bluuebunny/crossref_metadata_2025 huggingface dataset:
Balloon mitral valvotomy by using the twin‐at catheter: Immediate results and complications in 110 patients
Authors: Berland J. , Rocha P. , Choussat A. , Lefebvre T. , Fernandez F. , Rath P.
Published: March 2007

Balloon mitral valvotomy, using a new Twin AT catheter (two balloons attached side by side over one shaft), was performed in 110 consecutive cases. The age of the patients ranged from 19–78 yr (mean 46 ± 15). From a total of 94 females and 16 males, 23 of the patients (22%) had mitral valve calcification, 47 patients (46%) had atrial fibrillation, and 39 patients (37%) had mitral regurgitation (< +2). Twenty patients (18%) presented with restenosis following surgical commissurotomy. Total catheterization time was 101 ± 26 min and the duration of the valvotomy procedure was 37 ± 21 min in these cases. For the entire population, there was a significant reduction in mitral valve gradient (15 2 6 to 4.8 ± 2.6 mmHg, p < .001), an increase in mitral valve area (MVA) (1.1 ± 0.3 to 2.35 ± 0.7 cm2 ,p < .001), and a decrease in mean pulmonary arterial pressure (31 ± 12 to 26 ± 11, p <.002) after the balloon mitral valvotomy. Sixteen patients (1 4%) developed significant left to right shunt, and in 22 patients (20%) mitral regurgitation increased moderately but without resulting in emergency valve replacement. There was one incidence of embolic episode and one pericardial tamponade. Adequate hemodynamic results (MVA > 1.5 cm2 and % increase in MVA ≥ 50%) without major complications were obtained in 99 cases. In 9 patients with severely diseased valve (2 previous commissurotomy, one restenosis after balloon valvotomy), or small left ventricular cavity, insufficient results were obtained by the Twin‐AT catheter. The Twin‐AT balloon catheter was exchanged for larger 2 balloons combinations in 5 patients and lnoue catheter in 4, and significant improvement in MVA was obtained in 5 cases. Thus, BMV can be safely and effectively performed in most cases with this new Twin‐AT catheter, thereby saving time and cost. © 1993 Wiley‐Liss, Inc.
Cortical blindness after cardiac catheterization: Effect of rechallenge with dye
Authors: Rama Bhola Nath , Pagano Tom Victor , DelCore Michael , Knobel Kevin Robert , Lee Jonathan
Published: March 2007

Transient cortical blindness (CB) is a rare complication of dye usage during cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA) or directed coronary atherectomy (DCA), and is limited to few case reports. In this paper, we are describing three such cases of CB who, upon reexposure to dye during subsequent cardiac catheterization, did not develop CB. To our knowledge, the consequences of reexposure of these patients to dye has not been described in literature. © 1993 Wiley‐Liss, Inc.
Coronary neovascularity: A possible sign of new and growing mural thrombus
Authors: Nakamura Tai , Yamanaka Osamu , Fujiwara Yasumasa , Honda Morihiro , Kanoh Tatsuji , Yamaguchi Hiroshi
Published: March 2007

This is a case report of a coronary artery fistula through a mural thrombus on a left ventricular aneurysm into the left ventricle. Serial coronary arteriography disclosed a vessel exhibiting a “smokelike” appearance originating at the anterior descending artery. This abnormal finding faded away over a period of 10 years with a decrease in size of the mural thrombus. This finding strongly suggests that the abnormal vessel represents an acquired neovascularity related to a newly developed thrombus. © 1993 Wiley‐Liss, Inc.
Successful excimer laser angioplasty following unsuccessful primary balloon angioplasty
Authors: Wolfe Christopher L. , Landin Ronald J. , Linnemeier Thomas J. , Klette Melissa , Hodes Zachary I. , Ball Michael W. , Rothbaum Donald A.
Published: March 2007

We report five patients where excimer laser coronary angioplasty facilitated successful balloon dilatation of heavily calcified lesions that could not be dilated by conventional angioplasty techniques alone. In each case, the lesion was crossed successfully with a guide wire. Conventional angioplasty failed because of inability to cross the lesion with a balloon (four lesions) or inability to dilate the lesion with balloon inflation (two lesions). These cases illustrate an indication for excimer laser coronary angioplasty as an adjunctive procedure in heavily calcified coronary stenoses. © 1993 Wiley‐Liss, Inc.
Is aggressive heparinization necessary for elective ptca?
Authors: Frierson John H. , Dimas Alexios P. , Simpfendorfer Conrad C. , Pearce Gregory , Miller Mike , Franco Irving
Published: March 2007

The optimal level of heparin anticoagulation for elective PTCA is unknown. To determine if PTCA complications are related to the level of anticoagulation, serial ACT values were prospectively measured in 189 patients undergoing 201 elective PTCA procedures. The mean heparin dose before balloon inflation (pre‐inflation) was 10,100 units, and the mean dose per procedure was 13,200 units. The mean pre‐inflation ACT was 295 sec, but was <300 sec in more than 50% of patients. Acute complications were not related to any ACT parameter and the development of new intracoronary thrombus was not observed. In elective PTCA procedures, the routine monitoring of ACT values is unnecessary when standard heparin doses are used. © 1993 Wiley‐Liss, Inc.
Intracoronary blood flow velocity and transstenotic pressure gradient using sensor‐tip pressure and doppler guidewires: A new technology for the assessment of stenosis severity in the catheterization laboratory
Authors: Mario Carlo Di , De Feyter Pim J. , Slager Cornelis J. , De Jaegere Peter , Roelandt Jos R. T. C. , Serruys Patrick W.
Published: March 2007

In a patient undergoing percutaneous balloon angioplasty of a stenotic proximal right coronary artery the transstenotic pressure gradient was measured using a “0.018” guidewire with a distal optical microsensor. Blood flow velocity was measured proximal to the stenosis using a “0.018” Doppler guidewire. Transstenotic pressure gradient and blood flow velocity were measured in baseline conditions and after intracoronary injection of 12.5 mg of papaverine. Coronary blood flow was calculated from the measured blood flow velocity and the corresponding cross‐sectional area. The measured pressure gradients were compared with the values derived from the stenosis geometry assessed with quantitative coronary angiography (automated edge detection measurements in two orthogonal views, assuming an elliptical cross‐sectional area).

