bluuebunny/crossref_metadata_2025 huggingface dataset:
Implication of transstenotic coronary pressure gradient measurement during coronary angioplasty
Authors: Haraphongse Mant , Tymchak Wayne , Burton Jeffrey R. , Rossall Richard E.
Published: March 2007

The aim of this study was to establish a criterion for the success of an angioplasty based upon pressure gradients across coronary lesions. Sixty‐two percutaneous transluminal coronary angioplasties (PTCA) in 56 patients with isolated left anterior descending artery disease were examined. Pressure gradients measured before and after PTCA were expressed as normalized mean pressure gradients (NMPG) computed by dividing mean pressure gradient by mean aortic or proximal coronary artery pressure. Angiographic severity was expressed as percentage area stenosis (AS) calculated from diastolic caliper measurements of diameter of each lesion and the nearest normal adjacent segment in at least two projections. The relationship between AS and NMPG was nonlinear with a steep increase in gradients beyond a critical value of AS of about 60%. This relationship was unaffected by angiographically visualized collaterals.

All except one of 65 coronary stenotic lesions with NMPG of more than 0.32 had an AS of more than 60%. Only three of 57 coronary stenoses with NMPG of less than 0.32 had severe AS (p < 0.001). The results indicate that NMPG is a reliable, practical guide to the severity of coronary stenosis and is therefore a useful measurement for assessing either the success or the residual stenosis during PTCA.
Retrograde internal mammary artery flow and resistant angina pectoris: Clues to the coronary‐subclavian steal syndrome
Authors: Niemiera Mark L. , Haft Jacob I. , Goldstein Jonathan E. , Hobson Robert W.
Published: March 2007

A 68‐year‐old woman with persistent angina immediately following coronary bypass surgery using a left internal mammary artery graft was diagnosed as having “coronarysubclavian steal syndrome” 13 years after operation. We outline clinical and angiographic clues that will aid in the identification and diagnosis of this syndrome, which may become more common with the increased use of the mammary artery as a coronary bypass conduit.
Development of severe left ventricular outflow tract obstruction over the course of 14 years: An unusual natural history of hypertrophic obstructive cardiomyopathy
Authors: Wilson John H. , Razavi Mehdi
Published: March 2007

A patient with hypertrophic obstructive cardiomyopathy who when first seen had a normal physial examination, chest x‐ray, and electrocardiogram, and no provokable gradient with isoproterenol at cardiac catheterization, was re‐evaluated after 14 years. At the time of re‐evaluation, she was found to have a typical systolic ejection murmur, cardiomegaly, left ventricular hypertrophy, a pseudoinfarction pattern on electrocar‐diography, and a significant subaortic gradient both by catheterization and by doppler. This case demonstrates that hypertrophic obstructive cardiomyopathy can be a progressive disease and that patients with this condition warrant careful follow‐up. Echocardiography with doppler may provide an excellent noninvasive method of following these patients.
Platypnea‐orthodeoxia: Assessment with a unique cardiac catheterization procedure
Authors: Mills Tillet J. , Seward James B. , McGoon Michael D. , Callahan Mark J.
Published: March 2007

A case of platypnea‐orthodeoxia (orthostatic dyspnea and arterial desaturation) secondary to a patent foramen ovale in the absence of primary disease is presented. This case illustrates the use of recumbent and upright cardiac catheterization techniques for precise evaluation of the hemodynamic abnormality in this disorder.
New balloon catheter for prolonged percutaneous transluminal coronary angioplasty and bypass flow in occluded vessels
Authors: Erbel Raimund , Clas Werner , Busch U. , von Seelen Warner , Brennecke Rüdiger , Blümer H. , Meyer Jürgen
Published: March 2007

A new balloon catheter was developed for continuous perfusion of coronary arteries during angioplasty (CPC catheter). Steerable Grüntzig balloon catheters (3.7 mm) with two lumina were formed. The first lumen was used for balloon inflation. Side holes to the second lumen proximally and distally to the balloon were created for coronary perfusion even during inflation phase. At a perfusion pressure of 120 mmHg, a flow rate of 63 ± 3ml/min with 0.9% saline and 43 ±1 ml/min with plasma expander were measured. In experiments on five dogs, dilation time until appearance of signs of ischemia could be prolonged in three of five dogs, from 30 to 40 s, 120 to 203 s, and 180 to 420 s comparing conventional and CPC balloon catheters. In 11 patients with proximal lesions, dilation time could be increased from 39.5 ± 23.9 s to 81.1 ± 36.3 s (p < 0.01) until appearance of angina pectoris. ST segment changes were observed in 10/11 patients using conventional catheters. Using CPC catheters, no ST segment changes were observed in four patients; time until appearance of ST segment changes was delayed in the other seven patients.

