bluuebunny/crossref_metadata_2025 huggingface dataset:
Closure of a coronary fistula with a transcatheter implantable coil
Authors: Van Den Brand M. , Pieterman H. , Suryapranata H. , Bogers A. J. J. C.
Published: March 2007

Large sized coronary artery fistulas are rare and diagnosed in only 0.05% of adult catheterized patients. Only a minority of these fistulas are operated upon. We describe a percutaneous technique to close a left coronary artery fistula draining into the right atrium in a 30‐yr‐old male patient. The fistula was closed by implantation of a trefoil coil, inserted through a catheter selectively advanced into the fistula.
Effect of exercise on indices of valvular aortic stenosis
Authors: Martin Timothy W. , Moody Joe M. , Bird Julio J. , Slife David , Murgo Joseph P.
Published: March 2007

Changes in the physiologic state of the patient may affect indices of valvular aortic stenosis. We determined the effects of supine exercise on the Gorlin valve area, Cannon valve area, aortic valve resistance, and a modified stroke work loss index in 80 patients with aortic stenosis. Exercise caused a significant increase in the Gorlin and Cannon valve area, while work loss and valve resistance decreased significantly. The average percent change in work loss, 12.2%, was lower than the other indices (P < 0.02), i.e., 15.3% for valve resistance, 18.6% for the Gorlin area, and 19.3% for the Cannon area. The correlation between the rest and exercise measurements was highest for work loss (r = 0.94), compared to 0.93, 0.88, and 0.89 for the other 3 indices, respectively. In patients with a Gorlin area below 1 cm2, exercise caused a significant decrease in work loss, but not Cannon area or valve resistance. However, the percent change was significantly lower and the correlation was better with the work loss index. We conclude that the work loss index is less affected by supine exercise than other indices of aortic stenosis.
Intracoronary stent implantation: New approach using a monorail system and new large‐lumen 7 f catheters from the brachial route
Authors: Jenny Donald B. , Robert Gabriel P. , Fajadet Jean C. , Cassagneau Bernard G. , Marco Jean
Published: March 2007

In this brief report we describe a case of successful multivessel PTCA with intracoronary stent implantation using a new large‐lumen 7F catheter from the left brachial approach. The application of this technique should be considered for intravascular stent implantation when anticoagulation ideally should not be interrupted or in anatomical situations limiting femoral vascular access.
Mitral balloon valvuloplasty in pregnancy: Advantages of a unique balloon
Authors: Gangbar E. W. , Watson K. R. , Howard R. J. , Chisholm R. J.
Published: March 2007

The burden of pregnancy in patients with severe mitral stenosis continues to present a therapeutic challenge. We present two such cases successfully treated with balloon valvuloplasty using the Inoue balloon. The unique features of this balloon may render it the technique of choice for selected pregnant patients with severe mitral stenosis.
A prospective randomized study of 4.1 French catheters utilizing the percutaneous right brachial approach for the diagnosis of coronary artery disease
Authors: Talley J. David , Smith Steven M. , Walton‐Shirley Melissa , Hattel Larry , Szabo Tibor , Godlewski Krystof , Yussman Loan Stahr Zoeann , Palmer Sammie , Vogel Robert , Kupersmith Joel
Published: March 2007

To determine the utility of 4.1 French (F) catheters in diagnosing coronary artery disease, 50 patients were randomized to 4.1F Multipurpose or Judkins catheters utilizing the percutaneous right brachial approach. The randomized 4.1F tip shape catheter completed the procedure in 40% of the patients, and overall the 4.1F catheters completed the catheterization in 72% of the cases. With excessive or prolonged manipulation, the catheters were noted to kink and soften and required replacement for a catheter of similar or larger size. In 28% of the cases, larger F sizes (5F and 6F) were used to complete the procedure. There was 1 (2%) procedural complication. The total procedural success (accounting for all F sizes) without clinical complication was 98%.

There was no difference between the 4.1F Judkins or Multipurpose catheter shapes for coronary arteriography by either qualitative or quantitative angiographic analysis. Left ventricular opacification was improved with the 4.1F Pigtail vs. the 4.1 Multipurpose by qualitative angiographic analysis. When the 4.1F angiograms were compared by quantitative angiography in blinded, but not randomized fashion to angiograms performed with 6F Judkins catheters, there was improved opacification of the LAD and diastolic frame of the left ventriculogram with the larger catheter. This difference was not noted with qualitative angiography.

This study indicates that 4.1F catheters can be utilized from the right brachial approach for the diagnosis of coronary artery disease, thus avoiding the need for supine bedrest associated with routine femoral artery catheterization while maintaining diagnostic accuracy. © 1992 Wiley‐Liss, Inc.
In‐vivo validation of on‐line and off‐line geometric coronary measurements using insertion of stenosis phantoms in porcine coronary arteries
Authors: Haase Jürgen , Mario Carlo Di , Slager Cornelis J. , van der Giessen Willem J. , Boer Ad Den , de Feyter Pim J. , Reiber Johan H. C. , Verdouw Pieter D. , Serruys Patrick W.
Published: March 2007

