bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux
Authors: Lundell L , Abrahamsson H , Ruth M , Rydberg L , Lönroth H , Olbe L
Published: March 2007

The importance of the extent of the fundic wrap that encircles the distal oesophagus for the establishment of long-term control of gastro-oesophageal reflux disease (GORD) and for the risk of symptoms after fundoplication was evaluated in a prospective, randomized clinical trial. Of 137 consecutive patients with GORD, 72 were allocated to a semifundoplication (180–200°, Toupet) and 65 to a total fundoplication (360°, Nissen–Rossetti). Dysphagia was more common in the early postoperative period after a total fundic wrap, a difference which disappeared with time. This corresponded to a higher resting tone in the lower oesophageal sphincter area. Seven patients (5 per cent) experienced relapse of GORD during follow-up of more than 3 years. Although no difference in the cumulative relapse rate (5 per cent for Nissen–Rossetti versus 6 per cent for Toupet) was found between the two study groups, the total failure rate was higher (P<0·05) among patients who had a Nissen-Rossetti procedure because of a procedure-specific complication: intrathoracic herniation of the fundoplication in five patients caused obstructive symptoms without reflux (four had no posterior crural repair). In addition, symptoms in the form of flatulence were more frequently seen after Nissen-Rossetti fundoplication (P<0·05 at 2 years and P<0·01 at 3 years). Both Nissen–Rossetti and Toupet fundoplication equally well and durably controlled GORD. Fewer symptoms occurred in those having a semifundoplication, both in the early and late postoperative period.
Coronary angioplasty in high‐risk patients with left main coronary stenosis: Results from the national registry of elective supported angioplasty
Authors: Tommaso Carl L. , Vogel John H. K. , Vogel Robert A. ,   National Registry of Elective Supported Angioplasty
Published: March 2007

To assess the outcome of PTCA in circulatory supported patients with left main coronary artery (LMCA) stenosis, the National Registry of Elective Supported Angioplasty data bank was searched. Patients entered in the registry were considered high‐risk PTCA and the PTCA was performed using percutaneous cardiopulmonary bypass (PCPB). Criteria for high risk was left ventricular ejection fraction <25% or a target lesion supplying >50% of functioning myocardium. Of 455 patients entered in the registry, 61 (13.3%) had LMCA stenosis >60%. There were 42 patients in whom the PTCA target vessel was the LMCA (PTCA‐LMCA) and 19 in whom it was vessel(s) other than the LMCA (PTCA‐OTHER). The mean age was similar in the 2 groups (65 ± 10 vs. 68 ± 9yrs, p = ns). The left ventricular ejection fraction (LVEF) was higher in PTCA‐LMCA than in PTCA‐other (38 ± 16% vs. 27 ± 16%, p <0.05). The number of vessels dilated/patient was higher in PTCA‐LMCA than in PTCA‐OTHER (2.1 ± 1.0 vs. 1.1 ± 0.3, p <0.001). There were a total of 10 in‐hospital deaths (16%) in patients with LMCA >60% stenosis. This exceeds the mortality of the patients with <60% LMCA stenosis entered in the registry (4.5%, p <0.001). There were 6 in‐hospital deaths (14%) in PTCA‐LMCA and 4 (21%) in PTCA‐OTHER (p = ns).

PTCA in the presence of LMCA stenosis, whether the LMCA is the target vessel or not, carries a very high risk, independent of LVEF or the number of vessels dilated, despite the use of PCPB.
Review of radiation safety in the cardiac catheterization laboratory
Authors: Johnson Lewis W. , Moore Robert J. , Balter Stephen
Published: March 2007

With the increasing use of coronary arteriography and interventional procedures, radiation exposure to patients and personnel working in cardiac catheterization laboratories has increased. Proper technique to minimize both patient and operator exposure is necessary. A practical approach to radiation safety in the cardiac catheterization laboratory is presented. This discussion should be useful to facilities with well‐established radiation safety programs as well as facilities that require restructuring to cope with the radiation environment in a modern cardiac catheterization laboratory.
Excimer laser coronary angioplasty: Results in restenosis versus de novo coronary lesions
Authors: Reeder Guy S. , Bresnahan John F. , Holmes David R. , Litvack Frank ,   Excimer Laser Coronary Angioplasty Investigators
Published: March 2007

There is limited information regarding the use of excimer laser coronary angioplasty (ELCA) in patients with restenotic lesions. The purpose of this investigation was to compare the results of ELCA in patients with restenosis following prior PTCA with results obtained in de novo (no restenosis) patients. A retrospective review was obtained of all patients undergoing attempted ELCA at each of the 12 participating clinical investigative centers. There were 620 patients in the prior restenosis group and 949 in the de novo group. Both laser success (88% vs 78%) and procedural success (92% vs 88%) were higher in restenosis lesions compared with de novo lesions (P <0.001). Six‐month follow‐up was available in 40% of patients. Restenosis occurred in 49% of the prior restenosis group vs 44% of the de novo group (P nonsignificant) but death was more common in the de novo group (2.2 vs 0.4%, P = 0.01). ELCA can be performed with a high success rate in patients with restenosis following prior balloon angioplasty but recurrent restenosis following laser procedure remains a significant problem.
Initial experience with the disarticulated (one‐half) palmaz‐schatz stent: A technical report
Authors: Colombo Antonio , Hall Patrick , Thomas Jack , Almagor Yaron , Finci Leo
Published: March 2007