The CPC catheter seems to be an alternative catheter in proximal lesions of the left and right coronary artery, allowing the possibility of prolonged dilation and increased safety to the patient. In case of dissection or perforation, the CPC catheter can be used for perfusion of the distal part of the coronary vessel until emergency bypass surgery.
Balloon angioplasty of coronary bifurcation lesions: The kissing balloon technique
Authors: George Barry S. , Myler Richard K. , Stertzer Simon H. , Clark David A. , Cote Gilles , Shaw Richard E. , Fishman‐Rosen Jodi , Murphy Mary
Published: March 2007

Initial experience with the technique of “kissing balloon” angioplasty is described in 52 patients undergoing coronary angioplasty. Guiding catheters employing both the femoral and brachial approach were used in all but two of the coronary angioplasties and, in addition, the bilateral femoral approach was used in the renal and peripheral angioplasties. Initial success was achieved in 51 (98%) patients. Abrupt closure requiring urgent coronary revascularization occurred in one patient six hours following the completion of the procedure. Another patient developed a new Q‐wave on the electrocardiogram and moderate elevation of CPK‐MB fraction following the procedure due to loss of a diagonal branch. No deaths occurred in this series. Angiographic restenosis developed in ten patients. In the recurrence group, five had repeat kissing balloon angioplasty, two had repeat single vessel angioplasty, and three patients chose elective surgical revascularization.

Based on our experience, the technique of kissing balloon coronary angioplasty can be performed safely utilizing the brachio‐femoral technique. The risk of major side branch occlusion can be minimized with this technique and the overall complication rate does not significantly differ from that of our experience in single vessel coronary angioplasty. Patient selection criteria are based upon the angiographic relationship of the major branch to the side branch and is important in determining the initial and long‐term success of this technique.
Coronary angioplasty at the time of initial cardiac catheterization
Authors: Feldman Robert L. , Macdonald Robert G. , Hill James A. , Conti Richard , Pepine Carl J. , Carmichael Michael J. , Knauff Daniel G. , Alexander James A.
Published: March 2007

Following initial diagnostic cardiac catheterization in 20 patients with unstable angina, percutaneous transluminal angioplasty (PTCA) was successfully performed either immediately (15 patients) or later in the day (five patients). This approach offers certain clinical and financial advantages. PTCA immediately following diagnostic catheterization should probably only be performed by experienced operators and only when excellent cooperation with cardiovascular surgeons is possible.
Quantitative effects of osmotic diuresis following angiographic contrast administration
Authors: Louie Eric K. , Al‐Sadir Jafar , Emmanouel Dimitrios
Published: March 2007

Osmotic diuresis resulting from the administration of angiographic contrast poses the potential threat of marked volume losses obligated by the renal excretion of non‐reabsorbable solute. We prospectively assessed urinary excretion of solute and water following cardiac angiography in 14 euvolemic subjects without preexisting renal disease, by a protocol that allowed each patient to serve as his own control. During the initial 6 h after the beginning of angiography, contrast administration resulted in increased total osmolar excretion from a control rate of 0.79 ± 0.09 to 1.09 ± 0.09 mOsm/min (P <.05) with a return to control values thereafter. Surprisingly, sodium, potassium, and chloride excretion rates did not differ significantly from control values. After subtraction of the molar contribution of electrolytes, urea, and creatinine from the total osmolar excretion rate, it was apparent that the “residual osmolar excretion rate” of 0.48 ± 0.05 mOsm/min was markedly elevated over the control value of 0.11 ± 0.05 mOsm/min (P <.01), reflecting the excretion of contrast agent. Despite the marked osmotic diuresis, urine output during this period (3.9 ± 0.2 cc/min) did not differ significantly from the control value of 4.0 ± 0.3 cc/min. We conclude that marked volume losses are not a necessary concomitant of contrast‐induced osmotic diuresis in the euvolemic cardiac patient without renal disease.
Evaluation of a coronary lysing system: Results of a preclinical safety and efficacy study
Authors: Leyser Larry J. , Bundy Mark A. , Abreo Fleurette , Hanley Henry G. , Fadely Donald , Walker John M.
Published: March 2007

The purpose of this study was to evaluate the efficacy and safety of a recently developed transluminal lysing system in the removal of coronary stenotic lesions from a human cadaver heart and in the cannulation of coronaries in the anesthetized dog.

The left coronary arteries of three dogs were cannulated on separate occasions, with coronary arteriography and translation of the transluminal lysing system cutter to the distal segments of the coronary vessels performed each time. Proximal and distal coronary pressures were recorded from the guiding catheter and the transluminal lysing system cutter, demonstrating no significant pressure differential and minimal damping. Pathological examination of the dog coronaries after sacrifice demonstrated minor intimal irregularities with no significant thrombosis or vessel perforation. A significant portion of the occulsive stenotic lesions were removed from coronary vessels of a human cadaver heart with subsequent reestablishment of angiographic dye flow to the distal coronary vessels without evidence of debris loss from the transluminal lysing system cutter or the appearance of occlusions in the distal vessels.

