bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of pulmonary artery pressure from pulmonary vein wedge pressure
Authors: Chern Ming‐Shyan , Yeh San‐Jou , Lin Fun‐Chung , Wu Delon , Hung Jui‐Sung
Published: March 2007

Correlations between pulmonary artery and pulmonary vein wedge pressures were investigated in 13 patients with atrial septal defect and 1 patient with Tetralogy of Fallot. Pulmonary vein wedge pressure wave form resembled that of pulmonary artery pressure, and the former lagged behind the latter by 70 to 110 msec (mean 88 ± 14) as observed by the fluid‐filled catheter system. Diastolic pulmonary artery and diastolic pulmonary vein wedge pressures were nearly identical. Although systolic and mean pulmonary artery pressures correlated well with respective pulmonary vein wedge pressures, there were discrepancies when systolic and mean pulmonary artery pressure exceeded 35 and 20 mm Hg, respectively. However, systolic and mean pulmonary artery pressures could be estimated by adding the difference between the diastolic pulmonary vein wedge pressure and the mean left atrial pressure to corresponding systolic or mean pulmonary artery pressure. In conclusion, pulmonary artery pressures can be estimated by measuring pulmonary vein wedge pressures and the mean left atrial pressure.
Traumatic aortopulmonary window as a complication of pulmonary artery balloon angioplasty: Transcatheter occlusion with a covered stent. a case report
Authors: Preminger Tamar J. , Lock James E. , Perry Stanton B.
Published: March 2007

We describe a case in which pulmonary artery balloon angioplasty was complicated by formation of an aortopulmonary window, a previously unreported complication associated with this technique. A novel transcatheter approach for occluding the defect, a covered stent, was utilized. Deployment of the covered stent significantly reduced the shunt, allowed for clinical stabilization, and averted the need for emergency surgical intervention.
Percutaneous transseptal mitral valvuloplasty in the presence of atrial septal aneurysm
Authors: Lau Kean‐Wah , Ding Zee‐Pin , Johan Abdullah
Published: March 2007

We demonstrate the feasibility and efficacy of Inoue balloon valvuloplasty in two patients with the rare combination of mitral stenosis and atrial septal aneurysm. Following the procedure, the mitral valve area increased from 1.3 cm2 to 2.7 cm2 and 1.2 cm2 to 2.6 cm2, respectively, with no major complications encountered.
Percutaneous transluminal coronary angioplasty in patients with prior coronary artery bypass grafting: ten years' experience
Authors: Tan Kim H. , Henderson Robert A. , Sulke Neil , Cooke Richard A. , Karani Sheila , Sowton Edgar
Published: March 2007

We evaluated the acute and long‐term results of percutaneous transluminal coronary angioplasty in 140 patients with prior coronary artery bypass grafting treated over a 10‐year period (1981–1991). Angioplasty was technically successful in 85% of 122 nonoccluded native vessels and in 86% of 50 saphenous vein grafts. Two patients (1.4%) had a myocardial infarction and there were three procedure‐related deaths (2.1%). The cumulative probability of survival was 91.5% and 74.5% at 1 and 5 years, respectively. Survival free from myocardial infarction and repeat bypass grafting at 1 and 5 years was 77.3% and 53.9%, respectively. At census, 31% of the 117 survivors were asymptomatic, and 47% were improved by at least two angina grades. Coronary angioplasty provides an apparently safe and effective alternative method of revascularization in selected patients with prior coronary artery bypass grafting. This treatment strategy potentially avoids reoperation with its attendant risks. © 1994 Wiley‐Liss, Inc.
Spontaneous coronary artery dissection
Authors: Pita Javier Pasalodos , Gonzalez Nicolas Vazquez , Alvarez Luisa Perez , Rodriguez Jose Manuel Vazquez , Beiras Alfonso Castro
Published: March 2007

Spontaneous coronary artery dissection is a rarely identified entity whose exact incidence, etiology, pathogenesis, medium‐term evolution, and optimal treatment have not yet been firmly established. This article describes five new cases with additional specific characteristics.

Five of 2,241 coronary arteriograms taken between September 1989 and November 1992 showed angiographic signs of coronary dissection. Three of the patients were treated pharmacologically, and two were operated on. All were evaluated angiographically 10–18 months after diagnosis and followed up clinically for ≥20 months.

Three patients exhibited acute myocardial infarction, one showed effort angina and the fifth unstable angina. In four cases, coronary dissection was associated with coronary atherosclerosis, but in the fifth the coronary tree was apparently healthy except for the dissection. Dissection affected the right coronary artery in three cases and the left in two. Angiographic evolution varied among the five and was uncorrelated with treatment. Dissection disappeared in three; it persisted, with total obstruction of the artery in the middle of the dissected segment in one case; and advanced to affect the whole left coronary tree in the fifth. After an 18‐month follow‐up, none of the five patients experienced symptoms. These cases provide a good illustration of the variability of spontaneous coronary dissection as regards etiology, clinical presentation, treatment, and evolution. Coronary dissection is always caused by hemorrhage in the media of the arterial wall; its variability in evolution and in optimal treatment may be derived from the cause of the hemorrage, which possibly was not the same in all cases. © 1994 Wiley‐Liss,Inc..
Primary directional coronary atherectomy for acute myocardial infarction
Authors: Fscai Shigeru Saito , Arai Hidekazu , Kim Kunikane , Aoki Naoto , Sakurabayashi Tai , Miyake Shogo
Published: March 2007