The measured transstenotic pressure gradient was 15 mm Hg in baseline conditions and 42 mm Hg at the peak effect of the papaverine injection. A 50% flow velocity increase was observed at peak hyperemia (time‐averaged maximal flow velocity = 30 cm/s before and 45 cm/s after papaverine). The transstenotic pressure gradient calculated from the measured stenosis geometry was 20 mm Hg and 42 mm Hg in baseline and hyperemic conditions, respectively.

The combined use of a pressure and a Doppler guidewire provides a complete assessment of the transstenotic pressure/coronary flow velocity relation at rest and after pharmacologically induced hyperemia and allows the characterization of stenosis hemodynamics and functional severity. © 1993 Wiley‐Liss, Inc.
Epicardial and subselective transcoronary chemical ablation of incessant ventricular tachycardia
Authors: Gursoy Sinan , Nellens Paul , Guiraudon Gerard , Brugada Josep , Brugada Pedro
Published: March 2007

Incessant ventricular tachycardia in patients with severely depressed ventricular function remains a major therapeutic challenge. Although alcohol ablation via the tachycardia related vessel has been shown to be an effective alternative, it might not be applicable in some cases due to anatomic limitations. In three patients with ischemic cardiomyopathy and incessant ventricular tachycardia no effective antiarrhythmic therapy could be found. Alcohol ablation was then attempted but the tachycardia related vessel could not be intubated. A subselective injection of alcohol into a more proximal segment of the coronary artery was then performed in two cases. In one patient as subselective injection was also not possible, the injection was performed epicardially after thoracotomy. Ablation was successful in all cases. In very selected cases of incessant ventricular tachycardia that have failed all other therapeutic interventions, alcohol ablation of the tachycardia can be performed using an epicardial or subselective transcoronary injection of alcohol. © 1993 Wiley‐Liss, Inc.
Percutaneous retrieval of a deformed guidewire by a modified snaring technique
Authors: Roy Sumit , Phadke R. V. , Kumar Sunil , Rastogi Harsh , Baijal S. S.
Published: March 2007

An attempt to percutaneously remove a guidewire from the inferior vena cava was hampered by kinks developing in the wire during snaring. A modified technique was adopted that permitted its retrieval, obviating the need for a formal venotomy. © 1993 Wiley‐Liss, Inc.
Percutaneous balloon angioplasty for early postoperative modified blalock‐taussig shunt failure
Authors: Ormiston John A. , Neutze John M. , Calder A. Louise , Hak Nien‐Shen Chan Wah
Published: March 2007

Percutaneous balloon angioplasty was successful initial treatment for 2 infants who, early after operation, developed obstruction at the proximal anastomotic site of a modified Blalock‐Taussig shunt. Two years later the first child had not required reoperation and the dilatation site was patent angiographically. The other baby progressed well after angioplasty but because of surgical concern about the long‐term success of angioplasty, shunt surgery was repeated, the baby dying after reoperation.

Angioplasty of proximal obstruction in these shunts is feasible and satisfactory longterm palliation can be achieved avoiding repeat shunt surgery before the more definitive Fontan‐type procedure. © 1993 Wiley‐Liss, Inc.
Use of half of the palmaz‐schatz stent in a stent‐related dissection
Authors: Hadjimiltiades Stavros , Gourassas John , Louridas George , Tsifodimos Dimitrios
Published: March 2007

The placement of a Palmaz‐Schatz stent may be associated with the development of a dissection and this may increase the danger of coronary thrombosis. In this case report we describe the use of half of the Palmaz‐Schatz stent to cover such a dissection. The use of the half stent, by reducing the amount of metal and stent overlapping, may reduce the incidence of thrombosis and restenosis. © 1993 Wiley‐Liss, Inc.
Coronary artery aneurysms: An unusual case report and a review of the literature
Authors: Barettella Mark B. , Bott‐Silverman Corinne
Published: March 2007

© 1993 Wiley‐Liss, Inc.

Coronary artery aneurysms (CAA) were first recognized in postmortem studies. More recently they have been recognized in antemortem and angiographic studies and are reported to occur at an incidence of 1‐2%. Left main coronary aneurysms (LMCA) are extremely rare with an incidence of 0.1%. Most of the aneurysms discovered in these angiographic studies have been in patients with cardiac symptoms of angina or acute myocardial infarction who subsequently were found to have severe narrowing of the coronary arteries. Angiographic and clinical data of a patient with a large aneurysm of the left main coronary artery and with aneurysmal disease of the thoracic and abdominal aorta are presented along with a review of the literature. © 1993 Wiley‐Liss, Inc.
Successful directional atherectomy of eccentric renal artery stenosis using the simpson directional coronary atherocath as a primary therapy
Authors: Kushner Frederick G. , Helm Michael J.
Published: March 2007