We conclude that the transluminal lysing system can be introduced into the coronary artery of a living dog on repeated occasions without causing significant coronary damage, coronary occlusive thrombosis, myocardial destruction, morbidity, or mortality; furthermore, occlusive stenotic lesions can be removed from cadaver coronary vessels by the transluminal lysing system with the establishment of angiography patency.
Anomalous unilateral single pulmonary vein mimicking partial anomalous pulmonary venous return
Authors: Rey Christian , Vaksmann Guy , Francart Charles
Published: March 2007

We report a case in which the clinical findings of a partial anomalous pulmonary venous return were present but with termination of the anomalous pulmonary vein into the left atrium. There was hypoplasia of the right lung, dextroposition of the heart, and a loop‐like vascular density in the right lung field. Cardiac catheterization revealed no shunt, and on pulmonary angiograms, a large common right pulmonary vein draining the entire right lung and entering the left atrium by way of a single orifice. Possible embryologic explanations include atresia of the right inferior pulmonary vein and persistence of the ipsilateral superior pulmonary vein.
The brachial artery method to transluminal internal mammary artery angioplasty
Authors: Dorros Gerald , Lewin Ruben F.
Published: March 2007

A new catheter technique to perform angioplasty of the right or left internal mammary artery coronary graft utilizing the brachial artery approach is described. Utilization of the ipsilateral brachial artery permitted cannulation of the internal mammary artery with preformed polyurethane Teflon‐lined guide catheters. The coronary dilatation catheter was passed through the guiding catheter into the internal mammary artery. This technique permitted successful access into the ipsilateral mammary artery in eight patients, the left internal mammary artery graft in five and the right in three patients. The angioplasty procedure was successfully performed in seven of eight cases (spasm of the left internal mammary artery precluded successful dilatation catheter passage in one case). No brachial artery complications were encountered. In two cases, angioplasty was successfully performed in additional coronary vessels. Follow‐up of 1‐‐16 months (mean: 7.7 months) revealed no clinical evidence of restenosis. The ipsilateral brachial artery approach utilizing preshaped guiding catheters for visualization and introduction of dilatation catheters into the internal mammary artery graft is a safe and successful approach, and it is an acceptable alternative to the femoral technique.
Improved stability and visualization during coronary artery angioplasty using a double catheter technique
Authors: Dervan John P , Zalewski Andrew , Slysh Sonya , Goldberg Sheldon
Published: March 2007

Guiding catheters used in coronary angioplasty can make coronary angioplasty potentially hazardous when they become positionally unstable, induce myocardial ischemia, or impair angiographic visualization. In order to avoid this problem, a double catheter technique was employed in seven patients involving nine procedures consisting of a standard 8 or 9 French angioplasty guiding catheter and a standard 7 French angiographic catheter to prevent coronary flow reduction and to permit improved coronary artery visualization. In two of the procedures, the second diagnostic catheter also permitted the prevention of potential plaque disruption by the guide catheter in the proximal right coronary artery. The predilatation stenosis was 88 ± 12%; the postdilatation stenosis was 28 ± 9%. The use of the diagnostic catheter as a second catheter prevented damping and permitted the stable disengagement of the guiding catheter from the coronary artery. This technique is most useful in patients who have proximal right coronary artery stenoses because it provides optimal visualization of the segment undergoing dilatation, avoids the potential for ischemia in more distal stenoses, and thereby allows the procedure to be performed in a controlled, unhurried manner.
Catheter‐induced intimal injury during routine coronary catheterization in dogs
Authors: Pap John M.
Published: March 2007

The location and progression of changes in arterial permeability and structure were studied in nine dogs over a 13‐week period following left coronary catheterization with standard coronary catheters. Changes in arterial permeability were analyzed by quantitating Evans blue dye (EBD) uptake over the aortic luminal surface (blue areas). Structural changes were assessed by light and electron microscopy. In the catheterized animals, compared to uncatheterized controls, we observed a significant increase in aortic luminal EBD uptake that was maximal 4 hours after the procedure but still present up to 13 weeks later. Microscopic analysis of “blue areas” shortly after the procedure revealed widespread endothelial denudation, platelet and leukocyte adherence, with occasional intimal avulsions, disruption of the internal elastica, and thrombi. The EBD uptake patterns in association with the electron microscopic findings in these animals suggested that 67–;–;89% of the aortic endothelium was removed by the catheter during the procedure. The proliferative response that occurred following this catheter‐induced injury produced fibrocellular intimal thickening in the aortas and left main coronary arteries of animals studied 10 to 92 days after the procedure. In the aortic root, such thickening was associated with incomplete re‐endothelialization, thrombogenicity, and grossly abnormal permeability patterns. We conclude that significant catheter‐induced intimal injury can occur during coronary angiography. In the canine model, such injury is associated with widespread fibrocellular intimal thickening and abnormal permeability that persists for at least 13 weeks after the procedure.
Recurrence after coronary angioplasty
Authors: Myler Richard K. , Shaw Richard E. , Stertzer Simon H. , Clark David A. , Fishman Jodi , Murphy Mary C.
Published: March 2007

Recurrence (restenosis) after coronary angioplasty has undermined the initial success of the procedure and has compromised, to some extent, the attractiveness of the technique in the treatment of ischemic heart disease. Assessment of recurrence predictors has been problematic due to lack of coordination of angioplasty recurrence research and includes: incomplete angiographic documentation, variations in definitions of restenosis anatomically and the results of restenosis physiologically (ie, myocardial ischemia), the dirth of morphologic specifications of subsets under investigation and late outcome pathology, limitations in statistical analyses used, and minimal efforts to classify the available data on recurrence.

