bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequential multivessel coronary angioplasty assessed by thallium‐201 tomography
Authors: DePuey E. Gordon , Roubin Gary S. , Depasquale Eugene E. , Nody Agatha C. , Garcia Ernest V. , King Spencer B. , Berger Harvey J.
Published: March 2007

In 11 patients with multivessel coronary artery disease, SPECT thallium‐201 imaging was performed prior to and within 3 days after each of two sequential percutaneous transluminal coronary angioplasties on separate days designed to achieve total revascularization. Thallium‐201 SPECT was analyzed quantitatively, and an ischemic score for the vascular bed(s) supplied by the dilated vessel(s) was derived.

For the vessels dilated during the first procedure the mean diameter stenosis was 80 ± 8%, reduced to 27 ± 9%. For the second procedure mean stenosis was reduced from 67 ± 10% to 26 ± 6%. For the two procedures, the mean thallium scores decreased from 298 ± 225 to 115 ± 130 (P < .001) and from 135 ± 129 to 46 ± 60 (P < .001), respectively. Of 10 patients with abnormal thallium‐201 SPECT prior to angioplasty, nine improved after the first procedure, and seven improved further following the second procedure.

Thus, utilizing staged angioplasty with a strategy of dilating the most severe lesion first, thallium‐201 SPECT documented progressive improvement in myocardial perfusion.
A randomized trial of corticosteroids for the prevention of restenosis in 102 patients undergoing repeat coronary angioplasty
Authors: Stone Gregg W. , Rutherford Barry D. , McConahay David R. , Johnson Warren L. , Giorgi Lee V. , Ligon Robert W. , Hartzler Geoffrey O.
Published: March 2007

To examine the effect of corticosteroid therapy on the development of restenosis following successful percutaneous transluminal coronary angioplasty (PTCA), we randomized 102 patients with restenosis following prior PTCA to receive high‐dose steroids (n = 52) or no steroids (n = 50). The steroid regimen consisted of 125 mg methylprednisolone I.M. the night before and morning of the PTCA, and prednisone 60 mg p.o. Q.D. for 1 week post‐PTCA.

Angiographic follow‐up at 6 months was available in 27 steroid‐treated patients (52%) and 27 controls (54%). The per lesion incidence of restenosis was similar in the two groups (36% vs. 40%, respectively, P = NS). Clinical follow‐up was available in the remaining patients at a mean interval of 1.2 years. The clinical correlates of restenosis (incidence and severity of angina, positive treadmill exercise test, nonfatal infarction or death) were similar in the steroid treated and control groups (24% vs. 39%, respectively, P = .56). At late follow‐up, 30 steroid‐treated patients (58%) and 26 control patients (52%) had no clinical or angiographic evidence of restenosis (P = NS).

In conclusion, a short course of high‐dose corticosteroid therapy does not significantly reduce the frequency of restenosis following PTCA.
Case of spontaneous healing of occlusive dissection on percutaneous transluminal coronary angioplasty
Authors: Takatsu Fumimaro , Kinoshita Atsushi
Published: March 2007

A large pseudolumen due to dissection arose during percutaneous coronary angioplasty. The true lumen was compressed critically. However, no infarction took place because of good collaterals. During medical follow‐up, the patient's angina vanished suddenly. The repeat angiography showed healing of the dissection and patency of the coronary artery.
Intracoronary electrocardiogram during torsade des pointes secondary to intracoronary papaverine
Authors: Jain Avanindra , Jenkins Mark G.
Published: March 2007

Papaverine, a potent coronary vasodilator, is now commonly used to measure coronary reserve. We recorded intracoronary etectrogram in a patient who developed Torsade des pointes after 10 mg of papaverine. This was associated with marked prolongation of the QT interval. The ventricular tachycardia self‐terminated with shortening of the QT interval. We believe that although papaverine is a good agent because of its short duration of action, it must be used cautiously because of its effects on repolarization, which can result in arrhythmias.
Extendable probe
Authors: Phillips William J.
Published: March 2007

In order to maintain the advantages of utilizing the Probe “balloon on a wire” dilatation catheter and still retain the safety of an over‐the‐wire system for PTCA, a method for extending the probe is described.
Percutaneous transluminal coronary angioplasty: A review of current balloon dilatation systems
Authors: Avedissian Michael G. , Killeavy Eugene S. , Garcia Jose M. , Dear Wayne E.
Published: March 2007

The interventional cardiologist is faced with an expanding armamentarium for performing percutaneous transluminal coronary angioplasty (PTCA). Because of rapid advances in technology, new devices are produced on a regular basis, making it difficult to maintain a working knowledge of what is available. Although several excellent textbooks about PTCA have been written, descriptions of available equipment are usually obsolete by the time publication occurs. In order to provide succinct specifications of equipment, we have documented data on balloon catheters, guiding catheters, and guidewires. This information may be useful in the selection of appropriate equipment for PTCA procedures. In addition, the publication of such data in a monthly periodical may provide a more current overview of equipment; information may be occasionally updated as new equipment is released.
Coronary angioplasty–unstable lesions and prolonged balloon inflation time
Authors: Arie Siguemituzo , Checchi Hedy , Coelho Wilson M. C. , Bellotti Giovanni , Pileggi Fulvio
Published: March 2007