We developed an alternative method to stent suitable lesions located in anatomical settings considered to be too complex for regular Palmaz‐Schatz stent placement. This method consists of using a disarticulated (one‐half) Palmaz‐Schatz stent. Eight patients underwent stenting utilizing this method. The left anterior descending was stented in five patients, the right coronary artery in one patient, the proximal and mid shaft of a vein graft in one patient, and a protected left main coronary artery in one patient. In all patients the stents were placed in addition to full stents. In four patients, 11/2 stents were placed; two patients had 21/2 stents; one patient had 31/2 stents and the last patient had a total of 5 stents placed (1 full stent and 8 half stents). One patient had 8 disarticulated stents placed. All half stents prepared for delivery were successfully deployed to the pre‐designated angiographic site without complication.
Aortic dissection as complication of percutaneous transluminal coronary angioplasty
Authors: Moles Victor P. , Chappuis François , Simonet François , Urban Philip , De La Serna Fernando , Pande Abhay K. , Meier Bernhard
Published: March 2007

We report two cases of aortic dissection during coronary angioplasty with a disparate evolution that was due to the different location of the entry port of the dissection. Aortic dissection occurring during coronary angioplasty may be self‐limiting, but it may also be life‐threatening and may call for urgent surgical repair. © 1992 Wiley‐Liss, Inc.
High‐speed rotational angioplasty‐induced echo contrast in vivo and in vitro optical analysis
Authors: Zotz Rainer J. , Erbel Raimund , Philipp Achim , Judt Andreas , Wagner Hasso , Lauterborn Werner , Meyer Jürgen
Published: March 2007

High‐speed rotational angioplasty is being evaluated as an alternative interventional device for the endovascular treatment of chronic coronary occlusions. It has been postulated that this type of angioplasty device may produce particulate debris or cavitations that induce myocardial ischemia. To determine the clinical presence of myocardial ischemia during rotational angioplasty, echocardiographic monitoring for wall motion abnormalities was performed in 9 patients undergoing rotational atheroablation using the Auth Rotablator for 10‐sec intervals at 150,000 and 170,000 rpm. No wall motion abnormalities were detected in 5 patients evaluated with transesophageal echocardiography or in 4 patients monitored transthoracically, although AV block developed in one patient. Video intensitometry of the myocardial contrast effect for rotation times ranging from 3 to 20 sec found transient contrast enhancement of the myocardium supplied by the treated vessel. Intensity varied over time with half‐time decay between 5.6 and 40 sec, indicating the likelihood of microcavitation. An in vitro model was constructed to measure the cavitation potential of the Auth Rotablator. A burr of 1.25 mm diameter rotating at 160,000 rpm achieves a velocity in excess of the 14.7 m/sec critical cavitation velocity. Testing the device in fresh human blood and distilled water produced microcavitations responsible for the enhanced echo effect, with the intensity and longevity of cavitation more pronounced in blood and proportional to the rotation time and speed. The mean size of the microcavitation bubbles in water was 90 ± 33 (52–145) μm measured from photographs taken with a copper vapour laser emitting light pulses of 50 nsec duration as light source. The mean velocity of bubbles was found to be 0.62 ± 0.30 ranging from 0.23 to 1.04 m/sec. It was measured via the motion of the bubbles during 5 laser pulses within 800 nsec. Clearly, microcavitations are associated with enhanced myocardial echo contrast effect. © 1992 Wiley‐Liss, Inc.
Atrial septal puncture technique in percutaneous transvenous mitral commissurotomy: Mitral valvuloplasty using the inoue balloon catheter technique
Authors: Hung Jui‐Sung
Published: March 2007

Transseptal catheterization is a vital component of percutaneous transvenous mitral commissurotomy. Therefore, a well‐executed transseptal catheterization is the key to a safe and successful percutaneous transvenous mitral commissurotomy. Two major problems inherent in atrial septal puncture for percutaneous transvenous mitral commissurotomy are cardiac perforation and puncture of an inappropriate atrial septal site. The former may lead to serious complication of cardiac tamponade and the latter to possible difficulty in maneuvering the Inoue balloon catheter across the mitral orifice. This article details atrial septal puncture technique, including landmark selection for optimal septal puncture sites, avoidance of inappropriate puncture sites, and step‐by‐step description of atrial septal puncture. © 1992 Wiley‐Liss, Inc.
Excimer laser coronary angioplasty for failed PTCA
Authors: Watson Linley E. , Gantt Scott
Published: March 2007

Specific indications for excimer laser coronary angioplasty (ELCA) are yet undefined. We report two specific applications of ELCA when percutaneous transluminal coronary angioplasty (PTCA) failed: (1) to facilitate balloon crossing a long rigid stenosis that could not be crossed after the lesion was wired, and (2) to overcome prominent elastic recoil of the stenosis after PTCA. © 1992 Wiley‐Liss, Inc.
Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty
Authors: Saito Shigeru , Arai Hidekazu , Kim Kunikane , Aoki Naoto
Published: March 2007

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring‐coil embolization of the coronary artery. © 1992 Wiley‐Liss, Inc.
Inoue balloon usefulness in case of failure to stabilize bifoil catheter balloons during percutaneous mitral valvotomy
Authors: Rocha P. , Berland J. , Lefebvre J.M. , Strumza P. , Lacombe P. , Fernandez F.
Published: March 2007

A new bifoil balloon catheter has been used in the last 120 percutaneous mitral valvotomies carried out in our institution. The shaft segment between the two balloons of the bifoil catheter has been adjusted to the guide‐wire diameter, allowing its introduction through a 14F sheath. This thinner shaft does not always offer enough back up to the balloons during inflation. An Inoue balloon replaced an unstable bifoil balloon in 5 cases of mitral dilatation failure due to balloon instability, regularly providing firm stability until full balloon inflation. © 1992 Wiley‐Liss, Inc.
ST segment alternans during coronary angioplasty
Authors: Sochanski Mirek , Feldman Ted , Chua K. G. , Benn Andrew , Childers Rory
Published: March 2007