A review of the literature suggests that all findings regarding recurrence after angioplasty can be organized in four categories: (1) clinical, (2) morphologic, (3) technical (or procedural), and (4) pharmacologic. The reported findings with high concordance as risk factors for recurrence after angioplasty include the clinical factors of diabetes mellitus, hyperlipidemia, and angina of short duration or unstable presentation. Morphologic factors which have been corroborated vis‐à‐vis recurrence include stenoses with diameter reduction of greater than 90% before and greater than 30% after angioplasty, residual trans‐stenotic pressure gradients of greater than 20 mmHg after angioplasty, and lesions that are diffuse, long, eccentric, or calcified. Technical factors associated with recurrence include lower balloon/vessel (or graft) ratios and the absence of (uncomplicated) “intimal dissection.” The category most deficient in research regarding recurrence after angioplasty is pharmacologic.

Since there are statistically documented and reproducible factors predictive of restenosis, to ignore or minimize these findings or resist further evaluation (because of the ease and safety of performing repeat angioplasty) is to deny the opportunity to understand the mechanisms and favorably affect the incidence of recurrence. This review concludes with two major implications of the restenosis research: (1) certain clinical, technical, and pharmacologic factors, if addressed, may predictably decrease the rate of restenosis and (2) certain clinical and morphologic factors may increase the risk of restenosis; these factors may be less readily modified (eg, diabetes, lesion calcification) and thus must be considered in the decision for angioplasty.

Finally, this review recommends that there be more effective coordination of angioplasty recurrence research with agreement on a single anatomic definition of restenosis with consistent physiologic correlatives, more lucid statistical presentation and improved efforts to clarify and organize the information so that meaningful conclusions regarding the causes (and therefore the prevention) of recurrence may be achieved.
Percutaneous transluminal coronary angioplasty of the “very proximal” coronary artery stenosis
Authors: Nakhjavan Fred K. , Goldman Anthony P. , Hutt Gordon H. , Wertheimer John H. , Yazdanfar Shahriar , Maranhao And Vladir , Weiner Ronald
Published: March 2007

We report on 11 patients with “very proximal” lesions out of a total of 300 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA). Eight patients had native left anterior descending (LAD) lesions and three had LAD saphenous vein grafts lesions. Lesions were considered to be “very proximal” when one half or more of the balloon was inflated in the left main coronary artery for the native LAD lesions or the aorta for the LAD coronary artery saphenous vein bypass graft (CABG) lesions. There was a mean reduction in stenosis from 88.3% (range 75–99) to 13.8% (range 0–60) and a mean reduction in transtenotic gradient from 47.2 mmHg (range 20–80) to 8.3 mmHg (range 0–20). The initial success rate was 90.9% (10 out of 11 patients) with a partial success in the other patient. No complications occurred in any of the patients. Two patients had restenosis (18.2%) at 3 months and 6 months, respectively, post‐PTCA. It is concluded that “very proximal” lesions can be successfully dilated with a high initial success rate and low complication rate. Nevertheless, these lesions may present problems with guiding catheter stability and, because of the potential risk of circumflex (CX) occlusion, this vessel may have to be protected with a second guidewire.
Initial and late results of coronary angioplasty for early postinfarction unstable angina
Authors: Gottlieb Sidney O. , Walford Gary D. , Ouyang Pamela , Gerstenblith Gary , Brin Kenneth P. , Mellits E. David , Riegel Mary Beth , Brinker Jeffrey A.
Published: March 2007

Unstable angina that occurs in the early postinfarction period is associated with an increased incidence of unfavorable cardiac events despite aggressive medical therapy. We examined the results of coronary angioplasty in 47 consecutive patients with postinfarction unstable angina who were referred for the procedure 12.9 ± 7 days following myocardial infarction, 14 of which were Q wave and 33 of which were non‐Q‐wave. Coronary angioplasty was performed on a total of 55 arteries with a mean predilatation stenosis of 95 ± 8%. These included 46 infarct‐related arteries and nine noninfarct arteries. Double‐vessel angioplasty was performed in eight patients. Successful coronary angioplasty (greater than 30% reduction of predilatation stenosis) was achieved in 43 patients (91%), with a mean residual stenosis of 33 ± 28%. There was one in‐hospital death, one patient required emergency bypass surgery, and two patients had early reocclusion resulting in myocardial infarctions. The 39 patients who had successful angioplasty procedures and who were discharged from the hospital without an unfavorable outcome were followed for 16.3 ± 7 months, and repeat coronary angioplasty was required in five patients from 45 to 105 days after the initial procedure. Two patients had subsequent elective bypass surgery, one had a recurrent myocardial infarction, and one patient had a noncardiac death. For selected patients with suitable coronary anatomy, coronary angioplasty appears to offer an efficacious therapeutic option for early postinfarction unstable angina.
Eosinophilic heart disease presenting with features suggesting hypertrophic obstructive cardiomyopathy
Authors: Miller William , Walsh Richard , McCall David
Published: March 2007

We report a 25‐year‐old female with characteristic features of eosinophilic heart disease on clinical presentation, echocardiography, cardiac catheterization, and LV endomyocardial biopsy. Concomitant physical examination and echocardiographic findings suggesting hypertrophic obstructive cardiomyopathy resolved during treatment with anticoagulation and prednisone therapy.
Endomyocardial biopsy with a modified bioptome introducer sheath: Focus on diagnostic yield and prevention of complications
Authors: Mortensen S. A. , Baandrup U.
Published: March 2007

With a focus directed on the potential diagnostic yield of tissue biopsy in suspected myocardial disease, transvascular endomyocardial biopsies were carried out prospectively in 130 patients. In 149 out of 153 consecutive procedures, where the number of associated major complications was less than 1%, King's bioptome and a specially designed radiopaque long introducer catheter were used. The rather thickwalled sheath had a conical tip which facilitated percutaneous entry and a preshaped distal bending which was particularly useful in the right ventricle for obtaining a steady and safe position in the direction of the interventricular septum.