Geometric coronary artery measurements with the Phillips Digital Cardiac Imaging System (DCI) and the Cardiovascular Angiography Analysis System (CAAS) were validated using percutaneous insertion of radiolucent stenosis phantoms in swine coronary arteries. Angiographic visualization of the stenosis lumens (ϕ 0.5, 0.7, 1.0, 1.4, 1.9 mm) was simultaneously recorded on DCI and cinefilm. The acquisition systems were calibrated by either the diameter of the guiding catheter (catheter CAL) or the isocenter method (iso‐center CAL). Minimal luminal diameters (MLD) obtained with CAAS and DCI on 20 corresponding cineframes were compared with the true phantom diameters (PD). The accuracy of MLD measurements with the CAAS using isocenter CAL was –0.07mm, the precision 0.21 mm (r=0.91; y = 0.30 + 0.79x; SEE = 0.19), with catheter CAL the accuracy was 0.09 mm, the precision 0.23 mm (r=0.89; y = 0.19 + 0.74x; SEE = 0.19). The accuracy of MLD measurements using the DCI with isocenter CAL was 0.08 mm, the precision 0.15 min (r = 0.96; y = 0.08 + 0.86x; SEE = 0.14), with catheter CAL the accuracy was 0.18 mm, the precision 0.21 mm (r=0.92; y = 0.09 + 0.76x; SEE = 0.17). DCI underestimated PD with isocenter CAL (p<0.05) and with catheter CAL (p< 0.001). MLD can be measured with high accuracy, both applying on‐line digital as well as off‐line cineangiographic analysis. The results of digital measurements demonstrate high reliability of the new digital software package.
Double marker ACX II: A new balloon catheter for coronary stent delivery
Authors: Brown R. I. G. , Penn I. M. , Ricci D. R. , Buller C. E.
Published: March 2007

We report our initial experience using the Double Marker ACX II for intracoronary stent deployment in 22 patients, 10 of whom were elective stents and 12 of whom were stented for complications following failed coronary angioplasty. The overall success rate was 95 percent. This dilatation catheter offers advantages which include accurate stent deployment with a double marker system, the option of using a delivery sheath, and the ability to deliver multiple stents with the same balloon catheter.
Angioplasty of tortuous left internal mammary artery: Description of a new technique
Authors: Nakhjavan Fred K. , Kothapalli Srinivasa
Published: March 2007

Angioplasty of the distal anastomosis site of a markedly tortuous left internal mammary artery (LIMA)‐anterior descending artery is described. Tortuosity of LIMA was negotiated using the Tracker‐Seeker catheter guidewire system. Angioplasty was then performed using the conventional technique.
Salvage angioplasty: An alternative to high risk surgery for unstable angina?
Authors: Morrison Douglass A. , Barbiere Charles C. , Johnson Randy , Marshall Guillermo , Fullerton David , Hammermeister Karl E. , Grover Frederick L. , Morgan Pamela , Olsen Mary Ann , Stovall James R. , West Elaine , Wolf Dianne
Published: March 2007

This prospective, Human Subjects Committee and Ethics Committee approved investigation was performed to determine if coronary angioplasty (PTCA) might be a reasonable alternative revascularization method for unstable angina patients thought to be at high risk for operative (CABG) mortality. Between March 1990 and October 1991, thirty‐four consecutive patients with medically refractory rest angina were deamed to have high risk of surgical mortality and underwent PTCA without surgical backup. Predicted operative mortality was calculated for each patient based upon the VA Surgical Risk Assessment model. Angioplasty of 52 vessels was attempted. Reduction in lumenal narrowing to < 50% and improved angiographic flow was obtained in 47 vessels. There were four complicating infarctions. One death occurred in the lab, and three patients with unsuccessful angioplasty died within 30 days of pump failure. Relief of angina occurred in 30/34. Thirty patients were discharged home. In follow‐up from 1 to 12 months, there have been 2 late sudden deaths at 4 months and 9 months, 1 death from lung cancer; 4 patients have stable exertional angina; 2 are awaiting heart transplant but are pain free, and one patient who had PTCA during cardiogenic shock from acute myocardial infarction had elective coronary artery bypass surgery. There have been no late myocardial infarctions. The observed angioplasty 30‐day mortality of 11.8% (95% confidence limit 1% to 22.6%) compares favorably with the predicted operative mortality of 23.8% for this group. This prospective but non‐randomized series supports the concept that balloon angioplasty may be a reasonable alternative to surgical intervention in some patients with unstable angina and high risk for surgery. A prospective randomized trial is warranted.
Budd‐chiari syndrome treated successfully by percutaneous transluminal balloon angioplasty: Two cases followed‐up for 6 years
Authors: Chan P. , Lee C. P. , Lee Y. S.
Published: March 2007

We report 2 cases of Budd‐Chiari syndrome that are due to complete membranous obstruction between the junction of the inferior vena cava and the right atrium. Both cases were treated successfully by King's bioptome breakthrough followed by balloon dilatation of the membrane. The patients showed remarkable symptomatic improvement and promising hemodynamic and angiographic results immediately after the procedure and 6 years later. We conclude that balloon angioplasty is a safe and effective method for treating this rare disease in selected cases.
Peripheral stent recovery after failed intracoronary delivery
Authors: Pan Manuel , Medina Alfonso , Romero Miguel , Suárez De Lezo José , Hernández Enrique , Pavlovic Djordje , Melián Francisco , Marrero José , Cabrera José A.
Published: March 2007

The Palmaz‐Schatz stent can be successfully deployed in most patients. However, in a small percentage of instances a systemic embolism of the stent has been reported. In the present article we describe an easy and fast method of stent capture when detachment from the balloon has happened (pulling back the stent‐loaded balloon into the guiding catheter or femoral sheath). In this situation we propose the use of the coronary guide‐wire “as a guide” to capture coaxially the lost stent. This method allows for continuing the procedure without removal of the femoral sheath.
Use of sideholes for diagnostic coronary arteriography by judkins technique in patients with ostial coronary stenosis
Authors: Bourdillon Patrick D. V.
Published: March 2007

