , Nath Amar , Kohli Ravinder S. , Cowley Michael J.
Published: March 2007

Significant coronary artery disease affecting the septal perforator arteries can cause anginal pain, rhythm disturbances, or septal infarction. However, since these vessels are usually inaccessible to coronary bypass surgery, there is a tendency among angiogra‐phers and angioplasters to overlook lesions of the septal perforator arteries. Our experience suggests that if medical treatment is not sufficient to treat clinical manifestations resulting from septal perforator disease, then coronary angioplasty can be considered a therapeutic alternative for revascularization. We herein present 11 patients who underwent coronary angioplasty of a major septal artery and discuss angiographic and technical aspects of the procedure.
Comparison of exercise performance in left main and three‐vessel coronary artery disease
Authors: Gibbons Raymond J. , Earl F. Fyke , Brown Manuel L. , Lapeyre Andre C. , Zinsmeister Alan R. , Clements Ian P.
Published: March 2007

From a consecutive series of patients who underwent rest and exercise radionuclide angiography over several years, we retrospectively identified 34 patients with left main coronary artery disease and 103 patients with three‐vessel coronary artery disease who did not have significant left main disease. The results of gated equilibrium radionuclide angiography were compared in these 2 groups. Multiple exercise hemodynamic, exercise electrocardiographic, and exercise radionuclide angiographic parameters were considered in an attempt to separate the 2 groups. The only parameter that was significantly different between the 2 groups was exercise heart rate. However, no value of the exercise heart rate could meaningfully separate the 2 groups. Despite their known difference in prognosis, patients with left main and three‐vessel disease had very similar exercise performance and could not be distinguished from one another by exercise electrocar‐diography or exercise radionuclide angiography. The inability to distinguish these two groups is a clear limitation of noninvasive exercise modalities.
Percutaneous transluminal coronary angioplasty of anomalous right coronary artery
Authors: Musial Bart , Schob Alan , Marchena Eduardo De , Kessler Kenneth M.
Published: March 2007

Coronary angioplasty of tortuous anomalous coronary arteries can be technically challenging. We describe a successful percutaneous transluminal coronary angioplasty (PTCA) of an anomalous right coronary artery after a failed previous attempt. The anatomic limitations of anomolous right coronary arteries and technical considerations for PTCA are discussed.
Predictability and prognosis of ptca‐induced coronary artery aneurysms
Authors: Bal Egbert T. , Plokker H. W. Thijs , van den Berg Eduard M. J. , Ernst Sjef M. P. G. , Gijs Mast E. , Gin R. Melvyn Tjon Joe , Ascoop Carl A. P. L.
Published: March 2007

The natural history of coronary aneurysms, defined as local dilatations exceeding the diameter of the normal adjacent vessel segments by at least 1.5 times, is not significantly different from the natural history of nonaneurysmal coronary disease. However, little is known about the prognosis of percutaneous transluminal coronary angioplasty (PCTA)‐induced coronary aneurysms. Therefore, we investigated the occurrence and the medium long‐term prognosis of such aneurysms in 728 patients who, after successful PTCA, underwent repeat coronary angiography at mean 4.5 months post‐PTCA. A coronary aneurysm at the site of PTCA ws noted in 3.9% of patients (n + 28). Of the potentially predictive factors analyzed, only a coronary dissection at the time of PTCA had statistically significant influence. The long‐term prognosis of PTCA‐induced coronary aneurysms was excellent. One patient underwent (unrelated) cardiac surgery, all other 27 patients remained eventfree. We conclude that the same benign nature of coronary aneurysmal disease holds true for those aneurysms that develop after PTCA.
Identification of ischemic and hibernating myocardium: Feasibility of post‐exercise f‐18 deoxyglucose positron emission tomography
Authors: Marwick Thomas H. , Maclntyre William J. , Salcedo Ernesto E. , Go Raymundo T. , Saha Gopal , Beachler Annette
Published: March 2007

The identification of ischemic and hibernating myocardium facilitates the selection of patients most likely to benefit from revascularization. This study examined the feasibility of metabolic imaging, using post‐exercise F‐18 deoxyglucose positron emission tomography (FDG‐PET) for the diagnosis of both ischemia and hibernation in 27 patients with known coronary anatomy. Normal post‐exercise FDG uptake was defined in each patient by reference to normal resting perfusion and normal coronary supply. Abnormal elevation of FDG (ischemia or hibernation) was compared in 13 myocardial segments in each patient, with the results of dipyridamole stress perfusion imaging performed by rubidium‐82 positron emission tomography (Rb‐PET).

