bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention and Management of Interventional Complications
Authors: HOFMANN MANFRED
Published: June 2007

Preventing interventional PTCA complications starts with a precisely planned procedure that takes into consideration the possible pitfalls for each case, choice of materials, including alternatives for guiding catheters, wires, balloons, stents, and the possibility of emergency surgery. Beginners should have enough experience with diagnostic procedures and should start with type A lesions. The overall low rate of severe complications, despite the greater number of complex lesions, is based on the increasing worldwide individual and institutional PTCA experience. Therefore, even high risk PTCA procedures can be carried out with acceptable good results, but should be performed by the most experienced colleague available. This is the best prerequisite for the management of complications.
Practical Clinical Evaluation of Stents
Authors: NGUYEN THACH , DAVE VIJAY , JIA SANQING , FANG CHEN , WANG LEFENG , ZHANG CHEN , NGUYEN JAMES , FEARNOT NEAL , SAITO SHIGERU
Published: June 2007

This article discusses the clinical issues pertaining to an optimal stenting result and analyzes relevant stent structures and functions. There are five components of optimal stenting: favorable clinical features, easy stent delivery, ideal scaffolding, low stent thrombosis, and low restenosis. In straightforward cases, such as stenting in the mid‐right coronary artery with a straight proximal segment, procedural success can be achieved with any stent. In vessels with curved, tortuous proximal segments, a highly flexible stent is needed for a smooth and successful delivery. For ostial, protected left main, or aortoanastomotic lesions, stents with sufficient radial strength and good visibility are needed. The two major concerns of an interventional cardiologist choosing a stent are excellent trackability for fast delivery and low long‐term restenosis rate. In all situations, the procedural success depends on the operator's manual dexterity, experience with a particular stent design, and critical evaluation of different structural stent features to maximize benefits. Any new stent with high longitudinal flexibility, excellent scaffolding and radial strength, adequate radiopacity, complete deployment after one inflation, and that is easily recrossed and provides a good symmetrical conduit for a smooth coronary flow resulting in little tendency for thrombosis or restenosis would be today's stent of choice.
Medical Management of Acute Coronary Syndromes
Authors: TALLEY J. DAVID
Published: June 2007

The primary goals of the medical management of acute coronary syndromes are to restore and to maintain coronary patency. Blood flow in totally occluded coronary arteries is restored by fibrinolysis with plasminogen activators. The ongoing thrombosis is controlled by inhibiting the coagulation cascade and platelet activity. The latter is of greater importance, as the formation of platelet‐rich thrombi is the main pathophysiological mechanism leading to acute coronary syndromes. Several new classes of agents for the management of acute coronary syndromes have recently been introduced, including fibrin specific plasminogen activators, direct thrombin inhibitors, low molecular weight heparins, and inhibitors of the platelet receptor glycoprotein (GP) IIb‐IIIa. Recent major trials indicate that the use of these new agents may lead to a significant decrease in morbidity and mortality in patients with acute coronary syndromes.
Coil Occlusion of the Arterial Duct
Authors: TYNAN MICHAEL , HUGGON M.B. IAN , ROSENTHAL ERIC , QURESHI SHAKEEL , BAKER EDWARD
Published: June 2007

In 1976 Poretmann introduced a catheter‐mediated method of closure of the arterial duct. The first device to achieve widespread use was the Rashkind double umbrella. Closure rates were of the order of 80% with one device. The method was expensive and occlusion with Gianturco coils was shown to be as effective in small ducts. More recently, controlled release coils have proved to be as effective and have considerable popularity because they appear to carry a lower risk of embolization from the duct, and closure rates with one or more coils implanted at one procedure are in excess of 95%. Coil occlusion is safe and effective. However, large ducts still need other types of devices or must be closed surgically.
Successful Withdrawal from the Right Coronary Artery of an NIR Stent Dislodged from the Balloon Catheter
Authors: ANTONELLIS IOANNIS P. , PATSILINAKOS SOTIRIOS P. , PAMBOUKAS CONSTANDINOS A. , KRANIDIS ATHANASIOS J. , PAPADOPOULOS ANASTASIOS , MARGARIS NIKOLAOS , TAVERNARAKIS ANTONIOS G. , ROKAS STYLIANOS G.
Published: June 2007

A 58‐year‐old patient who underwent right coronary arterial angioplasty with NIR stent placement is described. The stent was dislodged from the balloon catheter and a technique of stent entrapment with two guidewires was successfully performed to remove it from the coronary artery.
External Radiation for Restenosis
Authors: ROBINSON KEITH A. , VERHEYE STEFAN , SALAME MAHOMED Y. , MARIJIANOWSKI MONIQUE , CUI JIANHUA , CHRONOS NICOLAS A.F. , KING SPENCER B. , CROCKER IAN R.
Published: June 2007