Patients with ostial left main coronary artery stenosis are at increased risk from diagnostic cardiac catheterization. In order to reduce this risk a modified Judkins coronary catheter with a sidehole 1.5–2 cm from the tip has been used in 6 patients in whom pressure damping was observed after initial use of a standard end‐hole Judkins left coronary catheter. This eliminates damping and allows forceful hand injection with good proximal and distal vessel opacification. It also allows the acquisition of multiple views without the need for catheter removal after each injection, thereby reducing the risk involved in multiple cannulations of a vessel with a potentially unstable lesion at its origin. The technique has also been used for ostial lesions in a right coronary artery and a vein graft.
Endomyocardial biopsy in heterotopic heart transplant recipients via the femoral vein
Authors: Boffa G. M. , Grassi G. , Cocco P. , Razzolini R. , Isabella G. B. , Livi U. , Thiene G. , Chioin R.
Published: March 2007

The results of endomyocardial biopsy (EMB) via the femoral vein in heterotopic heart transplant recipients were retrospectively analyzed and compared with those obtained using the right internal jugular vein approach. A total of 139 EMB were performed in 8 patients using the femoral (35) or the jugular (104) approach. Twenty three (64.7%) of the procedures performed via the femoral vein were part of the yearly hemodynamic and coronary artery study, and 12 (35.3%) constituted a routine postoperative evaluation of the myocardium rejection state in patients with imperviousness of the right internal jugular vein. Comparing the results obtained with the femoral approach, we observed a higher overall success rate (94.3 vs 88.5%, NS) and obtained more samples that were useful for histologic evaluation (95.5 vs 85.9%, NS); with the jugular procedure, the fragments were significatively larger in diameter (1.28 ± 0.55 vs 1.61 ± 0.85 mm, mean ± SD) and in area (1.49 ± 1.16 vs 2.28 ± 2.24 mm2, mean ± SD). No cardiac or local complications were noted when the femoral approach was used, while two attempts to perform biopsy via the jugular vein resulted in obstruction of this vessel. Our data suggest that the femoral venous approach for endomyocardial biopsy in heterotopic heart transplant recipients is a valid alternative to the more commonly used routes.
Pulmonary wedge angiography for prediction of pulmonary vascular disease in down syndrome
Authors: Wilson Nigel J. , Culham J. A. Gordon , Sandor George G. S. , Taylor Glenn P.
Published: March 2007

We performed high resolution pulmonary wedge angiography (PWA) and conventional hemodynamics to predict the reversibility of structural pulmonary vascular disease. Sixty‐one pulmonary wedge angiograms were performed on 41 patients with intracardiac shunts and Down syndrome (median age 8 months). Balloon occlusion wedge angiograms were analyzed for (1) monopedial branches from the distal 10 mm of muscular arteries, (2) capillary blush, (3) tapering indices, and (4) tortuosity. Twenty‐five patients had open lung biopsy, graded by the Heath Edwards classification, and analyzed morphometrically. Pulmonary vascular resistance of ≥6 units was 100% sensitive and 94% specific for Heath Edwards Grade III‐IV. A monopedial count < 3 vessels was 83% sensitive and 100% specific for Heath Edwards Grade III‐IV. Abnormal capillary blush was 83% sensitive and 69% specific for Heath Edwards Grade III‐IV. Tapering indices and tortuosity showed no significant correlation with lung biopsy. A combination of pulmonary vascular resistance <6 units, monopedial count ≥3, and normal capillary blush was 100% sensitive and specific for Heath Edwards Grade 0‐II, and a combination of pulmonary vascular resistance ≥ 6 units, monopedial count < 3, and abnormal capillary blush was 100% sensitive and specific for Heath Edwards Grade III‐IV. Using the 3 criteria, Heath Edwards Grade was accurately predicted in 17 patients. In 4 patients, only 2 criteria were available. Morphometric analysis showed an inverse relationship between the lowest monopedial count and the number of occlusive vessels per cm of tissue, r = −0.74, p < 0.001. Arteries showing intimal and/or medial thickening causing >90% luminal narrowing were scored as “occlusive.” These results show that when the hemodynamic and pulmonary wedge angiography data are concordant, the structural changes of pulmonary vascular disease can be accurately predicted and lung biopsy may be avoided.
Continuous cardiac output monitoring by the Fick method
Authors: Baxley William A. , Cavender J. Bradley , Knoblock John
Published: March 2007

Current methods for longitudinal assessment of cardiac output in severely ill patients are intermittent only and in many respects appear unsatisfactory. We have developed a computerized on‐line system for continuous Fick cardiac output monitoring, utilizing fiberoptic arterial and pulmonary arterial probes with a metabolic analyzer for VO2. In 15 patients, cardiac output ranged 1.9–6.8 L/min and 12 were within 5% of thermodilution values. Continuous output monitoring during interventions in two patients (saline infusion and coronary angioplasty) illustrate the utility of the technique. Two additional patients had unsatisfactory VO2 data due to low airflow velocity. The results of this pilot study suggest that cardiac output monitoring by the Fick method may have clinical and investigational uses in intensive care units and during cardiac catheterization or surgical procedures. © 1993 Wiley‐Liss, Inc.
Effects of intracoronary injection of acetylcholine on coronary collateral circulation
Authors: Yamanishi Kazuto , Fujita Masatoshi , Miwa Kunihisa , Igawa Akihiko
Published: March 2007