Four patients with severe proximal or mid‐LAD stenosis were noted to have ST alternans during balloon angioplasty. Neither mechanical alternans nor increased ventricular ectopy were noted. In contrast to prior descriptions in animals or patients with variant angina, ST alternans did not occur following a premature ventricular contraction. Frequent use of calcium channel blockers during PTCA may interfere with the mechanism leading to electrical alternans and its consequences as seen in animal studies, accounting for the low frequency with which this phenomenon is noted during PTCA.
Coronary aneurysms: A case report and review
Authors: Burns Carolyn A. , Cowley Michael J. , Wechsler Andrew S. , Vetrovec George W.
Published: March 2007

This case report describes a large coronary aneurysm and poses questions regarding management. The discussion that follows addresses what is known about the natural history of and options for management of coronary aneurysms.
Changing incidence and management of abrupt closure following coronary intervention in the new device era
Authors: Kuntz Richard E. , Piana Robert , Pomerantz Richard M. , Carrozza Joseph , Fishman Robert , Mansour Michael , Safian Robert D. , Baim Donald S.
Published: March 2007

Abrupt closure of the dilated segment occurs in approximately 4 to 7% of cases following conventional percutaneous coronary angioplasty. Additional balloon angioplasty reverses roughly 40% of these closures, to yield an overall 1.6 to 3.4% rate of emergent surgery. The impact of new devices on the incidence and reversal rate of abrupt closure has not been examined.

Abrupt closure occurred in 80 (4.2%) of 1,919 consecutive coronary angioplasties performed in our single center, 389 (20%) of which were performed using newer interventions (208 Palmaz‐Schatz stents, 170 directional coronary atherectomies, and 11 elective laser balloon angioplasties). Abrupt closure was less frequent following newer coronary interventions (1.8%) compared to standard balloon angioplasty (4.9%, P < 0.01), possibly reflecting case selection. When abrupt closure did occur, percutaneous rescue was successful in 53 (66%) patients, including 42 (53%) who were rescued using standard or perfusion balloon angioplasty, and 11 (13%) who were rescued using laser balloon balloon angioplasty after failure of additional angioplasty attempts. Medical therapy alone was used in 8 (10%), while emergent coronary bypass surgery was performed in 18 (23%), yielding an overall emergent surgery rate of 0.9%. Q‐wave myocardial infarction was significantly less frequent (0.2%) following percutaneous rescue, compared to either medical therapy (25%) or emergent surgery (33%, P < 0.001).

In our catheterization laboratory, use of these 3 new coronary interventional devices coincides with a trend towards a lower incidence of abrupt closure, a higher percutaneous rescue rate with reduced incidence of myocardial infarction, and a lower emergent bypass surgery rate.
Early coronary artery stent restenosis: Utility of percutaneous coronary angioscopy
Authors: Resar Jon R. , Brinker Jeffrey
Published: March 2007

Restenosis of an endovascular stent may be caused by thrombus, intimal hyperplasia, or extrinsic compression. Angiography may not adequately define the etiology of restenosis. We describe a patient in whom angioscopy proved important in diagnosing intimal hyperplasia obviating the need for thrombolytic therapy and prolonged anti‐coagulation.
The tracker catheter: A new vascular access system
Authors: Hibbard Michael D. , Holmes David R.
Published: March 2007

Technologic advances in dilation equipment have been important in improving angioplasty success rates and in expanding the indications of dilation. Despite these improvements, approximately 7% to 10% of attempted dilations may ultimately fail because of inability to cross the culprit lesion. As angioplasty techniques are applied to an increasingly complex cohort of patients, the ultimate success of a given procedure depends more and more on the ability of the operator to select the appropriate equipment for a given procedure. We report the unique application of a commercially available perfusion catheter which may improve patient outcome during complex angioplasty.
Rotational atherectomy in anomalous coronary arteries
Authors: Bass Theodore A. , Gilmore Paul S. , Ceithaml Eric L.
Published: March 2007

We describe two cases of high speed rotational atherectomy performed in patients with anomalous coronary anatomy. These procedures are performed with standard equipment requiring no modifications using a percutaneous femoral approach. We feel these cases clearly illustrate the facile application of this new technology to unusual anatomical situations.
Improved support for right coronary artery angioplasty with a new guiding catheter
Authors: Shubrooks Samuel J.
Published: March 2007

Inadequate guiding catheter support is a frequent cause for failure in right coronary angioplasty (PTCA). A new guiding catheter designed to provide easy placement in the right coronary and improved stability and backup support is described. Use of this catheter for PTCA of right coronary lesions, the majority of which were considered technically difficult to dilate, in 100 patients resulted in successful dilatations in 88% of patients. Failures were due to inability to seat the guide adequately in 8 patients with narrow aortic roots or unusual coronary origins and to inability to cross a lesion in 4 patients despite good support. In 4 patients successful dilatation was achieved after failure using another presently available guide.
Discordant results of visual and quantitative estimates of stenosis severity before and after coronary angioplasty
Authors: Bertrand Michel E. , Lablanche Jean M. , Bauters Christophe , Leroy Fabrice , Mac Fadden Eugene
Published: March 2007

The ability to accurately estimate the severity of epicardial coronary stenoses is critical in the assessment of the immediate and long‐term results of percutaneous transluminal coronary angioplasty (PTCA). We prospectively compared visual estimates, performed by experienced interventional cardiologists, with computerized quantitative angiographic measurements of stenosis severity in a group of patients (n = 305) before, immediately after and 6 months after PTCA. Before PTCA the visual estimate of the mean (±SD) percentage stenosis severity, 80.6 (±9.7)%, was significantly (P<0.001) higher than the equivalent value, 73.4 (±11.1)%, obtained with use of quantitative angiography. Immediately after PTCA the visual estimate of the mean residual stenosis, 18.8 (±12.3)%, was significantly (P<0.0001) lower than the equivalent quantitative estimate, 37.4 (±14)%. Additionally, the residual stenosis was more frequently (18% vs. 3%) classified as significant (>50%) by quantitative angiography. At follow‐up, quantitative measurements of stenosis severity showed a Gaussian distribution with a mean of 54.8 (±21)%, whereas visual estimates had a bimodal distribution with populations greater than 70% and less than 50%.

