bluuebunny/crossref_metadata_2025 huggingface dataset:
Angioscopic evaluation of incompletely obstructing coronary intraluminal filling defects: Comparison to angiography
Authors: Uretsky Barry F. , Denys Bart G. , Counihan Peter C. , Ragosta Michael
Published: March 2007

At 66 sites in 40 patients, we evaluated the sensitivity and specificity of coronary angiography in detecting intraluminal filling defects of varying sizes and in characterizing the contents (thrombus, intimal flap, both) of such defects using coronary angioscopy as “the gold standard.” Overall angiographic sensitivity for thrombus was 37% and for intimal flap 45%. Specificity for thrombus was 100% and intimal flaps 96%. Angioscopically small flaps were less frequently seen angiographically (28%) than larger sizes (65%, p = 0.03). Angioscopically small thrombi were seen less often angiographically (30%) than larger ones (75%, p = 0.13). Filling defects (intimal flaps, thrombus, both) were characterized correctly in only 37% of sites. Angiography is relatively insensitivity in detecting intraluminal filling defects. Angioscopy may be preferred to or adjunctive with angiography in detecting these lesions. © Wiley‐Liss, Inc.
Retrograde nontransseptal balloon mitral valvuloplasty for rheumatic mitral stenosis
Authors: Bahl Vinay K. , Juneja Rajnish , Thatai Deepak , Kaul U. , Sharma Sanjiv , Wasir Harbans S.
Published: March 2007

Retrograde nontransseptal balloon mitral valvuloplasty is a relatively new technique for dilating stenosed mitral valves, wherein a specially designed steerable catheter is used to enter the left atrium retrogradely. Over a 1‐yr period, 52 patients (34 M, 18 F; mean age 26.4 ± 6.5 yr) with symptomatic noncalcific rheumatic mitral stenosis underwent balloon mitral valvuloplasty by this technique at our center. The procedure was completed in 51 out of the 52 patients and technically successful dilatation was achieved in 47 (90.4%) patients. The mean valve area increased from 0.8 ± 0.2 cm2 to 1.86 ± 0.37 cm2 and end diastolic gradients decreased from 21.2 ± 9.4 mm Hg to 4.0 ± 2.2 mm Hg. Significant mitral regurgitation (>2+) developed in two (3.9%) patients, and both remained stable on medical treatment. In two patients, there was a significant decrease in femoral pulse, which improved with thrombolytic therapy.

Our study is the first report of this technique from a center other than that of its origin. The results of this study further establish that this new retrograde technique may be a useful alternative to the conventional transseptal techniques for mitral valvuloplasty. © Wiley‐Liss, Inc.
Percutaneous double balloon valvotomy for bioprosthetic tricuspid stenosis
Authors: Block Peter C. , Smalling Ronnie , Owings R. Mark
Published: March 2007

We report two cases of percutaneous balloon valvotomy of porcine tricuspid valves and review the brief literature. Both procedures were successful, but “restenosis” resulted in tricuspid valve replacement in patient 2. The explanted valve showed leaflet thickening and calcified cuspal nodules. Patient 1 is improved 10 months later. © Wiley‐Liss, Inc.
Intravascular ultrasound in the management of acute coronary artery dissection: A case report
Authors: Labinaz M. , Culp S. C. , Kisslo K. B. , Brott B. C. , Phillips H. R. , Stack R. S.
Published: March 2007

Crossing total occlusions is frequently difficult. The guidewire may enter a false lumen, thereby preventing successful balloon dilatations. We present a case of an acute arterial dissection following attempted angioplasty of a totally occluded right coronary artery. With an intravascular ultrasound probe in the false lumen, we were able to visualize a second guidewire and direct its passage into the true arterial lumen. This allowed for successful balloon dilatation and stent deployment restoring vessel patency.
Retrograde pulmonary vein wedge angiography: A new technique
Authors: Bahl Vinay K. , Kothari Shyam S. , Kumar Krishna , Wasir Harbans S.
Published: March 2007

A new technique of pulmonary vein wedge angiography to delineate pulmonary artery anatomy is described. Conventional pulmonary vein wedge angiography requires an interatrial communication—natural or created by a transseptal puncture. In retrograde pulmonary vein wedge angiography, the left atrium and pulmonary veins are entered from arterial route using a specially designed catheter. This technique can be specially utilized for patients in whom there is no interatrial communication.
Maximal myocardial perfusion by videodensitometry in the assessment of the early and late results of coronary angioplasty: Relationship with coronary artery measurements and left ventricular function at rest
Authors: Vassanelli Corrado , Menegatti Giuliana , Molinari Jonata , Zanotto Gabriele , Zanolla Luisa , Loschiavo Isabella , Zardini Piero
Published: March 2007

