bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcatheter Ablation of Incessant Ectopic Left Atrial Tachycardia Using Radiofrequency Current
Authors: TRAPPE H.J. , PAUL T. , PFITZNER P. , LICHTLEN P.R.
Published: June 2007

Catheter ablation of ectopic atrial tachycardia has been previously reported in a small number of patients in whom the ectopic focus was predominantly located in the right atrium. We report on a 51‐year‐old patient with atrial automatic tachycardia originating in the left atrium, in whom successful radiofrequency catheter ablation was pet formed via a transseptal puncture. The patient had suffered incessant atrial tachycardia for several years, refractory to antiarrhythmic drug treatment and DC‐cardioversion. Radiofrequency ablation terminated left ectopic atrial tachycardia and, therefore, should have been attempted before resorting to open heart surgical ablation.
Interventional Cardiology in South Africa
Authors: MANGA PRAVIN , LANDLESS PETER
Published: June 2007

South Africa is a country in political and cultural flux. Because of the iniquitous system of apartheid, inequalities have been perpetuated at all levels including health care. Due to the high prevalence of ischemic heart disease and rheumatic heart disease, coronary angiography, PTCA, intracoronary stenting, and balloon valvuloplasty have become established cardiological procedures in South Africa. However, a new political dispensation promises changes to health care, which will impact on interventional cardiology. With a proposed emphasis on primary health care, resources for tertiary health care will probably be curtailed. Thus consideration will have to be given to reducing expenditure by careful review of indications for expensive interventional procedures and developing new ideas to contain costs. This will be the challenge facing cardiologists in a “New South Africa”.
Coronary Angioplasty in High Risk Patients: Comparison of Elective Intraaortic Balloon Pump and Percutaneous Cardiopulmonary Bypass Support—A Randomized Study
Authors: KAUL UPENDRA , SAHAY SANGEET , BAHL VINAY K. , SHARMA SANJEEV , WASIR HARBANS S. , VENUGOPAL P.
Published: June 2007

Forty patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with severely impaired left ventricular ejection fraction (LVEF) < 30% were randomized between prophylactic intraaortic balloon pump (IABP) support (N = 20) and percutaneous cardiopulmonary bypass (PCPB) support (N = 20). The indications for both groups were left ventricular (LV) dysfunction and a large area of myocardium (> 50%) being perfused by the target vessel. The IABP and PCPB supported groups were comparable in LVEF (20%± 6.4% vs 22.8%± 8.1%), mean pulmonary artery pressure (46.5 ± 10.5 mmHg vs 42.6 ± 12.6 mmHg), average number of vessels dilated (1.4 vs 1.3), mean inflation time (2.8 ± 0.3 min vs 3.1 ± 0.5 min), and hospital stay after PTCA (5.6 ± 1.2 days vs 5.2 ± 1.4 days). The primary success rate (95% vs 95%) and hospital mortality (5% vs 5%) were also similar in the two groups. Two patients required surgical exploration of the femoral artery and eight patients required blood transfusion in the PCPB group. IABP patients had no vascular complications and did not require blood transfusion. High risk PTCA is equally effective whether using prophylactic IABP or PCPB support. PCPB support, however, has a higher rate of vascular complications and need for blood transfusions. IABP has the additional advantage of ease of insertion and the support can be used for a longer period after PTCA, if required. (J Interven Cardiol 1995;8:199–205)
Emergency Use of Cardiopulmonary Bypass
Authors: OVERLIE PAUL A.
Published: June 2007

Emergency cardiopulmonary support has been used in the United States since 1986. Physicians at participating centers for the National Registry of Elective Supported Angioplasty have contributed data on emergent cardiopulmonary support from their institutions. Results were analyzed to assess the benefits of cardiopulmonary support in patients with hemodynamic collapse. Patients with either cardiac arrest or hemodynamic collapse with cardiogenic shock unresponsive to pressor agents were placed emergently on cardiopulmonary support. Subsequent treatment comprised either angioplasty or surgical revascularization. Patients placed on cardiopulmonary support in < 20 minutes experienced a 41% survival rate across the entire registry of the participating centers of the National Cardiopulmonary Bypass Registry. Two centers with considerable experience demonstrated a 69% survival rate. Patients treated with emergency cardiopulmonary support because of hemodynamic collapse showed improved survival over any other hemodynamic support system. Results have improved for survival with increased operator experience, particularly in the early application group. (J Interven Cardiol 1995;8:239–247)
A Prospective Randomized Trial Comparing the Benefits and Limitations of 6Fr and 8Fr Guiding Catheters in Elective Coronary Angioplasty: Clinical, Procedural, Angiographic, and Economic End Points
Authors: TALLEY J. DAVID , MAULDIN PATRICK D. , BECKER EDMUND R.
Published: June 2007