Visual estimates provide an inaccurate assessment of the immediate and medium term results of PTCA. Quantitative measurements suggest that the immediate results of PTCA are frequently misclassified as successful by the operator. Conversely, restenosis rates are underestimated by the operators suggesting that a more objective method must be used in trials to assess the impact of new therapies on the rate of restenosis.
Use of excimer laser in the treatment of chronic total occlusion of a coronary artery that cannot be crossed with a balloon catheter
Authors: Berger Peter B. , Bresnahan John
Published: March 2007

The inability to advance a balloon across a chronically occluded coronary artery that has been crossed with a guidewire occurs in 5% of patients with chronic occlusions. In this report, a new indication for the excimer laser is described: the recanalization of a chronic occlusion that has been crossed with a guidewire that cannot be crossed with a balloon catheter. © 1993 Wiley‐Liss,Inc.
Examination of the effects of hemodynamic and pharmacologic interventions on coronary collateral flow in a patient during cardiac catheterization
Authors: Donohue Thomas , Kern Morton J. , Bach Richard , Aguirre Frank , Wolford Thomas
Published: March 2007

The vasomotor response of native human collateral vessels to pharmacologic or hemodynamic vasodilatory stimuli is not well known. We describe a case where retrograde collateral flow velocity was measured both at baseline and following selected hemodynamic and pharmacologic interventions. This index case represents the first in a series of potential human physiologic studies designed to address questions pertaining to control of collateral blood supply in humans. © 1993 Wiley‐Liss, Inc.
High flow coronary fistula closure by percutaneous coil packing
Authors: Lacombe P. , Rocha P. , Marchand X. , Mulot R. , Rigaud M. , Jondeau G. , Weber J. M. , Kahn J. C.
Published: March 2007

Few cases of transcatheter coronary fistula closure have been reported. High flow coronary fistulae are usually treated by surgery. This case report presents a 5.4 liters/min flow coronary fistula percutaneously closed by steel coils. This large flow needed the packing of 25 coils, 10‐15 cm long, for its total occlusion. © 1993 Wiley‐Liss, Inc.
Percutaneous mitral valvotomy using inoue and double balloon technique: Comparison of clinical and hemodynamic short term results in 350 cases
Authors: Sharma Satyavan , Loya Yunus S. , Desai Dhruman M. , Pinto Robin J.
Published: March 2007

The results of percutaneous mitral valvotomy (PMV) by double balloon (N = 230, Group I) and Inoue single balloon (N = 120, Group II) technique were compared. The groups were similar with respect to baseline characteristics. Following PMV there were marked symptomatic and haemodynamic benefits in both the groups. There was significant increase in mitral valve area (MVA) estimated by Gorlin's equation (Group I: from 0.83 ± 0.18 cm2 to 2.10 ± 0.45 cm2, p < 0.001; Group II: from 0.83 ± 0.17 cm2 to 2.16 ± 0.39 cm2, p < 0.001) and by echoplanimetry (Group I: from 0.84 ± 0.18 cm2 to 1.91 ± 0.35 cm2, p < 0.001; Group II: from 0.88 ± 0.17 cm2 to 1.96 ± 0.30 cm2, p < 0.001). However, the percentage increase in MVA in the two groups by echoplanimetry (Group I: 136 ± 59; Group II: 130 ± 51; p = NS) and by Gorlin's equation (Group I: 164 ± 69; Group II: 168 ± 61; p = NS) were not statistically significant. Results were considered optimal when increase in MVA was ± 1.5 cm2, percentage increase was ± 50, and mitral regurgitation was < 2/4. Out of 216 patients in Group I where PMV could be performed, optimal results were achieved in 184 (85.2%) by Gorlin's equation and 178 (82.4%) by echoplanimetry. In Group II, out of 116 patients, optimal results were achieved in 107 (92.2%) by Gorlin's equation and 103 (89%) by echoplanimetry. Incidence of mitral regurgitation although higher in Group II (24.1% vs. 18.9%) was not statistically significant. The results of both the techniques are similar and the main advantage of Inoue technique is its short procedure (Group I: 120 ± 35 minutes; Group II: 90 ± 30, p < 0.01) and fluoroscopy time (Group I: 22 ± 4.5; Group II: 11 ± 3.3, p < 0.01). © 1993 Wiley‐Liss, Inc.
Successful directional coronary atherectomy in a patient with dextrocardia and situs inversus
Authors: Lewis Bruce E. , Leya Ferdinand S. , Jones Paul , Grassman Eric D. , Stasior Christine , Haryani Vijay , McKiernan Thomas L. , Johnson Sarah A. , Scanlon Patrick J.
Published: March 2007

We describe a case of successful percutaneous transluminal coronary angioplasty of an infarct‐related vessel followed later by directional coronary atherectomy of a noninfarct vessel in a patient with dextrocardia using standard preformed catheters.