Background: Restenosis after balloon angioplasty remains a substantial clinical problem. Endovascular radiation has been shown to reduce neointima formation in animal models of restenosis, and the results of early clinical trials are promising. However, this technique has several limitations, particularly, the inability to delay or fractionate therapy and inhomogeneous dose distribution. These shortcomings might be overcome by delivering radiation therapy from an external approach. This study investigated the effects of high dose external beam irradiation on balloon‐injured pig coronary arteries. Methods and Results: Eight domestic juvenile pigs underwent balloon overstretch injury. External beam irradiation (21 Gy) of the heart was performed within 2 hours on four pigs and the remainder were not irradiated (controls). Sections of paraffin embedded injured arteries, perfusion fixed at 4 weeks, were measured by computer‐assisted histomorphometry. Luminal area in the 21‐Gy group was 3.84 ± 1.80 mm2 compared to 2.0 4 ± 0.49 mm2 in the controls (P < 0.01). Neointimal area and maximal intimal thickness were reduced in the 21‐Gy group (0.23 ± 0.36 vs 1.36 ± 0.67mm2, P < 0.0005; 0.25 ± 0.35 vs 0.64 ± 0.2, P < 0.01, respectively). Diffuse focal interstitial fibrosis was observed in the myocardium of the irradiated group. Conclusions: At 21 Gy, external beam irradiation significantly increased lumen size and reduced neointima formation in balloon‐injured pig coronary arteries. However, myocardial damage was also induced by irradiation of the whole heart at this dose.
The Platelet IIb/IIIa Inhibitor Abciximab as Adjunctive Therapy in Carotid Stenting of Potential Thrombotic Lesions
Authors: CECEÑA FELIPE A. , HOELZINGER DAVID H. , MILLER JESS A. , ABU‐SHAKRA SAWSAN
Published: June 2007

We evaluated the use of abciximab (ReoPro), a monoclonal glycoprotein (GP) IIb/IIIa inhibitor, in 45 patients and 49 carotid vessels undergoing stent placement for neurologically symptomatic, critical lesions of the common and/or internal carotid arteries. Our assessments included procedural success and clinical outcomes including stroke, myocardial infarction (MI), neurological death, and bleeding. There were no instances of minor or major stroke, Q‐wave or non‐Q‐wave MI, thrombocytopenia, or neurological death in the periprocedural in‐hospital period immediately poststenting to discharge, nor any neurological events related to the ipsilateral hemisphere or neurological death during follow‐up of up to 1 year, 6 months, and 30 days (30,10, and 5 patients, respectively). The hemoglnbin/hematocrit levels dropped in two patients, necessitating blood transfusions. Two patients died with multiple organ failure, and three more developed a non‐Q‐wave infarction at 4 months, 2 months, and 3 weeks poststenting, respectively.
Emergency Platinum Coil Embolization in a Coronary Artery Perforation with Tamponade During Abciximab Infusion in Acute Myocardial Infarction
Authors: COTO HUMBERTO
Published: June 2007

This case describes a patient with an acute myocardial infarction treated with intravenous abciximab, primary angioplasty, rotablation, and stenting, who had a hydrophilic‐coated guidewire‐induced vessel perforation, leading to tamponade. Following successful percutaneous pericardiocentesis, leakage was controlled immediately with the delivery of a platinum coil into the perforation, thus avoiding emergency surgical intervention. In selected cases. placement of intracoronary platinum coils to seal guidewire‐induced perforations might prevent the need of emergency surgical intervention, especially in highly anticoagulated patients or in those receiving glycoprotein IIb/IIIa blockers.
Coronary Flow Reserve Versus Geometric Measurements of Coronary Dimensions: Advantages and Limitations of the Functional Stenosis Assessment
Authors: CARLIER STÉPHANE G. , VAN LANGENHOVE GLEN , LUPOTTI FERMIN , ALBERTAL MARIANO , MASTIK FRITS , BOM KLAAS , SERRUYS PATRICK W.
Published: June 2007

This article reviews the physiopathological background of invasive functional assessment of coronary artery stenoses and the recent developments for clinical decision making based on intracoronary flow and pressure measurements. Limitations of these recordings are stressed, as well as their present clinical application to guide the decision of performing an intervention, or to assess the results of a percutaneous procedure. The additional value over (quantitative) angiography and intravascular ultrasound is discussed. Finally, the potentials of a new method of coronary flow measurement, based on the processing of the radiofrequency IVUS signal, offering combined simultaneous morphological and physiological assessments, are briefly introduced.
Fractional Flow Reserve: Who Needs the Pressure Wire?
Authors: BARTUNEK JOZEF , PIJLS NICO H. J. , BECH G. JAN WILLEM , DE BRUYNE BERNARD
Published: June 2007

Recently, the interest in coronary pressure measurements has been revived thanks to technical innovations (the development of pressure‐measuring angioplasty guidewire) and theoretical progress (the concept of pressure derived fractional flow reserve). Fractional flow reserve (FFR) is the ratio of maximal flow in the myocardial region depending on a stenosis to maximal flow in that same region if the stenosis were absent. With the development of pressure guidewires, fractional flow reserve can be calculated rapidly and safely in the diagnostic and interventional setting. It has been shown that pressure derived FFR can be used as a surrogate for a stress test for on‐line clinical decision making in the catheterization laboratory. Values < 0.75 are most often associated with exercise‐inducible myocardial ischemia, while values > 0.75 exclude objective signs of ischemia during exercise. The accuracy of FFR for that purpose is approximately 95% and higher than that of any single noninvasive test taken alone. Of note, it has been shown that prognosis is favorable in patients in whom a planned angioplasty was deferred on the basis of a myocardial fractional flow reserve > 0.75. After regular balloon angioplasty, the combination of a good angiographic result and a FFR > 0.90 is associated with an event rate during a 2‐year follow‐up, which is similar to that after stenting. After stent implantation, FFR should normalize. A FFR < 0.94 after stent implantation appears to be as accurate as intravascular ultrasound (IVUS) to detect stent malposition. Thus, pressure derived FFR is a well‐validated index of stenosis severity that has evolved from a physiological index to a clinical tool.
Stent Coatings: How to Reduce the Biological Response to Vessel Wall Injury
Authors: HAASE JURGEN
Published: June 2007