With respect to the histopathological information from an average of 4.2 biopsies per patient, a high clinical yield was gained in 28% of the patients, in the form of specific diagnoses and/or findings influencing subsequent therapy, and useful diagnostic information was gleaned from a further 53%.

Thus, the procedure appears safe as a part of routine cardiac catheterization, and biopsy may contribute to a more accurate and clinically relevant classification of a substantial number of patients with suspected myocardial disease.
Value of immediate coronary angioplasty following intracoronary thrombolysis in acute myocardial infarction
Authors: Suryapranata H. , Serruys P. W. , Vermeer F. , De Feyter P. J. , van den Brand M. , Simoons M. L. , Bäaur F. W. , Res J. , van der Laarse A. , van Domburg R. , Beatt K. , Lubsen J. , Hugenholtz P. G.
Published: March 2007

A total of 533 patients with acute myocardial infarction of less than 4‐h duration were enrolled in the multicenter randomized trial of intracoronary thrombolysis compared to conventional treatment. In two of the five participating centers, an additional coronary angioplasty immediately after thrombolysis was attempted in 46 patients. According to the treatment allocation and early and late patency of the infarct related vessel, patients were subdivided into three groups: conventionally treated (group A); successful coronary angioplasty following thrombolysis with persistent patent infarct related vessel (group B); and late patency of the infarct related vessel postthrombolytic therapy without angioplasty (group C). The highest global ejection fractions were observed in group B (54% ± 10%) and group C (55% ± 13%), while the lowest ejection fraction was found in group A (47% ± 14%). The sequential changes in global ejection fraction from the acute to the chronic stage was + 4% (p = 0.05) in group B, while no significant changes could be demonstrated in group C. Furthermore, in the group successfully treated by angioplasty, the improvement in global ejection fraction was more pronounced and persisted up to three months after the intervention. This was supported by analysis of regional myocardial function of the infarct zone (+16% improvement, p = 0.01). The long‐term clinical follow‐up (median 24 months) of the patients successfully treated by combined procedure of thrombolysis and angioplasty (group B) was most favourable with a lower incidence of re‐infarction (6%), and late coronary bypass surgery (13%) and/or (re)‐percutaneous transluminal coronary angioplasty (3%) was performed less frequently.

These results suggest that reperfusion may need to be supplemented by additional revascularization procedures in order to optimize the chances of obtaining full functional recovery and so to improve the prognosis.
Comparison of visual estimate with digital caliper measurement of coronary artery stenosis
Authors: Schweiger Marc J. , Stanek Ed , Iwakoshi Kenny , Hafer Jesse G. , Jacob Andrew , Tullner William , Gianelly Ralph E.
Published: March 2007

We compared visual estimate and digital caliper measurement of coronary stenoses, utilizing both a 50% and 70% diameter reduction as a definition of significance and both experienced angiographers and cardiology fellows as readers. Ten angiograms were interpreted twice, using the different methods, by four readers, two months apart. The angiograms were divided into 12 vessel segments. Stenoses were judged more severe by visual estimate in 11 segments. Seven of twelve segments had significant differences between readers using the visual estimate, but no significant differences were obtained using caliper measurements. Variability was highest for fellows using the visual method. Interobserver agreement was highest using the digital caliper and the 70% criteria. Intraobserver agreement was most dependent on the amount of time taken in film interpretation. The digital caliper appears to be preferable in interpreting angiograms, particularly for cardiology fellows.
Left ventricular diastolic filling abnormalities in left anterior descending disease
Authors: Lavine Steven J. , Dennenberg Barry S. , Bove A. Alfred , Spann J. F.
Published: March 2007

Reduced left ventricular diastolic filling (Df) has been noted in coronary disease (CD) patients with normal left ventricular systolic function (NLVF). However, previous studies have included patients with regional wall disease, hypertension, or left ventricular hypertrophy. In the absence of these factors, only a subgroup of patients who had >75% luminal obstruction of the left anterior descending artery (LAD) demonstrated DF abnormalities. Using 60 frames/sec biplane contrast ventriculography, we evaluated the left ventricular filling curve and its derivative in 21 patients with normal coronary arteries and NLVF (group 1), 17 CD patients with NLVF and no LAD disease (group 2), and 18 patients with LAD disease and NLVF (group 3). The peak filling rate (PFR) as end diastolic volumes/sec (EDV/S) was reduced in group 3 patients (group 3: 3.00 ± 0.51 EDV/S vs group 1: 3.59 ± 0.84 EDV/S, p <.05; and group 2: 3.61 ± 0.91 EDV/S, p <.05). There was marked overlap in the Pfr's between the normal and LAD group. DF may be normal in CD patients with NLVF in the absence of LAD disease. LAD patients have abnormal DF, but these abnormalities lack predictive valve.
Analysis of the position of the left ventricular apex and base during systole
Authors: Nogueira Eduardo A. , Carvalhal Silvio S. , Macmillan Robert M. , Maranhao Vladir
Published: March 2007