Objectives: To determine the relation between guiding catheter size, procedural and angiographic details, and cost of coronary angioplasty. Background: Miniaturized angiographic equipment used during coronary angioplasty is proposed as a method to decrease the duration of supine bed rest, length of hospital stay, and cost of expensive inpatient hospitalization. Methods: One hundred and sixty patients were randomized to undergo elective coronary angioplasty with a 6Fr (external diameter, 0.079‐in; internal diameter 0.062‐in) or 8Fr (external diameter, 0.105‐in internal diameter, 0.078–0.079‐in) guiding catheter. Standard balloon dilatation catheters were used. End points: 1° peripheral vascular complications, 2° technical and procedural outcomes; quantitative and qualitative quality of the coronary angiograms; and the in‐hospital (“bottom up” cost accounting of equipment, supplies, support personnel, postcoronary angioplasty room), and physician cost (using Resource Based Relative Value Scale). Results: There was no difference in peripheral vascular complications between the two groups (6Fr, 21%; 8Fr, 30%; P = NS). Less contrast medium was used with the 6Fr guiding catheters (6Fr, 178 ± 102 mL; 8Fr, 257 ± 147 mL; P = 0.0001). The qualitative quality of the angiograms was better with 8Fr than with 6Fr guiding catheters. For the entire population, the total cost of coronary angioplasty was less with 6Fr guiding catheters ($3,956 ±$2,415) than with 8F guiding catheters ($5,073 ±$3,985, P = 0.03). Excluding patients with either a coronary or peripheral vascular complication, there was less cost savings (6F, $3,720 ±$1,338; 8F, $4,376 ± 2,699, P = 0.05). Independent variables associated with increased cost included: large body mass index; hypercholesterolemia; nonionic contrast media; 8F guiding catheter; complex lesions; and duration of procedure. Conclusions: The use of smaller guiding catheters led to use of less contrast medium with a modest decrease in angiographic visualization. The cost savings seen with 6F guiding catheters is multifactorial due to smaller arteriotomy accompanying sheath insertion and reduced rate of clinically significant coronary and peripheral vascular complications. (J Interven Cardiol 1995;8:345–353)
Directional Coronary Atherectomy for the Diagnosis and Treatment of Radiation‐Induced Coronary Artery Stenosis
Authors: JOSEPH ABRAHAM , BUNKER DANIEL , TALLEY J. DAVID , SEEGER JANELL , ACKERMAN DOUGLAS
Published: June 2007

While radiation therapy has been known to cause myocardial and pericardial damage, its role in accentuating coronary artery disease in the absence of traditional cardiovascular risk factors has been controversial. As younger patients with treatable cancers are being treated with mediastinal radiation, coronary artery disease as a cause for severe chest pain should be entertained as a possible diagnosis. We describe a 25‐year‐old male who presented with an inferior wall myocardial infarction 6 years after receiving mediastinal radiation and chemotherapy for Hodgkin's disease. He was subsequently treated by directional atherectomy to a 95% lesion in the right coronary artery. Histological examination of the atherectomy specimen revealed evidence of radiation‐induced endothelial damage that had resulted in plaque formation and subsequent ischemia. Possible mechanisms for radiation‐induced coronary artery disease and treatment options are discussed. (J Interven Cardiol 1995;8: 355–358)
Balloon Angioplasty for Postoperative Recurrent Coarctation of the Aorta
Authors: HIJAZI ZIYAD M. , GEGGEL ROBERT L.
Published: June 2007

Surgical repair for recurrent or residual postoperative coarctation of the aorta is associated with some morbidity, mortality, and an incidence of recurrent coarctation that may be as high as 20%. Balloon angioplasty for recurrent or residual postoperative coarctation has become the standard treatment of choice for this condition. In this article, we review the protocol we use, and the acute and long‐term results of this procedure. Since 1983, over 400 patients have undergone balloon angioplasty for recurrent coarctation with excellent immediate relief of the gradient and improvement in the diameter. On long‐term follow‐up, the majority of these patients enjoyed a lasting beneficial effect of the balloon angioplasty. We discuss the future use of stems for selected patients who are not amenable or failed, balloon angioplasty of recurrent or residual postoperative coarctation. (J Interven Cardiol 1995;8:509–516)
Transcatheter Occlusion of Patent Ductus Arteriosus
Authors: Moore John W. , Gambler Patrick A.
Published: June 2007

This article reviews the current status of transcatheter technology, which has been applied to close the patent ductus arteriosus (PDA). Pioneering work in this field was performed by Porstmann in the 1960s and Rashkind in the 1970s. Devices which have been implanted in the PDA have basic designs as plugs, umbrellas, or coils. The experience reported with each type of device is detailed. Issues and controversies are examined. It appears that coils should be the preferred method for closing smaller PDAs (3‐mm diameter or smaller), and Rashkind or similar devices, if available, should be reserved for larger PDAs (> 3‐mm diameter). Surgery is necessary for neonatal and for rare large PDAs. Transcatheter technology is still evolving and may become more effective and cheaper. (J Interven Cardiol 1995;8:517–531)
The Use of Echocardiography in Pediatric Interventional Cardiac Catheterization Procedures
Authors: LUDOMIRSKY ACHI
Published: June 2007

The last decade saw a dramatic change in the management of congenital heart defects. The introduction and development in echocardiography and Doppler modalities enable definitive diagnosis of congenital lesions without cardiac catheterization. At the same time, new therapeutic procedures for congenital defects using the catheter as a channel for different procedures were developed. These therapeutic procedures have replaced cardiac surgery in many types of defects. The new developments in echocardiography and Doppler modalities provide accurate imaging and visualization of the transcatheter devices and brought these two imaging modalities into a close marriage. The use of echocardiography and Doppler in the catheterization laboratory became a must, especially when used in atrial (ASD) and ventricular septal defect (VSD) closure. In this article we will detail the role of echocardiography in the different transcatheter interventional procedures in the. catheterization laboratory. Those include atrial septostomy, blade atrial septectomy, balloon dilation, ASD closure, VSD closure, patent ductus anterior closure, and pericardiocentesis. (J Interven Cardiol 1995;8:569–578)
Cost‐Effectiveness Analysis of Interventions for Congenital Heart Disease
Authors: GRAY DARRYL T.
Published: June 2007