A 67‐yr‐old female patient with accelerated hypertension, severe peripheral vascular disease, diabetes mellitus, and coronary artery disease had an abnormal renal scan, renal angiogram, and renal vein renin determination with lateralization to the left kidney. Angiography demonstrated a very tight, eccentric plaque obstructing the left renal artery of approximately 99%. Because of the anatomy of the plaque, balloon dilatation was deemed inadvisable. Subsequently, a Simpson 7F graft DCA atherocath through a four‐curved 10F right bypass graft guiding catheter was used to successfully debulk the left renal artery. After debulking, the artery was dilated with a 5 mm Meditech balloon on a wire through a Cobra guiding catheter. The patient's blood pressure responded immediately and there were no complications. A large amount of atherosclerotic plaque was removed from the renal artery. © 1993 Wiley‐Liss, Inc.
Aortic dissection with aortopulmonary artery fistula
Authors: Tate David A. , Parker L. Alden , Starek Peter J. K. , Harper James R.
Published: March 2007

A case of aortic dissection complicated by aortopulmonary artery fistula is reported. Aggressive diagnostic and surgical management was associated with a favorable, longterm outcome. © 1993 Wiley‐Liss, Inc.
Effect of percutaneous balloon mitral valvuloplasty on serum creatinine phosphokinase MB‐isoenzyme levels
Authors: Yip Alex S. B. , Chow W. H. , Fu K. H. , Cheung K. L. , Li J. P. S. , Lee J. S. K.
Published: March 2007

Twenty‐one patients with moderate to severe mitral stenosis were treated with percutaneous balloon mitral valvuloplasty (PBMV) using lnoue mitral double‐lumen balloon catheters. Creatinine phosphokinase MB isoenzyme (CPK‐MB) levels were measured at baseline, 5 min, 6 h, and 18 h post dilatation. Haemodynamic indexes, 12‐lead ECGs, and 2‐dimensional echocardiograms were performed to evaluate systolic function postprocedure. CPK‐MB levels were modestly increased at 5 min and at 6 h postprocedure compared with the baseline level (p < 0.001) but were still within the normal reference range, except for one patient who had a level at 5 min minimally above the upper limit of normal. CPK‐MB levels were not significantly increased at 18 h after the procedure. No significant changes in ejection fractions, 12‐lead ECGs, and regional wall motion occurred in any of the patients studied. In conclusion, PBMV causes modest early elevation of CPK‐MB. This elevation is not associated with changes in LV systolic function and does not interfere with the diagnosis of acute myocardial infarction using the enzyme elevation criteria. © 1993 Wiley‐Liss, Inc.
Resistance of the atherosclerotic plaque during coronary angioplasty: A multivariate analysis of clinical and angiographic variables
Authors: Chenu Patrick , Zakhia Raymond , Marchandise Baudouin , Jamart Jacques , Michel Xavier , Schroeder Erwin
Published: March 2007

The atherosclerotic lesion resistance to balloon inflation was assessed prospectively in 200 patients undergoing primary single‐site balloon percutaneous transluminal coronary angioplasty (PTCA) by using an identical inflation protocol. This resistance was evaluated by the stenosis resolution pressure, which is the pressure at which the lesion mark is no longer visible on the inflated balloon. The stenosis resolution pressure distribution was normal with a mean value of 4.4±2.3 atmospheres.

Multivariate analysis revealed 4 factors related to the stenosis resolution pressure: stable angina pectoris (p < 10−6), the presence of calcifications (p = 0.016), the occurrence of vessel wall dissection after balloon angioplasty (p = 0.005), and the absence of a branch arising in the middle of the stenosis (p = 0.047).

It is concluded that the mechanical resistance of the coronary lesion is related to the anginal status, the presence of calcifications, and the occurrence of vessel wall dissection after balloon angioplasty, probably on the basis of the plaque composition. © 1993 Wiley‐Liss, Inc.
New techniques for guiding catheter management during directional coronary atherectomy
Authors: McLvor Michael E. , Rosenthal Andrew D. , Lawson Jan
Published: March 2007

Directional coronary atherectomy (DCA) is an important advance in the mechanical revascularization of stenotic coronary arteries. The bulky nature of the DCA device has necessitated the use of guiding catheter designs that are more cumbersome to use than balloon angioplasty guiding catheters. Because engagement of coronary artery ostia with the currently available DCA guiding catheters is often difficult and because DCA guiding catheters significantly “relax” and reshape during the atherectomy procedure, angiography using these guiding catheters before and after atherectomy can be suboptimal. A new technique for angiography during atherectomy using long Judkin's diagnostic catheters inserted through the existing DCA guiding catheters is described. This technique can be used for optimal visualization of the coronary arteries with minimal use of contrast before and after sessions of atherectomy and also can be used to help engage the DCA guiding catheters. Some improvements in the design of guiding catheters for DCA are suggested. © 1993 Wiley‐Liss, Inc.
Left ventricular rupture following myocardial infarction treated with streptokinase: Successful resuscitation in the cardiac catheterization laboratory using pericardiocentesis and autotransfusion
Authors: Proli Joseph , Laufer Nathan
Published: March 2007

An 80‐year‐old female developed left ventricular rupture in the cardiac catheterization laboratory following myocardial infarction treated with streptokinase. The patient was resuscitated using pericardiocentesis and autotransfusion. This technique and the predisposing factors for left ventricular rupture are discussed. © 1993 Wiley‐Liss, Inc.
Cardiac catheterization and coronary angiography using 5 french preformed (Judkins) catheters from the percutaneous right brachial approach: A comparative analysis with the femoral approach
Authors: Bush Charles A. , Vanfossen Douglas B. , Kolibash Albert J. , Magorien Raymond D. , Bacon James P. , Ansel Gary M. , Eaton Gregory M. , Ramancik Mary Jo , Orsini Anthony R. , Palmer Sammie L.
Published: March 2007

This study describes a method for the performance of cardiac catheterization using 5 French preformed Judkins catheters from a percutaneous right brachial approach, and compares that technique to the more traditional percutaneous right femoral approach with 6 French catheters. One hundred consecutive patients requiring diagnostic left heart catheterization and selective coronary angiography were randomized according to femoral versus brachial arterial technique. Procedural efficiency, radiation exposure, and diagnostic film quality favored the femoral approach, while patient comfort, hemostasis time, time to ambulation, and decreased need for post‐procedure nursing care favored the brachial approach. No differences were identified in complications.