In the assessment of the acute results of percutaneous transluminal coronary angioplasty (PTCA), myocardial perfusion at maximal vasodilatation theoretically has fewer limitations than the coronary flow reserve measurements and quantitative coronary angiography. The purpose of this study was to compare the myocardial perfusion to the measurements of the severity of the lesion (minimal luminal diameter and percent area stenosis) and to relate it to the changes of left ventricular function after PTCA. Regional myocardial perfusion was assessed during intracoronary papaverine, using the inverse mean transit time of contrast medium (1/Tmn), before, 15 min after, 18—24 hr after, and 6 months after successful single‐vessel PTCA in 14 patients with stable angina. Left ventricular angiography (before angioplasty, 18—24 hr after, and 6 months later) was analysed by area‐length and centerline methods. Immediately after PTCA, 1/Tmn increased from 0.14 ± 0.07 sec−1 to 0.21 ± 0.09 sec−1 (P = .001). Maximal myocardial perfusion remained higher than the pre‐PTCA value the day after angioplasty (1/Tmn of 0.23 ± 0.09 sec−1), while it reduced to near pre‐PTCA values at follow‐up (1/Tmn of 0.16 ± 0.05 sec−1). Before PTCA, three out of ten patients had ejection fraction of <65%, and seven had mild‐to‐moderate hypokinesis. The day after PTCA the ejection fraction and the regional dysfunction improved significantly. The change in ejection fraction 18—24 hr after PTCA did not correlate with minimal luminal diameter and percent area stenosis and correlated slightly with the improvement of perfusion (r = 0.54, P = .10). At follow‐up left ventricular function deteriorated in the whole group, despite the persistence of angiographic success of PTCA, possibly because of changes in the loading condition. Coronary artery stenosis measurements and 1/Tmn failed to correlate with the left ventricular function. Given the difficulties in routine application of the analysis of time‐density curves, the measurement of minimal luminal diameter remains a more practical assessment of the results of the intervention. However, the improvement of myocardial perfusion may give more information than coronary artery dimensions of the early recovery of left ventricular function.
Balloon catheter retrieval of dislodged coronary artery stents: A novel technique
Authors: Cishek Mary Beth , Laslett Lawrence , Gershony Gary
Published: March 2007

Potential complications of intracoronary stenting include stent dislodgement and embolization. We describe a patient in whom a stent was dislodged from a coronary balloon catheter to the iliac artery. A peripheral angioplasty balloon was used to withdraw the stent into the arterial sheath and thereby remove it from the patient.
Simultaneous inflation of tandem (sequential) angioplasty balloons: A means of simultaneously treating multiple lesions in one coronary artery
Authors: Ormiston John A. , Webster Mark W. I.
Published: March 2007

We report a novel approach to dilating multiple lesions in a coronary artery. Through the same guide and over different wires, a 3.5 mm diameter, 20 mm length, and a 3.0 mm diameter, 90 mm length balloon were simultaneously inflated in a right coronary artery. This approach, which simultaneously treats sequential (tandem) lesions of different diameter and length, allows reduction of both the total duration of ischemia and procedural time and may improve early angiographic outcome.
Septic endarteritis following percutaneous transluminal coronary angioplasty
Authors: Kardaras Fotis G. , Kardara Dimitra F. , Rontogiani Dimitra P. , Mpourazanis Ioanis A. , Flessas Leonidas P.
Published: March 2007

We report a case of bacterial arteritis of the external iliac artery complicated by mycotic aneurysm following coronary angioplasty. To our knowledge, this is the first reported instance of arterial wall infection caused by coronary angioplasty at a distance from the insertion site equal to the length of the sheath.
Coronary angiographic morphology of congenital coronary arteriovenous fistulas in adults: Report of four new cases and review of angiograms of fifteen reported cases
Authors: Said Salah A. M. , El Gamal MamdouhI. H.
Published: March 2007

The coronary angiographic features of four new cases of congenital coronary arteriovenous fistulas (CAVFs) are described, and the angiograms of 15 reported cases are reviewed. The morphologic appearance of CAVFs varied from a small discrete single channel to a highly complex plexiform network with a maze of fine vessels. The majority of CAVFs in our series were composed of a single channel. Aneurysmal formation was present in 26% (6/23). Aneurysmal formation involved only the pathway and/or the termination, but never originated from the beginning of the CAVFs. © 1995 Wiley‐Liss, Inc.
A new guidewire for coronary rotational ablation
Authors: Brown Robert I. G. , Penn Ian M. , Viera Fernando M.
Published: March 2007

We report three cases using a new guidewire designed for coronary rotational ablation. The tips are.014 in diameter and available in different degrees of flexibility. The improved torquability of these guidewires may improve the success rate of coronary rotablation in select cases. © 1995 Wiley‐Liss, Inc.
Aspiration of coronary thrombus during angioplasty for postmyocardial infarction ischemia
Authors: Khoury Alexander F. , Donohue Thomas J. , Kern Morton J.
Published: March 2007

We report the use of direct coronary aspiration to remove obstructing thrombus from a proximal right coronary artery after failure of balloon angioplasty to resolve the thrombus responsible for postmyocardial infarction ischemia. © 1995 Wiley‐Liss, Inc.
Bailout Palmaz‐Schatz coronary stenting in 39 patients with occlusive dissection complicating conventional Angioplasty
Authors: Antoniucci David , Santoro Giovanni M. , Bolognese Leonardo , Leoncini Mario , Buonamici Piergiovanni , Fazzini Pier F.
Published: March 2007