Since a variety of technical solutions to coat metallic stents with a layer of chemically inert and potentially biocompatible material has become available, stent coatings again have attracted the attention of interventional cardiologists. Numerous stent coatings were tested in vitro and by stent implantation in animals. Some of them undergo clinical evaluation in patients with coronary artery disease to test the hypothesis whether thrombosis may be eliminated and the phenomenon of late intimal hyperplasia can be further reduced. It has been demonstrated that heparin‐coated stents significantly diminish the incidence of stent thrombosis without improving the long‐term outcome. Gold‐coated stents gave a higher rate of in‐stent restenosis compared to uncoated stainless steel stents. Most promising are recently developed stent coatings with silicon carbide and turbostratic carbon, which is currently undergoing clinical evaluation.
Introduction of Brachytherapy to a German Catheterization Laboratory: How to Meet the Regulations Within a Reasonable Time Frame
Authors: SILBER SIGMUND , SCHNEIDER ARMIN
Published: June 2007

Presently, approximately 100 catheterization laboratories in the United States and over 20 in Europe perform intracoronary brachy therapy. In Germany, the first patients were treated with intracoronary afterloading in 1998. In this article, we describe our experience with the approval processes for clinical research and for routine use with the Novoste BetaCath™ system. First, all major German authorities and laws involved in this process are named and explained. Then, the required steps for obtaining the license for research and routine use are described. Finally, we compare three systems (BetaCath™ Novoste, Gamma‐IVT™ Cordis, and BetaMed™ Boston Scientific) regarding handling for security and maintenance checks, dosimetry verifications, and leakage testing. With the increasing amount of data, obtaining the license for clinical routine use is possible in Germany within a reasonable time frame, provided the brachytherapy device has a CE certificate.
The Minimally Invasive Surgical Approach: A Critical Reappraisal
Authors: BAUER ERWIN P. , KLÖVEKORN WOLF‐PETER
Published: June 2007

The use of minimally invasive techniques for cardiac surgery procedures has increased in the last 5 years. The term minimally invasive is used to describe cardiac procedures performed through a small incision or heart surgery performed without cardiopulmonary bypass. A review of the minimally invasive heart surgery literature is presented. According to the literature coronary bypass grafting without cardiopulmonary bypass can be carried out with similar early and mid‐term results when compared to coronary bypass grafting with cardiopulmonary bypass. The same is true for LIMA to LAD bypass grafting performed through a lateral mini‐thoracotomy. Controversial results are reported regarding morbidity after aortic and mitral valve surgery operated through a mini‐incision. Some report less postoperative pain, earlier mobilization, shorter hospital stays, and lower costs. Others did not find any difference between full sternotomy and mini‐incisions except a better cosmetic outcome. According to the literature there is no proven advantage of performing open heart surgery minimally invasively except in special situations, such as reoperation or polymorbid patients.
Carotid Artery Percutaneous Transluminal Angioplasty and Stenting: Indications, Technical Approach, and Complications
Authors: CORDERO‐YORDAN HERBERT , LOPEZ ALEJANDRO N. , HEUSER RICHARD R.
Published: June 2007

Carotid percutaneous transluminal angioplasty and stenting are relatively new tools in the field of vascular therapeutics. They are products of the evolution of the techniques used in the therapy of coronary and peripheral vascular disease. Carotid endarterectomy is still the “criterion standard” to which all other carotid interventions are compared. This status has been achieved on the basis of extensive studies on symptomatic and asymptomatic patients. For carotid percutaneous transluminal angioplasty and stenting to become a proven alternative for the therapy of carotid disease, their precise use and role still need to be defined by randomized prospective trials. If performed by experienced operators with meticulous technique, the risk of complications is very low. Outpatient‐based 1‐day hospitalization, well tolerated, and avoiding anesthesia related complications make their future in the therapy of carotid disease very optimistic.
Overlapping Coronary Stents Result in an Increased Neointimal Hyperplasia: Insight from a Porcine Coronary Stent Model
Authors: WANG KAI , ZHOU XIAO R. , VERBEKEN ERIC , PING QIANG BEI , YANMING HUANG , JIANHUA HUANG , VAN DE WERF FRANS , DE SCHEERDER IVAN
Published: June 2007

Clinical experience suggests that overlapping coronary stents result in an increased in‐stent restenosis. This study investigates the underlying mechanisms in a porcine coronary model. Single or two overlapping self‐made stainless steel single wire sinusoidal helical coil stents were randomly deployed in the right coronary artery of 20 cross‐bred pigs. The pigs underwent a control angiogram at 6 weeks and were then sacrificed. Quantitative coronary analysis before, immediately after stent implantation, and at 6 weeks was performed using the semiautomated Polytron 1000 system. Morphometry was performed using a computerized morphometric program. Angiographic analysis revealed a decreased recoil in the overlapping group (1% vs 4%: P < 0.02) and a significantly larger minimal stent lumen diameter at follow‐up in the single stent group (2.87 ± 0.16 vs 2.58 ± 0.22 mm, P = 0.005). Histopathology showed a significantly increased injury (1.27 ± 0.43 vs 0.83 ± 0.44, P = 0.042) and inflammatory reaction (1.51 ± 0.11 vs 1.09 ± 0.54, P = 0.035) surrounding the stent filaments in the overlapping stent group. Morphometric analysis showed a significantly higher neointimal hyperplasia (3.34 ± 0.68 vs 2.16 ± 1.48 mm2, P = 0.034) in the overlapping stent group. Overlapping stents result in a more pronounced coronary vessel injury resulting in more inflammation and neointimal hyperplasia compared to single stents.
Successful Double Percutaneous Alcohol and Coil Embolization of Bilateral Coronary‐to‐Pulmonary Artery Fistulas
Authors: SANGIORGI GIUSEPPE , CASTELVECCHIO SERENELLA , INGLESE LUIGI
Published: June 2007