One of the most important complications after percutaneous transluminal coronary angioplasty is the abrupt closure of the dilated vessel (unstable lesion). The treatment of choice for this complication is a new dilation, but unfortunately many of these cases require immediate surgery to avoid an acute myocardial infarction. Prolonged balloon inflations have been suggested to control this kind of complication. In order to discover the effect of prolonged inflations on the incidence of unstable lesions we studied 439 patients enrolled in two groups: Group I (195 patients and 207 arteries) treated with balloon inflation time less than 40 sec per session and Group II (244 patients and 265 arteries) treated with inflation time over 60 sec since the first series of inflations. As a result there was a significantly lower incidence of unstable lesions and immediate surgery in Group II without an increase in the incidence of diffuse ischemia.
Cine angiographic findings in young Iraqi men with first acute myocardial infarction
Authors: Al‐Koubaisyl Omar K. , Mehdi Ryiad S. , Arem Falah D. , Ahmed Ibrahim Taha
Published: March 2007

Among 100 consecutive Iraqi men aged 40 years or less with first acute myocardial infarction, coronary angiography performed 8–12 weeks later showed single‐vessel coronary artery disease in 64, multivessel disease in 26, and normal coronary arteries in ten patients. Most patients (90%) had one or more coronary risk factors.

The left anterior descending artery was involved in 66 patients, the right coronary artery in 38, and the circumflex artery in 29. Total occlusion was seen in 37 patients and severe (≥ 90%) stenosis in 14 patients. Severe wall motion abnormality (aneurysm formation) on left ventriculography was found in 33 patients. Thus, in developing countries as elsewhere, one‐vessel coronary artery disease remains the most common angiographic finding in young men with first acute myocardial infarction.
Assessment of the “long sheath” technique for percutaneous aortic balloon valvuloplasty
Authors: Plante Sylvain , Beatt Kevin J. , van den Brand Marcel , Di Mario Carlo , Meier Bernhard , Serruys Patrick W.
Published: March 2007

A 100 cm‐long 16.5 F valvuloplasty catheter introducer was assessed as an adjunct for percutaneous transluminal aortic valvuloplasty (PTAV) via the femoral artery in 31 patients with severe aortic stenosis. Observed improvements in peak systolic gradient (81.6 ± 29.9 mm Hg vs. 35.5 ± 16.0 mm Hg, P < 0.000001) and aortic valve area (0.6 ± 0.4 cm2 vs. 1.0 ± 0.6 cm2, P < 0.00001) were similar to those achieved in a control group (C) of 17 patients in which no femoral sheath was used. However, a shorter procedure duration (211 ± 81 min vs. 117 ± 30 min, P < 0.001) and a reduced rate of vascular complications at the femoral puncture site (41% vs. 6.5%) were observed in patients in whom the long sheath (LS) technique was used. The frequency of other PTAV‐related complications was comparable (C = 35%, LS = 29%, P = n.s.).

Other technical advantages of this device are: 1) prevention of looping and bending of the balloon catheter in tortuous vessels and easy positioning of the balloon across the aortic orifice provided by the LS trackability, 2) stabilisation of the balloon during inflation, 3) monitoring of supravalvular aortic pressure provided by the side‐arm of the LS and reliable measurement of systolic gradient, and 4) the ability to perform aortograms without the need of another catheter in the ascending aorta. Thus, in our experience, the long sheath technique is a valuable adjunct for PTAV.
Below‐the‐knee angioplasty: Tibioperoneal vessels, the acute outcome
Authors: Dorros Gerald , Lewin Ruben F. , Jamnadas Pradip , Mathiak Lynne M.
Published: March 2007

Conventional balloon angioplasty (PTA) was attempted in 111 patients (60% male; mean age 67≥9 years) with 168 below‐the‐knee, tibioperoneal vessels (TPV) lesions. The presenting predominant symptoms were claudication in 52 (47%), non‐healing ulcer/gangrene in 30 (27%), and rest pain in 29 (26%) of patients. An above‐the‐knee vessel was dilated before TPV angioplasty in 62 patients (56%). A successful PTA was achieved in 152/168 (90%)TPV: stenoses, 124/125 (99%); occlusions, 28/43 (65%). Complications encountered included contrast‐induced renal failure (4%), distal embolization (4%), entry site arterial repair or embolectomy (2%), dissection or occlusion (2%), and groin hematoma (2%). A significant complication (death, emergency bypass surgery, or distal embolization) occurred in only 3 patients (3%); no complications whatsoever were found in 100 patients (90%). At discharge, 106 patients (95%) were clinically improved. A restenosis and/or second PTA procedure occurred in 44/108 patients (40%) (mean time: 9≥6 months) with the presenting predominant symptom being claudication in 38 patients (86%). However, only 36% of patients had lesion recurrence with or without new disease, and 64% showed evidence of disease progression with symptoms. Angiographic and clinical success was achieved in 42 patients undergoing second PTA (96%). These data indicate that balloon angioplasty can be successfully utilized in patients with symptomatic obliterative disease of the tibioperoneal vessels with excellent success, a low risk of complications, and good clinical improvement. PTA of the below‐knee vessels should not be restricted to patients in limb salvage situations.
Comparison of meglumine sodium diatrizoate, lopamidol, and lohexol for coronary angiography and ventriculography
Authors: Murdock Challon J. , Davis Michael J. E. , Ireland Mark A. , Gibbons Fran A. , Cope Geoffrey D.
Published: March 2007