The purpose of this study was to evaluate feasibility, safety, and efficacy of bailout Palmaz‐Schatz stenting in a series of 39 patients with coronary dissection associated with acute or unequivocal threatened closure complicating conventional angioplasty. No anatomical characteristics other than reference vessel diameter < 3 mm were considered as contraindications for bailout coronary stenting. Stringent criteria were adopted in defining optimal results (<10% residual stenosis, no angiographic evidence of residual dissection), suboptimal results (>10% residual stenosis or angiographic evidence of residual dissection), deployment failure (failure to deploy the stent because of poor trackability or persistent occlusion despite stent deployment). A total of 49 stents and 7 half‐stents were implanted in 36 patients (range 1–5; mean 1.45 ± 0.84). Successful stenting without in‐hospital death, urgent or semielective coronary surgery, stent thrombosis, or Q‐wave myocardial infarction was achieved in 33/39 patients (85%). A suboptimal result was associated with an increased risk of in‐hospital recurrence of ischemia and other related major adverse events (2/5 patients with suboptimal results vs. 1/31 patients with complete deployment success; P < 0.05). Multiple stents implantation did not carry a significant risk of major cardiac adverse events. The results of this study suggest that bailout Palmaz‐Schatz stenting may be considered a stand‐alone treatment of coronary dissection if an optimal acute angiographic result is achieved. © 1995 Wiley‐Liss, Inc.
Latex versus lodinated contrast media anaphylaxis in the cardiac cath lab
Authors: Myers Gene E. , Crick William F. , King S. William , Mumma Michael , Friedberg H. David , Jamieson Donna M. , Bloom Frederick
Published: March 2007

A 65‐year‐old man had bypass surgery 10 years previously with pulmonary artery catheter monitoring. Shortness of breath and mitral regurgitation necessitated repeat left and right heart catheterization using a pulmonary artery catheter. Before any iodinated contrast media exposure, the pulmonary artery catheter was inserted and within 2 min the patient developed anaphylaxis associated ventricular fibrillation. It was discovered that the pulmonary artery catheter used in the cath lab had a latex balloon and that the patient had been exposed to latex 10 years ago. Latex induced anaphylaxis is rarely considered in the differential diagnosis of patients with hypersensitivity reactions in the cath lab, intensive care unit, and operating room. The principal reason for failure to recognize the latex balloon as a potential allergen is that most health professionals are not aware that almost all pulmonary artery catheters contain a latex balloon. The risk of an allergic response to latex is 0.8% for the general population. Others at high risk include those who have had multiple surgical procedures and interventions with repeated latex exposure. Five to 10% of all U.S. health professionals and those performing household duties wearing latex gloves have an allergic response to latex. Latex hypersensitivity is an IgE dependent reaction, while iodinating contrast medium reaction is an IgE independent reaction. If latex hypersensitivity is suggested by pre‐procedural history or if the patient falls into a high‐risk group, pre‐procedural skin testing and/or latex IgE radioallergosorbent (RAST) should be performed. A latex‐free pulmonary artery catheter (Zeon Medical, White Plains, NY) has been evaluated and found to have favorable performance characteristics from the femoral, jugular, and subclavian approach and is an economic equivalent to the conventional pulmonary artery catheters which contain latex. © 1995 Wiley‐Liss, Inc.
Dislocation of the rotating cutter during directional coronary atherectomy: A note of caution
Authors: Bauriedel Gerhard , Schluckebier Sven , Welsch Ulrich , Werdan Karl , Höfling Berthold
Published: March 2007

Directional coronary atherectomy (DCA) has received increased attention, especially as a bail‐out procedure after failed balloon angioplasty. However, this technique may also be burdened by severe pitfalls. We report a patient with a balloon‐resistant left coronary artery lesion subsequently treated with DCA. Despite its over‐the‐wire guidance, as the rotating cutter was advanced, it deviated from its intra‐housing course and intruded into the vascular wall. Dislocation of the rotating blade was due to pressure from hard plaque tissue. After having carefully pulled back the complete catheter system, a severe spasm of the left main stem occurred, which was reversed by intracoronary nitroglycerine. The final angiography showed a left coronary artery without significant, residual stenosis. The case report underscores that DCA passes must be performed under continous fluoroscopic control, especially for balloon‐resistant lesions because of the unpredictability of DCA‐imminent complication. © 1995 Wiley‐Liss, Inc.
Renal artery stenosis presenting as crescendo angina pectoris
Authors: Tami Luis F. , McElderry Michael W. , Al‐Adli Naim M. , Rubin Michael , Condos William R.
Published: March 2007

The coexistence of different clinical syndromes due to atherosclerosis in different organs is not rare and emphasizes the diffuse nature of this vascular process. Although renovascular disease may cause hypertension and/or renal insufficiency, it may also occur in the absence of the usual clinical markers that suggest renovascular hypertension. We report a patient with stable coronary anatomy who presented with crescendo angina pectoris. Diagnosis of renovascular hypertension was made by screening renal angiography at the time of the cardiac catheterization. Renal artery stenting resulted in stabilization of the coronary syndrome and obviated the need for further coronary intervention. To our knowledge, this is the first case of renovascular hypertension precipitating an unstable coronary syndrome in a patient with documented stable coronary anatomy. Review of the literature supports that patients undergoing cardiac catheterization are a high risk population for renovascular disease, particularly in the presence of other predictive factors such as documented coronary artery disease, older age, female gender, congestive heart failure, peripheral vascular disease, renal insufficiency, and smoking. Firm recommendations for routine screening renal angiography in patients undergoing peripheral or coronary angiography will need further studies. © 1995 Wiley‐Liss, Inc.
In‐hospital outcome of percutaneous transluminal coronary angioplasty for long lesions and diffuse coronary artery disease
Authors: Kaul Upendra , Upasani Prashant T. , Agarwal Rajiv , Bahl Vinay K. , Wasir Harbans S.
Published: March 2007

We performed coronary angioplasty on 151 long or diffuse lesions (120 long and 31 diffuse) in 141 patients (86% male, mean age 50 ± 9 years). Long lesions were defined as lesions 11‐20 mm in length and diffuse lesions as lesions longer than 20 mm, or three or more lesions in the same vessel. One or more adverse morphologic features were present in 131 (93%) lesions. Long balloons were used in 44%, significantly more often for diffuse disease (long lesions 39% and diffuse disease 64%; P = 0.004). Newer devices including the rotational atherectomy device (9 lesions), stents and perfusion balloons were employed in 18 (12%) lesions, more often for diffuse lesions (long lesions 8% vs. diffuse lesions 26%; P = 0.017). Lesion severity was comparable in the two groups (long lesions: 88 ± 7%; diffuse lesions: 88 ± 8%), but diffuse lesions were associated with significantly higher residual stenosis (long lesions: 6 ± 8%; diffuse lesions: 12 ± 13%, P = 0.01). Major complications occurred in five (3.5%) patients, including one death (0.7% mortality). The angiographic and clinical success rates for all patients were 99% and 96%, respectively, and were comparable for long and diffuse lesions.