Expansion of the options available for the treatment of congenital heart disease has been accompanied by an increasing realization of the limits of our available health care resources. Cost‐effectiveness analysis is one of several analytic approaches that can improve decisions about the appropriate use of technology in interventional pediatric cardiology and other fields. In this article, cost‐effectiveness analysis is distinguished from related approaches, such as cost‐benefit analysis. Then, basic principles of cost‐effectiveness analysis are described. Next, the application of these principles is illustrated, using a recently published comparison of transcatheter versus surgical closure of patent ductus arteriosiis. Finally, potential research implications of the surprising findings of this study are discussed. (J Interven Cardiol 1995; 8:579–597)
Laser‐Assisted Coronary Angioplasty in Patients with Severely Depressed Left Ventricular Function: Quantitative Coronary Angiography and Clinical Results
Authors: TOPAZ ON , ROZENBAUM ELIEZER A. , LUXENBERG MICHAEL G. , SCHUMACHER AUDREY
Published: June 2007

Laser‐assisted coronary angioplasty can be successfully applied to lesions not ideal for balloon angioplasty. Patients with severely impaired left ventricular (LV) function and complex coronary artery stenoses who call for percutaneous revascularization are considered a high risk group for balloon angioplasty. In order to determine the feasibility, safety, and acute clinical outcome of a solid state, pulsed wave, mid‐infrared (2.1 micron) laser facilitated angioplasty in these patients, data from 112 patients with 129 lesions were analyzed. Patients were identified according to angiographic LV function; group I included 22 patients with left ventricular ejection fraction (LVEF) ≤ 40% (mean = 25%± 10%) and group II included 90 patients with LVEF ≥ 40% (mean = 58%± 8%). No difference in age, gender, diabetes, hypertension, tobacco use, history of previous coronary artery bypass surgery (CABGS) or percutaneous transluminal coronary angioplasty was registered between the two groups. Multivessel disease, previous myocardial infarction (MI), and severe angina were more prevalent among group 1 patients (P = 0.03). No difference was found in lesion location, complexity, length, or calcification between the two groups; although group I had more eccentric lesions. Both groups were treated with the same laser energy level followed by adjunctive balloon angioplasty. One hundred percent procedural success was obtained in group 1 versus 93% in group II (P = NS). By Q.C.A. (independent core lab), minimal luminal diameter increased in group I from 0.9 ± 0.5 mm preprocedure to 2.0 ± 0.5, as compared to 0.8 ± 0.5 mm to 1.9 ± 0.5 mm (P = NS) in group II. Stenosis severity improved from 69%± 16% preprocedure to 37%± 13% postprocedure in group I, as compared to improvement from 78%± 16% to 37%± 12.7% in group II (P = NS). Overall complication rate was remarkably low, with no death or perforation in either group; emergency CABGS 0% in group 1 and 1.1% in group 11; dissections 4.5% in group I and 8.8% in group II. There was no significant difference in complication rate between the two groups. The results of this study suggest that holmium; YAG laser facilitated coronary angioplasty can be safely performed in patients with severe LV dysfunction, achieving a remarkably high procedural success and low complication rate.
Magnetocardiographically‐Guided Catheter Ablation
Authors: FENICI RICCARDO R. , COVINO MARCELLO , CELLERINO CATERINA , DI LILLO MARIANGELA , DE FILIPPO MARIA CONCETTA , MELILLO GUIDO
Published: June 2007

After more than 30 years since the first magnetocardiographic (MCG) recording was carried out with induction coils, MCG is now approaching the threshold of clinical use. During the last 5 years, in fact, there has been a growing interest of clinicians in this new method which provides an unrivalled accuracy for noninvasive, three‐dimensional localization of intracardiac source. An increasing number of laboratories are reporting data validating the use of MCG as an effective method for preoperative localization of arrhythmogenic substrates and for planning the best catheter ablation approach for different arrhythmogenic substrates. In this article, available data from literature have been reviewed. We consider the clinical use of MCG to localize arrhythmogenic substrates in patients with Wolff‐Parkinson‐White syndrome and in patients with ventricular tachycardia in order to assess the state‐of‐the‐art of the method on a large number of patients. This article also addresses some suggestions for industrial development of more compact, medically oriented MCG equipments at reasonable cost.
Catheter Ablation in Competitive Athletes: Indication
Authors: FURLANELLO FRANCESCO , BERTOLDI ANNALISA , INAMA GIUSEPPE , FERNANDO FREDRICK
Published: June 2007