We report the case of a 70‐year‐old man with recent myocardial infarction who was admitted for further evaluation of his effort angina. Cardiac catheterization and selective coronary angiography excluded significant coronary atherosclerotic disease of the coronary arteries. Double coronary‐to‐pulmonary artery fistulas, one originating from the proximal right, the other from the left anterior descending coronary arteries, and draining into the right and left branch of the pulmonary artery, respectively, were observed. A left‐to‐right shunt was visualized at angiography. The patient was successfully treated with percutaneous alcohol and coil embolization of both coronary artery fistulas with total resolution of clinical symptoms. At 6‐month follow‐up a coronary angiography confirmed complete disappearance of the fistulas. We conclude that a “coronary steal” phenomenon caused by the fistulas induced myocardial ischemia in this patient and that percutaneous transcatheter exclusion with chemical and mechanical devices is a safe. effective, and reasonable alternative to traditional cardiac surgery.
Intravascular Electroporation Markedly Attenuates Neointima Formation After Balloon Injury of the Carotid Artery in the Rat
Authors: DEV NAGENDU B. , HOFMANN GÜNTER A. , DEV SUKHENDU B. , RABUSSAY DIETMAR P.
Published: June 2007

The present study examined the use of electroporation (pulsed electric field application) to temporarily permeabilize vascular cell membranes and thereby deliver drugs directly into cells of the vessel wall to treat focal cardiovascular diseases (e.g., postangioplasty restenosis). A unique intravascular porous balloon electroporation catheter has been designed specifically to enhance drug uptake directly into the arterial wall. The effect of heparin on neointimal growth following balloon‐induced injury of the carotid arteries of rats was used as a measure of effective drug delivery. Histomorphometrical analysis of arteries showed that neointimal growth and lumen loss were significantly inhibited by heparin in combination with electroporation, but not by heparin delivered without electroporation. We conclude that the application of electroporation technology may be a viable approach to intramural drug delivery of potential therapeutic compounds for the treatment of neointimal growth and negative remodeling during postangioplasty restenosis.
Interventional Versus Surgical Closure of Atrial and Ventricular Septal Defects: Advantages and Limitations of the Catheter‐Based Approach
Authors: SIEVERT HORST
Published: June 2007

New techniques and devices have revolutionized the transcatheter techniques used to close congenital intracardiac shunts. The advantages, compared to surgery, are the avoidance of a thoracotomy, postoperative pain and morbidity, a long hospital stay, and most often general anesthesia. Atrial septal defect closure has become a routine procedure in many centers. It is amenable in about 80% of the patients with a secundum‐type defect. The success rate today is dx > 99% and the rate of any complication is < 0.5%. Ventricular septal defect closure, however, is still in its infancy. Apical, mid‐muscular, and selected perimembraneous VSDs with a significant septal rim between the defect and the aortic valve can be closed with the devices currently available. Analysis is still needed to prove the long‐term safety and efficacy of ASD or VSD closure.
Critical Pulmonary Stenosis
Authors: LATSON LARRY A.
Published: June 2007

Critical pulmonary stenosis causes cyanosis and can be potentially lethal in the neonate. Initial treatment includes general resuscitation and infusion of prostaglandin E1 to dilate the ductus. The diagnosis is usually made echocardiographically, but a right ventriculogram in the outflow tract may be necessary in some patients with only a tiny valve opening. Preformed catheters may aid in the passage of an appropriate guidewire. Valvuloplasty should be performed with a balloon approximately 1.2 times the annulus diameter. Most patients remain mildly to moderately cyanotic immediately after the procedure. With right ventricular (RV) growth and improved RV compliance, the cyanosis eventually resolves. Some patients may require prolonged prostaglandin infusion, a surgical shunt, or other mechanical means of maintaining systemic‐to‐pulmonary artery flow. Intermediate‐ to long‐term results are excellent. However, only 5%‐10% of patients may require surgical relief of residual valve or subvalvular stenosis. Very long‐term follow‐up raises concern about the significance of induced pulmonary insufficiency. Up to 30% of patients may require repeat balloon valvuloplasty.
Comprehensive Management of Branch Pulmonary Artery Stenosis
Authors: BACHA EMILE A. , KREUTZER JACQUELINE
Published: June 2007

Branch pulmonary artery stenosis may occur as an isolated finding or in conjunction with other cardiac malformations; it may be congenital or acquired postoperatively. Transcatheter management with balloon pulmonary angioplasty (BPA) and/or endovascular stenting is generally considered the procedure of choice for most patients. With the introduction of high‐pressure balloons, the results of BPA have improved significantly (75%). Stent implantation has increased the success rate to over 90%. However, BPA continues to be the initial procedure of choice for distal stenoses, or those associated with branching points, and in small children or infants. Stent implantation is preferred over BPA for central or proximal stenoses, and those due to kinking or tenting, external compression, intimal flaps, failed balloon dilation, and early postoperative procedures. Certain lesions, such as supravalvar pulmonary stenosis, or stenosis at the branch pulmonary arteries bifurcation, are better dealt with at surgery. High‐risk situations for the development of postoperative pulmonary artery (PA) stenosis exist in small infants with hypoplastic branch PAs after a conotruncal procedure, after duct ligation, after shunt insertion, after PA band placement, or after pulmonary arteriotomies or anastomoses of any kind. A combined collaborative transcatheter and surgical approach is essential for many patients with PA stenosis, particularly in complex forms of tetralogy of Fallot.
Ostial Left Anterior Descending Coronary Artery Stent Positioning: Partial Preinflation Prevents Stent Oscillation and Facilitates Accurate Deployment
Authors: HILDICK‐SMITH DAVID J.R. , SHAPIRO LEONARD M.
Published: June 2007