Myocardial ischemia was diagnosed by either FDG‐PET or Rb‐PET in 34 segments subtended by significant local coronary stenoses. Increased FDG uptake was present in 32/34 (94%) and a reversible perfusion defect was identified by Rb‐PET in 22/34 (65%, p < .01). In 3 patients, ischemia was identified by metabolic imaging alone. In 16 patients with previous myocardial infarction, perfusion defects were present at rest in 89 regions, 30 of which (34%) demonstrated increased FDG uptake, consistent with the presence of hibernation.

Increased post‐exercise FDG uptake appears to be a sensitive indicator of ischemia and myocardial hibernation. This test may be useful in selecting post‐infarction patients for revascularization.
Analysis of high‐frequency rotational angioplasty‐induced echo contrast
Authors: Zotz R. , Stähr P. , Erbel R. , Auth D. , Meyer J.
Published: March 2007

During high‐frequency rotational angioplasty (HFRA), myocardial contrast enhancement (echo contrast) was observed by means of two‐dimensional echocardiography. In order to evaluate the echo contrast produced by HFRA, an in vitro experimental model was built using a cylinder with the HFRA catheter scanned in a water bath. The cylinder was filled with blood, mineral water, and distilled water. With a 2.5‐MHz transducer, echograms were recorded and analyzed by video intensitometer, and the maximum intensity IUmax and persistence time P were calculated. Rotation frequencies of 20,000–200,000 rpm with 2.0‐mm burrs and times of 10 s were tested. In another model, hyperbaric conditions for the same media were produced. The influence of debris from arterioscleroic plaque and of hematocrit on echo contrast intensity were also analyzed. The effect of HFRA on hemolysis (LDH, free hemoglobin) within 10 s and temperature were also measured.

The contrast effect was transient, depending on the rotation frequency. In blood, it appeared at 20,000 rpm (IUmax at 200,000 rpm: 237 IU), in mineral water at 40,000 rpm (IUmax 165 IU), and in distilled water at 80,000 rpm (IUmax 72 IU). Persistence time was measured up to about a half‐minute. Echo contrast production was reduced at 0.5 bar and fully suppressed at 2.5 bar. Debris increased contrast intensity from about 219 IU to 225 IU (at 160,000 rpm). In blood IUmax decreased from 227 IU to 97 IU by lowering the hematocrit from 44.2% to 3.6%. Free hemoglobin increased up to 4,890 mg/L (baseline value 38 mg/L), LDH increased up to 680 U/L (baseline value 100 U/L). Temperature rose only by 1.0°C within 10 s of rotation, whereas an increase up to 7.7°C occurred within 40 s. The observed echocontrast seems to be due to microcavitation, depending on the fluid, frequency, and pressure.
Acute angiographic and clinical outcome of high speed percutaneous rotational atherectomy (rotablator®)
Authors: Dorros Gerald , Iyer Sriram , Zaitoun Rafic , Lewin Ruben , Cooley Ryan , Olson Karen
Published: March 2007

Percutaneous rotational atherectomy (Rotablator®), a high speed (>100,000 RPM) rotational burr, was used successfully in 38 of 43 patients (88%) (mean age: 65 ± 7 years) with 82 lesions (71 stenoses and 11 occlusions). The clinical indications were claudication (84%), nonhealing ulcer (7%), and renovascular hypertension (7%). Rotablation was successful in 78 of 82 lesions (95%): 68 of 71 (96%) stenoses (12 of 12 iliac, 11 of 11 femoral, 7 of 8 popliteal, 36 of 37 tibial, and 2 of 3 renal arteries; 60% of lesions were diffuse, i.e., >/4 cm in length), and 10 of 11 (91%) occlusions (5 of 6 femoral, 1 of 1 popliteal, 3 of 3 tibioperoneal, 1 of 1 brachial artery). The Rotablator significantly (p<0.001) reduced the arterial obstruction (stenoses: 85 ± 11% to 12 ± 12%); occlusions: (100% to 25 ± 10%). The effective final burr size for arteries varied at 3.5–4.5 mm for renal, 3.0–3.5 mm for femmoral, and 2.0–3.0 mm for brachial and tibial. Complications included gross hemoglo‐binuria without sequelae in 27 patients (63%), groin hematoma in 10 (23%), arterial spasm in 10 (23%), and arterial bypass in 2 (5%). The Rotablator® was successfully used, without concomitant conventional balloon angioplasty, to open arterial lesions with excellent angiographic results in both diffuse and segmental peripheral vascular disease. There was gratifying patient clinical improvement.
Cortical blindness after coronary angiography: A rare but reversible complication
Authors: Kinn Robert M. , Breisblatt Warren M.
Published: March 2007

