bluuebunny/crossref_metadata_2025 huggingface dataset:
A Ten‐Year Chronicle of Student Attitudes Toward Foreign Language in the Elementary School
Authors: HEINING–BOYNTON AUDREY L. , HAITEMA THOMAS
Published: June 2007

This article reports the results of 2 studies conducted over a 10‐year period that researched student attitudes toward early foreign language learning. These studies are unique because of the long time frame in which the students were followed, and the large data sets collected at the elementary school level. Surveys of students in the Foreign Language in the Elementary Schools (FLES) programs examined the attitudes of all children in 2 school systems in North Carolina: one suburban and one urban. The students studied either French or Spanish. The number of responses to the survey questions ranged from 22,549 to 52,227 for a 4‐year period. The results indicated that boys and girls had positive attitudes when responding to 2 questions about enjoyment of their FLES classes and teachers. The girls were positively inclined, and the boys were neutral, in their desire to continue with foreign language study in the next grade. Two items about the use of foreign language outside the school venue and comprehension of foreign language teacher input revealed negative attitudes for both genders.

As a follow‐up to the quantitative study, qualitative data about attitudes toward foreign language speakers, foreign cultures, and their own education with respect to foreign language study were gathered through structured interviews. The participants were the same students who had completed the original surveys 10 years earlier. In corroboration of the quantitative data, a qualitative analysis revealed that, for a majority of the students, foreign language study was viewed positively, as were foreign language speakers and their cultures.
Acquisition of Requests and Apologies in Spanish and French: Impact of Study Abroad and Strategy‐Building Intervention
Authors: COHEN ANDREW D. , SHIVELY RACHEL L.
Published: June 2007

The primary aim of this study was to assess the impact of a curricular intervention on study‐abroad students’ use of language‐ and culture‐learning strategies and on their acquisition of requests and apologies. The intervention consisted of a brief face‐to‐face orientation to learning speech acts, a self‐study guidebook on language and culture strategies, which included strategies for learning speech acts, and electronic journaling by the students. The study used an experimental design in which the participants, all university students (N =86) who spent 1 semester abroad in a Spanish‐ or a French‐speaking country, were randomly assigned to an experimental (E) group (N= 42) or to a control (C) group (N= 44). The findings indicated that the students as a whole improved their request and apology performance over the course of 1 semester, as rated by the Spanish and French native speakers. In addition, whereas there were no statistically significant differences between the E and C groups in their rated speech act performance overall, a qualitative analysis of speech act development among learners of Spanish (N= 67) helped to identify areas in which their performance on requests and apologies either resembled that of native speakers or diverged from it. Although fewer students than native speakers used the “query preparatory with verbal downgrading,” there appeared to be some increase in the use of this strategy by study‐abroad students from pre‐ to posttest, especially among the E group students, perhaps suggesting that for some of these students awareness about mitigating requests was enhanced by the treatment. In making apologies, not as many study‐abroad students intensified their apologies in instances where native speakers tended to do so. Likewise, the percentage of study‐abroad students who acknowledged responsibility for certain infractions tended to be lower than that of the native speakers, suggesting that these nonnative speakers were unaware of sociopragmatic norms for what might be expected in such situations.
Affective Factors Influencing Plurilingual Students’ Acquisition of Catalan in a Catalan–Spanish Bilingual Context
Authors: BERNAUS MERCÈ , MOORE EMILEE , AZEVEDO ADRIANA CORDEIRO
Published: June 2007

This study explored the affective factors influencing students’ learning of Catalan across different year levels in a multilingual school community in Barcelona (Catalonia, Spain). Questionnaires were distributed to 176 students, from 12 to 17 years of age, registered in a public secondary school, the majority of whom were not born in Catalonia. This study is unique for two reasons. First, many of the students were simultaneously learning 2 official languages—Catalan and Spanish—both inside and outside the classroom, plus 1 foreign language, English. Second, the instrument used to assess the affective variables made use of scales from 2 different models, by Dörnyei (2001) and Gardner (1985). There were 4 major results. First, it was found that the students used Catalan very infrequently in comparison to Spanish even though Catalan is an official language and is the language of the school. Second, the students’ country of origin had relatively little influence on most of the affective measures. Third, attitudes and motivation decreased and language anxiety increased as year level increased. Finally, the constructs assessed by the scales in the 2 models (i.e., Dörnyei, 2001; Gardner, 1985) are largely factorially distinct, tapping different affective dimensions.
Informing State Economic Development Policy in the New Economy: A Theoretical Foundation and Empirical Examination of State Innovation in the United States
Authors: Hall Jeremy L.
Published: June 2007