Ostial intracoronary stent deployment is complicated by the influence of cardiac motion, which causes the stent to oscillate back and forth during the cardiac cycle. Accurate deployment can be facilitated by initial low pressure inflation of the balloon on which the stent is mounted. This stabilizes the stent within the stenosis, while still allowing adjustment of the exact stent location prior to deployment.
Transatrial Access to the Normal Pericardial Space For Local Cardiac Therapy:Preclinical Safety Testing with Aspirin and Pulmonary Artery Hypertension
Authors: PULERWITZ TODD C. , WAXMAN SERGIO , ROWE KATHARINE A. , QUIST WILLIAM C. , LIPINSKA IZABELLA , VERRIER RICHARD L.
Published: June 2007

The reliability, rapidity, and safety of nonsurgical, transatrial pericardial access for local cardiac therapy have been demonstrated in healthy animals. Since many patients take aspirin or have increased right‐sided pressures, we evaluated the procedure's safety under these conditions. Transatrial pericardial access was performed in anesthetized pigs following aspirin administration (162 mg po, n = 6) or during experimental pulmonary artery hypertension (n = 4 different animals) and required only 3 minutes following guide catheter positioning. Platelet aggregability testing with arachidonic acid confirmed aspirin effectiveness. Mean pericardial fluid hematocrit was 0.1 ± 0.1% after 2 days of aspirin therapy and 1.9 ± 1.1% at sacrifice 24 hours later (NS). Mean pericardial fluid hematocrit was 1.0 ± 0.5% after 45 minutes of pulmonary artery hypertension and 4.3 ± 0.8% at sacrifice 30 minutes later (NS). Histologic analysis in both groups revealed a small thrombus and localized inflammation at the site of puncture. Neither aspirin use nor pulmonary artery hypertension causes significant bleeding into the pericardial space following transatrial access and thus does not preclude this route for local cardiac drug delivery.
Carotid Stenting: Which Stent for Which Lesion?
Authors: ISCHINGER THOMAS A.
Published: June 2007

Dedicated catheter and stent systems for use in the carotid circulation have only been developed recently. Almost exclusively, self‐expandable metallic stents are being used. Longitudinal flexibility, contourability of the luminal configuration, sufficient radial resistive force, narrow meshwork for sealing of the diseased vessel wall, low profile of the constraint stent, and compatibility of the devices with routine angioplasty techniques are the premier requirements. Most of the current experience is based on the longitudinal wire mesh design (Carotid Wallstent). The narrow meshwork has excellent sealing capacity but the inherent (yet manageable) problem of foreshortening with expansion needs attention. The segmented ring designs of the more recent Nitinol stents permit more precise positioning and contouring of the luminal surface, yet their capacity to seal a complex or thrombotic lesion and their clinical safety needs further evaluation. As more distinct features of dedicated carotid stents are being developed and as their differential importance gets recognized, a more meaningful and individual stent selection for the carotid anatomy may further improve clinical outcome.
Difficult Percutaneous Mitral Commissurotomy: Failure of the Inoue Balloon Technique and Successful Double‐Balloon Technique
Authors: BENNANI RAJA , EL NAIMA , AOUAD AICHA , FELLAT NADIA , FELLAT IBTISSAM , MOULINE NABIL , BENOMAR MOHAMED
Published: June 2007

From December 1994 to May 1999, 487 patients underwent percutaneous transvenous mitral commissurotomy according to the Inoue balloon technique for tight mitral stenosis. In three cases, the Inoue balloon technique was not possible because the catheter balloon could not enter the mitral orifice and the double‐balloon technique was performed instead. In two cases, a flow‐guided balloon catheter met the mitral orifice and the double‐balloon technique was effective. In the third case, passing the valve with a flow balloon catheter was impossible, a 0.032 Terumo straight wire crossed the valve, which was dilated with a single balloon the first time and a double balloon the second time. The mitral valve area increased in the three cases from 0.8 to 1.8 cm2, from 0.7 to 1.6 cm2, and from 0.5 to 1.5 cm2, respectively. There were no complications. (J Interven Cardiol 2001; 14:17–19)
Rheolytic Thrombectomy for In‐Stent Thrombosis: Creating a Diagnostic Window
Authors: ADAMS MARK R. , BLAKE GAVIN J. , KINLAY SCOTT , ROGERS CAMPBELL
Published: June 2007

Acute stent thrombosis is a relatively uncommon complication of coronary artery stenting, however, it is a potentially catastrophic event. In this case report of stent thrombosis, rheolytic thrombectomy is used to reestablished flow within the artery and, thereby, facilitate intravascular ultrasound. This documented that inadequate stent expansion, residual disease, and tissue prolapse through the stent at an angulated segment of the artery are factors that may underlie thrombosis. This case illustrates that rheolytic thrombectomy is feasible in subacute thrombosis, and that this approach facilitates diagnostic evaluation and treatment of underlying factors involved in stent thrombosis. (J Interven Cardiol 2001;14:27–31)
Hypoxemia Related to Right‐to‐Left Shunting Through a Patent Foramen Ovale: Successful Percutaneous Treatment with the CardioSeal Device
Authors: PIÉCHAUD JEAN‐FRANÇOIS
Published: June 2007