Some supraventricular tachyarrhythmias (SVT), particularly if paroxysmal and/or related to Wolff‐Parkinson‐White syndrome (WPW), may in some cases endanger an athlete's professional career due to hemodynamic consequences during athletic activity, which in some instances may be life‐threatening. One must also take into account that in Italy the law makes antiarrhythmic drug treatment (AAD) incompatible with sport eligibility. For these reasons, the utilization of radiofrequency ablation (RFA) in athletes has different indications as opposed to the normal population, since the primary goal is“the eligibility of the athlete.” In our study, we discuss the criteria for indication of RFA in athletes with SVT on the basis of the data obtained from our population of athletes, studied over a 20‐year period, from 1974 to the 31st of December 1993. These athletes were evaluated for arrhythmic events, utilizing a standardized cardioatrhythmological protocol: 1,325 athletes (1,125 men, 200 women, mean age 20.7 years). One subgroup included 380 athletes with WPW (28.7%), 22 athletes with aborted sudden death (1.6%), 6 of whom had WPW, 13 athletes with sudden death (0.98%), and 2 of whom had WPW. Another subgroup was formed by 116 top level elite professional athletes (TLA) (mean age 22.9 years), of which 10 of 116 (8.6%) had WPW and 12 of 116 (10.3%) had paroxysmal SVT. The most important indications for RFA in athletes are represented by: WPW asymptomatic at risk, symptomatic during athletic activity, andlor requiring AAD treatment: paroxysmal junctional reentrant tachycardia; when this condition is disabling and related to exercise and therefore compromising an athlete's performance and sports career. Paroxysmal junctional reentrant tachycardia is easily reproduced via transesophageal atrial pacing (TAP) during exercise (bicycle ergometer), common in athletes but normally the recurrences are concentrated only during the period in which the athlete is engaged in sport. Rare indications for RFA are focal or reentry, permanent SVT, and particularly junctional reentrant tachycardia. For each individual athlete, we have to consider the possible side‐effects of RFA, the possible recurrences with psychobiological traumatic consequences, the effective recovery period, and the natural history of the tachyarrhythmias, which frequently disappear after interruption of the sports career.
Wrapping of an ACETM Balloon‐on‐a‐Wire Device During PTCA Through a Diagnostic 5Fr Catheter
Authors: KOH TIAN‐HAl
Published: June 2007

Balloon wrapping is a new phenomenon that has been described with the introduction of balloon‐on‐a‐wire devices. The ACETM balloon catheter is one such second‐generation device. There have been no reports of balloon wrapping or twisting with this fixed wire catheter. This article describes a patient who developed balloon wrapping in the course of percutaneous transluminal coronary angioplasty through a 5.2Fr Cordis diagnostic catheter, during multilesion dilatation in a small and tortuous left anterior descending coronary artery. The causative mechanisms, as well as alternative approaches for dealing with such a similar scenario in future are discussed. (J Interven Cardiol 1996;9:53–57)
Primary Stenting of a Coronary Pseudoaneurysm After Postpartum Dissection
Authors: JAKOB MARKUS , RITTER MANFRED , FLURY GIAN , JENNI ROLF , AMANN FRANZ W.
Published: June 2007

A case of spontaneous peripartum coronary dissection which led to myocardial infarction and life‐threatening ventricular fibrillation is reported. At the site of coronary dissection, a pseudoaneurysm developed, diagnosed by intravascular ultrasound imaging. A stent was successfully positioned, leading to complete thrombotic obliteration of the pseudoaneurysm while peripheral blood flow was restored. Follow‐up examination after 6 months revealed normal stent perfusion, whereas the pseudoaneurysm remained occluded. This case demonstrates that primary stenting may be a safe, noninvasive procedure in therapy of coronary pseudoaneurysms. (J Intcrven Cardiol 1996;9:69–72)
The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Trials: A Decade of Reperfusion Strategies
Authors: BARSNESS GREGORY W. , OHMAN E. MAGNUS , CALIFF ROBERT M. , KEREIAKES DEAN J. , GEORGE BARRY S. , TOPOL ERIC J.
Published: June 2007

Beginning with its inception in 1985, the TAMI group performed randomized clinical trials in both academic: and nonacademic settings. The ten TAMI trials not only proved the viability of clinical research in a nontraditional environment, but also contributed significantly to the clinical investigation of acute myocardial infarction through small mechanistic trials. Despite having insufficient power to address overall survival and clinical outcome measures because of patient enrollments ranging from only 50–575 patients, the trials used similar entry criteria and follow‐up measures, which permitted broader analyses of the prospectively collected dataset of randomized patients. This article reviews the history of the TAMI collaboration and discusses the findings of the individual trials as well as the contributions of larger analyses to our understanding of patient selection, prognosis, costs, and outcomes. (J Interven Cardiol 1996;9:89–115)
Quantitative Coronary Dimensions and Restenosis After Directional Atherectomy or Balloon Angioplasty
Authors: GARRATT KIRK N. , ROGERS PAUL J. , VLIETSTRA RONALD E. , KAUFMANN URS P. , GRILL DIANE E. , BAILEY KENT R. , CHESEBRO JAMES H. , HOLMES DAVID R.
Published: June 2007

Coronary artery dimensions were evaluated in 42 patients (52 lesions) undergoing directional atherectomy of primary atheromatous lesions in native coronary arteries between October 1989 and April 1991, Dimensions were compared with a cohort of 162 patients (213 lesions) undergoing percutaneous transluminal coronary angioplasty of similar lesions between March 1984 and April 1988. Computer‐assisted quantitative angiography was performed for paired near‐orthogonal views (captured during diastole) of each treated lesion; image pairs taken prior to, immediately following, and 6 months after coronary intervention were studied. Although coronary dimensions were equivalent for the two treatment groups before therapy, the immediate posttreatment minimal lumen diameter was significantly larger after atherectomy than angioplasty (2.24 ± 0.53 mm vs 1.52 ± 0.34 mm, P < 0.01). Despite this, coronary dimensions were similar in the two groups at follow‐up angiography. Several dichotomous definitions of restenosis were tested using these quantitative data. Restenosis rates were similar for the two treatments using most definitions, but those definitions based on loss of relative or absolute lumen dimensions resulted in higher rates of restenosis following atherectomy. These data demonstrate that: (1) directional coronary atherectomy can achieve greater initial gain in luminal dimensions than angioplasty; (2) the loss in vessel dimensions within 6 months (late loss) is greater after atherectomy than after angioplasty; and (3) restenosis definitions rely on relative or absolute loss of initial luminal gain favor of angioplasty. (J Interven Cardiol 1996;9:121–127)
Dissections Following Excimer Laser‐Assisted Angioplasty of Saphenous Vein Bypass Grafts: Analysis of Incidence and Effect of Adjunctive Balloon Angioplasty
Authors: BATCHELOR WAYNE B. , CHISHOLM ROBERT J. , STRAUSS BRADLEY H.
Published: June 2007