© 1993 Wiley‐Liss, Inc.
Assessment of the hemodynamic significance of a left internal mammary artery graft‐pulmonary artery shunt in a post‐bypass patient using a doppler‐tipped guide wire
Authors: Reis Steven E. , Gloth Sean T. , Brinker Jeffrey A.
Published: March 2007

We assessed the hemodynamic significance of a left internal mammary artery (LIMA) graft‐pulmonary artery (PA) fistula in a post‐bypass patient with chest pain. A Dopplertipped guide wire and quantitative coronary angiography (QCA) were used to demonstrate that flow through the proximal LIMA (14.0 ml/min) was similar to the distal LIMA's contribution of flow to the left anterior descending artery (LAD) (15.6 ml/min), suggesting that the fistula was not hemodynamically significant. Therefore, intravascular Doppler and quantitative angiography may be used to assess the hemodynamic significance of a LIMA‐PA fistula in a post‐bypass patient. © 1993 Wiley‐Liss, Inc.
PTCA of “shepherd's crook” right coronary arteries with a new shape of guiding catheter
Authors: Nesto Richard W. , Sassower Michael A.
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) of lesions in a right coronary artery with a “shepherd's crook” configuration may pose procedural difficulties due to inadequate guiding catheter back‐up support. We evaluated the utility of a new shape of guiding catheter, previously evaluated for PTCA of lesions in the left coronary artery, in five cases with this particular right coronary artery anatomy. Factors responsible for success in these cases relate to the catheter's shape and construction.
Pulmonary valvuloplasty in adults using the Inoue balloon catheter
Authors: Lau Kean‐Wah , Hung Jui‐Sung , Wu Jong‐Jen , Chern Ming‐Shyan , Yeh Kou‐Ho , Fu Morgan
Published: March 2007

This report describes a new balloon pulmonary valvuloplasty technique using the Inoue balloon catheter performed in 14 consecutive adult patients, aged 17–47 years (mean 27). The mean right ventricular systolic pressure and the pulmonary valvular peak‐to‐peak systolic gradient decreased from 102 ± 41 to 52 ± 19 mm Hg (p = 0.001) and 81 ± 40 to 7 ± 7 mm Hg (p = 0.0002), respectively. An infundibular peak‐to‐peak systolic gradient either developed (n = 13) or increased (n = 1). None of the patients were treated with beta‐adrenergic blockers before or after the valvuloplasty. Eight patients underwent repeat hemodynamic study 12–30 months (mean 17) after treatment, and had no evidence of valvular restenosis. The mean right ventricular systolic pressure and the mean infundibular peak‐to‐peak systolic gradient decreased, compared to the values immediately after valvuloplasty (54 to 40 mm Hg, p = 0.03, and 28 to 10 mm Hg, p = 0.03, respectively). The study suggests that pulmonary valvuloplasty in adults using the Inoue balloon catheter technique is feasible, safe, and effective. © 1993 Wiley‐Liss, Inc.
Contrast echocardiography during cardiac catheterization in patients with congenital heart diseases
Authors: Andrade Jose L. , Leal Samira M. Borges , Filho Orlando Campos , Carvalho Antonio C. , Tebexreni Antonio S. , Lima Valter C.
Published: March 2007

Contrast echocardiography performed during cardiac catheterization has mostly been limited to a few published case reports. We studied 37 patients with congenital heart disease to assess the capability of the method to diagnose cardiac shunts and valve regurgitation. Injections of 5% dextrose in water through an angiographic catheter were made to evaluate septal integrity and valve competence compared with conventional contrast angiography. An overall sensitivity of 93% and specificity of 78% were found. In four cases of atrial septal defect and seven of mitral regurgitation, the sensitivity was 100%. It was slightly lower for eleven cases of ventricular septal defect (91%) and four of patent ductus arteriosus (75%). When assessing aortic, tricuspid and pulmonary valve competence, the method proved to be more sensitive than conventional angiography to detect mild regurgitation. Contrast echocardiography is a sensitive and safe technique that may be used in association with conventional angiography reducing the need for radiographic contrast and ionizing radiation time. © 1993 Wiley‐Liss, Inc.
Early stent occlusion is not always caused by thrombosis
Authors: Heijer Peter Den , van Dijk René B. , Twisk S. Pé M. , Lie Kong I.
Published: March 2007

Early occlusion of intracoronary stents has been exclusively attributed to thrombosis. Using intracoronary angioscopy, we have found 2 patients in whom this common and serious complication of coronary stenting was caused by obstructive intima dissection rather than thrombosis. © 1993 Wiley‐Liss, Inc.
Use of translesional coronary flow velocity for interventional decisions in a patient with multiple intermediately severe coronary stenoses
Authors: Kern Morton J. , Flynn Michael S. , Caracciolo Eugene A. , Bach Richard G. , Donohue Thomas J. , Aguirre Frank V.
Published: March 2007

Translesional pressure gradients are currently not performed routinely for most angioplasty procedures because of the technical limitations. With the use of an 0.18 inch Doppler flow velocity guidewire, coronary flow velocity, both proximal and distal to a lesion, can be easily assessed. In branching arteries, significant lesions are characterized by a ratio of proximal to distal flow velocity of > 1.7, loss of the normal phasic diastolic predominant flow velocity pattern, and/or loss of distal hyperemia.