Meglumine sodium diatrizoate (Urografin), iopamidol, and iohexol were compared in a double‐blind, randomized study of 287 patients undergoing elective cardiac angiography. Ninety‐six patients received Urografin, 98 received iopamidol, and 92 received iohexol. The groups were similar in all respects. Variables measured before and after contrast injection were left ventricular end‐diastolic pressure (LVEDP), left ventricular systolic pressure (LVSP), systolic arterial pressure (SAP), RR, PR, and QTc intervals, QRS duration, ST segment change greater than 2 mm, arrhythmias, and symptoms. The adequacy of coronary and ventricular opacification was assessed by two experienced observers. Following left ventriculography, small rises in LVEDP occurred with iopamidol and iohexol (mean ± SD: 187 to 21 ± 7 mmHg) and a moderate fall in LVSP with Urografin (150 ± 32 to 133 ± 32 mmHg). Following coronary angiography there was a progressive fall in SAP (130 ± 26 to 117 ± 30 mmHg) and prolongation of RR intervals (900 ± 138 to 1,266 ± 692 msec) and QTc (440 ± 61 to 471 ± 73 msec) and QRS duration (87 ± 25 to 100 ± 27 msec) with Urografin. There was a small fall in SAP with iopamidol(138 ± 25 to 128 ± 27 mmHg) and prolongation of QRS duration with iohexol (85 ± 29 to 90 ± 24 msec). Other parameters were not significantly affected. Frequent bradyarrhythmias (sinus pause 14.5%, asystole 6%) and ST segment depression occurred following Urografin. Urografin was less well tolerated, with 10% of patients experiencing severe nausea or vomiting and 30% of patients experiencing extreme heat sensation. Differences between iohexol and iopamidol were minor. Coronary and left ventricular opacification were satisfactory and not significantly different between the groups. Iopamidol and iohexol have fewer adverse hemodynamic, electrocardiographic, and symptomatic effects, and their use in preference to Urografin is advocated.
Hugging balloon coronary angioplasty of a large left circumflex coronary artery
Authors: Spaccavento Leo J. , Tomlinson Gregory C. , Grassman Eric D.
Published: March 2007

A case is described in which hugging balloons were used to perform coronary angioplasty through a single catheter. A discussion concerning selection of balloon combinations and technique is included.
Ventricular arrhythmia due to intracoronary papaverine: Analysis of QT intervals and coronary vasodilatory reserve
Authors: Kern Morton J. , Deligonul Ubeydullah , Serota Harvey , Gudipati Chalapathirao , Buckingham Thomas
Published: March 2007

Intracoronary papaverine commonly produces striking QT interval prolongation with rare but serious ventricular dysrhythmias reported. Because of 3 cases of severe papaverineinduced dysrhythmia in our laboratory, QT intervals and hemodynamic and intracoronary velocity data collected during intracoronary papaverine administration were retrospectively reviewed in 34 patients; 20 patients with angiographically normal coronary arteries (group 1) and 14 patients (group 2) before and (group 2) after single‐vessel left coronary angioplasty. QT intervals increased from 394 ± 44 to 464 ± 73 msec, 414 ± 47 to 504 ± 95 msec, and 410 ± 41 to 486 ± 75 msec for groups 1 and 2 before and after angioplasty, respectively (all P < 0.01). There was no correlation with hemodynamic, electrocardiographic, or coronary vasodilatory reserve responses and change in QTc interval. In the 3 index patients having significant papaverine‐related arrhythmias, a baseline QT interval was prolonged (after prior papaverine exposure) in only 1 in association with trosade de pointes. These data indicate that QT interval prolongation after papaverine is a common occurrence, but that the production of ventricular dysrhythmia is probably idiosynchratic in origin. In view of these findings, we recommend that appropriate antiarrhythmic preparations be in place for patients receiving intracoronary papaverine.
Platypnea‐orthodeoxia as a cause of unexplained hypoxemia in an 82‐yr‐old female
Authors: Nazzal Sami B. , Bansal Ramesh C. , Fitzmorris Steven J. , Schmidt Carlos A.
Published: March 2007

We describe an 82‐yr‐old patient with platypnea‐orthodeoxia without identifiable lung disease in whom the diagnosis was suspected because of clinical history, echocardiography, and orthostatic measurement of arterial blood gases. Recumbent and upright cardiac catheterization techniques confirmed the presence of orthostatic variation in the degree of right to left shunt across the fossa ovalis. This was successfully treated by surgical closure of the interatrial communication in the region of the fossa ovalis.
New passive perfusion PTCA catheter
Authors: White Christopher J. , Ramee Stephen R. , Banks Alan K. , Ross Terence C. , Berman Michael , Sogard David , Price Herman L.
Published: March 2007

Percutaneous coronary angioplasty with a new passive perfusion balloon catheter was compared to a standard angioplasty balloon catheter during prolonged balloon inflations in miniature swine. Inflations with the passive perfusion balloon were alternated with a standard balloon with the initial balloon chosen randomly in 24 coronary arteries. Endpoints for terminating the balloon inflation were the appearance of 2 mm of ST segment deviation from baseline on the electrocardiogram, the occurrence of ventricular fibrillation, or 30 min of balloon inflation. During balloon inflation contrast injections were performed through the guiding catheter and flow distal to the balloon was graded 0–3 using the TIMI scale. The average (±SD) inflation time for the standard balloon was 3.1 ± 2.2 minutes and for the perfusion balloon was 27.2 ± 4.8 min (P < 0.001). Electrocardiographic evidence of 2 mm of ST segment deviation from baseline was seen during 11/13 inflations with the standard balloon and in 3/11 balloon inflations with the perfusion balloon. Ventricular fibrillation occurred during 2/13 of the standard balloon inflations and in none during passive balloon inflations. Distal contrast flow during passive balloon inflations averaged 2.7 ± 0.5 (TIMI scale 0–3) and was absent during inflations with the standard balloon. The perfusion balloon allowed prolonged inflations with excellent distal flow when compared to the standard balloon. The passive perfusion balloon may allow safer, longer inflations in humans while also improving patient comfort. The passive perfusion balloon may also have utility as a bailout catheter to preserve distal flow during abrupt occlusions, and may be useful in conducting prospective trials evaluating the benefits of prolonged balloon inflation during coronary angioplasty in man.
Clinical experience with percutaneous brachial coronary angiography in a “Judkins” laboratory
Authors: Mills Roger M. , Berger Peter , Garber Gary R. , Larosa David , Faxon David P.
Published: March 2007