This study considers recent evidence of state innovation capacity in order to better understand where new economy–type economic development is likely to occur and, by extrapolation, where strategies geared toward such growth are more likely to succeed. The research focuses on data from the National Science Foundation’s State Science and Engineering Profiles, supplemented by data from other sources. Factor analysis was performed on this data set to observe underlying common factors that explain the variability of the original data in fewer dimensions. The resulting factor scores—human capacity and financial capacity—were used to classify states into four categories of new economy resource density: lagging, low, developing, and progressive. The scores for the two resulting factors were then used as independent variables in subsequent regression analyses, demonstrating positive correlations among innovation capacity resources, actual innovations, and overall state economic performance.
Increase of Initial Success and Safety of Single‐Vessel Percutaneous Transluminal Coronary Angioplasty in 1371 Patients: A Seven‐Year Experience
Authors: DE FEYTER PIM J. , VAN DEN BRAND MARCEL , SERRUYS PATRICK W. , SURYAPRANATA HARRY , BEATT KEVIN , ZIJLSTRA FELIX , VAN DOMBURG RON , PATIJN MAX
Published: June 2007

Three successive time periods were compared to study the impact of evolving techniques and new equipment on the immediate results of single‐vessel percutaneous transluminal coronary angioplasty (PTCA), the initial success rate and major complication rate (death, myocardial infarction, and urgent surgery). The three periods were selected on the basis of a significant advance in either PTCA technique or equipment. In period I from 1980 to 1983 a nonsteerable catheter system was used. In period II from 1983 to 1986 a steer‐able catheter was used. In period HI from 1986 to 1987 the long guidewire technique and/or monorail system was used. A total of 1,371 successive patients underwent single‐vessel dilatation for stable angina (848 patients) or for unstable angina (523 patients). Initial success was defined as a reduction of the stenosis to less than 50% with no major complications (myocardial infarction or death, or the necessity of proceeding to coronary artery bypass surgery). The initial success rate increased from 68% (period I) to 88% (period II) and to 91% (period III) for all attempts. When attempts of dilatation of totally occluded vessels were excluded these figures were 71%, 91%, and 95%, respectively. The overall major complication rate decreased from 16% (period I) to 8% (period II) to 3.5% (period III). Thus, increase in investigator experience, technical improvements of balloon catheter systems, and introduction of new PTCA techniques have resulted in an increase in success and safety of PTCA procedures. (J Inter‐ven Cardiol 1988:1:1)
Late Results of Pulmonary Balloon Valvuloplasty in Adults Using Double Balloon Technique
Authors: FAWZY MOHAMUD EID , MERCER EDWARD N. , DUNN BRUCE
Published: June 2007

Between July 1985 and July 1987, 18 consecutive adult patients with congenital pulmonary stenosis underwent pulmonary balloon valvuloplasty (PBV). There were 11 males and 7 females, aged 15–45 years (mean 25). A double balloon technique was used in 14 patients and a single balloon in four. The size of the balloon used was 0.9 to 1.4 times the size of the pulmonary annulus. Eleven patients were restudied by repeat cardiac catheterization 6 months later. Student's t‐test was used for comparison of data. Right ventricular (R V) systolic pressure before dilatation ranged from 84 to 180 (mean 123 ± 28.3) mmHg and the right ventricular to pulmonary artery (PA) peak systolic gradient ranged from 60 to 165 (mean 105 ± 30.2) mmHg. Immediately after dilatation, the RVsystolic pressure dropped to 30–80 (mean 53 ± 14.2) mmHg (P < 0.001). RV to PA peak systolic gradient dropped to 10–57 (mean 32 ± 14.2) mmHg (P < 0.001). A restudy of 11 patients 6 months later showed a further drop of RV systolic pressure to 35–65 (mean 49 ± 11.3) mmHg (P < 0.05). RV to PA peak systolic gradient continued to drop to 10–48 (mean 26 ± 11.3) mmHg (P < 0.01). Cardiac index improved from 2.68 ± 0.73 to 3.03 ± 0.40 L/min/m2, P < 0.05. No complication was noted apart from either sinus bradycardia or extrasystole in a few patients. It was noted that balloon to annulus ratios of 1.1 to 1.4 produced sustained relief of the pulmonary valve stenosis. We concluded that PBV is the treatment of choice for congenital pulmonary stenosis. It reduced the hospital stay to 2 days and avoids the ri±k of open heart surgery. (J Interven Cardiol 1988:1:1)
Intracoronary Nitrogylcerin and Regional Coronary Blood Flow Responses During Coronary Angioplasty in Patients
Authors: KERN MORTON J. , VANDORMAEL MICHEL , DELIGONUL UBEYDULLAH , LABOVITZ ARTHUR , HARPER MICHAEL , GIBSON PAUL , PRESANT STEPHEN , KENNEDY HAROLD L.
Published: June 2007