Excimer laser angioplasty, when first developed for the treatment of coronary artery disease, appeared promising based on preliminary work suggesting minimal vessel wall damage with excimer laser ablation. The excimer laser has since been used in the treatment of bulky, saphenous vein graft (SVG) lesions. To investigate the significance of the laser‐vessel wall interaction, we studied the incidence of laser‐induced dissections as well as the effect of adjunctive balloon angioplasty, in a multicenter trial of 188 SVG lesions undergoing CVX‐JOO™ excimer laser ablation. Adjunctive balloon angioplasty was performed at the discretion of the individual operators. Laser‐induced dissections were angiographically evident in 78 (41%) of 188 SVG lesions following laser ablation. Most of these were mild (National Heart, I.ung, and Blood Institute [NHLBIJ A or B). Adjunctive balloon angioplasty was performed following 73% of laser ablations and tended to improve the severity of laser‐induced dissections, including the successful recanalization of 7 of 9 laser‐induced total occlusions. Of the 117 SVG lesions with either no dissection or only mild dissection (NIILBI A or B), only 4 worsened to a moderate or severe (NHLBl C‐F) status after adjunctive balloon angioplasty. Vessel wall injury, manifested as dissection, frequentlv occurs following excimer laser angioplasty of SVG lesions. Most of these dissections are angio‐graphicaliy mild, and, when severe, are effectively reduced by adjunclive balloon angioplasty. Further techniques, such as multiplex catheters or saline infusion, aimed at minimizing vessel wall injury from laser ablation, may be required to reduce the occurrence of laser‐induced dissections.
New Procedure of Treatment for Combined Systemic Venous and Pulmonary Venous Obstruction Following the Mustard Operation for Transposition of the Great Arteries
Authors: ABDULHAMED JASSIM M. , ALYOUSEF SAAD , MULLINS CHARLES , GODMAN MICHAEL
Published: June 2007

Three patients aged 4.6, and 9 years were discovered at cardiac catheterization to have combined pulmonary venous and systemic venous obstruction following the Mustard operation for transposition of the great arteries. Relief of systemic venous baffle obstruction may unmask pulmonary venous obstruction. Full evaluation of the pulmonary venous confluence is recommended in any patient with systemic baffle obstruction.
Clinical Experience with Wiktor Stent Implantation: A Report from the French Multicentric Registry
Authors: CARRIÉ DIDIER , PUEL JACQUES , KHALIFE K. , MONASSIER J.P. , LANCELIN BERNARD , GROLLIER G. , ELBAZ M. , FOURCADE J.
Published: June 2007

Our objective was to evaluate, in a French multicenter study, the results of implantation of Wiktor tantalum wire coronary stents in stenosed or occluded coronary vessels or in saphenous vein bypass grafts. The study was a retrospective analysis of clinical and angiographic data from patients treated with tantalum wire stent implanted at five centers. Stenting of native coronary arteries or saphenous vein bypass grafts was attempted in 272 patients after acute or threatened closure of the target vessel, or because the lesions concerned were considered to be at particularly high risk of becoming restenosed, or because the result of primary angioplasty was inadequate. Successful stent deployment was achieved in 261 95.9%) of 272 patients. The incidence of major complications such as death, myocardial infarction (MI), or a condition requiring urgent bypass surgery was 8.1%. Major vascular complications occurred in 2.6% and actually decreased with a new anticoagulant regimen. Angiographic follow‐up at a mean of 6 months after stenting showed restenosis in 23.6% with a more frequent restenosis in the group with stent size equal to 3 mm than in the group with stent size superior to 3 mm (46.1% vs 13.7%, P < 0.01). Stenting with the Wiktor tantalum wire stent is an effective means of treating acute complications and suboptimal results after angioplasty. This stent seems to offer hope of a significant reduction in the rate of late restenosis in native coronary vessels, but a prospective comparison of balloon angioplasty and stenting is needed.
Pitfalls of Pacemaker Treatment for Hypertrophic Cardiomyopathy
Authors: SLADE ALISTAIR K. B. , McKENNA WILLIAM J.
Published: June 2007

Permanent dual chamber pacing with a shortened AV delay has been increasingly utilized as a therapeutic approach to the problem of drug refractory symptomatic obstructive hypertrophic cardiomyopathy. Such patients are a small proportion of the total patient population, potentially limiting the applicability of pacing. Attention has focused on the effect of pacing on indices of systolic function, primarily the left ventricular outflow tract gradient. The effects of pacing on diastolic function are uncertain, although recent acute catheterization studies suggest an adverse effect. Studies have concentrated on subjective symptomatic improvement. The available data on objective improvement suggests modest improvements at best. The limitations of current pacemakers together with the role of adjunctive techniques such as radiofrequency (RF) ablation of the atrioventricular node and coronary sinus pacing are also reviewed. Current ongoing randomized trials of DDD pacing in hypertrophic cardiontyopathy will resolve many issues, although data comparing myectonty versus pacing is as yet unavailable.
Techniques in the Angiographic Analysis of Coronary Flow: Past, Present, and Future
Authors: DOTANI IMRAN , DODGE THEODORE , GOEL MUKESH , AL‐MOUSA EYAS N. , McLEAN CHRISTINE , RIZZO MICHAEL , RYAN KATHRYN , VATNER RALPH , MARBLE SUSAN J. , DALEY WILLIAM L. , GIBSON C. MICHAEL
Published: June 2007