Transient cortical blindness is a recognized complication after vertebral and cerebral angiography but is a rare event after cardiac angiography. The development of cortical blindness appears to be an adverse reaction to the contrast agent which results in an osmotic disruption of the blood‐brain barrier which appears to be selective for the occipital cortex. Patient outcome appears to be generally favorable with return of vision within 24–48 hr. This study describes three patients who had transient cortical blindness after cardiac catheterization and reviews what is known about this unusual problem.
Fatty infiltration: Another restrictive cardiomyopathic pattern
Authors: Dervan John P. , Ilercil Arzu , Kane Philip B. , Anagnostopoulos Constantine
Published: March 2007

Restrictive cardiomyopathies have been shown to occur as result of infiltrative processes from a variety of sources. The current report describes an obese male, who was found to have hemodynamic evidence of a restrictive cardiac process. His pericardium was proven to be normal and an incisional biopsy obtained of the myocardium during coronary artery bypass surgery demonstrated histologic evidence of fatty infiltration of myocardium. Review of the restrictive and pathology literature is discussed and indicates that this is the first report to demonstrate the association between fatty infiltration and hemodynamic findings consistent with a restrictive cardiomyopathy.
Origin of the left main coronary artery from the “non‐coronary” sinus of valsalva
Authors: Cohen David J. , Kim Ducksoo , Baim Donald S.
Published: March 2007

A case is described in which the left main coronary artery arises from the posterior sinus of Valsalva in an otherwise normal heart. This coronary anomaly did not result in any functional obstruction or myocardial ischemia but represents only the third such anomaly described in the English language literature.
Transseptal catheterization in adults: Enhanced efficacy and safety by low‐volume operators using a “non‐standard” technique
Authors: Doorey Andrew J. , Goldenberg Edward M.
Published: March 2007

Transseptal catheterization is often not performed because of concerns about morbidity and mortality. The authors present several refinements of this technique that have allowed a series of cases to be done with minimal morbidity or mortality. This was possible despite limited previous experience in this technique and a relatively low‐volume of cases.
Influence of radiographic contrast media viscosity to flow through coronary angiographic catheters
Authors: Roth Robert , Akin Mustafa , Deligonul Ubeydullah , Kern Morton J.
Published: March 2007

To assess the influence of viscosity on flow resistance, 4 clinically available contrast media were injected through 12 angiographic catheters of varying dimensions at 20° and 37°C. Seven cc of contrast was injected at a pressure of 200 PSI at 3cc/sec by Medrad Mark IV power injector. The pressure of injection through the manifold was recorded with an electronic pressure transducer.

The lowest injection pressure at 37°C occurred with Hexabrix®. Differences in contrast media viscosity were apparent with catheters <6 French diameter. There were minimal differences in injection pressures with regard to the coronary curve tip configurations for any of the contrast agents. At 20°C, Isovue® had lower injection pressures than the other contrast agents. Injection through 5 French catheters demonstrated a >1.5 atmosphere difference, especially between Omnipaque® and Hexabrix®. The difference in contrast media injection pressure was >2 atmospheres between 8 Frenchguidingand 8 Frenchdiagnosticcatheters and between 5 French and 6 French diagnostic catheters and <2 atmospheres between 8 French and 6 French diagnostic catheters. Injection pressure differences >1 atmosphere were not observed for catheters of the same French size at body or room temperature contrast injection.