Hypoxemia related to right‐to‐left shunting through a patent foramen ovule (PFO) is not rare. It can be observed in correlation with a specific situation such as pneumonectomy and can occur even with normal pulmonary pressure. This article reports the experience of 12 patients in which a transcatheter closure with the CardioSeal device was done successfully. Clinical improvement is often obtained, despite incomplete occlusion of the defects. The author demonstrated that transcatheter closure of PFO can be performed safety and should be considered as an efficient alternative to surgery in cyanotic patients with PFO. (J Interven Cardiol 2001; 14:57–60)
Microvena Atrial Septal Defect Occlusion Device ‐ Update 2000
Authors: P. O'LAUGHLIN MARTIN
Published: June 2007

This article (1) summarizes the Duke University results with the Das‐Angel Wings atrial septal defect occlusion device, (2) outlines the rationale for design changes in the device, and (3) describes the new Microvena atrial septal defect occlusion device characteristics, and plans for the future. At Duke University, investigators using the first‐generation device attempted closures in 3.5 patients with atrial level communications. Ages ranged from 5 to 83 years with a median of 28 years, and weights ranged from 16 to 100 kg. Thirty‐two of the 3.5 defects had successful device placement. On follow‐up, the defects of 27 of 32 patients with an implanted device were completely closed, and 5 patients had < 2‐mm residual leaks. Three patients had malposition of the device, two of whom were treated surgically and one of whom was treated with percutaneous device retrieval. Complications included one small mitral valve perforation with no clinical sequelae. There have been no strokes, delayed enibolizations, nor procedure or device related deaths. There have been no new or late problems in the cohort in a follow‐up extending to 63 months. Opportunities for improvement of the device were noted during the clinical study. The manufacturer, Microvena Corporation, voluntarily withdrew the occluder for a redesign initiative. The objectives of redesign were ready deployment, reduction of device manipulation, rounding of the device, and retrievability. The Guardian Angel device has been the product of the redesign effort. It is a percutaneously inserted atrial septal defect occlusion device that uses the same materials as the initial device, but which has advantages of retrievability, repositionability, and no need for device manipulation. Initial studies have been performed in experimental animals, and clinical trials are planned for the near future. (J Interven Cardiol 2001;14:77–80)
Conscious Sedation with Intermittent Midazolam and Fentanyl in Electrophysiology Procedures
Authors: PACHULSKI ROMAN T. , ADKINS DANIELLE C. , MIRZA HUMAIR
Published: June 2007

Objectives: To determine the safety and efficacy of intermittent midazolam and fentanyl conscious sedation for electrophysiology procedures (EP). Background: Intermittent midazolam and fentanyl conscious sedation was administered in 700 consecutive cases (175 radiofrequency ablations, 163 EP studies, 261 pacemakers, and 101 implantable cardioverter‐defibrillators) for 471 patients (239 males, 51%) mean age 65 ± 15 years. The mean dose of midazolam was 0.063 mg/kg/hr and fentanyl was 0.591
μg/kg/hr. Methods: Cardiac rate and rhythm were monitored continuously, while blood pressure and arterial oxygen saturation were noninvasively assessed evevy 5 minutes. Drugs were administered in aliquots of 0.5 to 2.0 mg of midazolam and 6.25 to 25 μg of fentanyl as determined by clinical condition every 15 to 30 minutes. Results: There were no deaths. In no case was endotracheal intubation required. Mild hypoxemia (SaO2 > 80%, but < 90%) occurred in 17 cases (2.4%) and was easily reversed with verbal stimulation and oropharyngeal repositioning (12 cases, 1.7%), increased F1O2 (3 cases, 0.4%), or intravenous naloxone (2 cases, 0.3%). Reversible hypotension (systolic blood pressure < 90, but > 60 mmHg) occurred in 14 patients (2.0%) and was corrected with intravenous crystalloid bolus or flumazenil (10 cases, 1.4%) or inotrope infusion (4 cases, 0.6%). No patient stay was prolonged due to sedation. Only five patients (0.7%) had any recollection of the procedure, while two (0.3%) were aware of pain. All hypoxemic episodes occurred during the first hour, whereas 43% (6/14) of hypotensive episodes occurred after the first hour. Conclusion: Conscious sedation with intermittent midazolam and fentanyl is safe and eficacious for a broad range of EP procedures. (J Interven Cardiol 2001; 14:143–146)
Covered Stents in the Treatment of Aortic Coarctation
Authors: V. DE GIOVANNI JOSEPH
Published: June 2007

Coarctation of the aorta can be managed in different ways depending upon the age of presentation, anatomical details of the coarctation, the aortic arch anatomy, and whether the coarctation is native or a recurrence following surgery. In infants, surgery is the preferred treatment of choice, whereas in older children and adults, percutaneous procedures, such as balloon angioplasty or stent implantation, are becoming increasingly popular methods for treating coarctation. Various types of stents have been used and this paper specifically addresses the use of covered or graft Jomed stents in a small group of patients with coarctation. (J Interven Cardiol 2001;14:187–190)
Transcatheter Closure of Secundum Atrial Septal Defect with a New Self‐Expanding Nitinol Double Disk Device (Amplatzer Device): Experience in Nanjing
Authors: KONG XIANGQING , CAO KEJIANG , XU DI , CHEN MINGLONG , YANG RONG , HUANG JUN
Published: June 2007