The current method of analyzing coronary flow data is the TIMI flow grade method. This method is convenient and easy to apply, but there are limitations to this categorical method of analyzing coronary artery flow. We have developed a new method of analyzing coronary blood flow called the “TIMI frame count.” Using the TIMI frame counting method, we have shown that the flow in the coronary arteries is in fact distributed as a continuous variable and that there are nondiscrete categories of slow and fast flow. This article discusses the statistical basis for the development of this new, simple, and continuous index of coronary flow and provides a “how‐to manual“ describing the practical implementation of the new TIMI frame count method. We also describe simple new techniques for measuring the distance to the landmark used for TIMI frame counting. Knowing the distance and the time from the TIMI frame count, velocity can easily be calculated. Tables are provided that can be used for these calculations on‐line in the cardiac catheterization laboratory. If the diameter is known, flow can also be calculated from these tables. We also describe new applications of marker wires to measure distance and velocity.
The Application of Epidemiologic Methods to the Assessment of Cardiology Outcomes
Authors: GRAY DARRYL T.
Published: June 2007

While the options available for treatment of congenital heart disease continues to expand, rigorous evaluation of outcome has not always accompanied the introduction of new therapeutic modalities. For example, transcatheter implantation of the Rashkind double‐umbrella occluder for persistent patent ductus arteriosus had not previously been compared to conventional surgery in a rigorous fashion. Consequently, a 14‐center retrospective study compared outcomes of 631 prognostically similar patients treated concurrently with these two modalities. Particular efforts were made to reduce the bias and confounding that often plague nonrandomized comparisons. The study's design is described in detail as an example of the use of epidemiologic methods to enhance the rigor of observational studies of outcomes of cardiology interventions.
Use of the Contrast Volume to Estimated Creatinine Clearance Ratio to Predict Renal Failure After Angiography
Authors: ALTMANN DORY B. , ZWAS DONNA , SPATZ ALLISON , BERGMAN GEOFFREY , SPOKOJNY ARTUR , RIVA SUZANNE , SANBORN TIMOTHY A.
Published: June 2007

Little data exists regarding the relationship between the volume of radiographic contrast infused and the risk of contrast nephropathy for individual patients based on specific patient characteristics. Because the likelihood of renal failure is increased when there is preexisting azotemia or when larger volumes of contrast are used, it was hypothesized that the contrast volume:estimated creatinine clearance ratio would serve as a predictor of nephropathy following cardiac angiography. A retrospective analysis was performed of 152 high risk patients whose baseline serum creatinine concentration was >2.0 mg/dL or who received ± 300 ce of contrast. Nephropathy, defined as in increase in serum creatinine of > 1.0 mg/dL within 48 hours, occurred in 11 patients (7%). The contrast volume: creatinine clearance ratio was > 6.0 in 64% of patients who developed nephropathy and 31% of patients who did not (P < 0.05). The contrast volume:creatinine clearance ratio was then studied prospectively in 250 consecutive patients. The risk of nephropathy was 61% for patients with a ratio > 6.0, but only 1% otherwise (P < 0.01). This ratio can be used to calculate an upper limit for contrast volume and might reduce the chance of renal failure.
Platelet and Thrombin Inhibitors as Adjuncts to Thrombolytic Therapy and Percutaneous Coronary Interventions: A Review
Authors: AMSTERDAM PETER B. , TCHENG JAMES E.
Published: June 2007

A large body of evidence supports the critical role of thrombus formation in the pathogenesis of acute MI as well as the early ischemic complications after percutaneous coronary interventions. Both platelets and the plasma proteins involved in fibrin formation are intimately involved in the thrombotic process. Recently, pharmacological agents that hinder fibrin formation and platelet activation or aggregation have been developed. These drugs are being tested in patients with acute MI, in conjunction with thrombolytic agents, and in patients undergoing percutaneous coronary interventions. So far, the antiplatelet agents appear very promising in the area of percutaneous coronary intervention. Information on their role in acute myocardial infarction is still too preliminary to draw conclusions. Results with antithrombin agents have been less promising. This article will briefly describe the mechanisms of thrombus formation, detail the mechanism of action of available antithrombotic pharmacological agents, and review recent clinical trials of these agents.
Comparison of Arterial and Venous Blood Flow Between Patients with Pressure Dressing or a New Hemostatic Puncture Closure Device After Cardiac Catheterization
Authors: ESPINOLA‐KLEIN CHRISTINE , RUPPRECHT HANS‐JÜRGEN , VOIGTLÄNDER THOMAS , KOPP HELMUT , NAFE BERNHARD , DIETZ ULRICH , MEYER JÜRGEN
Published: June 2007