More than 98% of coronary studies performed in our laboratory are done with the transfemoral approach. In this report, we review our experience with 67 cases in which we used the percutaneous brachial approach as an alternative for patients with peripheral vascular disease. Sixty‐six cases (99%) were completed; one case (1%) was aborted due to cardiogenic shock. No death, stroke, or myocardial infarction occurred. Seven patients (10%) had minor complications; none required surgical intervention. The percutaneous brachial approach with standard preformed catheters offers a simple and satisfactory alternative to transfemoral coronary angiography.
Predictors of increased mitral regurgitation after percutaneous mitral balloon valvotomy
Authors: Roth Robert B. , Block Peter C. , Palacios Igor F.
Published: March 2007

Left ventriculography (LVG) was performed to assess severity of mitral regurgitation (MR) on a scale of 0–4 + in 157 patients before and immediately after percutaneous mitral balloon valvotomy (PMV). There were 129 women and 28 men aged 51 ± 1 (range 13–87) yr. With PMV, mitral valve area increased from 0.9 ± 0.1 cm2 to 2.0 ± 0.1 cm2 (P <.0001). Increase in mitral regurgitation (MR) occurred in 69 patients (44%). Patients were divided into two groups based on increase in MR after PMV. Group A (n = 136) had 0–1 + increase in MR. Group B (n = 20) had ± 2 + increase in MR after PMV. The only predictor of increase in MR≥2+ was the ratio of effective balloon dilating area to body surface area (EBDA/BSA). EBDA/BSA was 4.0 ± 0.1 cm2/m2 in Group A vs. 4.37± 0.2 cm2/m2 in Group B (P =.02).

Follow‐up of patients in Group B showed: Four patients remained NYHA Class III and required mitral valve replacement 4.3 ± 1.1 (range 5–21) mo after PMV. One patient who had undergone combined aortic and mitral valvotomy died in the hospital of worsening heart failure. One patient died 1 mo later of sepsis related to a dental abscess. Follow‐up of the remaining 14 patients at 9.5 ± 1.1 (range 2–7) mo showed 10 in NYHA Class I and four in NYHA Class II. Eight of 15 patients (53%) who had repeat left ventriculogram at 9.0 ± 0.8 mo after PMV had a decrease in MR of one grade when compared to LVG immediately after PMV.
Elective supported angioplasty: Initial report of The National Registry
Authors: Vogel Robert A. , Tommaso Carl L.
Published: March 2007

A National Registry of 14 centers performing elective supported angioplasty was formed to collate the initial experience with high‐risk patients. Suggested indications were ejection fraction less than 25% and/or target vessels supplying greater than half of the viable myocardium. The data from 105 patients were entered into the Registry during 1988. This group included 30 patients who had dilation of their only patent coronary vessel and 20 patients whose disease was deemed too severe to undergo bypass surgery. Chest pain and ECG changes were uncommonly experienced during balloon inflation. The group experienced a high angioplasty success rate (95%) with an average of 1.7 dilatations per patient. Morbidity was frequently experienced, the majority of which was associated with cannula (18–20F) placement and/or removal. The overall hospital mortality was 7.6%, although half of the deaths occurred in patients who were both over 75 years of age and had left main coronary artery stenosis. Patients under the age of 75 years without left main coronary artery stenosis experienced a hospital mortality rate of 2.6%. Symptomatic improvement occurred in 91% of the patients surviving hospitalization. During the followup period of 1–12 months, three patients died of cardiac complications. This multicenter experience suggests that supported angioplasty can be performed safely in high‐risk patients in several high‐risk subgroups with the expectation of good symptomatic improvement and short‐term survival.
Use of percutaneously inserted cardiopulmonary bypass in the cardiac catheterization laboratory
Authors: Tommaso Carl L.
Published: March 2007

A cardiopulmonary bypass system that can be percutaneously inserted is available. In addition to its use in stabilization of severely hemodynamically compromised patients, it has many uses in cardiology including use as an adjunct to high‐risk interventional procedures. The purpose of this report is to communicate our experience with cardiopulmonary bypass in the Catheterization Laboratory and discuss technique, indications, and potential complications.
Angioplasty of a large aortocoronary bypass graft utilizing a single oversized balloon catheter
Authors: Esente Paolo , Giambartolomei Alessandro , Reger Mark J. , Johnson Lewis W.
Published: March 2007

Angioplasty of large saphenous vein grafts may present problems because of unavailability of adequately sized balloon dilatation catheters. We report a case of successful PTCA of a left anterior descending graft by using a 5 mm balloon and a standard 8F guiding catheter.
Balloon embolization of latrogenic aortocoronary arteriovenous fistula
Authors: Graeb Douglas A. , Morris D. Christopher , Ricci Donald R. , Tyers G. Frank
Published: March 2007