To clarify the effect of intracoronary injection of acetylcholine on coronary collateral circulation, acetylcholine (20 and 50 μg) was injected directly into the donor artery of 5 patients with rest angina who had angiographically demonstrable collateral channels. Coronary spasm was defined as severe vasoconstriction (≥ 90% of luminal diameter) with chest pain and/or ischemic ST‐segment changes. The intracoronary injection of acetylcholine induced spasm in all the 5 patients. The site of spasm was collateral vessels in 3, and the recipient coronary artery in 2 of the 5 patients. The spasm resolved spontaneously without administration of nitroglycerin. The contralateral intracoronary injection of acetylcholine also induced diffuse coronary spasm in 4 patients. These findings indicate that collateral vessels and recipient coronary arteries of the collateral circulation are susceptible to acetylcholine. Impaired relaxation and vasospastic responses to acetylcholine presumably due to endothelial dysfunction in the collateral and recipient coronary vessels may explain, at least in part, myocardial ischemia in patients with a well‐developed collateral circulation. © 1993 Wiley‐Liss, Inc.
Percutaneous transvenous mitral commissurotomy using the inoue balloon catheter
Authors: Inoue Kanji , Feldman Ted
Published: March 2007

Since its inception in 1982, percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter has gained increasingly wide use internationally. The procedure is technically successful in over 90% of patients, and the long‐term durability of commissurotomy is excellent in those with pliable mitral valve leaflets and minimally deformed submitral apparatus. PTMC offers an alternative to patients previously not considered candidates for surgery, where no alternative had existed in the past. After transseptal puncture, PTMC using the Inoue balloon can be accomplished easily in the majority of patients. In comparison to double balloon mitral valvotomy, the postdilatation valve area is similar, the incidence of mitral regurgitation is not different, and the fluoroscopic and procedure time are markedly shorter. While patients with little valve deformity are excellent candidates for this procedure, and those not considered candidates for surgical therapy are also easily defined, selection of patients for balloon dilatation among those with significant valve deformity who are otherwise candidates for valve replacement therapy remains a challenging problem. © 1993 Wiley‐Liss, Inc.
Percutaneous double balloon valvuloplasty for stenosis of porcine bioprostheses in the tricuspid valve position: A report of 2 cases
Authors: Slama Michel S. , Drieu Luc H. , Malergue Marie‐Christine , Dibie Alain , Temkine Jacques , Sebag Claude , Lecompte Yves , Laborde Fraņois , Motté Gilbert
Published: March 2007

The feasibility and results of percutaneous double balloon valvuloplasty were evaluated in 2 patients with stenosis of porcine bioprostheses in the tricuspid valve position. The procedures were performed with a Trefoil 3 × 10 and a 15 mm balloon. Long inflations (4 and 3 minutes) were well tolerated. A significant immediate increase in the valve area, without significant valvular regurgitation, was achieved in both cases, from 0,65 to 1,15 cm2 in case 1 and from 0,9 to 1,65 cm2 in case 2. Both patients required valve replacement during the follow‐up, at 14 and 21 months. There was no restenosis, but echocardiography showed right atrial thrombosis in case 1. Progressive restenosis with peripheral edema and increase of the mean doppler gradient occurred in case 2.

The procedure is feasible, safe, and well tolerated. It provides significant immediate hemodynamic improvement, but it should be considered as a palliative technique since a normal valve area can not usually be obtained and a restenosis is likely to occur at midterm follow‐up. © 1993 Wiley‐Liss, Inc.
Successful percutaneous mitral balloon commissurotomy in a patient with a previous mitral valve repair
Authors: Skudicky Daniel G. , Skoularigis John , Essop Mohammed R. , Rothlisberger Christian , Sareli Pinhas
Published: March 2007

A case of successful percutaneous mitral balloon commissurotomy (PMBC) in a patient who had undergone mitral valve repair with a Carpentier ring 6 years earlier is described. © 1993 Wiley‐Liss, Inc.
A unique scenario for coronary atherectomy
Authors: Franzen Damian , Höpp Hans Wilhelm , Arnold Georg , Winter Ulrich , Hilger Hans Hermann
Published: March 2007

Despite several attempts, balloon angioplasty of a slightly eccentric stenotic lesion in the proximal right coronary artery failed to result in any increase of luminal diameter. Following disruption and partial removal of a fibrous atherosclerotic cap using directional atherectomy, subsequent balloon angioplasty was highly successful. © 1993 Wiley‐Liss, Inc.
Use of angioplasty in the management of complicated perioperative infarction following bypass surgery
Authors: Dorogy Mark E. , Highfill William T. , Davis Richard C.
Published: March 2007

Ischemic complications in the perioperative period following bypass surgery adversely affect both short‐ and long‐term prognosis. Coronary angioplasty was successfully performed in 2 patients sustaining complicated postoperative myocardial infarctions with resolution of angina and restoration of hemodynamic stability. These cases illustrate that angioplasty can be done safely in such patients and may favorably alter short‐term outcome. © 1993 Wiley‐Liss, Inc.
Nineteen years survival after occlusion of the left main coronary artery by virtue of an anomalous septal branch
Authors: Vliegen Hubert W. , Cats Volkert Manger
Published: March 2007

This case presents a patient who survived 19 years with an occluded left main coronary artery as a result of collateral flow to the anterior wall from an anomalous septal branch arising from the right coronary artery. The case illustrates that minor variations in coronary anatomy may have important effects on the prognosis of a patient. © 1993 Wiley‐Liss, Inc.
Catheter lavage and drainage of pneumococcal pericarditis
Authors: Thavendrarajah Vasanthy , Ghia Pradeep S. , Kozinn Wesley , Little Thomas
Published: March 2007

An 88 year old woman with streptococcal pneumonia developed purulent pericarditis and cardiac tamponade despite treatment with antibiotics. Percutaneous pericardial drainage was effected with a 6 French pigtail catheter inserted via the subxyphoid approach. Catheter drainage was continued for 7 days in conjunction with systemic antibiotics. Catheter patency was maintained with antibiotic lavage.