We describe the use of coronary flow velocity in assisting important decision making in a young patient with a recent myocardial infarction and multiple coronary lesions. The decision for angioplasty of the hemodynamically significant stenosis was confirmed by translesional flow velocity measurements. A rational approach to coronary intervention in patients with multiple stenoses of intermediate severity appears to be facilitated by direct measurement of translesional flow dynamics. © 1993 Wiley‐Liss, Inc.
Initial experience with a new balloon‐on‐a‐wire catheter: The bijouTM
Authors: Goy J‐J. , Hofman Eeckhout E. E. , Vogt P. , Beuret P. , Stauffer J.‐C. , Jeanrenaud X. , Kappenberger L.
Published: March 2007

This paper presents our initial experience with a new low‐profile balloon “on‐a‐wire” catheter, the Bijou. The concept of this balloon is to provide an additional side lumen with the advantages of (1) the ability to measure pressure gradient, (2) the possibility of drug infusion, and (3) the ability to advance a steerable guidewire through this side lumen. The balloon has been tested in 15 patients; 14 underwent an elective procedure for stable angina pectoris (with 2 cases of restenosis) and one an emergency angioplasty in a case of acute myocardial infarction. The stenosis was located on the left anterior descending artery in 11 procedures, on the right in 3, on a marginal branch in 2, on the circumflex and a saphenous vein graft in 1. All stenoses could be dilated successfully (residual stenosis <25%). The transstenotic pressure gradient felt from 49±13 mmHg to 7±4 mm Hg after angioplasty. Except for an uncomplicated dissection in 3 patients, no other complication was noted. With this new catheter, the double‐lumen configuration adds the advantages of an “over‐the‐wire” to an “on‐a‐wire” system. © 1993 Wiley‐Liss, Inc.
Percutaneous balloon mitral valvuloplasty: Comparison of double and single (Inoue) balloon techniques
Authors: Rihal Charanjit S. , Nishimura Rick A. , Reeder Guy S. , Holmes David R.
Published: March 2007

To assess relative merits of the double and single (Inoue) balloon techniques of percutaneous balloon mitral valvuloplasty for treating symptomatic mitral stenosis, 33 patients who underwent dilatation with the double balloon were compared retrospectively with 28 who underwent dilatation with the lnoue balloon. There were no baseline differences in mean left atrial pressure, mean mitral gradient, or calculated mitral valve area between the two groups. The procedure was successful in 89% of patients in the double balloon group and in 93% in the lnoue balloon group. Final mitral valve area and absolute increase in mitral valve area were significantly greater in the double balloon group, in which there was a nonsignificant trend toward greater incidence of acute complications. Final left atrial pressure and mitral gradient were not different. Both techniques are useful and safe. © 1993 Wiley‐Liss, Inc.
Rapid development of left main disease after coronary artery bypass grafting for failed angioplasty: A rare cause of postoperative angina
Authors: Kahn Joel K. , Fischer John C.
Published: March 2007

We report a case of failed coronary angioplasty requiring urgent coronary artery bypass graft surgery. The return of angina pectoris early after surgery led to repeat catheterization, demonstrating a rapidly progressive stenosis of the left main coronary artery. This was treated successfully with coronary angioplasty. In patients with recurrent angina early after bypass surgery in whom angioplasty preceded surgery, acceleration of left main disease should be considered. © 1993 Wiley‐Liss, Inc.
Collateralized chronic total occlusion: A different animal
Authors: Agarwal Subodh K. , Macander Peter J. , Roubin Gary S.
Published: March 2007

This report describes a patient with a chronically occluded proximal LAD in whom antegrade flow was not re‐established by successful dilatation alone. Obliteration of retrograde collateral flow restored antegrade flow. This case demonstrates the potential detrimental effect of vigorous collateral flow on the patency of chronic occlusions after successful PTCA. © 1993 Wiley‐Liss, Inc.
Hemi‐balloon dislodgement during a percutaneous balloon pericardial window procedure: Removal using a second pericardial catheter
Authors: Block Peter C. , Wilson Michael A.
Published: March 2007

We describe retrieval of a balloon fragment from the pericardial space during a percutaneous balloon pericardial window procedure. A second pericardial catheter was placed, and the transfer wire was snared. The second catheter was then used to push the balloon fragment back through the pericardium and out to the skin. © 1993 Wiley‐Liss, Inc.
Pseudodissection of the coronary artery: A variation caused by interventional tools
Authors: Garnic J. Daniel , Lee Don W. , Garza Juan L.
Published: March 2007

During PTCA immediate decisions often must be made on the basis of a less than optimum data set. We present a combination of factors which produce an incorrect perception of a coronary artery dissection. This potential must be understood by the interventionalist to avoid misdiagnosis and inappropriate therapeutic maneuvers. © 1993 Wiley‐Liss, Inc.
Sources of error in quantitative coronary angiography
Authors: Herrington David M. , Siebes Maria , Walford Gary D.
Published: March 2007

Many studies have reported the accuracy of quantitative coronary angiography (QCA) based on experiments using moderated‐size phantoms imaged under unrealistic radiographic conditions. However, these observations may not be generalizable to the setting of clinical angiography. To determine QCA accuracy in a realistic radiographic setting and evaluate the impact of the x‐ray system line spread function, plexiglass phantoms were imaged inside and out of a human thorax. A realistic radiographic background was associated with a 38% increase in variability of results (p< 0.05). Low concentrations of contrast and large image intensifier input screens were associated with significantly larger errors and variability in results (p< 0.05). There was a systematic overestimation of diameter in the smallest phantom. A mathematical model of the x‐ray line spread function was developed that explains the observed overestimation of the smallest phantom and provide a rational approach for correction of the line spread function for QCA. Many factors encountered in clinical coronary angiography such as nonuniform radiographic background, low concentrations of contrast, and small vessel diameters have a significant adverse impact on the accuracy and/or variability of gradient‐based edge detection QCA systems. © 1993 Wiley‐Liss, Inc.
In vitro evaluation of blood flow through autoperfusion balloon catheters
Authors: de Muinck Ebo D. , Angelini Paolo , Dougherty Kathy , Verkerke Bart J. , Rakhorst Gerhard , van Dijk Rene B. , Lie Kong I.
Published: March 2007