The aim of the study was to compare arterial and venous flow volume in the punctured leg in patients given a conventional pressure dressing and those given a new hemostatic puncture closure device (Angio‐Seal) after cardiac catheterization. We prospectively measured blood flow in 25 patients with pressure dressing (group A) and 25 patients with Angio‐Seal (group B) after cardiac catheterization. Duplex sonographic measurements were performed at the superficial femoral artery and vein of the punctured leg. In group A measurements were performed before catheterization, during pressure dressing, and after removal of pressure dressing. In group B we performed the measurements before catheterization and after closure of the puncture site with Angio‐Seal. Mean arterial and venous blood flow of the superficial femoral artery and vein were calculated. Statistical evaluation was performed using the one‐sample Wilcoxon test. In group A there was a significant reduction of blood flow volume in both the femoral artery, from a mean of 119 mL/min before puncture to 78 mL/min with pressure dressing, and the femoral vein, from 114 mL/min before puncture to 82 mL/min with pressure dressing (P < 0.0001). After removal of pressure dressing the blood flow rose to 119 mL/min in the femoral artery and 116 mL/min in the femoral vein. In group B there was no change in flow volume before and after catheterization (femoral artery: 117 vs 118 mL/min, femoral vein 119 vs 120 mL/min, P = ns). We conclude that the use of pressure dressing after cardiac catheterization caused a significant reduction in arterial and venous blood flow (about 30%) during immobilization. The new Angio‐Seal closure device did not affect arterial or venous flow.
Combined Carotid and Coronary Stenting in a Severely Ill Patient
Authors: MANGIERI ENRICO , BARILLÀ FRANCESCO , BRESADOLA LUCIANO , ZAMPINO DEBORA , PAPALIA UGO , SCIBILIA GIOVANNI , CRITELLI GIUSEPPE
Published: June 2007

A 71‐year‐old man symptomatic for critical stenosis of both carotid and coronary arteries was successfully managed with combined carotid and coronary stenting. Such an approach could represent a valuable therapeutic tool for selected patients suffering from coronary artery disease associated with carotid artery stenosis.
Stenting of Anomalous Right Coronary Artery from the Posterior Sinus of Valsalva
Authors: WONG PHILIP C. , CHOW JOSEPH
Published: June 2007

This article describes a patient with an extremely rare anomaly, with the origin of the right coronary artery arising from the posterior (noncoronary) sinus of Valsalva. The technique of angioplasty and stenting in this anomaly is disussed.
Successful Stent Implantation in Acute Myocardial Infarction and Successful Directional Coronary Atherectomy of a Stenotic Lesion Involving an Aneurysm in a Woman with Kawasaki Disease of Adult Onset
Authors: ODA HIROTAKA , MIIDA TSUTOMU , OCHIAI YUKIE , TOEDA TETSUROU , HIGUMA NORIO , ITO EIICHI
Published: June 2007

Our patient was a woman who suffered from Kawasaki disease at the age of 20. Coronary aneurysms were confirmed in the left main trunk and proximal sites of the left anterior descending artery and the circumflex artery by coronary angiography at the age of 21. When she suffered an inferior acute myocardial infarction at the age of 24, two Palmaz‐Schatz stents were successfully implanted in the right coronary lesion in order to prevent acute closure. One month later, directional coronary atherectomy was successfully performed to the left anterior descending artery lesion which had a rapid progression of the stenosis, and the pathological examination revealed that the cause of the stenosis was thrombus. She has remained well during the following 2 years.
Emergency Placement of Platinum Coils to Prevent Cardiac Tamponade After Wire Perforation of an Occluded Venous Coronary Bypass Graft
Authors: SCHOFER JOACHIM , RAU THOMAS , LEPPIEN ANDREAS , SCHLÜTER MICHAEL , MATHEY DETLEF G.
Published: June 2007

A case is reported of a patient with impending cardiac tamponade due to vessel perforation following balloon angioplasty of an occluded venous bypass graft. Prolonged balloon inflation failed to seal the perforation. Leakage was controlled immediately by the delivery of two platinum coils into the perforation. In case of a vessel perforation during an attempt to recanalize an occluded coronary artery bypass, placement of intracoronary platinum coils to seal the perforation may prevent the development of cardiac tamponade.
Stenting for Unprotected and Protected Left Main Stem Disease: A Comparison of Short‐ and Long‐term Outcome
Authors: AMIN FOUAD R. , KELLY PAUL A. , KURBAAN ARVINDER S. , CLAGUE JONATHAN R. , SIGWART ULRICH
Published: June 2007

Left main coronary artery (LMCA) stenosis is usually treated with coronary artery bypass surgery. However, in high risk surgical patients, coronary stenting may be advantageous. We reviewed the records of all 16 patients who had undergone this procedure in our institution. Group I (nine patients, eight males, mean age 64.6 years) had protected LMCA disease. Group II (seven patients, six males, mean age 69.5 years) had unprotected LMCA disease. Procedural success was achieved in 15 patients. Outcome was divided into short‐term (in hospital), and long‐term events. The mean follow‐up for both groups was 16.9 months and 9 months respectively. Three patients died (two in group II). Three patients had repeat revascularization procedure (group I). Six patients were asymptomatic (two in group I), and four had a significant improvement in angina symptoms. LMCA stenting is a relatively safe and effective revascularization procedure for patients with either protected or unprotected LMCA disease at high risk for surgery.
Efficacy of Percutaneous Vascular Hemostasis System Prostar: Comparison to Manual Compression
Authors: MURAMATSU TOSHIYA , TSUKAHARA REIKO , AKIMOTO NAOKO , HOH MAMI , ITO SHIGEKI
Published: June 2007