Immediate hemodynamic improvement followed the initial pericardial drainage. Fever, leukocytosis, and sepsis resolved during the course of therapy. The patient recovered fully from the closed space bacterial infection without additional surgical drainage. There has been no recurrence of streptococcal infection and no echocardiographic evidence of recurrent pericardial effusion after 3 months of follow‐up.

Indwelling catheter drainage combined with antibiotics may be an effective substitute for surgical drainage in the treatment of streptococcal pericarditis. © 1993 Wiley‐Liss, Inc.
Catheter atherectomy of intimal fibroplasia of the common iliac artery
Authors: Mandke Jyotsna V. , Sharma Satyavan , Phatak Anuradha M. , Sanzgiri Vasundhara P. , Loya Yunus S. , Desai Dhruman M.
Published: March 2007

An 18‐year‐old woman presented with renovascular hypertension and left lower extremity claudication. Aorto‐iliac angiography showed stenotic lesions in the left renal artery and the left common iliac artery. For uncontrolled hypertension, nephrectomy was performed and histopathology of the renal artery showed intimal fibroplasia, an uncommon type of fibromuscular dysplasia. The left common iliac artery lesions were treated with directional atherectomy, which produced excellent immediate angiographic and symptomatic improvement. © 1993 Wiiey‐Liss, Inc.
Bail‐Out coronary stenting in an extremely tortuous right coronary artery with the palmaz‐schatz stent and teleguide sheath
Authors: Foran J. P. M. , Nordrehaug J. E. , Xynopoulos G. , Wainwright R. J.
Published: March 2007

Significant vessel tortuosity is a relative contraindication to the use of the Palmaz‐Schatz coronary stent for fear of stent displacement during delivery. We describe a patient with unstable angina in whom conventional coronary angioplasty in an extremely tortuous right coronary artery resulted in an occlusive dissection. Emergency bypass surgery was avoided by the successful placement of a protected Palmaz‐Schatz stent using a 5F Teleguide sheath. © 1993 Wiiey‐Liss, Inc.
Treatment of simple and complex coronary stenosis using rotational ablation followed by low pressure balloon angioplasty
Authors: Borrione Massimo , Hall Patrick , Almagor Yaron , Maiello Luigi , Khlat Boutros , Finci Leo , Colombo Antonio
Published: March 2007

High speed coronary rotational ablation followed by adjunctive low pressure coronary balloon angioplasty was used in 166 patients. Complex lesions were present in 63% of patients. Clinical success was achieved in 157 patients (95%). Angiographic success rate was 10% in A lesions, 95% in B1 lesions, 98% in B2 lesions, and 93% in C lesions. Mean vessel lumen diameter has increased from 0.4 mm to 1.4 mm after rotational ablation and to 2.3 mm following adjunctive balloon angioplasty. Left ventricular dysfunction, the presence of total occlusion, and the severity of stenosis before theprocedure were predictive of clinical failure. There were three abrupt vessel closures (1.8%) with one Q wave myocardial infarction. Non‐Q wave myocardial infarction occurred in 14 patients (8.4%) and three patients died during hospitalisation (1.8%). We conclude that rotational atherectomy followed by adjunctive low pressure balloon angioplasty gives comparable high success rates in different coronary lesions. © 1993 Wiiey‐Liss, Inc.
Prolonged heparin therapy for occlusive intracoronary thrombus
Authors: Kolansky Daniel M. , Shapiro Timothy A. , Laskey Warren K.
Published: March 2007

The presence of intracoronary thrombus is associated with increased complications during coronary angioplasty. Such thrombus may also mimic the appearance of a critical stenosis. We report a case of nearly occlusive intracoronary thrombus which resolved after prolonged heparin therapy, revealing only a minimal underlying stenosis. The recognition and treatment of this entity is discussed. © 1993 Wiiey‐Liss, Inc.
Use of the stiff shaft, straight terumo glidewire in crossing stenotic aortic valves
Authors: Sharma Samin K. , Israel Douglas H. , Kumar Kul , Ambrose John A.
Published: March 2007

One of the more difficult and time‐consuming diagnostic procedures in the cardiac catheterization laboratory is retrograde crossing of the severely stenotic aortic valve. Whereas patients with advanced aortic stenosis tend to be complicated and elderly, lengthy procedures can lead to a higher incidence of thrombo‐embolic and vascular complications and relatively greater procedural blood loss. This report concerns the use of the Terumo Glidewire to facilitate passage through stenotic and tortuous peripheral arteries. © 1993 Wiiey‐Liss, Inc.
Percutaneous transradial artery approach for coronary stent implantation
Authors: Kiemeneij Ferdinand , Jan Laarman Gert
Published: March 2007

A new approach for implantation of Palmaz Schatz coronary stents is reported. We describe the technique and rationale of coronary stenting with miniaturized angioplasty equipment via the radial artery.