The effective flow rates with human blood through an autoperfusion catheter cannot be monitored in vivo and have not been experimentally determined in vitro. The manufacturers (Advanced Cardiovascular Systems [ACS], Temecula, CA) have suggested that “the flow rate” through the Stack over the wire and the RX‐60 monorail catheter is 60 ml/min with a pressure gradient of 80 mmHg. We measured human blood flow rates in vitro through these catheters under different continuous pressure regimens (between 40 and 120 mmHg), with varying hematocrit levels (between 25% and 62%). Measured blood flows at a gradient of 80 mmHg were found to vary from 32 to 65 cc/min, with hematocrit levels of 62‐25%. Minor variations in the circuitry, besides the viscosity of the medium, cause significant changes in observed flow rates (such as kinking of the catheter and blood sedimentation). In vitro determinations of blood flows cannot automatically be transferred to the in vivo condition, primarily because in vitro determinations do not account for the systolic intramural pressure increase (which may overcome the aortic pressure). If such a phenomenon is also considered, then the in vitro flow rates reported here should be multiplied by a factor of 0.40–0.60 to determine effective in vivo flow rates. Such information is relevant for the clinical operator of angioplasty, especially in the treatment of patients at high risk for undergoing percutaneous transluminal coronary angioplasty. © 1993 Wiiey‐Liss, Inc.
Experimental validation of geometric and densitometric coronary measurements on the new generation cardiovascular angiography analysis system (caas ii)
Authors: Haase JÜRgen , Escaned Javier , van Swijndregt Eline Montauban , Ozaki Yukio , Gronenschild Ed , Slager Cornelis J. , Serruys Patrick W.
Published: March 2007

Computer‐assisted contour detection and videodensitometric cross sectional area assessment of coronary artery obstructions on the CAAS II system were validated in vitro and in vivo by angiographic cinefilm recording and automated measurement of stenosis phantoms (luminal diameter 0.5, 0.7, 1.0, 1.4, 1.9 mm) which were first inserted in a plexiglass model and then serially implanted in swine coronary arteries. “Obstruction diameter” (OD) and “obstruction area” (OA) values obtained from 10 in vitro and 19 in vivo images at the site of the artificial stenoses were compared with the true phantom dimensions. The in vitro assessment of OD yielded an accuracy of 0.00±0.11 mm (correlation coefficient: r = 0.98, y = 0.18 + 0.82x, standard error of estimate: SEE = 0.08), whereas the in vivo measurement of OD gave an accuracy of −0.01 ± 0.18 mm (r = 0.94, y = 0.22 + 0.82x, SEE = 0.15). The assessment of OA gave an accuracy of −0.08 ± 0.21 mm2in vitro (r = 0.97, y = 0.08 + 0.99x, SEE = 0.22) and −0.22 ± 0.32 mm2in vivo (r = 0.95, y = 0.21 + 1.01x, SEE = 0.33). The mean reproducibility was ±0.09 mm for geometric measurements and ±0.21 mm2for videodensitometric assessments, respectively. Thus, due to inherent limitations of the imaging chain, the reliability of geometric coronary measurements is still far superior to videodensitometric assessments of vessel cross sectional areas. © 1993 Wiiey‐Liss, Inc.
Transluminal extraction atherectomy and adjunctive balloon angioplasty for restenosis after palmaz‐schatz coronary stent implantation
Authors: Ikari Yuji , Yamaguchi Tetsu , Tamura Tsutomu , Isshiki Takaaki , Saeki Fumihiko , Hara Kazuhiro
Published: March 2007

Two patients who developed restenosis after implantation of Palmaz‐Schatz coronary stents were successfully treated by transluminal extraction atherectomy and there has been no recurrence on follow‐up angiograms. The optimum strategy for managing restenosis after coronary stenting remains unclear, but transluminal extraction atherectomy appears to be a safe and effective option. © 1993 Wiiey‐Liss, Inc.
Giant left main pseudoaneurysm obstructing the left anterior descending coronary artery demonstrated by transesophageal echocardiography and coronary angiography
Authors: Shalev Yoseph , Vidne Bernard , Snir Etan , Kracoff Oscar H. , Oetinger Michael , Caspi Abraham
Published: March 2007

Left main pseudoaneurysm is a rare angiographic finding in young adults. We describe a 23‐year‐old male who presented with an acute anterior wall myocardial infarction. Coronary angiography and transesophageal echocardiography reveal a huge aneurysm of the distal left main obstructing the left anterior descending artery (LAD), which was defined by history as a pseudoaneurysm. The pseudoaneurysm was successfully resected and mammary artery was used to repair the distal left main and to bypass the LAD. © 1993 Wiiey‐Liss, Inc.
Glidewire treatment of resistant coronary occlusions
Authors: Freed Mark , Boatman James E. , Siegel Noah , Safian Robert D. , Grines Cindy L. , O'Neill William W.
Published: March 2007

Inability to cross the site of occlusion with a guidewire is the most common cause of failed angioplasty. The Glidewire, a kink‐resistant, flexible wire with a hydrophilic coating, was applied to 71 (59 total, 12 subtotal) refractory occlusions, resulting in an overall angioplasty success rate of 45%. The Giidewire may improve the success rate for PTCA of total and subtotal occlusions that cannot be crossed with conventional guidewires.© 1992 Wlley‐Liss, Inc
Total aortic occlusion caused by sustained balloon inflation: a previously unreported complication of intraaortic balloon counterpulsation
Authors: Ferrell Margaret A. , Doherty Martin , Zusman Randall M. , Nash Ira S.
Published: March 2007