Cardiac catheterization from a right brachial artery percutaneous approach with 5 French preformed catheters has both advantages and disadvantages when compared with a more traditional femoral approach with 6 French catheters. Multiple factors should be considered before selecting an approach to diagnostic cardiac catheterization and each patient should be individually evaluated for determination of the optimal technique. © 1993 Wiley‐Liss, Inc.
Transcatheter occlusion of the patent ductus arteriosus in the presence of mild isthmal hypoplasia
Authors: Nykanen David G. , Hayes Alison M. , Benson Lee N. , Freedom Robert M.
Published: March 2007

Between January 1990 and February 1992, 5 asymptomatic patients were identified with hypoplasia of the aortic isthmus at the time of cardiac catheterization for closure of a small patent ductus arteriosus. Isthmal diameters measured from lateral aortograms were 62 ± 11% of age‐matched controls. All patients had a small communication occluded with a 12 mm device and remained asymptomatic at 6–30 months follow up. Residual shunting was demonstrated by color Doppler in 2 patients. No child has developed an arm‐leg systolic blood pressure gradient or systemic hypertension. Following device placement, Doppler interrogation across the isthmus in 2 patients demonstrated a velocity shift of 2.1 m/s. Transcatheter occlusion of the patent ductus arteriosus associated with mild isthmal hypoplasia of the aortic arch appears safe and effective and does not result in a clinically significant impairment to isthmal flow in short‐term follow‐up. © 1993 Wiley‐Liss, Inc.
Balloon rupture during peripheral stent implantation: A new technique for balloon retrieval
Authors: Bersin Robert M. , Gold Richard S.
Published: March 2007

Balloon rupture is a known technical problem with implantation of vascular stents. In most cases, the ruptured balloon can be retrieved with simple maneuvers. In this case report, a peripheral balloon became trapped within an undeployed peripheral vascular stent and could not be removed by application of standard maneuvers. A novel approach to balloon retrieval was devised and undertaken with success. © 1993 Wiley‐Liss, Inc.
Successful aortic balloon valvuloplasty in critical aortic stenosis with shock
Authors: Bhatia Atul , Kumar Anil , Seth Ashok , Bhatia M. L. , Trehan Naresh
Published: March 2007

Emergency balloon valvuloplasty was performed in a 42 year old male with critical aortic stenosis, severe congestive heart failure, and shock. Hemodynamic and clinical improvement occurred and he underwent elective aortic valve replacement. Balloon aortic valvuloplasty may provide a “bridge” to aortic valve replacement in patients with critical aortic stenosis and shock. © 1993 Wiley‐Liss, Inc.
Quantitative demonstration of dipyridamole‐induced coronary steal and alteration by angioplasty in man: Analysis by simultaneous, continuous dual doppler spectral flow velocity
Authors: Kern Morton J. , Wolford Thomas , Donohue Thomas J. , Bach Richard G. , Aguirre Frank V. , Caracciolo Eugene A. , Flynn Michael S.
Published: March 2007

In the course of studying the effects of coronary angioplasty on branch vessel flow using two Doppler flow velocity guidewires, we quantitated simultaneous blood flow responses proximal and distal to a stenosis. The alterations of flow documented a horizontal epicardial steal induced during dipyridamole hyperemia, hyperemic flow reversal by intravenous aminophylline, and subsequent normalization of distal hyperemia after endoluminal enlargement by successful angioplasty. The quantitative physiology of the patient described here confirms one postulated mechanism of abnormal myocardial perfusion stress scintigraphy. Continuous dual flowire spectral coronary flow determinations appear to be a valuable method in verifying postulated mechanisms of various pharmacologic and mechanical stimuli influencing coronary blood flow in patients with atherosclerotic coronary artery disease. © 1993 Wiley‐Liss, Inc.
Radiation exposure: Comparison of rapid exchange and conventional over‐the‐wire coronary angioplasty systems
Authors: Linnemeier Thomas J. , McCallister Scott H. , Lips Daniel L. , Klette Melissa A. , Rothbaum Donald A. , Ball Michael W. , Landin Ronald J. , Hodes Zachary I. , Riddell Robert V.
Published: March 2007

The growth of coronary angioplasty has resulted in increased fluoroscopy time to patients, staff, and physicians. Rapid exchange‐type catheters have purported to reduce fluoroscopy time and procedure time compared to conventional over‐the‐wire systems. Of 150 consecutive patients, 54 were treated solely with rapid‐exchange catheters and 84 were treated solely with over‐the‐wire catheters. Excluding 12 cases treated with fixed wire or combination catheters, the following data were found:
magnified image