The relative positions of the left ventricular apex and base in end‐diastole (ED) and end‐systole (ES) were determined in a group of normal individuals using cross‐sectional echocardiography (group A) and in a group of patients with normal hemodynamics and angiographic parameters using cine‐computed tomography (group B). In both groups no change was detected in the position of the epicardial aspect of the apex from ED to ES. The base moved in direction of the apex by 10.2% ± 1.9% (mean ± standard deviation) of the longitudinal dimension of the chamber in group A and by 12.9% ± 5.1% in group B. In both groups the apical cavity was obliterated by the peri‐apical walls. Apical obliteration is responsible for the apparent movement of the apical segment seen in cineventriculography.
The usefulness of the lateral projection in the assessment of the right coronary artery during percutaneous transluminal coronary angioplasty
Authors: Goldbaum Thomas S. , Disciascio Germano , Cowley Michael J. , Vetrovec George W.
Published: March 2007

Optimum coronary angiographic definition of lesion morphology and side branch orientation is important during percutaneous transluminal coronary angioplasty (PTCA) to enhance the ease and safety of guidewire passage. This study was performed to compare the efficacy of the lateral (LAT) projection to conventional angiographic views for right coronary artery (RCA) evaluation pre‐ and post‐PTCA. In 45 consecutive patients undergoing PTCA of 56 RCA lesions, the LAT was available to evaluate 40 lesions pre and 44 lesions post‐PTCA. Angiographic comparison of the LAT versus standard LAO, LAO cranial, and RAO views were performed by two experienced angiographers with consensus reading. The LAT was the best projection for assessing lesion morphology pre‐PTCA in 19/40 (48%) and in 19/44 (43%) post‐PTCA, while the LAT was significantly better (P < 0.01) than standard views for assessing side branch orientation (48/56, 86%) and post‐PTCA intimal disruption (18/33, 55%). In addition, LAT was the best view for assessing mid RCA lesions 13/21 (62%) pre‐PTCA and 12/27 (44%) post‐PTCA, while post‐PTCA intimal disruption was best detected by LAT in 14/24 (58%). Lesions only recognized in the LAT view occurred in five instances, four involving right ventricular branch ostia and one involving the proximal posterior descending. Thus, the LAT projection appears helpful during PTCA to assess lesion morphology, eccentricity, side branch orientation, and intimal disruption pre‐ and post‐PTCA as an adjunct to conventional views.
The simplified formula for the calculation of aortic valve area: Potential inaccuracies in patients with bradycardia or tachycardia
Authors: Hillis L. David , Winniford Michael D.
Published: March 2007

Since the Gorlin equation for calculation of aortic valve area is somewhat complicated, a simplified formula has been introduced in which the cardiac output (in liters/min) is divided by the square root of the peak pressure gradient across the valve (in mmHg), yielding a valve area in cm2. This study was done to examine the reliability of this simplified formula in patients with bradycardia or tachycardia. In 68 patients with aortic stenosis, aortic valve area was calculated with both formulae, and the results were compared with one another. In the 43 individuals whose heart rates were 65 to 100 beats/min, the results of the Gorlin equation and the simplified formula showed excellent agreement (absolute percentage difference, 8 ± 8% [mean ± SD]). In contrast, in the 25 patients whose heart rates were < 65 or > 100 beats/min, the absolute percentage difference between the results of the two formulae was 18 ± 13% (p < 0.001). Although the results of the two equations were especially likely to be disparate in these patients, there was no predictable relationship between them. Thus, in patients with bradycardia or tachycardia, the simplified formula should be utilized with caution and cognizance of its potential inaccuracy.
Guide wire entrapment during PTCA: A potentially dangerous complication
Authors: Lotan Chaim , Hasin Yonathan , Stone David , Meyers Stuart , Applebaum Azai , Gotsman Mervyn S.
Published: March 2007

The tip of a “high‐torque” floppy guide wire became entrapped in a coronary artery during elective PTCA in four patients. In two it was removed through the guiding catheter, in the third an operative intervention was needed in order to free the wire, and in the fourth the remnant was left in situ.

Interventional cardiologists should be aware of this potential complication.
Total occlusion of the left main coronary artery in chronic stable angina pectoris
Authors: Sudhir Krishnankutty , Abraham Abraham K. , Cherian Maman K. , Reddy Narasimha K. , Gupta Srikrishna
Published: March 2007

We present the clinical and angiographic profile of three patients with class 1 stable angina pectoris. All had strong coronary risk factors, and stress testing was positive in stage one of the Bruce protocol. Coronary angiography revealed total occlusion of the left main coronary artery (LMCA), and aortocoronary bypass surgery was performed. Thus, total LMCA occlusion may be an unexpected angiographic finding in patients with class 1 angina.
Origin of the right coronary artery from the descending thoracic aorta: Angiographic diagnosis and unique coronary artery anatomy at autopsy
Authors: Cheatham John P. , Ruyle Nanci A. , McManus Bruce M. , Gammel George E.
Published: March 2007