This technique is illustrated in three patients. One patient underwent Palmaz Schatz stent implantation for a saphenous vene coronary bypass graft stenosis, the second patient for a restenosis in the anterior descending coronary artery after atherectomy, and the third patient for a second restenosis after balloon angioplasty in the circumflex coronary artery. © 1993 Wiley‐Liss, Inc.
Acute occlusion of a remote coronary artery complicating directional coronary atherectomy
Authors: Blankenship James C.
Published: March 2007

Two cases of acute occlusion in a remote coronary artery complicating directional coronary atherectomy are reported. In neither case was there definite angiographic evidence of spasm, dissection, or embolization. Since this complication is seldom seen with coronary angioplasty, it may represent a relatively specific risk of directional atherectomy.© 1993 Wlley‐LIM, Inc
Contralateral femoral vein removal of a circumferentially ruptured balloon‐catheter following pulmonary artery angioplasty
Authors: Luk Gordon , Rothman Abraham
Published: March 2007

While attempting to remove a circumferentially ruptured balloon following branch pulmonary artery angioplasty, the shaft of the catheter broke, leaving the distal portion of the balloon and catheter in the femoral vein but still on the exchange wire. We describe a method to retrieve the broken balloon catheter via the contralateral femoral vein.© 1993 Wlley‐Liss, Inc
Balloon angioplasty of totally and subtotally occluded coronary arteries: results using the hydrophillic terumo radifocus guidewire m (glidewire)
Authors: Gray D. F. , Sivananthan U. M. , Verma S. P. , Michalis L. K. , Rees M. R.
Published: March 2007

Balloon angioplasty was attempted, using hydrophillic Terumo guidewires, in 52 totally and subtotally occluded coronary arteries (50 patients), in which recanalisation by conventional angioplasty guidewires had failed. Hydrophillic guidewires had a crossing success rate of 65.4% (34/52); there was subsequently a technical success rate of 56% (29/52) and clinical success of 39% (20/52). Dissection of the coronary artery was seen in 16/29 technically successful cases. In 12/16 arteries, dissection was small and localised, whereas in 4/16 large and extended distally. There was one myocardial infarction and no peri‐procedural deaths. Eleven out of 29 technically successful cases continued to be regarded as successful 12 no postangioplasty. We conclude that the hydrophillic Terumo guidewire can improve the success rate in angioplasty of totally and subtotally occluded coronary arteries when conventional wires have failed.
© 1993 Wlley‐Liss, Inc
“Pseudo‐Narrowing” during right coronary angioplasty: How to diagnose correctly without withdrawing the guidewire
Authors: Chalet Yann , Chevalier Bernard , Hadad Simon El , Guyon Philippe , Lancelin Bernard
Published: March 2007

The straightening of a sinuous proximal segment of a coronary artery using the stiffness of the guidewire has recently been recognized as likely to cause false coronary lesions. The accurate diagnosis between a true dissection and a pseudo‐lesion is usually only done once all intra‐coronary material has been removed into the guiding catheter. Such a manoeuvre may prove dangerous in case of dissection. We propose to demonstrate that it is possible to diagnose this phenomenon while leaving the guidewire within the coronary artery, and withdrawing it progressively until its floppy segment rests equally on either side of the suspect lesion.
Immediate arterial hemostasis after cardiac catheterization: Initial experience with a new puncture closure device
Authors: Aker Umit T. , Kensey Kenneth R. , Heuser Richard R. , Sandza Joseph G. , Kussmaul William G.
Published: March 2007

A novel device for obtaining arterial hemostasis after invasive procedures was tested in 30 patients undergoing diagnostic catheterization (26 patients) or coronary angioplasty (4 patients). The device is deployed through an arterial sheath and forms a positive mechanical seal both inside and outside the defect in the arterial wall. The components are all bioabsorbable.

Thirteen patients received a heparin bolus during the catheterization procedure. The activated clotting time recorded in 15 patients just prior to device deployment averaged 264 sec. 29 of 32 attempted device deployments were successful (91%); and the remaining 3 devices pulled completely out as called for by design in the event of incomplete deployment. Twenty‐nine patients ultimately achieved successful hemostasis using the device, with the other patient receiving manual hemostasis. Of these 29, hemostasis was immediate and complete in 19 patients. Light digital pressure was required in another 8 patients for less than 5 min. There was minor delayed bleeding requiring supplemental light pressure in several cases. A total of 11 patients required supplemental pressure in addition to the hemostasis device. The use of bolus heparin was significantly (P = 0.05, Fisher's exact test) related to the requirement for supplemental pressure.

Three patients developed hematomas, one of which was present prior to device deployment. The other two patients had received bolus heparin. No patient required transfusion or surgical repair. There was no change in the ankle/brachial systolic blood pressure index after device deployment or at late (30–60 day) follow‐up.

Ultrasound studies revealed no significant pathology relative to the device. There was no residual evidence of the device at 2 month follow‐up ultrasound study.

Thus the Kensey Nash Hemostatic Puncture Closure Device can safely, reliably, and rapidly provide arterial hemostasis after cardiac catheterization procedures. Its use warrants further study in comparison to standard manual hemostasis.
Stent shortening and elongation: Pitfalls with the wiktor coronary endoprosthesis
Authors: Vogt Pierre , Eeckhout Eric , Stauffer Jean‐Christophe , Goy Jean‐Jacques , Kappenberger Lukas
Published: March 2007

This report demonstrates two specific complications that occurred during implantation of a Wiktor (Medtronic, Inc., Minneapolis, MN) coronary stent: stent shortening and elongation were observed and attributed to the unique coil structure of the device. Major cardiac events occurred during follow‐up as a consequence of this stent deformation. Therefore, semiurgent bypass surgery should be considered to treat this complication.
Cardiac stab wound resulting in a left anterior descending artery to left ventricular fistula with delayed pericardial tamponade
Authors: Rossum Alfred , Osborn Larry , Wernly Jorge , Timm Craig , Abrams Jonathan
Published: March 2007

We describe the third known case of a traumatic left anterior descending artery to left ventricular fistula. Emergency operative repair was required on day 7 for delayed pericardial tamponade. The significant incidence of late serious sequelae with traumatic coronary artery fistulas suggests that early surgery is warranted.
Angioscopic guided interventions in a saphenous vein bypass graft
Authors: Annex Brian H. , Ajluni Steven C. , Larkin Timothy J. , O'Neill William W. , Safian Robert D.
Published: March 2007