A case of acute lower‐body ischemia 2 days following intraaortic balloon pump insertion is reported. Fluoroscopy revealed persistent balloon inflation throughout the cardiac cycle with distal aortic occlusion. Attempts to manually deflate the balloon were unsuccessful until a guidewire was advanced through the gas‐exchange lumen into the body of the balloon. The balloon catheter was removed without clinical sequelae other than transient oliguria and an asymptomatic increase in creatinine phosphokinase (CPK). This is a previously unreported complication of intraaortic balloon counterpulsation.© 1993 Wlley‐Liss, Inc
Retrieval of undeployed stents from the right coronary artery: report of two cases
Authors: Veldhuijzen Frank L. M. J. , Bonnier Hans J. R. M. , Michels H. Rolf , El Gamal Mamdouh I. H. , van Gelder Berry M.
Published: March 2007

Two patients are described in whom an undeployed stent (1 Wiktor and 1 Palmaz‐Schatz) was retained in the proximal segment of the right coronary artery during coronary angioplasty. In both cases the stent was caught by a technique using a second guidewire. The stent was removed in the first patient during bypass surgery; in the second patient it was removed from the femoral sheath© 1993 Wlley‐Liss, Inc
Adaptor device for shortening guide catheters to access distal lesions in coronary angioplasty
Authors: Chan Rodrigo C. , Rihal Charanjit S. , Menke Kristina K. , Winter Steven J. , Holmes David R.
Published: March 2007

One of the challenges in interventional cardiology is accessing distal stenoses in both native coronary arteries and bypass grafts. This article reports the fabrication and use of an adaptor device that can be connected to the proximal segment of a shortened guide catheter for easier and safer access to these distal lesions.
© 1993 Wlley‐Liss, Inc
Guidelines for personnel radiation monitoring in the cardiac catheterization laboratory
Authors: Balter Stephen
Published: March 2007

The Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions has devised guidelines to inform catheterization laboratory personnel about appropriate radiation monitoring and protection.

A personal monitoring dosimeter must be placed over any radiation protective garments on the collar near the thyroid.

A second dosimeter, worn at the waist level under any radiation protective garments, is mandatory for any declared pregnant workers exposed to radiation. This dosimeter is recommended, but not required, for all personnel in the catheterization laboratory.

The limit for whole body radiation exposure is stated in terms of the effective dose equivalent (EDE). Different formulas are used for calculating the EDE, depending on the number of dosimeters worn simultaneously by the individual.

Finger dosimeters should be worn by personnel whose hands are likely to be directly exposed to the x‐ray beam.

Initial and periodic training in radiation protection is a part of good laboratory practice.
© 1993 Wlley‐Liss, Inc
Multiple spontaneous coronary artery dissections in a middle aged woman: support for an underlying eosinophilic arteritis predisposing to intimal disruption
Authors: Burkey David , Love John , Fanning Joseph , Lambrew Costas
Published: March 2007

A 43‐year‐old female received tissue plasminogen activator for an acute antero‐apical myocardial infarction. Cardiac catheterization demonstrated three focal dissections involving the left anterior descending and circumflex arteries. She expired unexpectantly after undergoing emergency coronary artery bypass grafting for therapy of an extension of her infarct. To our knowledge, this is the fourth report of multiple spontaneous coronary artery dissections and the second in which tissue plasminogen activator was administered. The histiologic findings and their implications are reviewed.
© 1993 Wlley‐Liss, Inc
Improved anticoagulation management after palmaz schatz coronary stent implantation by sealing the arterial puncture site with a vascular hemostasis device
Authors: Kiemeneij Ferdinand , Jan Laarman Gert
Published: March 2007

Sealing the arterial puncture site with a vascular hemostasis device has the potential to maintain optimal anticoagulation after stent implantation. The level of heparinization during the first 3 days after successful stent implantation was retrospectively compared between 2 groups of medically treated patients with (group A; n = 18) and without (group B; n = 17) a Vasoseal™ after sheath removal. The number of APTTs sampled in group A and B was 233 and 168, respectively. Respective mean values of APTT (seconds) in group A and B were 180 ± 79 and 172 ± 91 at day 1 (p = NS), 132 ± 43 and 125 ± 61 at day 2 (p = NS) and 123 ± 36 and 116 ± 48 at day 3 (p = NS). More APTTs were suboptimal (< 80 secs) in group B (34/168; 20%) compared to group A (17/233; 7%) [p < 0.001]. More patients in group B compared to group A had 1 or more (14/17; 82% vs. 8/18; 44%; p = 0.04), 2 or more (10/17; 59% versus 3/18; 17%; p = 0.02) and 3 or more (8/17; 47% vs. 2/18; 11%; p = 0.03) suboptimal APTTs. Bleeding complications were seen in 4 patients without and in 3 patients with a Vasoseal™. Thus application of a vascular hemostasis device results in a less variable anticoagulation after coronary stenting, but it does not abolish entry site‐related bleeding complications.© 1993 Wlley‐Liss, Inc
Miniature angled sub‐selective guiding catheter aids in placing guidewire through difficult anatomy
Authors: Gibson Paul H.
Published: March 2007

A method for fabricating and using a “mini” guiding catheter is presented. Use of the mini guiding catheter provides the back up support necessary to enable a guidewire to traverse difficult anatomy. Use of this device to cross a lesion in an acutely angulated circumflex artery is presented.© 1993 Wlley‐Liss, Inc