An infant born at term with hypoplastic left heart syndrome was found angiographically to have an anomalous artery arising from the descending thoracic aorta which supplied the posterior and right coronary branches. Morphologically, the right coronary artery had atypical and striking elastotic changes and wall thickening.
Simultaneous cannulation: A technique for percutaneous transluminal coronary angioplasty of chronic total occlusions
Authors: Sherman C. Todd , Sheehan Dennis , Simpson John B.
Published: March 2007

Three patients with indications for percutaneous transluminal angioplasty of a totally occluded coronary artery also had distal opacification by a collateral vessel. The balloon catheter and guide wire were manipulated proximally through the guide catheter. With a second catheter, angiography of the collateral vessel opacified the occluded artery distal to the obstruction. In all three cases, simultaneous catheterization was safe and aided our assessment of distal vessel contour, length of occlusion, and the intraluminal position of the wire beyond the complete obstruction. We conclude that this technique may improve success rates for dilating chronic total obstructions by allowing safer manipulation of less flexible wires.
The design and clinical application of a new #5 French angioplasty catheter
Authors: Wholey Mark H.
Published: March 2007

Although major technological advances have occurred in coronary artery angioplasty balloons and steerable wire systems, there have been surprisingly few advances in the development and designs for balloons in the peripheral circulation. For example, a #7 French shaft has become the standard for most peripheral as well as visceral angioplasty balloons. In most instances, the shaft is unnecessarily large and not only interferes with tractability over the conventional wire but in certain situations is also unnecessarily traumatic to the vascular intima as the catheter is passed to the angioplasty site. For these reasons a newly designed catheter with a shaft measuring 1.67 mm (#5 French) has been designed to incorporate a variety of dimensional balloons varying from 2 mm through 7 mm. In addition, the open end allows passage of a. 035 inch wire and consequently the balloon is ideally suited for applications from vessels as small as the tibial circulation or renal visceral or iliac circulation.
Factors that predict improvement in left ventricular ejection fraction after coronary angioplasty for acute myocardial infarction
Authors: Brodie Bruce R. , Weintraub Richard A. , Hansen Charles J. , Miller Paula F. , LeBauer E. Joseph , Katz Jeffrey D. , Stuckey Thomas D.
Published: March 2007

Acute and follow‐up angiograms were analyzed in 75 patients with acute myocardial infarction treated with emergency coronary angioplasty to determine factors that might predict improvement in left ventricular ejection fraction. Ejection fraction improved 8.4 ± 8.2% in 60 patients who maintained patent infarct vessels at follow‐up angiography, compared with −4.1 ± 6.0% in 15 patients who developed reocclusion (p <.001). In patients with patent infarct vessels, univariate analysis revealed the following significant predictors of improvement in ejection fraction: initial ejection fraction (r = −.38, p <.003), subtotal vs total stenosis (12.9 ± 9.3% vs 6.9 ± 7.3%, p <.02), infarct vessel (left anterior descending 11.0 ± 8.4%, right 6.8 ± 6.4%, circumflex 2.6 ± 7.5%, p <.02), and time to follow‐up study (≤ 15 days vs > 15 days) (4.8 ± 5.8% vs 9.8 ± 8.6%, p <.03). Reperfusion time (≤2 hr vs >2 hr) predicted improvement when subtotal stenoses and stuttering infarctions were excluded (10.6 ± 7.0% vs 4.9 ± 6.9, p <.03). Multivariate analysis showed initial ejection fraction and subtotal vs total stenosis to be independent predictors.

Patients with anterior infarctions, low initial ejection fractions, and subtotal stenoses or reperfusion times ≤2 hr are likely to benefit most from coronary angioplasty for acute myocardial infarction.
Management of coronary occlusion during angioplasty: Stabilization using a guide wire
Authors: Tommaso Carl L. , Singleton Robert T.
Published: March 2007

During percutaneous transluminal coronary angioplasty of the left anterior descending artery in two patients, although the artery could be initially dilated, the vessel would not remain patent despite numerous redilations and pharmacological maneuvers. A third patient developed total occlusion of the right coronary artery during diagnostic catheterization. In these patients, the presence of a guide wire across the occlusion provided patency and stability. With the guide wire in place, the patients were taken to the operating room without further chest pain or evidence of ischemia.
Subacute left main coronary stenosis following percutaneous transluminal coronary angioplasty
Authors: Haraphongse Mant , Rossall Richard E.
Published: March 2007

Subacute left main coronary stenosis following percutaneous transluminal coronary angioplasty (PTCA) is an uncommon but recognized complication of the procedure. This report describes a case of left main coronary stenosis, which occurred 6 months following PTCA of an angulated, eccentric, proximal (adjacent to the left main stem) left anterior descending artery stenosis. Angiographically demonstrated morphology of complicated coronary stenosis adjacent to the left main coronary artery may represent a risk factor threatening major complications of PTCA. Detailed evaluation of angiographic coronary anatomy may improve patient selection and reduce the likelihood of such complications.
Percutaneous retrieval of foreign body from the left ventricular cavity
Authors: Keltai Matyas , Meier Bernhard
Published: March 2007

During aortic valvuloplasty a guidewire was broken, and the broken fragment remained in the left ventricle. This left ventricular foreign body was retrieved percutaneously by a snare.
Pulmonary varix associated with mitral valve disease
Authors: Narula Jagat , Talwar K. K. , Bharani Anil , Mukhopadhyaya S. , Rajani M. , Bhatia M. L.
Published: March 2007