A detachable latex balloon was used to occlude an iatrogenic aortocoronary arteriovenous fistula. The aim of providing retrograde myocardial perfusion was not achieved to any significant degree because of rapid recruitment of collateral venous routes to the coronary sinus. This may have implications for the effectiveness of deliberate grafting of the coronary venous system with proximal venous ligation, as has been recommended when the coronary arterial system is small and diffusely diseased.
Prediction of coronary artery reperfusion after tissue plasminogen activator infusion
Authors: Kinney Evlin L. , Wright Robert J.
Published: March 2007

We investigated whether clinical and laboratory variables can predict perfusion status after t‐PA administration, by using the data from 138 patients who received t‐PA during the Thrombolysis in Myocardial Infarction (TIMI) I study. All clinical and laboratory variables that were collected at baseline or during perfusion for TIMI I were evaluated by the current study. Via stepwise discriminant analysis, 7 variables were closely associated with perfusion status at 90 minutes (listed in the order of their discriminant effect): baseline grade of stenosis in the infarct‐related coronary artery, whether nausea was present during the infusion, baseline aspartate aminotransferase (SGOT) concentration, whether arrhythmias were present during the infusion, baseline fibrinogen concentration, baseline partial thromboplastin time, and baseline diastolic blood pressure. Baseline severity of stenosis and the likelihood of there being reperfusion were inversely related. Eighty‐four percent of patients with adequate perfusion after 90 minutes of t‐PA infusion were classified correctly, but only 50% of those without perfusion at 90 minutes were classified correctly. In addition, since 70% of the TIMI I patients, on average, did achieve perfusion, the use of these 7 variables added little predictive information. Our findings suggest that 1) there is as yet no practical way to predict reperfusion after t‐PA therapy and 2) the severity of coronary stenoses, if known ahead of time, should be considered when selecting patients for thrombolytic therapy.
Monorail™ Piccolino catheter: A new rapid exchagne/ultralow profile coronary angioplasty system
Authors: Mooney Michael R. , Douglas John S. , Mooney Jodi Fishman , Madison James D. , Brandenburg Robert O. , Fernald Rex , Van Tassel Robert A.
Published: March 2007

The MonorailTM Piccolino coronary angioplasty balloon catheter (MBC) was evaluated on 118 patients at two centers. Technical success was achieved in 110 patients (93%). Time for catheter exchange and total fluoroscopy time were significantly lower for the Monorail catheter than with standard equipment (exchange time 97 vs. 170 seconds P <.05 and fluoroscopy time 17 vs. 88 seconds P < 0.001). The advantages of rapid exchange and the ability of utilize 2 Monorail balloon catheters through one 9F guiding catheter for simultaneous inflations allowed for maximal flexibility in treating patients with bifurcation lesions. The double wire approach utilizing one Monorail balloon catheter with a 7F guiding catheter was also technically successful. The MonorailTM Piccolino balloon catheter has unique features that allow for greater ease of operator use, rapid catheter exchange, and optimal angiographic visualization. It is felt that this catheter design provides distinct advantages over standard angioplasty equipment.
Complete atrioventricular block during cardiac catheterization: Two case reports in patients without pre‐existing conduction abnormalities
Authors: Brachfeld Claude , Marshall James , Volosin Kent J. , Groh William C.
Published: March 2007

Third‐degree atrioventricular block has been well documented during ventricular catheterization of patients with underlying conduction abnormalities. Two cases reported here describe patients with normal conduction at baseline who sustained complete heart block during ventricular catheterization. Catheterizing physicians should be aware of this risk, which has not been previously reported.
Complete heart block complicating retrograde left heart catheterization
Authors: Feit Alan , Kipperman Robert , Ursell Shantha , Reddy C. V. R.
Published: March 2007

Three cases of complete heart block complicating retrograde left heart catheterization are presented. In two of the three cases, electrophysiologic study documented block below the AV (atrial ventricular) node. In the third recurrent complete heart block was fatal. It appears that complete heart block complicating retrograde left sided cardiac catheterization is not simply a pericatheterization event; rather, it appears that there is high risk of recurrent complete heart block and that electrophysiologic study is mandatory.
Pseudo‐aneurysm formation following balloon angioplasty for recurrent coarctation of the aorta
Authors: Joyce Douglas H. , McGrath Lynn B.
Published: March 2007

Intraluminal balloon dilatation of re‐stenosis encountered after operative repair of coarctation of the aorta has been recently advocated. A case is presented that demonstrates a potential serious complication of this procedure: rupture of the aortic wall with pseudoaneurysm formation. The operative repair and mechanism of injury are discussed. Balloon dilatation of recurrent coarctation of the aorta can cause a significant morbidity and potential mortality.
Anomalous origin of the right coronary artery from the ascending aorta
Authors: Rovani Xavier , Relland John , Gaux Jean‐Claude
Published: March 2007

A 47 yr‐old man had an anomalous origin of the right coronary artery from the left anterior wall of the ascending aorta. This was demonstrated by aortography and by selective right coronary angiography.
Cardiac catheterization in the patient with history of allergy to local anesthetics
Authors: Feldman Ted , Moss Jonathan , Teplinsky Kerry , Carroll John D.
Published: March 2007

Patients with a history of allergic reactions to local anesthetic drugs present a difficult problem during evaluation for cardiac catheterization procedures. In the worst cases the procedure may be deferred, or even performed without local anesthesia. In the vast majority of patients an acceptable agent for safe local anesthetic use can be found. Skin testing beginning with very dilute solutions of preservative free local anesthetic agent may be administered easily. This report describes the practical aspects of skin testing and local anesthetic agent selection in patients with a history of allergic reaction to local anesthetic drugs.
Coronary angioplasty for medically refractory unstable angina in patients with prior coronary bypass surgery
Authors: Morrison Douglass A.
Published: March 2007