In this study, we evaluated the safety and efficacy of the percutaneous vascular surgery device (Prostar) for sealing the femoral artery puncture site after coronary interventions. We also compared the results with Prostar (n = 167) and conventional manual compression methods (n = 50) in a nonrandomized fashion. The average time to hemostasis in the Prostar system group was 13.5 minutes, versus 36.6 minutes in the compression group. The average time to ambulation was 2.2 hours in the Prostar system group, versus 17.8 hours in the manual group. Bleeding was observed in 1.2% of the subjects in the Prostar system group, versus 12% in the manual compression group. One emergency surgery was required in the manual compression group, whereas no surgical intervention was required in the Prostar group. We conclude that the Prostar system for percutaneous vascular closure appears to be a safe technique for achieving an early hemostasis and ambulation after coronary intervention.
Directional Coronary Atherectomy in Takayasu's Disease
Authors: ODA HIROTAKA , MIIDA TSUTOMU , KIKUCHI HIROSHI , SOGA SATORU , HIGUMA NORIO , TOEDA TETSUROU , ITO EIICHI
Published: June 2007

A 44‐year‐old woman with a history of coronary aorta bypass grafting (CABG)for stenosis of the left main trunk (LMT) due to Takayasu's disease underwent directional coronary atherectomy (DCA) to the LMT lesion under percutaneous cardiopulmonary support because she had angina pectoris and heart failure due to occlusion of the grafts. Three and a half years after the catheter intervention, her clinical condition remains good. DCA may be an alternative to CABG in limited cases with LMT disease.
The ASDOS Device: Technique and Guidelines for Clinical Use
Authors: BABIC UROS U.
Published: June 2007

The atrial septal defect occlusion system (ASDOS) is one of the recently developed systems for nonsurgical closure of interatrial communications. The ASDOS occluder consists of two self‐opening umbrellas made of nitinol wire frame and polyurethane membrane. The unique ASDOS technique provides: (1) an “over‐the‐wire” individual umbrella manipulation within the atria; (2) several positioning and repositioning attempts; (3) simultaneous selective left atriography; (4) adjustable joining together of both umbrellas depending on the atrial septal wall thickness; (5) septal tissue immobilization in patients with septal aneurysm; and (6) controlled “over‐the‐wire” retrieval through the same 11Fr introducing venous sheath. The experimental studies showed a complete device incorporation after 3 months. The clinical experience accumulated during a 4‐year period confirmed the safety and efficacy of this system. The complete defect closure was achieved in two thirds of patients immediately after the procedure. A significant residual shunt remained in a small number of treated patients. Complications included: (1) thrombus formation around the device in some patients; (2) perforation of the atrial wall in patients with inappropriately implanted devices; and (3) an infectious endocarditis. Device frame fracture was observed in 14% of patients during a follow‐up of 250 patient‐years. There have been no late device dislodgment and no injury to the atrioventricular valves after ASDOS closure. The ratio of the diameter of the implanted umbrellas to the short atrial septal diameter ranged between 1.4‐2.2. Since it can immobilize the septum, the ASDOS proved to be especially indicated for closure of defects with aneurysm of the residual septum. In patients with a patent foramen ovale (PFO), the adjustable ASDOS umbrellas keep the valve of the oval fossa tightly closed to the secundum septum. Our experience confirms the feasibility of catheter techniques for treatment of patients with centrally situated secundum ASD or PFO.
New Stents: Our Experience and Visions
Authors: REIFART NICOLAUS , STÖRGER HANS , SCHWARZ FRANZ , HAASE JÜRGEN
Published: June 2007

Intracoronary stents are the most widespread implants (besides tooth crownings). They almost eliminated the threat of abrupt vessel closure during and after PTCA and reduced the incidence of restenosis in all types of lesions. As a result, roughly 60% of all PTCA procedures are accompanied by a stent implantation. Currently, we are facing the third generation of stents that provide more flexibility, more radial strength, lower profiles and a variety of different lengths, and may be implanted at moderate balloon pressures. Stent restenosis is considered the main issue of the remaining problems associated with PTCA. Computer calculated stent designs, coatings with antithrombotic and antiproliferative compounds, coverings to act as a barrier against proliferation, and radioactivity are being thoroughly studied to finally defeat a major iatrogenic disease: restenosis. The solution is likely to be found by the end of the year 2000.
State of the Art: Trans‐ and Percutaneous Myocardial Revascularization
Authors: WHITBOURN ROBERT J. , OESTERLE STEPHEN N.
Published: June 2007

Traditional approaches to improve myocardial perfusion in patients with coronary artery disease previously have applied methods to restore blood flow through the existing coronary vessels. In contrast laser myocardial revascularization techniques rely on the creation of new myocardial channels to produce effects leading to improved perfusion and reduction in angina. Laser transmyocardial revascularization (TMR) is performed via open thoracotomy to access the epicardial surface, is relatively safe, and appears to have a beneficial effect on myocardial perfusion. Percutaneous myocardial revascularization (PMR), however, uses transmission of laser energy along a flexible, fiber‐optic catheter, thus permitting creation of laser channels from the endocardial surface of the left ventricle via a femoral artery approach. Tissue responses to lasers are dependent upon the energy used and its means of delivery, thermal, mechanical, or chemical effects of laser channel creation may all impact on the myocardium, although stimulation of angiogenic growth factors, with consequent neovascularization appears to be the principal underlying mechanism responsible for improvement in myocardial perfusion. Patients with severe, chronic angina refractory to drug therapies and in whom standard surgical or angioplasty revascularization approaches are not possible may be candidate for TMR or PMR techniques. Clinical studies of TMR have described reductions in angina class, hospital admissions, and the number of myocardial perfusion defects. PMR studies have reported improvements in angina class, increased exercise duration, and trends toward improvement in radionuclide perfusion defects. Randomized trials are underway and will provide more definitive insights into the future clinical role of laser myocardial revascularization techniques.