The effectiveness of primary coronary angioplasty for acute myocardial infarction (AMI) is now widely recognized. However, the reocclusion rate is as high as 10%. Directional coronary atherectomy (DCA), now used widely in the treatment of stable and unstable angina pectoris, has not been recommended as the primary reperfusion therapy for AMI. This report describes the first preliminary study of primary DCA for AMI without any antecedent thrombolytic therapy or balloon coronary angioplasty. Five patients primary DCA. The initial results were very good, but further study is necessary to determine the efficacy, particularly the long‐term results, of primary DCA in the treatment of AMI. © 1994 Wiley‐Liss,Inc..
Differential effects of synchronized coronary sinus retroperfusion on regional myocardial function during brief occlusion of the left anterior descending and circumflex coronary arteries
Authors: Feld Steven , Ekas Robert D. , Felli Patty , Amirian James , Smalling Richard W.
Published: March 2007

To test the hypothesis that coronary sinus retroperfusion would preserve regional myocardial function during either left anterior descending or circumflex occlusion, sonomicrometer crystals were implanted in the midmyocardium of five chronically instrumented dogs. Regional fractional shortening was measured during 5 min of coronary occlusion with and without retroperfusion. Percent fractional shortening in the left anterior descending region fell from 18% at baseline to −4% (dyskinesis) after 3 min of left anterior descending occlusion. With coronary sinus retroperfusion, the percent fractional shortening declined from 16% at baseline to 0 (akinesis) during occlusion. A modest but significant improvement in percent fractional shortening in the ischemic region during left anterior descending occlusion occurred with retroperfusion (p < .05). By contrast, no amelioration of ischemic dysfunction occurred with retroperfusion during circumflex occlusion. Coaxial flow into the great cardiac vein during retroperfusion may provide preferential protection to ischemic myocardium supplied by the left anterior descending coronary artery. However, it is unlikely that the modest degree of improvement in regional function observed during acute left anterior descending occlusion would be mechanically important in the presence of significant ischemic dysfunction. © 1994 Wiley‐Liss,Inc..
Assessment of the results of percutaneous transluminal coronary angioplasty using an integrated ultrasound imaging‐angioplasty Catheter
Authors: Wolfe Christopher L. , Klette Melissa A. , Trask Robert V. , Rothbaum Donald A. , Landin Ronald J. , Ball Michael W. , Hodes Zachary I. , Linnemeier Thomas J.
Published: March 2007

To evaluate the results percutaneous transluminal coronary angioplasty (PTCA), intra‐vascular ultrasound imaging was performed in 32 proximal coronary arterial segments and in 16 atherosclerotic lesions after PTCA in 13 patients using a 5 Fr balloon catheter with an ultrasound transducer mounted just proximal to the balloon. Simultaneous angiographic measurements of vessel diameter were also performed using electronic calipers from contrast cine angiograms. There was good correlation between ultrasound and angiographic minimum luminal diameters of the normal proximal vessel (y = 0.59x + 1.49, r = 0.70, P<0.01, n = 32). However, the luminal diameter measured by intravascular ultrasound was significantly greater than when measured by contrast angiography (2.81±0.10 vs. 2.34±0.12mm, n = 16, P<0.001, mean ±SEM). Post‐PTCA, there was good correlation between ultrasound and angiographic minimum luminal diameters of the lesion (y = 0.62x + 1.42, r=0.76, P<0.001, n = 16), but again luminal diameters were significantly greater when measured by intravascular ultrasound compared to contrast angiography (2.61±0.08 vs. 1.89 ± 0.10mm, n = 16, P<0.001). Furthermore, residual stenosis was significantly less when determined by intravascular ultrasound than by contrast angiography (7.3±2.0 vs. 18.1 ± 2.1%, n = 16, P<0.001). Intravascular ultrasound was able to detect coronary calcification that was not evident by contrast coronary angiography in 8 of 16 lesions. Post‐PTCA, dissection was evident in four lesions by ultrasound, whereas dissection was appreciated in only three lesions by contrast angiography. We conclude that intravascular ultrasound can accurately measure the luminal diameter of coronary arteries both before and after PTCA and reveals more information about the lesion characteristics than does conventional contrast angiography.
Sudden cardiac death from coronary artery spasm in a healthy subject
Authors: Tecce Marc A. , Schalet Bennett D. , Roberts Steven A. , Iskandrian Abdulmassih S. , Mette Stephen A. , Segal Bernard L.
Published: March 2007

The true incidence of sudden cardiac death (SCD) from coronary artery spasm is unknown. The following case involves SCD in a previously asymptomatic young man with reasonable evidence to implicate coronary artery spasm as a potential cause for his clinical event. Ergonovine provocation may be warranted in patients who present with SCD and no discernable cause. © 1994 Wiley‐Liss,Inc..
Utilization of the wallstent for the treatment of innominate vein obstruction: a case report
Authors: Gencheff Nelson E. , Schmidt Donald H. , Jean William J. , Bajwa Tanvir K.
Published: March 2007

Debilitating obstruction of the large veins may occur from external compression, neointimal proliferation or thrombosis. Appropriate interventions are contingent upon the underlying etiology and the local vascular anatomy. A case of innominate vein obstruction is presented illustrating the available intravascular therapeutic options, with special emphasis placed on intravenous stenting. © 1994 Wiley‐Liss,Inc..
Results of percutaneous transseptal mitral commissurotomy in patients 40 years and above with those under 40 years of age: immediate and 5‐year follow‐up results
Authors: Chan Charles N. S. , Berland Jacques , Cribier Alain , Rocha Paolo , Stix Gunter , Derumeaux Genevieve , Letac Brice
Published: March 2007