Purpose: Various devices have been developed for the transcatheter closure of secundum atrial septal defect (ASD II) to avoid the morbidity, discomfort, and thoracotomy scar associated with surgical closure. The purpose of this study was to evaluate the safety and efficacy of the Amplatzer septal occluder for transcatheter closure of ASD II. Patients and Methods: Only patients who were clinically diagnosed with ASD II were selected. The anatomy of ASD had to meet certain echocardiographic criteria. Under the guidance of echocardiography and fluoroscopy, the implantation of the device was accomplished as recommended by the manufacturer. Results: Thirty patients (median age 18.4 years) with an ASD II underwent transcatheter closure. Procedure time ranged from 30–200 minutes and fluoroscopy time from 10–50 minutes. The diameter of the ASD measured by echocardiography ranged from 13–25 mm, while both the stretched diameters of the ASDs and the sizes of the devices ranged from 18–34 mm. The successful placement rate was 100%. The residual shunt rate was 100% immediately after device implantation and 10% after 24 hours. After 3 months, 3.3% of the patients had a (trivial) residual shunt. The device did not affect the surrounding structures of ASD. No embolization of the device occurred. Conclusion: The Amplatzer device designed for the closure of ASD II can be implanted easily and also is retrievable. Due to a low ratio of residual shunt and few complications, this device is a good choice for transcatheter closure of ASD II. Long‐term follow‐up will be required for widespread clinical use. (J Interven Cardiol 2001;14:193–196)
Transcatheter Closure of Muscular Ventricular Septal Defects in Two Patients After Myocardial Infarction
Authors: PARSI A. , BRUCH L. , SZURAWITZKI G. , BOOSFELDT C. , O. GRAD M. , KREBS H. , V. SABIN G. , KLEBER F. X.
Published: June 2007

Acquired muscular ventricular septal defects (MVSD) after myocardial infarction (MI) can lead to right heart failure and cardiogenic shock with high mortality. Early surgical therapy is often difficult to perform but can reduce the mortality. The closure of congenital septal defects is performed with high safety. Therefore, the interventional closure of an acquired post‐MI VSD might be feasible and of potential benefit. To date, experiences with closure of post‐MI MVSDs are minimal. We report on two patients with post‐MI VSD. (J Interven Cardiol 2001;14:219–222)
The Duct‐Occlud Device: Design, Clinical Results, and Future Directions
Authors: MOORE JOHN W. , SCHNEIDER DOUGLAS J. , DIMEGLIO DOREEN
Published: June 2007

The successful employment of embolization coils for transcatheter occlusion of the patent ductus arteriosus (PDA) has resulted in acceptance of transcatheter occlusion as the treatment of choice for small to medium‐sized PDAs. The Duct‐Occlud device was developed to further improve the technique by utilizing a controlled release mechanism and coil shape specifically designed for the geometly of the ductus arteriosus. Clinical studies have demonstrated excellent efficacy with low embolization rates and low incidences of complications. Newer modifications have been designed for occlusion of larger PDAs and subaortic ventricular septal defects, and preliminary clinical results have been promising. (J Interven Cardiol 2001;14:231–238)
The Sideris Buttoned Devices for Transcatheter Closure of Patent Ductus Arteriosus
Authors: SIDERIS ELEFTHERIOS B. , RAO P. SYAMASUNDAR , ZAMORA ROLANDO
Published: June 2007

This article reviews the experience in the last decade with Sideris buttoned devices for occlusion of patent ductus arteriosus (PDA). The devices used were the regular buttoned device, the infant buttoned device, the device with the folding plug, and the wireless device. The buttoned devices were implanted transvenously and introduced through 7Fr—8Fr long sheaths for PDAs up to 12 mm; wireless devices required 9Fr‐11Fr sheaths for PDAs up to 22 mm. All different shapes of ductus were occluded. The records of 356 patients in the international and Food and Drug Administration (FDA) supervised United States (US) clinical trials were reviewed. Despite excellent long‐term full occlusion rates and the absence of significant complications with the regular buttoned device, modifications were necessary to improve the full occlusion rates in 24 hours. The 24‐hour rates improved from 60% with the regular device to 85% with the folding plug device. Most residual shunts disappeared on long‐term follow‐up without significant complications. Wireless devices were developed for very large PDAs and have excellent occlusion rates. The buttoned device with the incorporated folding plug and the wireless devices are currently under clinical trial. The safety record of the new devices needs to be established with larger clinical trials. (J Interven Cardiol 2001;14:239–246)
Patent Ductus Arteriosus Equipment and Technique. Amplatzer Duct Occluder: Intermediate‐Term Follow‐Up and Technical Considerations
Authors: (VASILIOS) D. THANOPOULOS BASIL , HAKIM FAKHRI A. , HIARI AKHTAM , TSAOUSIS GEORGE S. , PAPHITIS CHRISTOS , HIJAZI ZIYAD M.
Published: June 2007

Between May 1997 and June 2000, 69 patients, ages 0.1 to 34 years, underwent attempted anterograde transcatheter closure of a patent ductus arteriosus (PDA) using the Amplatzer Duct Occluder (ADO). The ADO is a cone‐shaped, self‐centering, and repositionable occluder made of nitinol wire mesh. A 5Fr to 7Fr sheath was used for the delivery of the device. The mean PDA diameter (at the pulmonary end) was 4.6 ± 1.9 mm (range 1 mm‐8.5 mm). Sixty‐seven of the 69 patients had successful device placement. The mean ADO smallest diameter was 6.9 ± 1.8 mm (range 4 mm‐12 mm). Complete angiographic closure occurred in 62 (92.5%) of 67 patients (95% confidence interval, 88.22%–98.77%). In five patients, there was a trivial residual shunt immediately after the procedure. At 24 hours, color Doppler flow imaging revealed complete closure in all 67 (100%) patients. The unsuccessful attempts occurred in two patients with a small, I‐mm diameter native PDA and residual PDA after surgical occlusion. Fluoroscopy time was 7.6 ± 1.8 minutes (4 min‐18 min). No complications were observed. At a median follow‐up of 1.5 years (range 0.25 to 3.2 years), all patients had complete closure without complications. We conclude that transcatheter closure using the ADO is a highly effective and safe treatment for most patients with PDA. (J Interven Cardiol 2001;14:247–254)
Suicidal thoughts in patients with Parkinson’s disease treated by deep brain stimulation of the subthalamic nuclei: two case reports and review of the literature
Authors: Balash Yacov , Merims Doron , Giladi Nir
Published: June 2007