These data indicate that important temperature related viscosity differences between agents are present and confirm that the largest differences in contrast media are most apparent for the smallest diameter catheters. Given equivalent image opacification and hemodynamic and adverse effects, selection of a low viscosity contrast media theoretically provides an advantage during procedures using small diameter catheters or interventional procedures requiring contrast media visualization through reduced channels.
Heart catheterization in a neonate by interacting magnetic fields: A new and simple method of catheter guidance
Authors: Ram Wolfgang , Meyer Hans
Published: March 2007

Catheter guidance in a critically ill neonate can be difficult and hazardous. A new technique of directing a catheter based on the interaction of magnetic fields is described. A strong external permanent magnet is moved across the body surface to control the magnetic tip of a catheter in the body. We report on the first clinical case of such a heart catheterization in a neonate with complex congenital heart disease. This method can also be used for other invasive investigations in the neonatal period.
Guiding catheter‐assisted renal artery angioplasty
Authors: White Christopher J. , Ramee Stephen R. , Collins Tyrone J. , Dearing Brian , Rees Andrew P. , Granke Kenneth , Hollier Larry H.
Published: March 2007

A guiding catheter was used in seven patients who underwent balloon dilation of nine renal arteries. The advantages of using a guiding catheter for renal angioplasty are analogous to the benefits obtained with a coronary angioplasty guiding catheter used in coronary angioplasty. The guiding catheter provides back‐up support to cross lesions and allows selective contrast visualization of the lesion before, during, and after dilation. It is also possible, when using a guiding catheter, to measure pressure gradients across lesions without having to recross the lesion which may help to ensure that adequate dilation of the stenosis has been accomplished.
Crossing failure in PTCA: Mind the deflated balloon profile!
Authors: Hoorntje Jan C. A. , De Boer Menko Jan , Zijlstra Felix
Published: March 2007

An attempt to reposition an Integra™ PTCA balloon‐on‐a‐wire failed although the whole stenosed segment could be crossed before inflation. After careful removal the device showed a grossly altered shape. Deflated balloon profiles, quite different from the initial shape, can determine the outcome both in dissections and in multilesion cases.
The kissing balloon technique with two over‐the‐wire balloon catheters through a single 8‐french guiding catheter
Authors: Heijer Peter Den , Bernink Peter J. L. M. , Van Dijk René B. , Twisk S. P. M. , Lie Kong I.
Published: March 2007

Some of the newer over‐the‐wire coronary angioplasty catheters have shaft sizes of 3.0 French (F) or less. The inner diameter of modern 8‐F guiding catheters is large enough to accommodate two of such balloon catheters. We report a kissing balloon procedure with two over‐the‐wire catheters through a single 8‐F guiding catheter.
Evaluation of the densitometric method of ejection fraction by direct digital subtraction left ventriculography
Authors: Shiba Kenji , Nanki Michio , Hori Hiroshi , Sakamoto Nobuo
Published: March 2007

The aim of the present study was to test the hypothesis that the densitometric ejection fraction (EF) could be calculated by direct contrast digital subtraction left ventriculography in a single heartbeat. Thirty patients underwent direct contrast digital subtraction left ventriculography and biplane conventional left ventriculography. The values of EF were obtained from digital subtraction ventriculograms of the first cardiac cycle after completion of the injection of the contrast medium by the videodensitometric technique and were compared with those obtained from conventional ventriculograms by the arealength method in the same patients. There was a close correlation between the densitometric EF from digital subtraction ventriculograms and the volumetric EF from conventional ventriculograms (r = 0.78). Densitometric EF measured in the 30° right anterior oblique projection highly correlated with densitometric EF measured in the 60° left anterior projection (r = 0.98). These data suggest that this densitometric technique is available in any projection and is a simple procedure for the accurate measurement of left ventricular EF.
Coronary angioplasty using new 6 french guiding catheters
Authors: Feldman Robert , Glemser Bsn Eric , Kaizer Judy , Standley Mary
Published: March 2007

Coronary angioplasty (PTCA) was performed with specially constructed 6‐French guiding catheters with an internal lumen of 0.051 inches. In 154 patients these guiding catheters were used in a variety of configurations in conjunction with miniature balloon‐on‐a‐wire dilatation catheters in 1.5 to 3.5 mm sizes to perform PTCA.

Overall patient success was 94%. PTCA was attempted in 24 totally occluded arteries with a success rate of 83% and 174 stenoses with a success rate of 97%. 6 French guiding catheters can be used to successfully perform PTCA.