Percutaneous transluminal coronary sngioplasty (PTCA) has been applied with good results to selected patients with unstable angina and to selected patients who have had prior bypass surgery. The population with prior bypass and unstable angina has not been specifically evaluated. This report reviews the results of angioplasty of 45 vessels in 34 patients with medically refractory unstable angina and at least one prior bypass heart surgery. Of these 34 patients, 32 had rest angina; 14 had resting electrocardiographic changes, all 34 were on aspirin 325 mg QD, 31 were on a calcium blocker. 22 were on a beta blocker, 9 were on intravenous nitroglycerin, and 5 required intraaortic balloon counterpulsation for temporary stabilization. Angioplasty of a vein graft was attempted in 17 patients; the left internal mammary was attempted in 4 patients; 24 native coronary arteries in 15 patients were attempted; 3 of the native arteries were protected left main arteries. Of the LIMA angioplasties, 3 were successful; in the 1 unsuccessful case, the occluded anterior descending artery was opened. Of the 17 vein grafts, 16 were successful: 1 had an acute occlusive syndrome and went to surgery with a balloon pump and bail out catheter; his recovery was uneventful. Of the 24 native artery angioplasties, 22 were successful: one patient was technically unsuccessful in the only vessel attempted; he went to semiemergent surgery and recovered uneventfully. In the other, a right coronary lesion was successfully dilated, but an occluded anterior descending artery was not opened. There were no deaths or in‐hospital myocardial infarctions. Of the 32/34 patients with technically successful angioplasty, all 32 had relief of rest angina, and 27 had pre‐discharge exercise testing: 19 were completely asymptomatic and 8 had angina only at maximal exertion. In follow‐up ranging from 6 months to 36 months, 4 patients with vein graft angioplasty, 2 patients with native artery angioplasty, and one of the operated patients, had complications. Two patients with recurrence at 2 months and 14 months, respectively, have undergone successful repeat angioplasty; two patients have had reoperation; 2 patients have had remote myocardial infarctions. Thus far, none of the LIMA have recurred clinically. There have been 2 late deaths in one angioplastied and one operated (the technical failure) patients: one from pulmonary emboli and one from heart failure, both at 6 months after index hospitalization. These data suggest that emergent or semiemergent angioplasty can be performed safely and with good clinical results in patients with unstable angina and prior heart surgery.
Use of femoral artery guiding catheters via the left brachial artery for transluminal coronary angioplasty
Authors: Spaccavento Leo J. , Breisblatt Warren M.
Published: March 2007

Percutaneous transluminal coronary angioplasty using the right brachial artery has been described using either a cutdown and arteriotomy or a percutaneous entry (Cohen et al.: American Journal of Cardiology 57:862–864, 1986; Dorros et al.: Catheterization and Cardiovascular Diagnosis 8:233–242, 1982) [1,2]. Each method requires the use of a brachial artery guiding catheter (Sterner guiding catheter; (USCI). This communication reports the use of percutaneous entry of the left brachial artery and coronary angioplasty performed with femoral guiding catheters. In this manner coronary angioplasty has been successfully performed in 42 of 47 patients (90%) without major complications.
Attenuation of pulsus alternans during coronary angiography
Authors: Ring Michael E. , Kern Morton J. , Genovely Harry , Serota Harvey , Vandormael MiChel
Published: March 2007

Following coronary angiography in a patient with cardiomyopathy and pulsus alternans, we observed a transient but marked attenuation of the alternation in pulse pressure associated with an elevation in pulmonary artery pressure. Attenuation of pulsus alternans has been rarely reported and may represent further deterioration of ventricular function.
Percutaneous double‐balloon valvuloplasty of porcine bioprosthetic valves in the tricuspid position
Authors: Attubato Michael J. , Stroh Jack A. , Bach Richard G. , Slater James , Feit Frederick
Published: March 2007

This is a description of the first two reported cases of double‐balloon valvuloplasty in the treatment of porcine bioprosthetic valve stenosis in the tricuspid position. In both cases, the double‐balloon technique resulted in a better hemodynamic improvement than single‐balloon valvuloplasty and was well tolerated. Double‐balloon valvuloplasty is a reasonable alternative to surgical replacement of a stenotic bioprosthesis in the tricuspid position.
Brachial approach to emergency cardiac catheterization during thrombolytic therapy for acute Myocardial Infarction
Authors: George Barry S. , Candela Richard J. , Topol Eric J. , Stack Richard S. , Kereiakes Dean J. , Abbottsmith Charles W. , Masek Ramona , Pickel Ann , Dillon Joanne , Harrelson Lynn , Califf Robert M.
Published: March 2007

The use of the brachial approach to acute coronary intervention has not been previously studied. In the course of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials, we used the transbrachial approach to cardiac catheterization with or without angioplasty in 202 of 704(28.6%) patients. The baseline characteristics of age, sex, risk factors, medical history, time from symptom onset to therapy, and left ventricular function were similar for the 2 different approaches. Time from therapy to coronary angiography was not delayed by the brachial approach compared with the femoral approach: 97.1±26 min vs. 99.9±133.8 min, respectively. Chemical patency was established in 78 vs. 73% of patients and technical success with acute PTCA with the brachial approach was 89% vs. 78% with the femoral approach. Clinical outcomes were quite similar with respect to death(6 vs. 6%), reocclusion (10 vs. 14%), and emergency coronary bypass surgery (5 vs. 6%). Baseline hematocrit was 43.9±4.4 and 43.5±4.8, respectively with a nadir of 32.9±5.6 vs. 33.0±5.4. The need for vascular repair occurred in 1% vs. 3% of patients and retroperitoneal hemorrhage was documented in 1% vs. 1% of patients. This study indicates that in thehands of experienced operators the transbrachial approach to acute coronary intervention in theacute phase of treatment with thrombolytic therapy can be used with equal risks and efficacy asthe femoral approach.
Use of a guiding catheter for contralateral femoral artery angioplasty
Authors: White Christopher J. , Nguyen Minh , Ramee Stephen R.
Published: March 2007