To examine the direct effects of nitroglycerin (NTG) on anterior regional coronary blòod flow, electrocardiographic and hemodynamic responses were measured immediately before, during, and after brief coronary occlusion in 17 patients undergoing left anterior descending coronary angioplasty (PTCA). Hemodynamic data and the time from the onset of coronary occlusion to 1.0 mm ST elevation or depression were compared for matched control and NTG occlusion periods. Ten seconds before the “NTG” occlusion, 200 μg of NTG was injected into the left coronary artery. Baseline and occlusion level great cardiac vein flow (thermodilution) was similar for both occlusion periods (93 ± 27 to 59 ± 23 mL/min for control; 95 ± 27 to 56 ± 22 mL/min for NTG occlusion). NTG reduced mean arterial pressure (91 ± 11 to 82 ± 15 mmHg, P < 0.05) during increased basal great vein flow (95 ± 27 to 127 ± 54 mL/min p < 0.01) immediately prior to occlusion. Great vein hyperemic flow after release of occlusion increased 21 ± 30% versus 36 ± 40% (P = ns) after control occlusion. There were no differences in heart rate or systolic‐heart rate pressure products, time to ischemic ST‐T wave changes or the maximal hyperemic responses from the control occlusion. These data suggest that during the initial minutes of coronary occlusion, the marked but transient coronary vasodilation induced by intracoronary NTG does not significantly modulate myocardial ischemia or regional coronary blood flow responses. The clinical benefits of NTG during PTCA most likely occur more through other mechanisms than direct myocardial flow augmentation. (J Interven Cardiol: 1988:1:1)
Computed Tomography During Experimental Balloon Dilatation For Calcific Aortic Stenosis. A Look into the Mechanism of Valvuloplasty
Authors: DI MARIO CARLO , VAN VEEN LEONARD C.P. , DE BAAT LEEN , ESSED CATHARINA E. , BEATT KEVIN J. , LEBORGNE OLIVER , SERRUYS PATRICK W.
Published: June 2007

Thin‐slice contiguous computed tomographic scanning was performed in four postmortem hearts with calcific aortic valve stenosis (mean weight: 583 ± 78 g; mean age: 65 ± 10 years) before, during, and after balloon valvuloplasty. Balloons of increasing diameter (15–19 mm single balloons, and 3 × 12‐mm trefoil‐shaped balloon) were positioned across the aortic valve and manually inflated to pressures of 3 to 4 atmospheres. During inflation of the 3 × 12‐mm balloon a larger residual orifice, potentially free for blood passage, was observed in the two cases with bicuspid valves and in one case with a fused tricuspid valve, while the reverse was noted in one case with a tricuspid valve without fusion. In most cases valvular orifice enlargement only occurred with larger diameter balloons. After valvuloplasty aortic valve area increased from 0.72 (range 0.20–0.95) cm2 to 2.36 (range 0.95–3.14) cm2. The smallest orifice enlargement after dilatation occurred in case 1, where valvular calcified deposits had the largest volume and the highest computed tomographic attenuation value. In each patient macroscopic changes (fracture of nodular calcifications, commissural splitting, tearing of the central raphe) were noted. No calcium dislodgement or aortic ring damage was observed. In autopsy specimens computed tomography provided accurate evaluation of aortic valve morphology, extent of valve calcification, balloon‐leaflet relationship during inflation, and effects of the dilatation on valve leaflets and commissures. Advances in computed tomographic cardiovascular imaging may achieve similar results in the clinical setting, and allow a more rational, individualized approach to the valvuloplasty procedure. (J Interven Cardiol 1988:1:2)
Endothelialization of Intravascular Stents
Authors: VAN DER GIESSEN W.J. , SERRUYS P.W. , VISSER W.J. , VERDOUW P.D. , VAN SCHALKWIJK W.P. , JONGKIND J.F.
Published: June 2007