Patients with mitral stenosis in Western countries are relatively old. It is anticipated that percutaneous transseptal mitral commissurotomy (PTMC) may have more complications and may not be as effective in this group of patient as in younger patients due to more calcification and fibrosis of the mitral valve. We analysed the clinical, hemodynamic, echocardiographic data in 296 consecutive patients divided prospectively into two groups; group 1 consisted of 184 patients ≥ 40 years and group 2 of 112 patients < 40 years coming mostly from developing countries. The immediate gain in valve area was 2.18 ± 0.61 cm2 in group 1 vs. 2.31 ± 0.65 cm2 in group 2 (P = ns). The incidence of acute regurgitation requiring surgical intervention was similar in both groups. Follow‐up data up to 5 years after PTMC was available in 170 patients (92.4%) in group 1 (mean 20 ± 13 months) and 83 patients (74.1%) in group 2 (mean 29 ± 17 months). Restenosis by Doppler method (valve area less than 1.5 cm2 with loss of at least 50% initial gain in valve area) was found in 33 patients in group 1 (29.2%) vs. 11 (14.9%) in group 2 (P < 0.05). Events free from death, need for mitral valve replacement or repeat PTMC at 5 year follow‐up was 76% in group 1 vs. 87% in group 2 (P < 0.05). We conclude that the immediate effectiveness and acute complications of PTMC in patients 40 years and above are comparable to younger patients. Restenosis is clearly higher and there is a trend towards need for mitral valve replacement in patients 40 years and above at follow‐up. However, the continuing benefit for the majority of the patients 40 years and above (76% free from adverse events) would suggest that PTMC is an appropriate treatment modality even in the older patients. © 1994 Wiley‐Liss,Inc..
Double perfusion system for coronary angioplasty at the origin of the main vessel
Authors: Kitazume Hidemasa , Kubo Ichirou , Iwama Toru , Ageishi Yoshio
Published: March 2007

For the treatment of stenosis near the origin of either the left anterior descending artery or the left circumflex artery, one autoperfusion catheter was used to dilate the lesion while another was used to maintain perfusion of the nonstenosed vessel, which would normally suffer from a decrease in blood flow. This technique was applied to nine procedures in six patients. The balloon could be inflated for more than 60 sec in all cases. Satisfactory dilation was achieved without a significant decrease of systemic blood pressure during the procedure. © 1994 Wiley‐Liss,Inc..
The technique and safety of transseptal left heart catheterization: the massachusetts general hospital experience with 1,279 procedures
Authors: Roelke Marc , Smith A. J. Conrad , Palacios Igor F.
Published: March 2007

With the introduction of interventional procedures such as percutaneous mitral valvuloplasty and radiofrequency ablation of left‐sided bypass tracts, there has been renewed interest in the technique of transseptal left heart catheterization. We review our experience with 1,279 transseptal catheterizations performed over the last 10 years. The most common indications for transseptal catheterization included direct measurement of left atrial pressure or access to the left ventricle in patients with prosthetic aortic or mitral valves, and in patients undergoing percutaneous mitral valvuloplasty. A total of 17 major complications occurred (1.3%), including cardiac tamponade (15 patients, 1.2%), systemic emboli (1 patient, 0.08%), and death secondary to aortic perforation (0.08%). We conclude that when performed by experienced operators, transseptal left heart catheterization is associated with low morbidity and mortality. © 1994 Wiley‐Liss,Inc..
Initial experience with an extendable and reusable probe balloon‐on‐a‐wire dilatation catheter in multivessel coronary angioplasty
Authors: Koh Tian‐Hai
Published: March 2007

The “probe” balloon‐on‐a‐wire device is an excellent balloon catheter for traversing very tight stenoses. Extending the probe by transecting its proximal inflation hub and then linking it to an extension wire has further enhanced its utility, as a wire exchange can then be performed without loosing wire access across a dilated lesion. We now report a previously undescribed technique for reconstituting and reusing an extended probe. The probe is initially transected at its proximal end. It is then extended by connecting a “Linx” wire into the open central lumen of the probe's hypotube. An over‐the‐wire balloon dilatation system is then substituted, via a wire exchange using a probing catheter, for final definitive dilatation. The probe is then reconstituted in the following manner. The inflation hub of the probe is recreated by modifying a standard USCI Tuohy‐Borst Y adaptor and attaching this to the transected probe hypotube. It is subsequently used for dilating other stenotic arteries during multivessel angioplasty. The utility of this method was demonstrated in 5 consecutive cases. All cases underwent successful dilatations. There were no complications. This initial experience would suggest that the probe can be reused quite safely and effectively. © 1994 Wiley‐Liss,Inc..
Comparison of hemodynamic and Doppler echocardiographic effects of a new low osmolar nonionic and a standard ionic contrast agent after left ventriculography
Authors: Werner Gerald S. , Schmidt Thomas , Scholz Karl H. , Figulla Hans‐R. , Kreuzer Heinrich
Published: March 2007

The hemodynamic effects of a new nonionic low osmolar contrast agent (iomeprol) during left ventriculography (LC) was compared with a standard ionic contrast agent (meglumine diatrizoate) in a randomized double blind study in 30 patients with suspected coronary artery disease and normal systolic ventricular function. LV diastolic function was assessed by Dopper echocardiographic recording of the transmittal filling curve and by intraventricular tip‐manometry before and within 30 sec of the LC. In the group receiving the ionic contrast agent the systolic pressure fell from 126 ± 23 to 111 ± 18 mmHg (P < 0.05), and heart rate increased from 64 ± 9 to 71 ± 11 min−1 (P < 0.05), while no such effects were observed with the nonionic contrast agent, indicating differences in the vasodilator properties. The latter caused an increase of the peak early Doppler velocity (52 ± 11 to 62 ± 14 cm/sec; P< 0.05). After the ionic contrast agent, the effect on the peak early Doppler velocity was less pronounced, probably due to an interaction with the known depressant effect of the increase in heart rate on the early Doppler velocity. In both groups the left ventricular enddiastolic pressure was increased from 7 ± 3 to 10 ± 4 mmHg. No significant effects on peak ‐dp/dt and dp/dt were observed in either group.