Intracoronary stents appear promising for treatment of focal vein graft lesions, but their use may be limited by the presence of intraluminal thrombus. This report describes the use of percutaneous coronary angioscopy to identify the presence or absence of intraluminal thrombus and to guide interventional therapy with transluminal extraction coronary atherectomy (TEC) and stenting in a patient with a complex vein graft stenosis.
Assessment of spontaneous coronary artery dissection by intravascular ultrasound in a patient with unstable angina
Authors: Kearney Peter , Erbel Raimund , Ge Junbo , Zamorano Jose , Koch Lothar , Görge Gunter , Meyer Jurgen
Published: March 2007

We describe a case of spontaneous coronary artery dissection that gave rise to post infarction unstable angina. An ambiguous angiographic appearance was shown by intracoronary ultrasound to arise from an extensive coronary dissection. The dissection membrane separating true and false lumina and features to suggest sluggish flow and early thrombosis in the false lumen were observed. No increase in lumen calibre was evident on ultrasound after PTCA (probably a consequence of the relatively large ultrasound catheter blank), but coronary flow reserve measured with intracoronary Doppler did improve and the patient remained stable and free of angina following the procedure.
Doppler catheter tip localization using color enhancement
Authors: Frazin Lee J. , Vonesh Michael J. , Yaacoub Adel S. , Kane Bonnie J. , Greene Rodney , Kemper W. Scott , Guberek Michael , McPherson David D.
Published: March 2007

The objective of this research was to determine if the ultrasound emissions of the Doppler catheter can be used to locate its position in 3 dimensions by conventional echocardiography. A Doppler catheter has previously been shown to permit nonfluoroscopic retrograde catheterization of the aortic root and left ventricular chamber by using velocity waveform polarity for directional guidance. A significant difficulty in providing ultrasound catheter guidance, however, has been the inability to recognize the Doppler catheter tip, because each point at which a flexible catheter crosses the image plane can be misinterpreted as the catheter tip. Initial in vitro water bath trials were performed using the Doppler catheter attached to a standard velocimeter. Using a 5 MHz imaging transducer and color Doppler methods, the presence or absence of a banded color pattern which could demarcate the Doppler catheter tip was recorded at various angles in and out of the scanning plane. Using Doppler retrograde guidance and transesophageal echocardiography, color Doppler banded patterns, which could identify the Doppler catheter tip, were investigated in the dog aorta. In order to understand the physical mechanisms involved, a series of water bath trials were then conducted using the Doppler catheter attached to a velocimeter which was synchronized to the echo machine. Initial nonsynchronized water bath trials revealed distinct banded color patterns demarcating the Doppler catheter tip when it pointed in any direction within the beam width, except for a 40° blind cone directly away from the imaging transducer. In vivo trials resulted in tracking of the Doppler catheter in the aorta and placement in the aortic root. The synchronized water bath trial revealed that the banded color pattern was a result of periodic direct sound transmission from the Doppler catheter to the imaging transducer. These studies have demonstrated that the ultrasonic emissions from the Doppler catheter allow its localization in three dimensions, and these properties may be useful in invasive ultrasonic diagnostic and therapeutic technology. © 1994 Wiley‐Liss,Inc..
Quantitation of the effective right ventricular output in patients with pulmonary atresia and intact ventricular septum after placement of a right ventricular outflow patch and an aorticopulmonary shunt
Authors: Saba Ziad , Armstrong Brenda E. , O'Laughlin Martin P.
Published: March 2007

A mathematical derivation is presented of an equation that allows quantitation, in the cardiac catheterization laboratory, of the effective output of the right ventricle (QRV) in patients with pulmonary atresia and intact ventricular septum (PA/IVS) after palliation with a right ventricular outflow patch and an aorticopulmonary shunt. This derivation is based on the Fick principle and accounts for that portion of the right‐to‐left atrial shunt that flows through the aorticopulmonary shunt to the lungs and thus contributes to the effective pulmonary blood flow (Qep). This equation relates QRV to pulmonary blood flow (Qp), systemic cardiac output (Qs), and Qep by QRV = Qp + Qs ‐ (Qp)(Qs)/Qep. By providing an assessment of right ventricular function, this equation may be helpful in determining the suitability of the right ventricle to support biventricular repair. © 1994 Wiley‐Liss,Inc..
Transverse coronary dissection resulting in abrupt vessel closure following directional coronary atherectomy: clinical, angiographic, and intracoronary ultrasound findings
Authors: Shurmur Scott W. , Deligonul Ubeydullah , Rayner Ralph W. , Sears Thomas W. , Porter Thomas R.
Published: March 2007

A 60‐year‐old man underwent directional coronary atherectomy (DCA) of the mid portion of a large, anatomically dominant left circumflex coronary artery, resulting in propagating transverse dissection and subsequent complete distal occlusion. Intravascular ultrasound imaging (IVUS) of the dissected segment demonstrated the entry point of the dissection, and systolic compression of the true vessel lumen, prior to angiographic deterioration of distal coronary flow. © 1994 Wiley‐Liss,Inc..
Longitudinal force focused coronary angioplasty: a technique for resistant lesions
Authors: Stillabower Michael E.
Published: March 2007