Wide clinical application of intravascular stenting devices is currently limited by occlusion or intraluminal narrowing caused by thrombosis and neointimal thickening in a considerable percentage of implantations. We studied the possibility of seeding one of the currently availiable stents, a stainless steel, self‐expandable wire‐mesh, with endothelial cells in vitro. Endothelial cells, derived from human umbilical cord veins, could be successfully attached to stent filaments. In vivo stent implantations in porcine femoral arteries showed complete covering of stent wires by endothelium after 1 week. We conclude that coating of stents with autologous endothelial cells prior to implantation might protect against early thrombosis during the period in which a neointima is formed. (J Interven Cardiol 1988:1:2)
The Effects of Coronary Angioplasty on Nitroglycerin‐Induced Augmentation of Regional Myocardial Blood Flow
Authors: KERN MORTON J. , PRESANT STEPHEN , DELIGONUL UBEYDULLAH , VANDORMAEL MICHEL , KENNEDY HAROLD L.
Published: June 2007

Percutaneous transluminal coronary angioplasty (PTCA) may improve coronary vasomotor responses after relief of flow limiting luminal narrowings. To evaluate the effects of PTCA on nitro‐glycerin‐induced augmentation of coronary blood flow, great cardiac vein (thermodilution) blood flow and systemic hemodynamic responses to low (50 meg) and high (200 meg) dose intracoronary nitroglycerin (NTG) before and after PTCA were measured in 20 patients undergoing left anterior descending artery (LAD) balloon dilatation. Before PTCA, low dose NTG increased great vein flow 44 ±31% (from 56 ± 21 to 81 ± 33 mL/min, P < 0.01). High dose NTG increased great vein flow 55 + 30% (56 ± 23 to 87 ± 38 mL/min, P < 0.01). PTCA reduced LAD stenosis (79 ± 13 to 20 ± 9%, P < 0.01) and translesional pressure gradient (49 ± 10 to 15 ± 13 mmHg, P < 0.01) increasing post‐PTCA basal great vein flow 45% (56 ± 21 mL/min to 81 ±27 mL/min, P < 0.01).

After PTCA, low dose NTG increased great vein flow only 26 ± 23% (81 ± 27 to 101 ± 39mL/min, P < 0.01; P < 0.05 versus 44 ± 31% before PTCA). The high dose NTG‐induced coronary hy‐peremic responses were unchanged after PTCA (55 ± 30, 55 ± 34%, P = ns). When compared to dose related NTG hyperemic responses in 10 patients with normal LAD, the post‐PTCA responses remained attenuated.

These data indicate that NTG‐induced augmentation of coronary blood flow remains unchanged or attenuated and does not appear to be improved by PTCA. These findings should be considered when evaluating pharmacological coronary blood flow responses after PTCA. These data also suggest that epicardial coronary resistance plays a limited role in NTG‐induced augmentation of coronary blood flow inpatients with atherosclerotic coronary disease. (J Interven Cardiol 1988:1:2)
Anterograde Transvenous Balloon Angioplasty of Recurrent Coarctation in Infancy
Authors: BEEKMAN ROBERT H. , MELIONES JON N. , RIGGS THOMAS W. , ROCCHINI ALBERT P.
Published: June 2007

Balloon angioplasty of a severe recurrent coarctation was performed in a 4‐month‐old infant using an anterograde approach not previously described for this lesion. The entire procedure was performed transvenously. After transseptal entry into the left atrium, the transseptal sheath was placed across the mitral valve and the angioplasty catheter advanced across the recurrent coarctation. Angioplasty reduced the systolic gradient from 65 mmHg to 22 mmHg, without acute complications. We feel that the anterograde transvenous approach should be considered as an alternative to retrograde transarterial angioplasty in infancy, since femoral artery injury is avoided. (J Interven Cardiol 1988:1:2)
Visualization of the Patent Ductus by Means of a New Low Pressure Balloon Catheter
Authors: SIEVERT H. , NIEMÖLLER E. , BUSSMANN W.‐D. , KOBER G. , KALTENBACH M.
Published: June 2007