Judicious case selection and the use of long balloons and newer interventional devices permit coronary angioplasty for long lesions and diffuse disease with excellent success and a low risk of complications. Diffuse lesions are associated with more frequent use of long balloons and newer devices, especially rotational atherectomy and slightly higher residual stenosis as compared to long lesions. © 1995 Wiley‐Liss, Inc.
Combined dissection of the right coronary artery and right coronary cusp during coronary angiography
Authors: Kwan Tak , Elsakr Ashraf , Feit Alan , Reddy C. V. R. , Stein Richard A.
Published: March 2007

Dissection of coronary arteries during diagnostic coronary angiography is infrequent; dissection of the coronary cusp is extremely rare. The combination of coronary artery and coronary cusp dissection has not been reported previously. A case of right coronary artery dissection and right coronary cusp dissection during diagnostic coronary angiography is described. © 1995 Wiley‐Liss, Inc.
Left ventriculography complicated by cerebral air embolism
Authors: Goldenberg Iian , Shupak Avi , Shoshani Oren , Boulos Monther
Published: March 2007

Cerebral air embolism is a severe complication of various invasive medical procedures. Hyperbaric oxygen is the sole definitive therapy. We describe a 68‐year‐old patient who presented with upper left limb motor and sensory deficits following the injection of a contrast medium for left ventriculography. Numerous air bubbles were seen on cineangiography concomitantly with injection of the contrast medium. Immediate compression with hyperbaric oxygen resulted in complete resolution of all neurological symptoms. latrogenic cerebral air embolism is an underdiagnosed condition that may result from cardiac catheterization. Physician awareness will improve prevention, and prompt diagnosis and the use of hyperbaric oxygen will result in an optimal outcome if it does occur. © 1995 Wiley‐Liss, Inc.
Coronary angioplasty of bifurcational lesions with the protecting branch technique using 6 French guiding catheter
Authors: Metz Damien , Nazeyrollas Pierre , Maillier Bruno , Maes Damien , Blaise Claude , Deschildre Alain , Elaerts Jacques
Published: March 2007

The use of 6 French guiding catheters is still usually limited to elective percutaneous transluminal coronary angioplasty. We describe our preliminary experience with this guiding size to perform a double guide wire procedure for angioplasty of coronary bifurcation lesions, to protect (n = 5) and/or to sequentialy dilate (n = 9) a major side branch. Technical success was 12/14 (86%), angiographic success 13/14 (93%), and in‐hospital outcome was event free in all patients. Thus, 6 French guiding size is both safe and effective for the majority of coronary bifurcation angioplasty.
Transluminal extraction catheter atherectomy in long saphenous vein grafts
Authors: Blankenship Jomes C. , Narke Joseph A. , Roberts James W.
Published: March 2007

Lesions in distal coronary vasculature present unique problems for catheter‐based interventions. We report two cases of attempted transluminal extraction catheter (TEC) atherectomy for very distal lesions in long circular saphenous vein grafts. One case succeeded with a simple modification of the TEC device; another failed because of excessive tortuosity in the proximal graft. This experience helps define the potential and limitations of TEC. © 1995 Wiley‐Liss. Inc.
Influence of expanded balloon diameter on palmaz‐schatz stent recoil
Authors: Rechavia Eldad , Litvack Frank , Macko Gail , Eigler Neal L.
Published: March 2007

After successful stent implantation, the residual luminal diameter of the stented vessel is usually smaller than the maximal stent‐expanded balloon diameter. The goal of this study was to determine whether immediate vessel diameter recoil after Palmaz‐Schatz stenting is affected by the final expanding balloon diameter used during stent deployment.

Single Palmaz‐Schatz balloon expandable stents were successfully placed in 108 stenotic lesions. There were 68 patients with 75 saphenous vein graft (SVG) and 30 patients with 33 native coronary artery lesions, including 26 restenotic and 82 de novo occlusive (>50% diameter stenosis) lesions. Quantitative coronary angiography was used for the assessment of stent recoil, defined as the difference between the minimal diameter of the fully expanded balloon and the postprocedure minimal lumen diameter divided by minimal diameter of the fully expanded balloon.

A strong correlation (r = 0.94) was found between the minimal diameter of the fully expanded balloon and poststenting minimal lumen diameter. Immediate recoil was 11.3 ± 7.5%, responsible on an average for 0.4 ± 0.2‐mm acute lumen loss. Recoil was less in SVG than in coronary arteries (9.7 ± 6.6% vs. 14.0 ± 7.8%; P = 0.004, and 0.3 ± 0.2 vs. 0.4 ± 0.2 mm; p = 0.01). Lesions were divided into four subgroups, based on the final stent expanding balloon diameter: (1) ⩽3.0 mm (n = 33); (2) >3 ± 3.5 mm (n = 43); (3) >3.5 ± 4 mm (n = 23); and (4) >4 mm (n = 9). For the four subgroups, the percentage recoil values were 15.0 ± 5.7, 10.4 ± 8.2, 9.0 ± 5.4, and 4.7 ± 2.0, respectively (P <0.001). Mean values of diameter stenosis, lesion length, maximal balloon pressure, balloon‐to‐artery ratio, relative vessel stretch, and absolute recoil were not statistically different.