Overall procedural success was obtained in 98.5% (136/138) of patients, 1.5% (2) requiring emergency coronary artery bypass graft surgery. A significant 35% reduction in fluoroscopy time and 13% reduction in procedure time were found when rapid‐exchange catheters were used, with identical success rates, number of balloons used per case, and complication rates compared to over‐the‐wire catheters. Rapid‐exchange catheters should be considered as part of an overall effort to reduce radiation exposure in the interventional cardiology laboratory.
Simplified method for calculating aortic valve resistance: Correlation with valve area and standard formula
Authors: Kegel Jeffrey G. , Schalet Bennett D. , Corin William J. , Iskandrian Abdulmassih S.
Published: March 2007

Aortic valve resistance (AVR) is a useful index to assess the severity of aortic stenosis. This study compared the standard method to calculate AVR with a simplified method based on the conventional approach for measuring vascular resistance: AVR = (peak‐to‐peak transaortic pressure gradient/(cardiac output*2.5))*80, where 80 is a conversion factor and 2.5 assumes that the systolic ejection period comprises 40% of the R‐R cycle. We compared the standard AVR, the simplified AVR, and the Gorlin‐derived value area in 118 patients with pure or dominant aortic stenosis. There was a strong linear correlation between the standard and simplified AVR (r = 0.96, p < .0001). There was a curvilinear relation between the aortic valve area and AVR (r = 0.92, p < .001). In 48 patients with aortic valve area ≥0.7 cm2, the AVR was <300 dynes‐sec‐cm−5 in 45 patients (94%) by the standard method and in 42 patients (88%) by the simplified method (p = NS). In conclusion, our method for measuring AVR is accurate and simpler than the standard method.© 1993 Wiiey‐Liss, Inc.
Fragmentation and embolization of a plastic‐coated guidewire
Authors: Prewitt Kerry C. , Resar Jon R. , Brinker Jeffrey A.
Published: March 2007

We report a case of fragmentation and embolization to the pulmonary artery of sheared pieces of a recently introduced hydrophilic plastic‐coated guidewire. The propensity for this to occur, the lack of initial recognition, and the ability to retrieve the fragments by catheter techniques are emphasized. As these guidewires are more frequently used, physicians should be aware of this potential complication. © 1993 Wiiey‐Liss, Inc.
Percutaneous transvenous mitral commissurotomy in patients with severe kyphoscoliosis
Authors: Ramasamy Dewi , Zambahari Robaayah , Fu Morgan , Yeh Kou‐Ho , Hung Jui‐Sung
Published: March 2007

Because transseptal catheterization is felt to be contraindicated in patients with severe kyphoscoliosis, there have been no reports of percutaneous transvenous mitral commissurotomy performed in such patients. This report describes percutaneous transvenous mitral commissurotomy in three patients with severe thoracic kyphoscoliosis, with special emphasis on the transseptal puncture technique. Biplane right atrial angiography and the contrast septal flush method are very useful in landmark selection for a safe transseptal puncture. © 1993 Wiiey‐Liss, Inc.
Evaluation of two oximeters for use in cardiac catheterization laboratories
Authors: Freeman Gregory L. , Steinke John M.
Published: March 2007

We evaluated two whole‐blood oximeters designed for use in the cardiac catheterization laboratory: the Oxicom 3000 and the AVOXimeter 1000. Unlike the larger CO‐Oximeters, which hemolyze a blood sample before analysis, these simple instruments use disposable cuvettes to allow determination of oxyhemoglobin saturation of whole blood. Thus they eliminate the need for cleaning solutions and considerable maintenance. We evaluated the accuracy of these instruments in comparison with a Radiometer OSM3 and found them both to work well on routine samples. Of note, the AVOXimeter performed better than the Oxicom when the sample was hemolyzed and when green dye was present. In addition, the AVOXimeter measures the total hemoglobin concentration and the oxygen content of each sample, eliminating errors that hemodilution introduces into the determination of cardiac output by the Fick principle. We conclude that whole‐blood oximeters are accurate and useful instruments for use in the cardiac catheterization laboratory. © 1993 Wiiey‐Liss, Inc.
Brachial approach directional coronary atherectomy of a left coronary artery saphenous vein bypass graft
Authors: Feldman Robert L. , Urban Paul L.
Published: March 2007

Directional coronary atherectomy (DCA) of a saphenous vein bypass graft to the left coronary artery was performed percutaneously from the brachial artery approach using a 7F endomyocardial biopsy sheath. Initial positioning was accomplished with a left bypass graft catheter inserted in the sheath. This technique permits use of smaller catheters than usual for DCA in patients in whom larger guides cannot be used. © 1993 Wiiey‐Liss, Inc.
Percutaneous rotational thrombectomy reduces acute reocclusion in an animal model of acute coronary thrombosis
Authors: Dewhurst Timothy A. , Bruneau Rodney , Titus Bradley , Clement Thomas J. , Auth David A. , Ritchie James L.
Published: March 2007

This study was designed to compare acute reocclusion rates after treatment of acute coronary thrombosis with a percutaneous thrombectomy device or standard balloon angioplasty. Our group has previously reported on the rationale and development of a mechanical device for the treatment of intra‐arterial thrombosis. This device removes fibrin from thrombus, allowing for dissolution of the cellular elements of the thrombus. Theoretically, thrombus removal (as opposed to displacement) might result in a lower rate of acute rethrombosis. The present study utilizes the device percutaneously in the coronary arteries of closed chest swine and compares recanalization and reocclusion rates with standard balloon angioplasty. Twenty‐six animals with total thrombotic coronary occlusions were treated; 13 with each device. Reocclusion rates with the thrombectomy device were significantly reduced at 60 min and 120 min after recanalization (p < 0.02), and the mean time to reocclusion was prolonged by 45 min (p = 0.07). Technical problems included poor handling characteristics in early prototypes and stress fractures secondary to improper use. Changes in catheter design and operator protocols have largely eliminated these problems. We conclude that this study demonstrates the feasibility of percutaneous mechanical thrombectomy in the coronary arteries and that reocclusion rates after recanalization of thrombotic occlusions compare favorably to standard angioplasty. © 1993 Wiiey‐Liss, Inc.
Ventricular free wall and septal rupture (double rupture): A “pseudocomplication” during post‐infarction laser angioplasty
Authors: Reiner Jonathan S. , Lundergan Conor F. , Tenner Monica P. , Abraham A. Andrew , Ross Allan M.
Published: March 2007