We describe a unique method employing a transseptal sheath as a “guiding catheter” that allows contralateral retrograde femoral artery access to perform balloon angioplasty of proximal superficial femoral artery lesions. This technique simplifies arterial access, provides support for crossing lesions, and allows angiographic visualization of target lesions during the procedure.
Left ventricular rupture complicating percutaneous mitral commissurotomy: Salvage using percutaneous cardiopulmonary bypass support
Authors: Shawl Fayaz A. , Domanski Michael J. , Yackee John M. , Wish Marc H. , Dullum Mercedes , Neimat Samir
Published: March 2007

Left ventricular rupture resulting in death has been reported to be a complication of percutaneous mitral commissurotomy. We report a 71‐year‐old man in whom a left ventricular rupture occurred during percutaneous mitral commissurotomy and resulted in hemodynamic collapse due to acute cardiac tamponade. The patient was stabilized using percutaneously instituted cardiopulmonary bypass support with subsequent repair of the left ventricle and successful mitral valve replacement. Three months later this patient remains in New York Heart Class I.
A rapid, effective technique for retrograde crossing of valvular aortic stenosis using standard coronary catheters
Authors: Harrison J. Kevin , Davidson Charles J. , Phillips Harry R. , Harding Michael B. , Kisslo Katherine B. , Bashore Thomas M.
Published: March 2007

Retrograde crossing of valvular aortic stenosis can be challenging even to experienced angiographers. In 446 of 447 consecutive patients with aortic stenosis catheterized during the past 3 years, a technique using a standard Judkins right coronary catheter and a floppy straight tipped guide wire was successful in rapidly and efficiently crossing these pathologically distorted valves in retrograde fashion. Once the valve was crossed, the coronary catheter was replaced with a pigtail catheter for pressure and ventriculography. The majority of these valves required less than 2 min to cross using this technique.

This method is valuable in limiting the time required for catheterization, thus helping to reduce procedure related morbidity in these oftimes critically ill patients.
Diagnosis of left atrial thrombi in mitral valve disease by coronary arteriography
Authors: Russo Giovanni , Tamburino Corrado , Ali Antonino , Monaco Orazio , Calvi Valeria , Drago Antonino , Cinnirella Carmelo , Abbate Mauro , Giuffrida Giuseppe
Published: March 2007

Arteriographic findings of neovascularity and fistula formation between coronary arteries and left atrium have occasionally been described in association with left atrial thrombosis in patients with mitrai valve disease. The validity of these coronary arteriographic findings in diagnosis of atrial thrombi has been evaluated in 112 patients with mitral valve disease. Comparison was made with surgery. The study furnished these diagnostic values: sensitivity 70%, specificity 85%, positive predictive value 72%. Even if this angiographic finding is complementary in diagnosis of atrial thrombosis, its identification during coronary arteriography in patients with mitral valve disease is useful. Its detection could improve diagnostic prediction of thrombosis, especially in patients without previous emboiic events or where echocardiography failed to reveal thrombi.
Catheterization of coronary artery bypass graft from the descending aorta
Authors: Bilazarian Seth D. , Shemin Richard J. , Mills Roger M.
Published: March 2007

The increasing frequency of reoperation for coronary artery disease has led to the use of a variety of grafts. This report describes the catheter technique for selective opacification of a saphenous vein graft from the descending thoracic aorta to the posterior coronary circulation.
Percutaneous transluminal coronary angioplasty of gastroepiploic artery graft
Authors: Komiyama Nobuyuki , Nakanishi Shigemoto , Yanagishita Yoshiki , Nishiyama Shinichiro , Seki Akira , Watanabe Yasunori , Konishi Toshio , Fuse Katsuo
Published: March 2007

The right gastroepiploic artery is being used as a third arterial conduit for coronary artery bypass surgery. Presented here is a case demonstrating successful percutaneous transluminal coronary angioplasty of the gastroepiploic artery graft. This successful accomplishment may avoid repeat surgical revascularization in case of failure of the gastroepiploic artery graft, hence may encourage people to use it more often.
Balloon valvuloplasty for fungal endocarditis induced stenosis of a bioprosthetic tricuspid valve
Authors: Benedick Bruce A. , Davis Stacy F. , Alderman Edwin
Published: March 2007

Palliative treatment was provided without complications by double balloon valvuloplasty of a stenotic porcine tricuspid valve in a patient with fungal endocarditis. With two 15 mm diameter valvulotomy balloons the peak tricuspid gradient decreased from 21 to 7 mm Hg and valve area increased from 0.3 to 1.2 cm2. After the procedure the patient clinically improved; however, valve replacement was not performed as planned because the patient developed an intracranial hemorrhage. She subsequently died of complications of fungemia. The present report demonstrates the possible use of valvuloplasty as a palliative procedure in selected patients with valvular stenosis involved with endocarditis.
Emergent saphenous vein graft stenting for acute occlusion during percutaneous transluminal coronary angioplasty
Authors: Mehl John Kurt , Schieman Gregory , Dittrich Howard , Buchbinder Maurice
Published: March 2007