Immediate vascular recoil in single implanted Palmaz‐Schatz stent is a function of the final expanding balloon diameter, with recoil larger at small‐balloon diameters and almost eliminated at large inflation diameters. This finding could contribute to less acute gain, increased restenosis, and higher stent thrombosis rates after stenting vessels of <3‐mm diameter. © 1995 Wiley‐Liss, Inc.
In vivo validation of an experimental adaptive quantitative coronary angiography algorithm to circumvent overestimation of small luminal diameters
Authors: Keane David , Gronenschild Ed , Slager Cornelis , Ozaki Yukio , Haase Jürgen , Serruys Patrick W.
Published: March 2007

The reliability of quantitative coronary angiography (QCA) measurements is of fundamental importance for the study and practice of interventional cardiology. In vivo validation results have consistently reported a tendency for QCA systems to overestimate small luminal diameters. Such a systematic error may result in the underestimation of luminal gain during intracoronary procedures and in the underestimation of progression of coronary artery disease during longitudinal studies.

We report the in vivo validation results of an experimental adaptive edge‐detection algorithm that was developed to reduce overestimation of small luminal diameters by incorporating a dynamic function of variable kernel size of the derivative operator and variable weighting of the first and second derivatives of the brightness profile. The results of the experimental algorithm were compared to those of the conventional parent edge detection algorithm with fixed parameters.

Dynamic adjustment of the edge‐detection algorithm parameters was found to improve measurements of small (lt;0.8‐mm) luminal diameters as evidenced by an intercept of +.07 mm for the algorithm with variable weighting compared to +0.21 mm for the parent algorithm with fixed weighting. A slope of <1 was found for both the parent and experimental algorithms with subsequent underestimation of large luminal diameters.

Systematic errors in a QCA system can be identified and corrected by the execution of objective in vivo validation studies and the consequent refinement of edge‐detection algorithms. The overestimation of small luminal diameters may be overcome by the incorporation of a dynamic edge‐detection algorithm. Further refinements in edge‐detection algorithms will be required to address the issue of underestimation of large luminal diameters before the absolute values derived from QCA measurements can be considered accurate over the full range of clinically encountered luminal diameters. © 1995 Wiley‐Liss, Inc.
Left ventricular false aneurysm: An unusually prolonged natural history
Authors: Bolognesi Roberto , Cucchini Francesco , Lettieri Corrado , Manca Carlo , Visioli Odoardo
Published: March 2007

A case of left ventricular false aneurysm of postinfarctual etiology with an unusually prolonged natural history (12 years survival) is reported. A first diagnosis of this rare cardiac complication was made in 1982 on the basis of hemodynamic and echocardiographic results. At that time the patient rejected surgical therapy.

Eleven years later the patient came back to our attention after resuscitation from a sudden cardiac death. Hemodynamic and echocardiographic (transesophageal) tests showed a remarkable impairment of left ventricular function and an abnormal enlargement (10 × 8 cm) of a pseudoaneurysmatic cavity full of thrombi. The patient died suddenly in April 1994.

We emphasize the unusual, prolonged survival of our patient suffering from an unresected left ventricular false aneurysm of postinfarctual etiology. © 1995 Wiley‐Liss, Inc.
Emergency rotational ablation of a calcified left main coronary artery stenosis in a patient with ischemic induced cardiogenic shock
Authors: Rozenman Yoseph , Lotan Chaim , Weiss A. Teddy
Published: March 2007

High‐speed rotational ablation is ideal in the treatment of chronic calcified atherosclerotic lesions. This report describes an elderly woman with a prior history of coronary artery bypass surgery, who developed cardiogenic shock secondary to occlusion of a saphenous vein graft to the obtuse marginal branch of the circumflex coronary artery. Her left main coronary artery was heavily calcified and almost completely occluded. She was treated successfully by high‐speed rotational ablation of her left main stenosis. © 1995 Wiley‐Liss, Inc.
Fatal aortic rupture following balloon angioplasty of aortic restenosis in aortoarteritis
Authors: Sharma Satyavan , Pinto Robin Joseph
Published: March 2007

We report a case of fatal aortic rupture following balloon dilation in a young female with aortoarteritis in whom restenosis of the aorta was observed 16 years after a patch aortoplasty operation. To the best of our knowledge, this complication has not been reported in aortoarteritis, although such instances have been reported in recoarctation. This unfortunate experience leads us believe that aortic segment in operated cases may be resistant to balloon dilation and vulnerable to rupture. In such cases, balloon angioplasty should either be avoided or performed with extreme caution. A sequential balloon dilation technique starting with a smaller balloon may be helpful in avoiding this complication. © 1995 Wiley‐Liss, Inc.
Is acoustic shadowing at intracoronary ultrasound always the marker of intramural calcium accumulation?
Authors: Depré Christophe , Havaux Xavier , Hanet Claude , Vanoverschelde Jean‐Louis J.
Published: March 2007