In a small percentage of vascular lesions undergoing angioplasty, the force generated by balloon inflation is insufficient to produce an acceptable deformation of the stenosis. Techniques developed to deal with this problem include the use of laser energy and rotational atherectomy. Use of a guidewire positioned between the dilating balloon and vessel wall has been reported to be effective in resistant heavily calcified lesions. The current case report describes a situation in which two wires between the balloon and the target lesion were required to produce an acceptable reduction in stenosis severity. This technique represents an extension of the single‐wire technique and may have relevance to the strategy being explored with the “cutting balloon”. © 1994 Wiley‐Liss,Inc..
Intravascular ultrasound imaging after excimer laser angioplasty
Authors: Honye Junko , Mahon Donald J. , Nakamura Shigeru , Wallis James , Al‐Zarka Amer , Saito Satoshi , Berns Michael , Tobis Jonathan M.
Published: March 2007

To help elucidate the mechanism of excimer laser coronary angioplasty (ELCA), intra‐vascular ultrasound (IVUS) imaging was performed in 19 of 29 patients who were treated with ELCA. The results were compared with a non‐randomized control group of 18 patients who had IVUS studies both before and after PTCA alone. After ELCA alone, lumen diameter (1.9 × 1.7 mm) and lumen cross‐sectional area (CSA) (2.9 mm2) by IVUS were not significantly different from baseline values in the patients before PTCA alone (2.1 × 1.8 mm, 3.2 mm2). After balloon dilatation in the laser treated group, lumen diameter (2.5 × 2.1 mm) and lumen CSA (4.9 mm2) were significantly greater than those post ELCA alone. However, there was no difference in lumen CSA or atheroma CSA in the group treated with excimer laser plus balloon dilatation vs. these measurements in the group treated with PTCA alone.

ELCA does not ablate a large amount of atheroma (9% reduction) but creates a pathway to permit easier passage of a PTCA balloon. These quantitative and morphologic results may help explain why the restenosis rate with ELCA is similar to PTCA alone. © 1994 Wiley‐Liss,Inc..
Cardiac catheterization and selective coronary angiography in ascending aortic aneurysm or dissection
Authors: Israel Douglas H. , Sharma Samin K. , Ambrose John A. , Ergin M. Arisan , Griepp Randall R.
Published: March 2007

Cardiac catheterization and coronary angiography can be technically demanding and is potentially risky in patients with ascending aortic aneurysm or dissection. We describe our approach to and results in catheterizing 63 patients with ascending aortic pathology. © 1994 Wiley‐Liss,Inc..
Adult respiratory distress syndrome complicating intravenous infusion of low‐molecular weight dextran
Authors: Taylor Marc A. , Diblasi Stephen L. , Bender Robert M. , Santoian Edward C. , Cha Se Do , Dennis Charles A.
Published: March 2007

Respiratory failure is one of the most uncommon and serious adverse drug reactions. Low‐molecular‐weight‐dextran (Dextran‐40) is a useful adjunctive anti‐platelet agent in the setting of coronary angioplasty and intracoronary stent placement. We report the occurrence of the adult respiratory distress syndrome following intravenous infusion of Dextran‐40. © 1994 Wiley‐Liss,Inc..
A technique for changing a ptca balloon catheter over a regular‐length guidewire
Authors: Nanto Shinsuke , Ohara Tomoki , Shimonagata Tsuyoshi , Hori Masatsugu , Kubori Syujiro
Published: March 2007

In 100 patients who underwent coronary angioplasty with more than one balloon catheter for a lesion, these over‐the‐wire balloon catheters were changed by using a regular‐length guidewire. In order to change to another balloon, the inflation device was connected to the central guide wire lumen of the catheter after pulling back the catheter until the proximal end of the regular length guide wire disappeared. By pulling back the balloon catheter from the guiding catheter by applying a pressure with the inflation device, the balloon was taken out of the guiding catheter leaving the wire in the coronary artery. One hundred forty‐nine of 163 attempted procedures were completed successfully. Our technique helped in performing a fast, safe, and reliable changing procedure compared to the procedure with an extended guidewire. © 1994 Wiley‐Liss,Inc..
Ancrod infusion for anticoagulation during and after ptca in a patient with heparin‐induced thrombocytopenia
Authors: Moore Joseph A. , Burket Mark W. , Puri Sanjeev , Temesy‐Armos Peter , Lachant Neil , Skeel Roland
Published: March 2007

Ancrod is a rapid‐acting defibrinogenating agent derived from the venom of the Malayan pit viper which has been used successfully as an alternative to heparin sulfate for anticoagulation during peripheral vascular procedures and coronary artery bypass surgery. We describe the first use of ancrod for anticoagulation before and during percutaneous transluminal coronary angioplasty (PTCA) in a patient with heparin‐associated thrombocytopenia. © 1994 Wiley‐Liss,Inc..
Relation between changes in severity of coronary artery stenosis and anginal patterns
Authors: Karnegis James N. , Matts John P. , Tuna Naip , Amplatz Kurt
Published: March 2007

Although myocardial ischemia causes angina pectoris, angina and the severity of coronary artery stenosis in individuals do not correlate. However, changes in anginal status over time correlated with changes in the severity of coronary artery stenosis as determined by repeated coronary arteriograms has not been previously studied. Coronary arteriograms, done both at entry into the Program on the Surgical Control of the Hyperlipidemias (POSCH) and 3 years later, were blindly graded for changes in overall severity of coronary artery stenosis according to protocol by the POSCH Arteriography Review Committee. Arteriographic and clinical data from 376 control subjects (347 men, 29 women) were analyzed. There was no statistically significant relation over a long‐term (3 year) period between the absence, presence, development, or disappearance of angina pectoris and changes in coronary artery stenosis severity as determined by coronary arteriography. © 1994 Wiley‐Liss,Inc