Background:

Deep brain stimulation (DBS) of the subthalamic nuclei (STN) can result in depression despite the obvious motor improvement.

Case presentations:

Two patients with serious life-threatening depressive episodes are described. In the first case, the trigger for depression was a slight adjustment of the left stimulating electrode’s contact. In the second case, reducing both the dopaminergic therapy and the voltage of DBS resulted in the manifestation of depressive symptoms.

Conclusions:

DBS-induced depression possibly has pathogenetic differences from ordinary Parkinson’s disease depression. The STN region seems to be a sensitive zone that influences emotions.
Repellent effects of pongam oil on settlement and oviposition of the common greenhouse whitefly Trialeurodes vaporariorum on chrysanthemum
Authors: PAVELA ROMAN , HERDA GERHARD
Published: June 2007

Abstract
The repellent activities, including host deterrence and anti‐oviposion, of pongam oil against the adults of the common greenhouse whitefly Trialeurodes vaporariorum Westwood in greenhouses were tested. Chrysanthemum plants treated with different concentrations (0.5%–2.0%) of water‐suspended pongam oil showed relatively longlasting host deterrent and anti‐oviposition effects on the adults of greenhouse whitefly. Although the repellent effect declined in time and concentration, strong effects on the reduction of oviposition were found, which lasts, dependent on concentration at least 12 days after application.
The use of ASBOS against young people in England and Wales: lessons from Scotland
Authors: Macdonald Stuart , Telford Mark
Published: June 2007

The Anti-Social Behaviour Order (ASBO) is one of the best known measures used to tackle anti-social behaviour. In keeping with the popular conception, the order is frequently used against young people. Of all ASBOs issued in England and Wales up to the end of 2005, roughly 40% were imposed on under-18s. This paper begins with a brief outline of the three principles at the heart of the celebrated Scottish children’s hearings system. With reference to these principles, and to the provisions which govern the use of the order against 12–15 year olds north of the border, the paper then discusses five areas of concern about the use of ASBOs against young people in England and Wales: the readiness to resort to ASBOs; the forum for ASBO applications; the terms of ASBOs; publicising the details of ASBOs; and custodial net-widening. The paper ends by suggesting reforms to the ASBO regime in England and Wales insofar as it is used against young people.
Advances in the diagnosis and management of cutaneous mast cell tumours in dogs
Authors: Dobson J. M. , Scase T. J.
Published: June 2007

Mast cell tumours are one of the most common tumours of the canine skin and have a reputation for being difficult to manage because of their variable clinical presentation, behaviour and response to treatment. This review of recent literature on canine mast cell tumours suggests that the majority of such tumours may not be as bad as their reputation suggests. Most grade I and grade II tumours can be managed successfully by good surgery. Recent literature also calls into question the utility of clinical staging systems and the value of assessing surgical margins for prognosis and highlights the paucity of well‐conducted, case‐controlled clinical trials in assessing the efficacy of medical management of high‐risk tumours. In terms of more basic research, recent studies have implicated the stem cell factor receptor KIT as having a role in the aetiology of canine mast cell tumours and there appears to be an association betweenc‐kitmutation and higher grade of tumour. This may offer a possible target for new therapeutic approaches.
Survival of 54 cats with oral squamous cell carcinoma in United Kingdom general practice
Authors: Hayes A. M. , Adams V. J. , Scase T. J. , Murphy S.
Published: June 2007

Objectives:To determine the survival of 54 cats with histologically confirmed feline oral squamous cell carcinoma (FOSCC) treated in UK general practice and to determine factors predictive for survival.

Methods:Cases were identified from consecutive samples submitted for histological diagnosis. Observational and survival data were collated retrospectively from submitting practices. Immunohistochemical analysis of cyclooxygenase (COX) expression variables was available using previously published data. Kaplan‐Meier product limit estimation for overall survival and Cox proportional hazards regression for potential explanatory variables were performed.

Results:The overall median survival time was 44 days [95 per cent confidence interval (CI): 31–79] and 1 year survival was 9·5 per cent. Variables associated with survival were whether the cat was pedigree [hazard ratio (HR)=8·17, 95 per cent CI: 1·96–34·12], whether the cat received non‐steroidal anti‐inflammatory drug (NSAID) therapy after diagnosis (HR=0·46, 95 per cent CI: 0·21–0·98) and whether the COX‐1 staining distribution was patchy rather than diffuse (HR=0·25, 95 per cent CI: 0·08–0·014).

ClinicalSignificance:This study suggests that although the prognosis for inoperable FOSCC remains poor, palliative treatments may offer a survival advantage that compares favourably with more aggressive treatment methods. Further work is needed to evaluate NSAID therapy in this disease, in particular to determine whether the potential survival advantage is because of an analgesic or anticancer effect or both. COX‐1 distribution patterns may have a role as a prognostic indicator in this disease.