Intracoronary ultrasound (ICUS) is increasingly used at catheterization to assess more precisely the severity of luminal narrowing, to delineate the composition of the atherosclerotic plaque, and to select the optimal therapeutic strategy. With this technique, a drop in signal intensity, known as acoustic shadowing, is usually equated with the presence of calcium in the plaque. We report the study of an atherosclerotic coronary artery showing intense acoustic shadowing at ICUS, but in which no calcium deposition could be evidenced at postmortem pathological analysis. This observation suggests a word of caution with regard to considering acoustic shadowing at ICUS as the reflection of superficial calcium deposition within a vessel wall. © 1995 Wiley‐Liss, Inc.
Long‐term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients
Authors: Schräder Rainer , Bussmann Wulf‐Dirk , Jacobi Volkmar , Kadel Christoph
Published: March 2007

In patients with coarctation of the aorta arterial hypertension frequently persists when surgical repair is performed after age 20 years. There are little data on the long‐term effect of angioplasty and the question remains to be determined whether hypertension is sufficiently treated by this procedure.

Twenty‐nine consecutive patients (9 females and 20 males) 14 to 54 years old (median, 25) underwent angioplasty for native coarctation of the aorta. Twenty‐five patients (86%) had pre‐existing systolic arterial hypertension (>140 mm Hg). The mean peak systolic pressure gradient decreased from 62 ± 18 to 21 ± 13 mm Hg immediately after angioplasty. At hospital discharge 13 patients still had hypertension. After a mean follow‐up interval of 4.0 years (range, 0.3–9.5) the residual peak pressure gradient was 14 ± 13 mm Hg. Blood pressure was normal without antihypertensive therapy in 23 patients (79%). In the six hypertensive patients the pressure gradients were 7,13,30,30,35, and 60 mm Hg. One patient died 8 months after angioplasty and another underwent surgery for aortic aneurysm.

Although this was an uncontrolled study the data suggest that normalization of blood pressure may occur more frequently after angioplasty than after surgery in adolescents and adults with native coarctation. © 1995 Wiley‐Liss, Inc.
Transcatheter closure of residual atrial septal defect following implantation of buttoned device
Authors: Zamora Rolando , Lax Daniela , Donnerstein Richard L. , Lloyd Thomas R.
Published: March 2007

We report a case in which residual shunting after a buttoned device occlusion of atrial septal defect (ASD) was eliminated by transcatheter retrieval of a portion of the device, followed by implantation of a second device. This method may be helpful for those patients with residual ASDs who decline surgical device retrieval and defect closure. © 1995 Wiley‐Liss, Inc.
Transcatheter closure of oversized persistent ductus arteriosus by simultaneous delivery of two rashkind umbrella devices
Authors: Sievert H. , Moor T. , Ensslen R. , Spies H. , Scherer D.
Published: March 2007

Transcatheter closure of persistent ductus arteriosus (PDA) with a diameter of >9 mm is considered to be impossible or at least difficult with the occlusion systems that are currently available. We report a simple technique for occluding oversized PDAs with two Rashkind umbrellas introduced simultaneously. Using this technique, a large PDA with a diameter of 13 mm was successfully occluded in a 40‐year‐old man. Complete closure without residual shunt was documented by echocardiogram and angiogram. © 1995 Wiley‐Liss, Inc.
Can coronary flow parameters after stent placement predict restenosis
Authors: Hong Mun K. , Wong S. Chiu , Mintz Gary S. , Popma Jeffrey J. , Kent Kenneth M. , Pichard Augusto D. , Satler Lowell F. , Leon Martin B.
Published: March 2007

Intracoronary stent was used to treat a dissection resulting from balloon angioplasty. Coronary flow parameters measured with Doppler Flowire pre‐ and post‐stenting suggested abnormal coronary flow even after stenting. The patient returned 4 months later with an instent restenosis. This case suggests the intriguing possibility of coronary flow parameters obtained immediately after new device angioplasty in predicting restenosis. © 1995 Wiley‐Liss, Inc.
Concurrent balloon dilatation of rheumatic trivalvular stenosis
Authors: Goel Saurabh I. , Desai Dhruman M. , Shah Leelam S.
Published: March 2007

A 26‐year‐old male presented with increasing dyspnoea and exertional palpitations of 2 months duration. The clinical and echo evaluation revealed severe stenosis of the mitral, aortic, and tricuspid valves. Concurrent percutaneous dilatation of all three valves was done as a single stage procedure. The procedure was successful and produced significant clinical and haemodynamic improvement. The mitral and tricuspid valves were dilated using the same Inoue balloon, whereas the aortic stenosis was dilated using the pigtail tipped balloon. © 1995 Wiley‐Liss, Inc.
Diffuse vasospasm following stenting of a free gastroepiploic artery graft: Resolution with balloon angioplasty and intensive medical therapy
Authors: Feld Steven , Kjellgren Olle , Sweeney Michael S. , Drtil Alexander , Anderson H. Vernon , Schroth George , Tauss Nancy , Taegtmeyer Heinrich , Smalling Richard W.
Published: March 2007

Vasospasm following balloon angioplasty of gastroepiploic artery bypass grafts can be prevented or reversed with vasodilators. In our patient, stent deployment for ostial stenosis of a free gastroepiploic artery graft was accompanied by severe, diffuse spasm and a change in graft configuration that required both intensive medical therapy and balloon angioplasty for resolution. © 1995 Wiley‐Liss, Inc.
Successful treatment of chronic total peripheral occlusions that failed conventional techniques using the stiff backend of the glidewire™
Authors: Kjellgren Olle , Feld Steven , Loyd Dan , Schroth George , Anderson H. Vernon , Smalling Richard W.
Published: March 2007