We report the rare occurrence of double rupture of the myocardium occurring immediately following successful laser recanalization of an occluded right coronary artery in a 72‐year‐old woman 5 days following infero‐posterior myocardial infarction. © 1993 Wiiey‐Liss, Inc.
Transcoronary cardiac pacing during myocardial ischemia
Authors: Laird MAJ. John R. , Hull MAJ. Robert , Stajduhar MAJ. Karl C. , Weston MAJ. Lawrence T. , Kufs MAJ. William , Wortham Dale C.
Published: March 2007

Severe bradyarrhythmias are a rare but potentially life threatening complication of percutaneous transluminal coronary angioplasty (PTCA). Previous work has outlined a technique for coronary pacing using the angioplasty guidewire. To examine the effectiveness of this technique during severe ischemia, seven swine underwent placement of an unmodified 0.014 inch angioplasty guidewire and 3.0 mm balloon catheter in the left anterior descending (LAD) artery. Baseline pacing thresholds were obtained. Pacing was begun at twice diastolic threshold and ischemia was produced by balloon inflation. Repeat capture thresholds were obtained after 1 and 8 minutes of ischemia. Transcoronary pacing was successfully performed in all seven animals and was continued for a mean of 13.8 1.5 minutes. The baseline capture threshold was 4.0 0.5 mA. The mean capture threshold was 3.3 0.3 mA and 4.5 0.9 mA at 1 and 8 minutes of ischemia, respectively. We conclude that transcoronary pacing using the angioplasty guidewire can be successfully performed during myocardial ischemia and may serve as a reliable backup system during interventional procedures complicated by bradyarrhythmias. © 1993 Wiiey‐Liss, Inc.
Multivariable model for prediction of risk of significant complication during diagnostic cardiac catheterization
Authors: Laskey Warren , Boyle John , Johnson Lewis W.
Published: March 2007

Although adequate data exist on the frequency of procedural‐related complications during diagnostic cardiac catheterization, little information is available for the quantitative assessment of risk factors for significant complication. We analyzed 58,332 procedures in the 1990 SCA&I Registry Database in order to assess (1) the independent and cumulative significance of easily obtainable pre‐procedural factors predictive of major complication and (2) the likelihood of a significant complication given the presence of these risk factors. A model was developed on a random sample of 38,888 patients and validated in the remaining 19,444 patients. Twelve variables were identified as having independent predictive behavior for significant complication with excellent agreement in the validation sample. The current model is an accurate and reliable instrument for stratifying risk of a significant complication during diagnostic catheterization.© 1992 Wlley‐Liss, Inc
Aneurysm of the left main coronary artery without obstructive disease: report of a case presenting with severe unstable angina and treated with systemic thrombolysis
Authors: Vecchia Luigi La , Bedogni Francesco , Ometto Renato , Mosele Gian Marco , Vincenzi Mario
Published: March 2007

A fusiform aneurysm of the left main coronary artery without associated obstructive disease was detected in a 77‐year‐old patient with severe unstable angina treated with systemic thrombolysis. The authors emphasize the following features: (1) unusual location of the aneurysm, (2) absence of concomitant obstruction in this age group, and (3) clinical efficacy of thrombolysis and subsequent long‐term oral anticoagulation.© 1993 Wlley‐Liss, Inc
“Kissing” stents for bifurcational coronary lesion
Authors: Colombo Antonio , Gaglione Antonio , Nakamura Shigeru , Finci Leo
Published: March 2007

The coronary stents implantation into each vessel of a bifurcational lesion (“kissing” stents) in two patients is reported. The first patient had two short “kissing” stents implanted in an ostial lesion of the left anterior descending and the intermediate branch. The second patient had successful “kissing” stents implantation in the bifurcational lesion of the left main coronary artery.© 1993 Wlley‐Liss, Inc
Miniaturized pressure‐guide‐wire: evaluation in vitro and in isolated hearts
Authors: Görge Günter , Erbel Raimund , Nießing Stephanie , Schön Frank , Kearney Peter , Meyer JÜRgen
Published: March 2007

The present study focused on the accuracy and reproducability of measurements performed with a miniaturized pressure guidewire system (PGWS) under standardized in vitro conditions and in an isolated pig heart model. We used a pressure guide wire system provided by Pressure Guide™, Radi Medical Systems, Uppsala, Sweden. Pressures were recorded by a fiber optic pressure sensor located laterally and 3 cm from the distal end. The basic principle is that the element modulates an optical reflection by pressure induced elastic movements. The light source is an emitting diode in the control unit. The PGWS replaces a standard 0.018 in. guidewire. The PGWS was introduced through a Y‐adapter in a recirculating perfusion model, consisting of tubing with internal diameters from 1.00 to 4.00 mm. Different perfusion pressures (range 20–140 mm Hg) were generated by a pressure controlled roller pump.