The nonionic contrast agent iomeprol had no significant effect on systolic arterial pressure and heart rate in contrast to the ionic contrast agent, probably due to a less pronounced vasodilator effect. Despite these differences of the global hemodynamic response, there were similar effects of both contrast agents on LV diastolic filling. © Wiley‐Liss, Inc.
Coronary artery dissection caused by exit of the guidewire through the distal perfusion sidehole of an auto‐perfusion angioplasty balloon catheter
Authors: Werns Steven W. , Bates Eric R.
Published: March 2007

A previously unrecognized cause of coronary artery dissection is reported. A 67‐year‐old woman underwent angioplasty of the right coronary artery using an autoperfusion balloon catheter. Dissection occurred because the balloon catheter was advanced while the guidewire exited from one of the distal perfusion sideholes. © Wiley‐Liss, Inc.
Intracoronary stenting in acute myocardial infarction
Authors: Wong Philip H. C. , Wong Chi M.
Published: March 2007

Stent implantation into an infarct‐related artery during acute myocardial infarction is generally contraindicated because of the risk of stent thrombosis. We report on 3 patients who had successful stenting for an acute occlusive dissection that developed during direct infarct coronary angioplasty and was refractory to conventional prolonged balloon dilatation, with good long‐term clinical and angiographic results. The prerequisites for success include proper premedication, presence of only a minimal amount of thrombus in the infarct‐related artery, liberal use of intracoronary thrombolytic therapy, as perfect an angiographic result as possible, as well as careful and aggressive post‐stenting anticoagulation. © Wiley‐Liss, Inc.
Obstruction of the right pulmonary artery by an aortic aneurysm complicating previous coronary bypass grafting
Authors: Guazzi Marco , Bortone Franco , De Cesare Nicoletta , Pepi Mauro , Moruzzi Paolo
Published: March 2007

We report a case of right main pulmonary artery compression due to a type II dissecting aortic aneurysm simulating massive pulmonary artery embolism. Aortic tear and intimal splitting developed around an aortocoronary bypass graft performed 11 months earlier. Ultrasound detected the aortic aneurysm and pulmonary hypertension, and excluded emboli in the pulmonary artery. Pulmonary angiography explained the lung involvement, showing compression of the right main pulmonary artery. Coronary and aortic angiograms demonstrated that the aortic aneurysm developed around the right venous bypass graft. Surgery confirmed the anglographic findings and the pathogenesis of the syndrome. © Wiley‐Liss, Inc.
Percutaneous transluminal coronary angioplasty of the left main coronary artery in patients with rest angina
Authors: Crowley Stephen T. , Morrison Douglass A.
Published: March 2007

Left main coronary angioplasty may be a therapeutic revascularization procedure for a subset of patients with symptomatic coronary artery disease. The purpose of this study is to report procedural outcomes and long‐term clinical follow‐up of 15 patients who underwent either protected or unprotected left main angioplasty for rest angina. These patients represent a cohort of unstable angina patients who were considered high risk for coronary artery bypass surgery. Ten of 15 patients had Canadian Heart Class IV angina, and three patients were hemodynamically unstable. Balloon angioplasty was successful in 14 patients, and one patient was treated with directional atherectomy. Initial angiographic success was achieved in 14 of 15 patients (93%). Major complications (myocardial infarction, emergent coronary artery bypass graft, death) occurred in one patient (6%); 73% of the patients were asymptomatic or had stable exertional angina at 6 months follow‐up. One year survival was 87% (13 of 15). During the follow‐up period six patients had repeat catheterization for recurrent angina. Four of these patients had left main restenosis and underwent successful repeat left main angioplasty. No patient had coronary bypass surgery during follow‐up. This report suggests that left main angioplasty can be a safe and effective revascularization procedure for critically ill patients with unstable angina who are at high risk for coronary bypass surgery. © Wiley‐Liss, Inc.
A simple balloon‐sizing method in Inoue‐balloon percutaneous transvenous mitral commissurotomy
Authors: Lau Kean‐Wah , Hung Jui‐Sung
Published: March 2007

This study was carried out to examine whether the previously determined balloon sizing method based on patient height was valid for percutaneous transvenous mitral commissurotomy using the current second‐generation Inoue balloon catheter. The study consisted of 70 patients with pliable noncalcified mitral valves (group 1) and 85 patients with calcified mitral valves and/or severe subvalvular lesions (group 2). The mitral valve area was increased more in group 1 than in group 2 (1.0 ± 0.3 to 1.9 ± 0.5 cm2 versus 1.0 ± 0.3 to 1.6 ± 0.5 cm2, P = 0.002). Using the stepwise dilatation technique, none of the group 1 patients developed severe mitral regurgitation. Severe mitral regurgitation occurred in 4 patients (4.7%) in group 2. In conclusion, a simple balloon sizing method based on body height for selection of an appropriate‐sized balloon catheter, as well as an initial inflated balloon diameter for the stepwise dilatation technique is useful for optimal acute outcomes in mitral commissurotomy. © Wiley‐Liss, Inc.
Reopening of an arterial duct after total occlusion with Rashkind's double umbrella device
Authors: Galal Omar , Abbag Fuad , Fadley Fadel , Redington Andrew
Published: March 2007