The vast majority of failures of transcatheter interventions in patients with peripheral vascular disease are due to inability to cross the lesion with a guidewire. Although the use of the GlidewireTM has clearly improved the success rate, failures with especially chronic total occlusions still occur. We describe a new technique using the very stiff backend of the Glidewire, which we have found very successful, when conventional techniques fail in crossing highly resistant lesions. © 1995 Wiley‐Liss, Inc.
A pulse programmer for nuclear magnetic resonance spectrometers
Authors: Odebrecht C.C. , Tagle D. , Zuriaga F.B. , Steren C.A.
Published: March 2007

A pulse programmer (PP) designed to control a nuclear magnetic resonance (NMR) spectrometer is reported on. The heart of the PP is a computer programmable logic device (CPDL) that provides flexibility to the design and, at the same time, reduces the number of electronics components needed and the dimensions of the printed circuit board. The PP works as follow: first, a pulse sequence defined by a set of instructions is loaded into the RAM memory of the PP. Then, when the process is started, the instructions are, one by one, read, decoded, and executed. Four types of instructions (functions) were defined: PRINT A, PRINT B, WAIT, and STOP. PRINT A and PRINT B change the status of the output channels A and B, respectively, WAIT generates a time delay, and STOP terminates the sequence. The output ports A and B have 14 channels each, and the shortest pulse and resolution are both 200 ns. The design of the PP is versatile, and new functions can be added through software without modifying the printed circuit board. To control the PP from a personal computer, a program named PulseJr was developed. It contains a graphical user interface (GUI) and pulse sequences can be drawn on the monitor screen with the mouse of the computer. Once the pulse sequence is sketched, clicking a button the program compiles the pulse sequence, generates the set of instructions, loads them into the RAM memory of the PP, and starts the pulse sequence. © 2007 Wiley Periodicals, Inc. Concepts Magn Reson Part A 30A: 127–131, 2007.
Coherence pathway selection by cogwheel phase cycling in liquid‐state NMR
Authors: Zuckerstätter Gerhard , Müller Norbert
Published: March 2007

Coherence selection as an integral element of most multipulse NMR methods also represents a bottleneck to the efficiency of multidimensional NMR methods. In particular, phase cycling often requires total scan numbers in excess of signal‐to‐noise demands. M. H. Levitt and coworkers have recently introduced cogwheel phase cycling in solid‐state NMR, which improves on this problem. In this article we recapitulate the principles of coherence selection in multipulse and multidimensional NMR. The fundamental differences between various coherence selection strategies are discussed, and examples of implementing cogwheel phase cycling in liquid‐state NMR experiments commonly used for biopolymers are given. Design guidelines are suggested for incorporating cogwheel phase cycles into other pulsed NMR techniques. For experiments with multiple coherence transfer steps, cogwheel phase cycling is more efficient in spectrometer time usage than traditional nested phase cycling, as the scan numbers can be adjusted in smaller steps. Even compared with pulsed field gradient selection methods advantages exist, especially for fast relaxing resonances. © 2007 Wiley Periodicals, Inc. Concepts Magn Reson Part A 30A: 81–99, 2007.
Human circulating specific antibody‐forming cells after systemic and mucosal immunizations: differential homing commitments and cell surface differentiation markers
Authors: Quiding‐Järbrink Marianne , Lakew Mekuria , Nordström Inger , Banchereau Jacques , Butcher Eugene , Holmgren Jan , Czerkinsky Cecil
Published: March 2007

Circulating spontaneous antibody‐secreting cells (ASC) induced by mucosal and systemic immunizations in human volunteers have been characterized with respect to differentiation stage and homing commitments. Irrespective of the immunization route, the large majority of ASC co‐expressed CD19 and HLA‐DR, which are normally lost during the transition of plasmablasts to plasmocytes, as well as CD38, a marker of activated B cell blasts, expressed also by plasmocytes. However, these cells expressed neither CD28, a molecule acquired by plasmocytes, nor CD22 and CD37, which are lost during the transition of plasmablasts to plasmocytes. Therefore, the large majority of ASC found in peripheral blood after oral and parenteral immunizations are terminally differentiated B cells, but not fully differentiated plasmocytes. As a whole, the mucosally derived ASC population seemed to be more homogenously differentiated. CD25 was detected on few ASC, whereas ASC expressing CD71 were more numerous, especially among systemically derived ASC. Almost all ASC expressed the adhesion molecules CD44 and α4‐integrins, irrespective of immunization route. However, virtually all systemically derived ASC expressed L‐selectin, recognizing the peripheral lymph node addressin, whereas only a minority of mucosally induced blood ASC expressed L‐selectin. These studies are the first to demonstrate in humans that circulating precursors of mucosal B cell immunoblasts utilize organ‐specific recognition mechanisms distinct from those of corresponding systemic B cells and appear to be more advanced in the B lineage maturation pathway. Specialization of receptor expression could explain both the unification of immune responses in diverse mucosal sites and the physiologic segregation of mucosal from non‐mucosal immune mechanisms in humans.
Expression of cell interaction molecules by immature rat thymocytes during passage through the CD4+8+ compartment: developmental regulation and induction by T cell receptor engagement of CD2, CD5, CD28, CD11a, CD44 and CD53
Authors: Mitnacht Rita , Tacke Michael , Hünig Thomas
Published: March 2007