This report describes the initial use in the United States of emergency intravascular stenting for the treatment of acute coronary occlusion complicating elective saphenous vein graft angioplasty. This case adds further support to the role of the balloon expandable stent as an effective “bail out” device for failed angioplasty.
Ex‐Vivo results using a new pullback atherectomy catheter (pac)
Authors: Fischell Tim A. , Fischell Robert E. , White Robert I. , Chapolini Robert
Published: March 2007

In order to evaluate the feasibility of performing definitive atheromatous plaque removal using a novel retrograde cutting (Pullback) atherectomy catheter, pullback atherectomy was performed in 13 severely diseased cadaveric superficial femoral arteries. All experiments were performed using cadaver tissue either mounted in a perfusion/mounting chamber (n = 10) or left in situ (n = 3). In general, a single cut was made with each of three sequentially larger atherectomy catheters (2.5 mm, 3.0 mm, and then 3.5 mm devices). The results were evaluated by angiography and by light microscopy. Nine of the 13 experiments were performed in totally occluded vessels. The mean pre‐atherectomy stenosis (all specimens) was 95 ± 3%, with a final mean postatherectomy stenosis of 21 ± 5%. There was one vessel performation. We conclude from these preclinical studies that retrograde atherectomy with the Pullback Atherectomy Catheter is a feasible means of performing definitive atherectomy. Despite the promising potential of retrograde atherectomy, little can be said with certainty about the clinical utility of such a device at this early stage.
Preservation of regional myocardial function during coronary angioplasty with an autoperfusion balloon catheter: A case report
Authors: Simonton Charles A. , Kowalchuk Glen J. , Austin W. Kenneth
Published: March 2007

Echocardiographic assessment of regional myocardial function was performed during standard balloon coronary angioplasty followed by autoperfusion balloon angioplasty of a proximal left anterior descending artery stenosis. Septal and apical akinesis occurred within 60 seconds of standard balloon inflation, but regional function was well preserved during prolonged autoperfusion balloon inflation.
Successful mitral valvuloplasty using the inoue balloon in a patient with mitral stenosis associated with subvalvular fibrosis and reduced left ventricular inflow cavity: A case report
Authors: Benit Edouard , Rocha Paulo , Geest Hilaire De , Werf Frans Van De
Published: March 2007

Percutaneous transvenous mitral valvuloplasty (PTMV) was performed with two cylindric pigtail balloon catheters in a 52‐year‐old woman with symptomatic mitral stenosis. The subvalvular apparatus was fibrous with welded chordae and the subvalvular left ventricular space was markedly reduced. As a result of this distorted anatomy, during the inflations, the two balloons constantly slipped back into the left atrium before full inflation was obtained. After the procedure, the mitral valve area (MVA), as estimated by echo‐doppler (ED), increased from 1.00 to 1.34 cm2. After 2 months of mild clinical improvement, the patient again became symptomatic and ED examination showed a MVA of 1.25 cm2. A second PTMV was performed with an Inoue balloon, the entire procedure taking less than 1 hour. A stable position of the Inoue balloon and complete dilatation were achieved. ED examination showed a mitral valve area of 2.30 cm2. There was no mitral regurgitation nor atrial septal defect. After 3 months, she has only N.Y.H.A. class I symptoms and MVA, as estimated by ED, was 2.40 cm2.
Takayasu's disease with axillary, right coronary artery, and right internal mammary stenosis treated with angioplasty
Authors: Lannone Liberato A. , Rayl Koreen Lemaster
Published: March 2007

A 47‐year‐old woman presented with progressive angina and failed medical therapy. After an unsuccessful attempt at angioplasty of a totally occluded right coronary artery, coronary artery bypass using the right internal mammary artery was performed. She presented 2 years later with stenosis in the mammary graft, right coronary artery, and axillary artery. These lesions were all treated with angioplasty.
Rate‐related left bundle branch block as a cause of non‐ischemic chest pain
Authors: Perin Emerson , Petersen Fernando , Massumi Ali
Published: March 2007

A case is presented of rate‐dependent left bundle branch block associated with chest pain in a patient with angiographically normal coronary arteries. Lactate extraction showed no evidence of myocardial ischemia. It appears that in this case, chest pain was associated with sudden ventricular asynergy rather than myocardial ischemia.
Accuracy and reproducibility of quantitative coronary arteriography using 6 and 8 french catheters with cine angiographic acquisition
Authors: Ellis Stephen G. , Pinto Ibraim M. F. , McGillem Mark J. , Deboe Scott F. , Lefree Michael T. , Mancini G. B. John
Published: March 2007

To determine the suitability of 6 French catheters for quantitative coronary arteriography, the relative accuracy and reproducibility of one type of these catheters was compared to that obtained with standard 8 French catheters in 20 stenoses. Duplicate injections with polyurethane 6 French catheters were obtained using hand and power injection technique with cineangiographic acquisition (four 6 French catheter injections total per stenosis). Measurements of both percent diameter stenosis and absolute dimensions were compared to those obtained with hand injection and cine acquisition using 8 French catheters as a “gold standard.” While the reproducibility of dimension determination with the 6 French catheter was generally similar to that obtained with the 8 French catheter (0.27 ± 0.23 mm for absolute diameter and 8.1 ± 7.4% for percent diameter stenosis), accuracy was significantly less for the 6 French catheter for measurement of absolute dimensions. Thus, while apparently well suited for serial measurements of the same stenoses, 6 French catheters may not be as accurate in the determination of absolute artery dimensions as 8 French catheters.