A new angiographic method of determining the anatomy of a patent ductus arteriosus (PDA) preparatory to its surgical or nonsurgical closure has been developed and compared to conventional angiographic techniques in 17 patients using a new low pressure balloon catheter (Edwards). The balloon, 5 cm long, is filled with contrast material and expanded to any diameter up to 20 mm. It may be passed into the ductus from either the arterial (14 patients) or venous (3 patients) side. The balloon is expanded by radiopaque material adjacent to the aortic orifice of the PDA and advanced (or pulled) through the ductus. Deformation of the balloon identified the length and caliber of the PDA providing virtually identical estimates thereof in all 17 patients when compared to conventional angiography. On the other hand, visualization of the PDA was good in only 41 (62%) or tolerable in 14 (21%) of 66 conventionally studied patients. (J In‐terven Cardiol 1988:1:2)
Staged Approach to Multivessel Coronary Angioplasty: Strategic Considerations and Results
Authors: DISCIASCIO GERMANO , COWLEY MICHAEL J. , GOUDREAU EVELYNE , VETROVEC GEORGE W. , KELLY KIM
Published: June 2007

PTCA was performed in separate sessions in 104 (24%) of the first 439 patients who had multivessel PTCA in our institution. There were 78 men and 26 women, mean age 58 years; 37patients (36%) had triple vessel coronary artery disease, 11 patients (10%) had prior CABG, 58 patients (56%) had unstable angina and 35 patients (34%) had recent MI (< 15 days): 14 of these (13%) had intravenous thrombolysis: ± 3 days before PTCA. Indications for staging were recent MI (28%), long procedure (22%), split or tear of first vessel(s) (22%), large number of lesions dilated (20%), pre‐PTCA complex lesions (8%). PTCA was done in 272 vessels (2.6/pt, range 2–6/pt) and in 385 lesions (3.7/pt, range 2–12/pt) with angiographic success in 262 vessels (96%) and 374 lesions (97%); angiographic success in all lesions attempted was obtained in 91% of patients and clinical success in 102 patients (98%). Complication rate was 3.8%: four patients (3.8%) had MI, no patients had urgent CABG. In comparison, significant differences were present in the 335 patients who had multivessel PTCA at one sitting: three vessel CAD was less frequent (22%, p < 0.05), recent MI was less frequent (18%), p < 0.01; the number of lesions dilated/patient was significantly lower (2.7/pt vs 3.7/pts, p < 0.001) and so was the number of total occlusions attempted (18% vs 31%, p < 0.02). Success in all lesions was achieved in 82% of these patients, p < 0.05; clinical success was similar (96%), with a 6.9% total complication rate (p < 0.07) [17 patients (5%) had MI, nine patients (2.7%) required urgent CABG]. Thus, staged multivessel PTCA is an effective strategy and may allow more extensive and safer dilatations in selected patients. (J Interven Cardiol 1988:1:3)
Quantitative Coronary Angiography and Digital Densitometric Perfusion Measurements—How to Assess the Success of Intracoronary Balloon Dilatation
Authors: HAUDE MICHAEL. , ERBEL RAIMUND. , BRENNECKE RUDIGER. , JUNG DIETER. , KIEFER ECKHARDT. , SCHMIDT THOMAS. , MEYER JURGEN.
Published: June 2007

Densitometric evaluation of digital subtraction angiocardiograms allows the assessment of local myocardial perfusion before and after pharmacological stimulation of coronary flow reserve during the catheterization procedure. This report deals with a case of a severe stenosis of the left coronary artery in which PTCA was regarded successful based on an appropriate increase in luminal diameter while an intima and media dissection at the dilatation site was documented. The perfusion measurements, however, pointed out a clear impairment of poststenotic myocardial perfusion after PTCA.
Resolution of Residual Pressure Gradients After Angioplasty by Stenting
Authors: KAUFMANN U. , SIGWART U.
Published: June 2007

Intravascular stents were conceived to improve the management of complications after PTCA. The beneficial effects of stents are thought to be due largely to the improvement of the primary PTCA result. To confirm this hypothesis, we have measured transstenotic gradients before and after stenting. Coronary pressure measurements were taken in 17 patients at the time of PTCA as well as before and after the implantation of a self‐expand‐able intracoronary mesh endoprosthesis. Before stenting the mean residual pressure gradient was 21 mmHg; after implantation of the endoprosthesis this pressure gradient dropped to a mean of 2 mmHg. This observation confirms the angio‐graphic observation of improvement of the primary result of PTCA by stenting. (J Interven Car‐diol 1989:2:1)
CO2 Laser Catheter Angioplasty in Human Atherosclerotic Xenograft Arteries
Authors: BATTLER ALEXANDER , GAL DOV , ELDAR MICHAEL , BASS ARIE , WALDEN RAPHAEL , ZWEIG AMI , GATON EDITH , WOLF NELSON , NEUFELD HENRY N. , KATZIR ABRAHAM
Published: June 2007