Reopening of a previously totally occluded ductus arteriosus with the Rashkind umbrella device occurred in a 5‐yr‐old girl, a previously unreported occurrence. Total occlusion using a second device was successful. This report emphasizes the need for regular follow‐up with color flow Doppler echocardiography to diagnose and exclude a residual ductus even when apparent early closure has occurred. © Wiley‐Liss, Inc.
Approach to total occlusion of an aorto‐ostial “Y” saphenous vein graft with anterior descending graft limb stenosis by serial balloon angioplasty and elective stent deployment
Authors: Flynn Michael S. , Caracciolo Eugene A. , Bach Richard G. , Donohue Thomas J. , Aguirre Frank V. , Kern Morton J.
Published: March 2007

Coronary revascularization using balloon angioplasty and stent placement for unstable angina was performed in a 74‐year‐old woman with an aorto‐ostial occlusion of a “Y‐type” saphenous vein graft and a severe stenosis in the body of a 14‐year‐old left anterior descending saphenous vein graft. Multiple prior coronary bypass graft surgeries, location of branch graft lesions, and length of the ostial stenosis must be considered in selecting the approach to revascularization. © Wiley‐Liss, Inc.
Role of side holes in guide catheters: Observations on coronary pressure and flow
Authors: De Bruyne Bernard , Stockbroeckx Jan , Demoor Danny , Heyndrickx Guy R. , Kern Morton J.
Published: March 2007

When performing coronary angioplasty, guide catheter intubation of the ostium often leads to a damping of the pressure tracing. In contrast, when a guide catheter with side holes is used, the pressure tracing is most often superimposable to the pressure wave recorded through the side arm of a femoral artery sheath introducer. This pressure wave gives the reassuring impression of normal hemodynamics in the coronary artery. To IIlustrate the role of guide catheter side holes and that guide catheter pressure does not necessarily equal the actual coronary artery perfusion pressure, we report observations on trans‐ostial pressure gradients at rest and during increased coronary flow rates. An abbreviated in vivo study of side holes on the maximal achievable blood flow, employing timed blood flow collections in 7F and 8F side hole guide catheters, was made in 10 patients. At high mean aortic pressure levels, the blood flow through the side holes did not exceed 80 and 60 mL/min for 8 and 7F guide catheters, respectively. These observations suggest that, under some conditions, the guide catheter may produce a resting or hyperemic trans‐ostial gradient and that the flow provided only by the side holes of guide catheter is limited. Guide catheter interference with normal flow should be considered in interventional procedures even when arterial pressure appears normal. © Wiley‐Liss, Inc.
Modified multipurpose catheter enhances clinical utility for cardiac catheterizations
Authors: Mannino Stanley C. , Scavina Michael , Palmer Sammie
Published: March 2007

The Multipurpose technique for coronary arteriography employs a single catheter. The benefits are a reduction in the cost of the procedure and a shorter procedural time by experienced operators.

To enhance the performance of these catheters, a modification was made in the materials and tip design, and these modifications were clinically evaluated in a small study. Compared to the control group of patients (n = 41), patients catheterized with the Multipurpose‐SM (n = 43) were shown to have a shorter procedural time as measured by a reduced fluoroscopy time (7.08 min vs. 9.52 min, P=.007). This difference is statistically significant at a 95% confidence level and resulted in less radiation exposure to the operator and cath lab staff. The procedural time was significantly reduced by fewer catheter exchanges (19% study vs. 46% control; P=.006), which were needed to successfully complete the procedure. The new Multipurpose‐SM catheter also demonstrated enhanced flexibility for cannulating coronary arteries with superior or anterior takeoffs.

This study concludes that the utilization of a modified Multipurpose‐SM catheter is safe and effective in cannulating both the left and right coronary arteries, bypass grafts, and performing left ventriculography. The primary benefits of using this modified catheter are reduced fluoroscopy time and the need for fewer catheter exchanges. © Wiley‐Liss, Inc.
Endoluminal stenting of a subclavian artery stenosis to treat ischemia in the distribution of a patent left internal mammary graft
Authors: Kugelmass Aaron D. , Kim Ducksoo , Kuntz Richard E. , Carrozza Joseph P. , Baim Donald S.
Published: March 2007

Subclavian artery stenosis is a rare cause of recurrent myocardial ischemia in patients who have undergone left internal mammary‐coronary artery bypass grafting. A patient with this syndrome was successfully treated by placement of Palmaz biliary stents in the left subclavian artery. Angiographic and hemodynamic evidence of restricted subclavian flow resolved following stenting, as did the patient's unstable angina syndrome. Endoluminal stenting of the proximal subclavian artery for the treatment of coronary‐subclavian steal can be performed safely and provides an alternative to other forms of surgical or percutaneous (PTCA, directional atherectomy) revascularization for treatment of this disorder. © Wiley‐Liss, Inc.
Comparison of 7 and 8 french guiding catheters for elective PTCA: Results of a prospective randomized trial
Authors: Talley J. David , Wilkins Charles , Ciccone John , Hattel Larry J.
Published: March 2007

A prospective randomized trial was performed to detect technical and clinical differences of 7F compared to 8F guiding catheters (GC) used in elective coronary angiopiasty (PTCA). One hundred and fifteen patients undergoing elective PTCA with standard balloon dilatation catheters were randomized to 7F (55 pts) or 8F (58 pts) guiding catheters. The endpoints were primarily coronary artery and peripheral vascular complications; and secondarily, technical details and quantitative and qualitative angiographic quality.