Rat thymocytes of the T cell receptorlow (TcRlow) CD4+8+ subset which is the target of repertoire selection are heterogeneous with respect to expression of the cell interaction (CI) molecules CD2, CD5, CD11a/CD18 (LFA‐1), CD28 and CD44. We show that this heterogeneity is due to the developmental regulation of these CI molecules during passage through the CD4+8+ compartment, and to up‐regulation by TcR engagement. Thus, cohorts of CD4+8+ cells differentiating synchronously in vitro from their direct precursors, the immature CD4−8+ cells, were homogeneous with regard to CI molecule expression. Upon entry into the CD4+8+ compartment, they expressed relatively high levels of CD2 and CD44, and moderate levels of CDS, CD28 and CD11a. CD2, CD28 and CD44 were slightly down‐regulated during the following 2 days, whereas CD5 slightly increased and CD11a remained constant. TcR stimulation using immobilized monoclonal antibodies resulted in rapid and dramatic up‐regulation of CD2, CD5 and CD28 and, to a lesser extent, of CD11a and CD44. Finally CD53, a triggering structure absent from unstimulated CD4+8+ thymocytes was also rapidly induced by TcR stimulation. Inclusion of interleukin (IL)‐2, IL‐4, or IL‐7 in this in vitro differentiation system did not affect the levels of CI molecules studied. Since the high levels of CI molecules induced by TcR‐stimulation correspond to those found in vivo on TcRintermediate thymocytes known to be undergoing repertoire selection, these results suggest that upregulation of CI molecules by TcR engagement provides a mechanism by which thymocytes that have entered the selection process gain preferential access to further interactions with stromal and lymphoid cells in the thymus.
CD28 functions as an adhesion molecule and is involved in the regulation of human IgE synthesis
Authors: Life Paul , Aubry Jean‐Pierre , Estoppey Sandrine , Schnuriger Valerie , Bonnefoy Jean‐Yves
Published: March 2007

Activated T cells induce IgE switching in B cells via a combination of lymphokines and direct T:B cell contact. As CD28‐deficient mice have reduced basal levels of IgG1 and IgG2a and diminished Ig class switching, we investigated whether the CD28/B7.1 (CD80) ligand pairing might also be involved in human IgE regulation. Co‐incubation of an allergen‐specific, human T cell clone with tonsillar B cells caused a marked up‐regulation of CD28 expression, whereas, in contrast, CD45 RB expression was unaffected. To test whether blocking the CD28:B7.1 interaction affected IgE synthesis, a dialyzed anti‐CD28 monoclonal antibody (mAb) was added to cultures containing tonsillar B cells, pre‐activated T cell clones and interleukin‐4. Anti‐CD28 treatment caused a reproducible, dose‐dependent inhibition of IgE, but not IgG synthesis that was accompanied by a visible decrease in cell aggregate formation. Conversely, an anti‐B7.1 mAb had no effect in this system. The effect of blocking CD28‐ligand interactions on lymphocyte adhesion was formally assessed on human T cell clones and B cell lines using dual intracellular staining and flow cytometry. Co‐incubation with an anti‐CD28 mAb, but not control IgG or anti‐B7.1 mAb, resulted in a marked impairment of conjugate formation that correlated well with T cell surface expression of CD28. Using this system we found that an anti‐CTLA‐4 mAb but not an anti‐B7.2 mAb inhibited T:B cell conjugate formation. Lastly, in addition to a direct effect of anti‐CD28 mAb on conjugate formation, 14‐day culture of T and B cells in the presence of anti‐CD28 caused a marked decrease of ICAM‐1 (CD54) expression on aggregated lymphocytes. In contrast, LFA‐1 (CD18) expression was unaffected. We, therefore, conclude that the T cell co‐stimulatory molecule CD28 is involved in the regulation of IgE synthesis in vitro. CD28 may act to a limited extent as an adhesion molecule, though apparently not by pairing with B7.1 or B7.2. It is more likely that ligation of CD28 under certain conditions modulates the expression of other T and B cell surface molecules.
Intracellular processing and presentation of T cell epitopes, expressed by recombinant Escherichia coli and Salmonella typhimurium, to human T cells
Authors: Verjans Georges M. G. M. , Janssen Riny , Uytdehaag Fons G. C. M. , van Doornik Claudia E. M. , Tommassen Jan
Published: March 2007

Vaccines based on recombinant attenuated bacteria represent a potentially safe and effective immunization strategy. A carrier system was developed to analyze in vitro whether foreign T cell epitopes, inserted in the outer membrane protein PhoE of Escherichia coli and expressed by recombinant bacteria, are efficiently processed and presented via human leukocyte antigen (HLA) class I and II molecules by bacterial infected human macrophages. A well‐defined HLA‐B27‐restricted cytotoxic T cell (CTL) epitope and an HLA‐DR53 restricted T helper (Th) epitope of the fusion protein of measles virus were genetically inserted in a surface‐exposed region of PhoE, and the chimeric proteins were expressed in E. coli and Salmonella typhimurium. Macrophages infected with both recombinant bacteria presented the Th epitope to the specific CD4+ T cell clone, but failed to present the CTL epitope to the specific CD8+ T cell clone. Presentation of the Th epitope by the infected macrophages was inhibited by cytochalasin D, indicating that phagocytic processing of intact bacteria within infected macrophages was essential for antigen presentation via HLA class II. Presentation of the Th epitope to the CD4+ T cell clone by infected macrophages was blocked by brefeldin A and cycloheximide, indicating the requirement of nascent HLA class II molecules for presentation. The efficiency of macrophages to process and present the inserted Th epitope was similar for both the recombinant E. coli and S. typhimurium strains.