A case of pulmonary varices with mitral valve disease is presented with a detailed review of the literature. Two distinct categories of the disease, with and without left artrial hypertension, are emphasized.
Percutaneous transluminal angioplasty involving internal mammary artery bypass grafts: A femoral approach
Authors: Pinkerton Cass A. , Slack John D. , Orr Charles M. , Vantassel James W.
Published: March 2007

Percutaneous transluminal coronary angioplasty is an effective technique for the treatment of selected patients with ischemic heart disease due to coronary artery stenosis. Successful angioplasty in saphenous vein bypass grafts has been documented, but little experience has been reported using angioplasty in internal mammary artery to coronary artery bypass grafts. Nine of ten patients with stenosis in the internal mammary artery to coronary artery anastomosis or in the coronary vessel distal to the anastomosis site were successfully treated with angioplasty. One patient developed restenosis 1 month after the procedure, and a repeat angioplasty was successful. In one patient, the balloon catheter could not be advanced through the left internal mammary artery to the stenosis site. Technical features of internal mammary artery angioplasty are discussed, including the use of specially designed guiding wires, guiding catheters, and balloon catheters that facilitate angioplasty involving internal mammary arteries from the femoral approach.
Percutaneous brachial catheterization: The hidden hazard of high brachial artery bifurcation
Authors: Deligonul Ubeydullah , Gabliani Gregory , Kern Morton J. , Vandormael Michel
Published: March 2007

We describe a patient in whom a brachial arterial cutdown done at the same site for percutaneous transluminal angioplasty immediately after uncomplicated percutaneous brachial coronary arteriography revealed the percutaneous sheath in a deeper, smaller, and more lateral artery than the brachial artery, complicating placement of the guiding catheter. This case illustrates the potential hidden hazard of normal brachial artery bifurcation variants, which may be responsible for some of the potential complications encountered in percutaneous brachial artery catheterization techniques.
Technique for closure of the small patent ductus arteriosus using the rashkind occluder
Authors: Benson L. N. , Dyck J. , Hecht B.
Published: March 2007

Percutaneous transcatheter closure of the patent ductus arteriosus has become a clinically viable procedure in childhood due to the pioneering work of Rashklnd and Mullins. Presented is a modification of the technique to accomplish catheter closure in the small ductus arteriosus.
Blood velocity measurements during selective coronary angiography before and after percutaneous transluminal coronary angioplasty
Authors: Nishimura Rick A. , Holmes David R. , Bove Alfred A. , Julsrud Paul R. , Ritman Erik L.
Published: March 2007

The velocity of blood flowing down a coronary artery may provide an index of myocardial perfusion, independent of the need for measuring the amount of myocardium supplied by a vessel. The velocity of the leading edge of contrast material was therefore measured before and after percutaneous transluminal coronary angioplasty in 15 patients utilizing digitized images from routine coronary angiography. The velocity (mean ± SD) before percutaneous transluminal coronary angioplasty in the 15 patients was 11.9 ± 6.0 cm/s, increasing to 21.7 ± 8.7 cm/s after (P < 0.01). There was a correlation between the percent change in velocity and the change in percent stenosis before and after percutaneous transluminal coronary angioplasty (r = 0.65; P < 0.001). The mean absolute interobserver and intraobserver variabilities for the velocity measurements were 2.1 and 1.8 cm/s, respectively. Measurement of coronary flow velocity from data obtained at the time of routine coronary angiography is an easily performed reproducible technique, which may be used to assess the results of an intervention such as percutaneous transluminal coronary angioplasty.
Application of a tapered teflon dilator to percutaneous transluminal coronary angioplasty
Authors: Garnic J. Daniel , Polito Santo S. , Lee Don W. , Tonnemacher David P. , O'Connor Lawrence R.
Published: March 2007

A tapered teflon dilator has been applied to 12 cases of percutaneous transluminal coronary angioplasty (PTCA). The technique was first used to predilate stenoses that could not initially be crossed with low profile over the wire PTCA ballons. In the first five cases, three angioplasties that would have been failures were converted to successes by this method. The dilator was used in place of a balloon catheter as an initial step to assess the ability of a guidewire to cross a lesion to reduce cost in five additional cases. Modification of an existing family of peripheral vascular dilators is described. The method of application of this technique to PTCA is outlined.
Subclavian‐coronary steal through a LIMA‐to‐LAD bypass graft
Authors: McLvor Michael E. , Williams G. Melville , Brinker Jeffrey
Published: March 2007

Eighteen months after coronary artery bypass grafting with a left internal mammary artery (LIMA) graft, a 58‐year‐old woman had a change in the character of her angina to include pain in the left arm, especially with upper extremity work, culminating in an episode of prolonged rest pain. Cardiac catheterization revealed retrograde flow through the LIMA graft to the subclavian artery and stenosis of the left subclavian artery at its origin from the aorta. Restoration of antegrade flow through the LIMA graft to the coronary arteries was achieved by a carotid‐subclavian bypass resulting in a resolution of symptoms. The evaluation of recurrent angina after LIMA bypass grafting should exclude the possibility of subclavian artery stenosis as well as disease of the native and graft coronary anatomy.