There was no difference between 7F or 8F GC for development of coronary or peripheral vascular complications. With 7F GC there was less blood loss (Hct, 3.5 ± 3.4% vs. 6.5 ± 9.6%, P = .033), and less contrast medium (160 ± 88 mL vs. 200 ± 119 mL, P = .049) used. Angiographic quality was similar, although visualization of lesions in the left anterior descending coronary artery in the left anterior oblique projection was improved with the 8F GC.

There is no advantage of 7F GC for the prevention of coronary or peripheral vascular complications, although there was less blood loss and contrast medium used with the 7F systems. © Wiley‐Liss, Inc.
Retrograde nontransseptal balloon mitral valvuloplasty using a modified inoue balloon catheter
Authors: Stefanadis Christodoulos , Stratos Costas , Kallikazaros Ioannis , Tsiamis Eleftherios , Vlachopoulos Charalambos , Sideris Assimakis , Toutouzas Costas P. , Toutouzas Pavlos
Published: March 2007

Retrograde nontransseptal balloon mitral valvuloplasty, a method developed in our institution for the treatment of symptomatic mitral stenosis, avoids transseptal catheterization. Until recently, the self‐positioning Inoue balloon catheter, unlike all other commercially available balloon catheters, had not been employed in this nontransseptal technique due to the short length of its catheter shaft. To employ a self‐positioning balloon in retrograde nontransseptal balloon mitral valvuloplasty, we modified the Inoue device by extension of the catheter shaft. After retrograde nontransseptal left atrial catheterization using a steerable cardiac catheter, the modified Inoue balloon catheter was inserted through the femoral artery and advanced to the mitral valve retrogradely. Valvuloplasty was performed in 20 patients, with a successful result achieved in all. The modified Inoue balloon catheter was easy to use in retrograde nontransseptal balloon mitral valvuioplasty and showed excellent stability during inflation. Mean mitral valve area increased from 1.0 ± 0.29 to 2.23 ± 0.64 cm2 (P<0.001) and mean transmitral gradient decreased from 11.4 ± 6 to 4.3 ± 2.1 mm Hg (P<0.001). No major or minor complications were observed. Retrograde nontransseptal balloon mitral valvuloplasty using a modified Inoue balloon catheter is a feasible and effective technique for the treatment of symtomatic mitral stenosis. It appears to combine the advantages of avoiding transseptal catheterization with the advantages of this balloon's special configuration. © Wiley‐Liss, Inc.
Correct and spurious calibration of the Oxicom™ oximeter
Authors: Russell Edward L.
Published: March 2007

Oxicom™ oximeters are widely used in cardiac catheterization laboratories. To calibrate the Oxicom oximeter, samples of oxygenated and deoxygenated whole blood are first analyzed on a CO‐Oximeter, and then the Oxicom is adjusted to agree with the CO‐Oximeter's readings. Subsequently, the Oxicom's calibration is confirmed at frequent intervals by taking readings from a white plastic stick that is inserted into the instrument to simulate a blood sample. The data in this report demonstrate that the readings from the white plastic “test simulator” failed to detect an out‐of‐calibration condition. By contrast, when the Oxicom was carefully adjusted to agree with a CO‐Oximeter's readings on arterial and venous blood, a linear calibration curve resulted, and the Oxicom achieved its specified accuracy (2.5%). The precautions necessary to calibrate the Oxicom correctly are enumerated in the text. © Wiley‐Liss, Inc.
Effect of atrial septal occlusion on mitral area after Inoue balloon valvotomy
Authors: Levin Thomas N. , Feldman Ted , Carroll John D.
Published: March 2007

The purpose of this study was to examine the influence of the atrial communication created during transseptal passage of the Inoue balloon catheter on calculated mitral valve area after balloon valvotomy for severe mitral stenosis.

Even in the absence of oxymetric evidence for a shunt, atrial septal puncture may result in left‐to‐right shunting of blood with reported spurious increases in postvalvotomy mitral valve area calculations ranging from 16–29% in prior studies. Occlusion of the septal puncture site after double balloon valvotomy has previously been shown to result in decreased postvalvotomy mitral valve area determinations.

We evaluated 20 patients undergoing mitral dilation. Each patient had three postvalvotomy measurements made: (1) with the Inoue balloon catheter positioned across the septum, (2) during septal occlusion with a 7F balloon‐tip catheter, and (3) without any catheters across the septum.

With the Inoue catheter across the septum after successful valvotomy, the cardiac output was 4.6 ± 1.5 L/min and the calculated mitral valve area was 1.7 ± 0.5 cm2. No difference was found in either cardiac output or valve area when the septum was unobstructed by catheters. During septal occlusion, however, the postvalvotomy cardiac output decreased to 4.3 ± 1.3 L/min (P<0.001) and the calculated mitral area decreased by 12% to 1.5 ± 0.5 cm2 (P<0.001). The calculated mitral valve areas determined with the Inoue catheter in place after valvotomy were in agreement with echo derived data.