Results: Different lumen sizes from 1 to 4 mm had no influence on the measurements. (a) In a range from 20 to 140 mm Hg no significant differences were found between the perfusion pressure and the pressures obtained by the PGWS, resulting in an r‐value of 0.99 and an equation of y = 1.04x + 1.9. (b) In pressure measurements proximal and distal of an artificial stenoses resulting in gradients from 0 to 100 mm Hg, the PGWS correctly identified the pressure difference with an equally high accuracy, 1,2, and 3 cm behind the stenoses. The equation was y = 1.06x + 5, with an r‐value of 0.97. (c) If the PGWS was introduced in curved segments of the phantoms, differences were found that correlated with the diameter of the bend and the angulation. If the transducer element was positioned in the convexity of the tubing, pressures were higher than the perfusion pressure. They were lower when if the pressure element was moved towards the concave part of the tubing. At a perfusion pressure of 100 mm Hg, a diameter of 2 cm and an angulation of 45°, no significant difference was found; but an angulation of 160° in the same phantom caused a difference of ± 45 mm Hg. (d) In isolated swine hearts (n = 6), the correlation of aortic perfusion pressure with the PGWS values (proximal LAD) was y = 1.02x + 3, r = 0.92. In the most bended part of the left circumflex artery, the maximal mean pressure difference was ± 28 mm Hg at a perfusion pressure of 100 mm Hg, depending on the position of the catheter.

Conclusion: The PGWS has the potential to accurately determine pressures within coronary arteries, if measurements within bends of > 45° are avoided.© 1993 Wlley‐Liss, Inc
Comparison of a low osmolarity nonionic radiographic contrast agent with a standard medium on renal function in cyanotic and normal dogs
Authors: Pridjian Ara K. , Bove Edward L. , Beekman Robert H. , Lupinetti Flavian M.
Published: March 2007

Renal dysfunction may follow administration of iodinated radiographic contrast agents. This complication may be less common when low osmolarity nonionic agents are used. Although potential benefits from the use of low osmolarity nonionic contrast may be minimal in individuals with normal physiology, a greater benefit has been postulated in the presence of chronic cyanosis. To test this hypothesis, six adult mongrel dogs underwent anastomosis of the inferior vena cava to the left atrium. This produced chronic cyanosis with a mean pO2 of 48 ± 4 mm Hg and polycythemia with a mean hematocrit of 56 ± 2 gm%. Three to 5 months after preparation, these cyanotic dogs and five control dogs each received diatrizoate (a high osmolarity ionic agent) or ioversol (a low osmolarity nonionic agent), 465 mg iodine/kg body weight, by intravenous bolus injection. One month later, each animal received the other agent. The order of administration was randomized. Renal function studies, including serum creatinine and creatinine clearance, were performed precontrast, after 60 min, and 24 hr postcontrast. Neither agent adversely affected renal function in either the cyanotic or the normal group. We conclude that at the doses that are commonly used in clinical practice, high osmolarity ionic contrast agents do not create a greater risk of renal injuiry than do low osmolarity nonionic agents in this model of cyanosis.
Coronary thrombus: A novel catheter‐based approach to treatment
Authors: Gershony Gary , Glass Pete R.
Published: March 2007

The presence of coronary thrombus during intracoronary interventions increases the risk of complications during the procedure. We describe a novel approach to infusing thrombolytic agents selectively into a coronary artery utilizing a new low‐profile perfusion balloon. This approach may add a useful new treatment for resistant intracoronary thrombi.
High‐Frequency rotational ablation following failed percutaneous transluminal coronary angioplasty
Authors: Dietz Ulrich , Erbel Raimund , Rupprecht Hans‐Jürgen , Weidmann Stephan , Meyer Jürgen
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) failed in 29 of 1,150 patients (2.5%) after successful passage of the guide wire. The reasons for failure were inability to pass the lesion with a balloon in 28 patients and inability to dilate the lesion in 1 patient. In these patients (15 stenoses and 14 chronic occlusions) rotational ablation was performed. We were able to pass the burr through the lesion in all of them, resulting in a reduction of diameter stenosis from 87 ± 15 to 51 ± 18%. Rotational ablation alone was initially successful (stenoses reduction >20% and residual stenoses <50%) in 15 of 29 (52%) patients. Additional PTCA was performed in 21 of 29 (72%) patients, in 8 to optimize the initially successful result and in 13 because the outcome was unsatisfactory. After dilatation the diameter stenosis was reduced to 41 ± 14% immediately after the procedure and to 36 ± 13% at 24 hr control. Overall success was achieved in 21 of 29 (72%) patients immediately after the procedure and in 26 of 29 (90%) patients at 24 hr control. No acute major complications occurred. We conclude that rotational ablation can be used as a safe and effective alternative when PTCA is not successful.
Acute results and long‐term outcome of transluminal extraction catheter atherectomy for saphenous vein graft stenoses
Authors: Twidale Nicholas , Barth Charles W. , Kipperman Robert M. , Bowles Mark H. , Galichia Joseph P.
Published: March 2007

Distal embolization of atheroma and thrombus is a major concern when performing balloon angioplasty in coronary saphenous vein grafts (SVGs). The transluminal extraction catheter (TEC) is designed to remove this material and may improve the safety of percutaneous treatment of SVG disease. We assessed the acute results and long‐term outcome of 67 patients (mean age 65.6 ± 8.1 years; range 47–83 years) who underwent 73 separate TEC atherectomy procedures. Eighty‐eight SVG lesions were treated (mean age 8.7 ± 3.8 years from bypass surgery). Procedural success (< 50% final diameter stenosis and absence of major complications) was obtained in 63 patients (86%). Adjunctive balloon angioplasty and/or directional coronary atherectomy was required in 69 of the procedures (95%). Major complications, occurring in 8 patients (ll%), were acute closure in 4 (5%), resulting in Q‐wave myocardial infarction in 3 and urgent bypass surgery in 1, and distal embolization in 4 (5%; 1 associated with Q‐wave myocardial infarction). Angiographic follow‐up was available for 50 patients and restenosis was present in 26 (52%). These data suggest TEC atherectomy can be performed in SVGs with an acceptable procedural risk, but restenosis remains a significant limitation which will require other strategies to overcome. o 1994 Wiley‐Liss, Inc.
Resection of guide catheter fragments during coronary atherectomy in aorto‐ostial lesions: A note of caution
Authors: Bauriedel Gerhard , Höfling Berthold
Published: March 2007