Although statistically significant differences in post‐Inoue valvotomy cardiac output and calculated mitral valve area were found during septal occlusion, these differences were small. Furthermore, echocardiographic valve area measurments agreed with invasively determined mitral valve areas regardless of whether or not the septum was ccluded. We conclude that septal occlusion is not necessary for valve area measurement after Inoue balloon mitral valvotomy. © Wiley‐Liss, Inc.
Part XII: Assessment of serial lesions in the proximal right coronary artery following intracoronary thrombolysis
Authors: Moore Joseph A. , Kern Morton J.
Published: March 2007

We present here coronary flow and pressure data in a patient in whom serial proximal right coronary stenoses are evaluated and treated following thrombolysis for unstable angina. © Wiley‐Liss, Inc.
Combined intraaortic balloon counterpulsation with synchronized coronary venous retroperfusion: The united states experience
Authors: Freedman Robert J. , Lasorda David M. , O'Neill William W.
Published: March 2007

Prompted by severe cardiogenic shock, impending or manifest, three cases from the United States Retroperfusion Clinical Trials utilized intraaortic balloon counterpulsation combined with retroperfusion. Temporary stabilization and improvement was noted in all three cases and long‐term survival was seen in two of the cases. The clinical and physiologic bases for combined use of these modalities is discussed. © Wiley‐Liss, Inc.
Use of half (disarticulated) Palmaz‐Schatz stents for thrombus‐containing coronary lesions
Authors: Mehan Vivek K. , Kaufmann Urs , Salzmann Christian , Meier Bernhard
Published: March 2007

Coronary stenoses associated with thrombus can lead to poor angioplasty results and increased procedural complications. Stenting in the presence of thrombus is associated with an increased risk of stent thrombosis. We report eight patients in whom half a Palmaz‐Schatz stent was implanted for inadequate angioplasty results owing to thrombus. Stenting resulted in improved angioplasty results; no stent thrombosis occurred. © Wiley‐Liss, Inc.
Repeat embolization of the side branch of the internal mammary artery graft by gelatin sponge particles and micro coils
Authors: Ishizaka Nobukazu , Ikari Yuji , Saeki Fumihiko , Ishizaka Yuko , Tamura Tsutomu , Yamaguchi Tetsu , Suma Hisayoshi , Ibukuro Kenji
Published: March 2007

The internal mammary artery (IMA) is increasingly used as a coronary bypass conduit because of better long‐term patency and improved prognosis as compared with venous grafts. Previous investigators have suggested that the “steal” of blood flow of the IMA graft via the subclavian artery or a persistent large side branch of the graft may lead to its thinning. However, only a few reports have described the embolization of a large side branch using a transcatheter procedure. We present a case of repeated embolization of a large lateral costal side branch of the left internal mammary arterial graft applying gelatin sponge particles and micro coils, as well as angioplasty to the graft conduit, with resulting easing of chest pain.
Localized drug delivery in atherosclerotic arteries via a new balloon angioplasty catheter with intramural channels for simultaneous local drug delivery
Authors: Hong Mun K. , Wong S. Chiu , Farb Andrew , Mehlman Moshe D. , Virmani Renu , Barry James J. , Leon Martin B.
Published: March 2007

A dual‐purpose angioplasty catheter with intramural channels and exterior pores for local drug delivery (“channeled balloon”) was studied in eight atherosclerotic human necropsy arteries and in 22 rabbits with atherosclerotic peripheral arteries, in which markers (0.005 m̈m to 15 m̈m) were infused locally at 2 atmospheres during simultaneous angioplasty at 6 atmospheres. Thirteen of the rabbits were sacrificed at 4 or 24 h after procedure to determine the intramural retention over time. Histology confirmed effective angioplasty and revealed presence of markers in the arterial wall in 29 of 43 treated arteries (67%), whereas all control segments without local delivery had no marker staining. Majority of the ineffective local delivery (12/14) occurred when 15 m̈m particles were infused (12/13 arteries without intramural markers), especially when examined 4 or 24 h later. Thus, in atherosclerotic arteries, the channeled balloon enabled simultaneous local drug delivery at low pressure during effective angioplasty, although particle size may play a role in successful intramural impregnation and retention.
Subclavian artery dissection during diagnostic cardiac catheterization: The role of conservative management
Authors: Frohwein Stephen , Ververis John J. , Marshall J. Jeffrey
Published: March 2007

Dissection of the subclavian artery during routine cardiac catheterization while obtaining cannulation to the left internal mammary artery is an unusual complication and to our knowledge has never been reported. Conservative management of this vascular injury can avoid the sequelae of high‐risk surgical repairs made difficult by a complex operative exposure. We describe a case in which dissection of the left subclavian artery was treated conservatively with an excellent outcome.
Aneurysm of saphenous vein graft to coronary artery presenting as non‐q‐wave myocardial infarction secondary to mass effect
Authors: Sahouri Saed J. , Steele Robert L.
Published: March 2007

Large aneurysms (>4 cm) of saphenous vein grafts (SVG) to coronary arteries are a rare complication of coronary artery bypass graft surgery (CABG). A 64‐year‐old male, status post‐CABG 14 years ago, presented with dyspnea and diaphoresis. Pneumonia and non‐Q‐wave myocardial infarction (MI) were diagnosed. Cardiac catheterization and chest computed tomography demonstrated a 5 × 7‐cm aneurysm of a SVG. At the time of surgery, the left internal mammary artery (grafted to the left anterior descending artery) was found to be stretched tautly over the aneurysm, resulting in impaired flow. The aneurysm was successfully resected. This is the first published case implicating a SVG aneurysm as the direct cause of a MI by mass effect.
Aneurysm of the aortic sinus of valsalva with reversed shunt of ductus arteriosus
Authors: Liang Chi‐Di , Su Wen‐Jen
Published: March 2007

A rare case of aneurysm of aortic sinus of Valsalva associated with patent ductus arteriosus and Eisenmenger's syndrome in a 7‐yr‐old boy is described. The diagnosis was made by echocardiography and cardiac angiography.
Hugging balloon angioplasty of right coronary artery
Authors: Oral Dervis , Pamir Gülgün , ömürlü Kenan , Alpman Ahmet , Ispanoglu Müfit , Akyol Turhan
Published: March 2007

We report a case of “hugging balloon” dilatation of a giant right coronary artery using two dilatation catheters, a balloon “on a wire” and a balloon “rapid exchange” systems via a single guiding catheter. The necessity of larger PTCA balloon catheter (>4.0 mm) was stressed.
Transcatheter radiofrequency perforation and stent implantation for palliation of pulmonary atresia in a 3060‐g infant
Authors: Schneider Martin , Schranz Dietmar , Michel‐Behnke Ina , Oelert Hellmut
Published: March 2007

In a 3060‐g infant with fibromuscular pulmonary atresia an open right ventricular outflow tract was created by means of interventional cardiological methods. Following two inadvertent perforations without sequelae or clinical symptoms, radiofrequency perforation and subsequent balloon dilatation were successfully performed. The implantation of a Palmaz iliac stent led to a predictable communication between the right ventricle and pulmonary artery.
Ductus arteriosus rupture as a balloon catheter atrioseptostomy complication
Authors: Caixeta Adriano Mendes , Kajita Luis Junya , Rati Miguel , Violante R. , Aiello Vera , Snitcowsky Rachel , Antônio Perin Md Marco , Veloso Walkimar U. , Ariê Siguemituzo
Published: March 2007

A newborn with transposition of the great arteries presented with rupture of the ductus arteriosus after balloon catheter atrioseptostomy. The necropsy study demonstrated persistent ductus patency, and a 0.5‐cm‐long horizontal fissure could be observed. On microscopy, there was laceration of the intimal layer, with wall dissection and focal hemorrhage extending to the adventitia. Ductus rupture was attributed to the wall weakess, as a consequence of prostaglandin E1 administration.
In vivo comparison of different quantitative edge detection systems used for measuring coronary arterial diameters
Authors: Desmet Walter , De Scheerder Ivan , Beatt Kevin , Huehns Tanya , Piessens Jan
Published: March 2007

Three different systems for quantitative coronary analysis [Cardiovascular Measurement System (CMS®); Polytron 1000® Angiographic Workstation (AWOS®)] were compared in 109 patients before and after coronary angioplasty and at follow‐up coronary angiography. Correlation coefficients were low and 95% limits of agreement were wide. In general, CMS® exhibited a tendency to yield lower values for very small diameters and higher values for larger vessels. The acute gain in minimal luminal diameter was considerably smaller when assessed by AWOS® as compared to Polytron® (0.52 vs. 0.71 mm, P < .0001) and to CMS® (0.52 vs. 0.75 mm, P < .0001). Long‐term gain was much larger when assessed by Polytron® as compared to AWOS® (18.8 vs. 11.5%, P < .001) and it was almost double for CMS® as compared to AWOS® (20.7 vs. 11.5%, P < .0001). In conclusion, in the individual patient very different results can be obtained when different QCA systems are used, and systematic differences between the systems are encountered.
Prolonged urokinase infusion for chronic total native coronary occlusions: Clinical, angiographic, and treatment observations
Authors: Ajluni Steven C. , Jones Denise , Zidar Frank , Puchrowicz Sylvia , Margulis Ann , O'Neill William W. , Grines Cindy L.
Published: March 2007

Prolonged intravascular infusion of urokinase has proven beneficial in reestablishing patency of chronically occluded peripheral arteries and saphenous vein grafts. This study was performed to assess the efficacy and safety of prolonged urokinase infusions as a prelude to angioplasty in chronically occluded native coronary arteries, that had failed standard angioplasty techniques. Twenty‐five patients with objective evidence for ischemia in the distribution of a chronic coronary occlusion were referred for percutaneous intervention. Patients were assessed for any potential exclusions from lytic therapy. Urokinase infusion through both a SOS wire and a stable guiding catheter was continued at 100,00–240,000 units/hr for 8–25 hr; patents then underwent attempted balloon angioplasty. Mean duration of urokinase infusion was 20.6 ± 7.7 hr (total dose 163,000 ± 52,447 units/hr). Fibrinogen levels dropped slightly with this (300 ± 129 to 203 ± 81 mg/dl, P = 0.02). Angiography posturokinase showed improvement in 7 (28%) with regard to coronary flow (± 1 TIMI‐grade). Angioplasty was successful in 13 (52%), with final angiographic result revealing thrombus in 5 (20%), or dissection 8 (32%). The infusions were well‐tolerated with a low incidence of chest pain, 2 (8%); or ischemic ECG response, 2 (8%); myocardial infarction, 2 (8%); or significant bleeding 2 (8%). All patients survived the procedure, with a length‐of‐hospital stay = 5.1 ± 4 days. Use of prolonged preangioplasty intracoronary urokinase infusion can be done safely with success in roughly one‐half of patients with chronic total native coronary occlusions who have failed prior attempts at percutaneous intervention. A larger more rigorously designed protocol is required to make specific recommendations about technique, cost, and long‐term follow‐up.