Angioplasty of coronary aorto‐ostial lesions is considered to be troublesome with decreased acute and long‐term results and high complication rates. We report a patient with an ostial right coronary artery lesion which was treated after failed PTCA with directional atherectomy as a rescue intervention. After a favorable angiographic and clinical outcome, plastic material was found in the AtheroCath's housing due to resection of the tip of the guide catheter.
Ergot induced peripheral vascular insufficiency, non‐interventional treatment
Authors: McKiernan T. L. , Bock K. , Leya F. , Grassman E. , Lewis B. , Johnson S. A. , Scanlon P. J.
Published: March 2007

We report a case of ergotamine tartrate induced severe vasospasm in the renal arteries and the arteries of the lower extremities. Classic features seen on peripheral angiography make the diagnosis. Anticoagulation, thrombolysis, vasodilation, steroids, and prostaglandin inhibitors all have been successfully used to treat symptomatic ergot induced arterial vasospasm. Although balloon angioplasty of ergot induced vasospasm has been described in case reports, ergot vasospasm is a self limited and medically treatable condition that does not require peripheral mechanical intervention, unless the immediate threat of necrosis and gangrene exists.
Alternative approaches to right ventricular endomyocardial biopsy
Authors: Corley David D. , Strickman Neil
Published: March 2007

Cardiologists are performing endomyocardial biopsy procedures with increasing frequency, particularly in patients who have undergone cardiac transplantation. Because of the necessity for performing multiple biopsies in many of these patients and the subsequent complications that may arise, we have developed a simple and efficient technique for obtaining endomyocardial biopsy samples. As an alternative to retrieving biopsy samples by the conventional right internal jugular or femoral venous approach, we use the right or left internal jugular or subclavian approach. The procedure utilizes a 7 Fr 35 cm sheath and dilator system placed into the right ventricle over a balloon‐tipped catheter. After the sheath is positioned via either the internal jugular or subclavian vein, multiple samples can be obtained with standard available bioptomes. The sheath may then be exchanged for a triple‐lumen catheter if desired. This approach permits routine changing of the central venous access lines within the sterile confines of the catheterization laboratory, with minimal discomfort to patients. We believe that this method represents an important alternative to conventional biopsy techniques.
Success, complications, and restenosis following rotational and transluminal extraction atherectomy of ostial stenoses
Authors: Koller Patrick T. , Freed Mark , Grines Cindy L. , O'Neill William W.
Published: March 2007

Our objectives were to determine procedural success, clinical complications, and follow‐up restenosis rates after rotational burr and transluminal extraction atherectomy of coronary artery and saphenous vein graft ostial stenoses. Balloon angioplasty of ostial lesions has been associated with low rates of success and high rates of clinical complications and restenosis compared to nonostial lesions. Atherectomy, due to its ability to excise (extraction atherectomy) or pulverize (rotational atherectomy) atheroma and the internal elastic lamina, may result in improved procedural outcome.

We retrospectively studied 101 patients with ostial stenoses treated by rotational burr and transluminal extraction atherectomy over a 3‐yr period. Quantitative angiography and clinical follow‐up were reviewed to determine success, complication, and restenosis rates. Rotational burr (n = 29) and transluminal extraction (n = 72) atherectomy were associated with high procedural success (93% and 90%, respectively) and a low incidence of complications (6.9% and 4.2%, respectively). Postatherectomy angiographic success was low (52% and 69%, respectively) and required adjunctive balloon angioplasty in 85% of patients overall. This lower success rate likely reflects device undersizing as the overall postatherectomy artery to device ratio was near unity (0.95). The rates of angiographic ostial restenosis remain high (39.1% and 65.9%, respectively, P < 0.05). The high rate of restenosis after transluminal extraction atherectomy was due to the higher rate of restenosis in saphenous vein grafts (80%) compared to TEC treated coronary arteries (59%). When only coronary artery lesions were compared, there was no significant difference between atherectomy device groups with respect to restenosis rates or late loss. Rotational or transluminal extraction atherectomy of ostial stenoses is associated with high procedural success rates and a low incidence of complications; however, the rates of restenosis in these lesions remain high.
Directional coronary atherectomy can be successfully performed in the elderly
Authors: Movsowitz Herman D. , Manginas Athanassios , Emmi Ronald P. , Bruss Jeffrey , Kothapali Sri , Wells Elizabeth , Ledley Gary S. , Kotler Morris N. , Nakhjavan Fred K. , Yazdanfar Shahriar
Published: March 2007

The influence of age on the clinical and angiographic outcome of directional coronary atherectomy is evaluated. Results demonstrate that DCA can be performed successfully in the vast majority (78.7–90%) of patients in all age groups. However, there is a non‐statistical trend toward decreased success rates in the elderly (P > .05). Major ischemic complications and groin complications tend to be more common in the elderly (P > .05). Blood transfusions are required significantly more often in the elderly (P < .05). Directional coronary atherectomy is a useful method of coronary artery revascularization in all age groups, including the elderly.