Human atherosclerotic xenograft arteries implanted in five mongrel dogs were subjected to in‐traluminal angioplasty using CO2 laser radiation. CO2 laser energy was delivered through a silver halide fiber, 0.9 mm in diameter and 100 cm long, inserted into a 6 Fr angiographic catheter. Results indicated that the technique is feasible, relatively simple and may have a low potential for perforation. (J Interven Cardiol 1989:2:1)
Concurrent Failure of Active and Redundant Ventricular Epicardial Electrodes in Children
Authors: SERWER GERALD A. , DICK MACDONALD , UZARK KAREN , SCOTT WILLIAM A. , BOVE EDWARD L.
Published: June 2007

Implanting an unused or redundant epicardial ventricular pacing electrode in children at the time of initial electrode placement for later use is a common practice. To investigate the ultimate utilization of this redundant electrode, the records of 38 children who had undergone implantation of 47 redundant epicardial electrodes between 1974 and 1987 were reviewed. As the primary electrode remains functional, 12 electrodes have not been in‐vasively tested or used; 11 were in nine children lost to follow‐up. The remaining 24 redundant electrodes implanted in 16 children, (ages 1 day to 18 years, median 5 years, at implantation) together with the utilized electrode were evaluated at the time of pacing system revision. At implant, all electrodes had thresholds < 1.4 volts at a pulse duration of0.5 msec. At follow‐up 0.2 to 11.7 years (mean 3.7 years) after implant, an electrode was considered functional if the threshold at 0.5 msec pulse duration was < 2.5 volts, and 14 of 24 redundant electrodes were nonfunctional. Of the ten functional redundant electrodes, the active electrode was functional in seven cases. In only three of 24 cases was the redundant electrode functional when the active electrode was nonfunctional. In all cases, when the active electrode exhibited exit block, the redundant electrode also exhibited exit block. Two of five redundant electrodes paired with a fractured active electrode were fractured. Two other redundant electrodes were fractured when the active electrode was functional. The state of the redundant and the active electrode was the same in 80% of the cases, P < 0.03. Of the 36 redundant electrodes implanted for which follow‐up data is available, 33 had not been used by the end of the study period. (J Interven Cardiol 1989:2:1)
“Double Steal” Syndrome
Authors: SAMUELS DAVID A. , FAITELSON LIONEL
Published: June 2007

A case is presented of a patient who had undergone internal mammary artery bypass grafting and subsequently developed angina pectoris and cere‐brovascular insufficiency as the result of a single proximal subclavian artery stenosis. The patient's ischemic symptoms resolved following successful angioplasty of the subclavian lesion. The status of the brachiocephalic circulation should be considered in patients presenting with angina following internal mammary artery bypass grafting and preoperatively in patients who are being considered for this procedure. (J Interven Cardiol 1989:2:1)
Incidence of Renal Artery Stenosis in Hypertensive Patients Undergoing Coronary Angiography
Authors: VETROVEC GEORGE W. , LANDWEHR DOUGLAS M. , EDWARDS VIRGINIA L.
Published: June 2007

To assess the frequency of renal artery stenosis in patients with hypertension and/or renal insufficiency undergoing coronary angiography, screening abdominal aortography was performed in 118 patients with a history of hypertension and/or renal insufficiency. Single plane cine abdominal angiography was performed immediately following routine coronary angiography utilizing 20–40 mL of 76% renografin. Abdominal angiography was adequate for interpretation in 116 and 118 (98%) patients. One hundred and two patients had hypertension, two had renal insufficiency, and 12 patients had hypertension and renal insufficiency. Renal artery stenosis (> 50%) was present in 27 of 116 patients (23%); 18 of 102 (18%) hypertensive patients, and 9 of 14 (67%) renal insufficiency patients. Significant renal artery stenosis was present in 22 of 76 (29%) patients with significant coronary artery disease while only 5 of 40 (10%) patients without coronary artery disease had significant renal artery stenosis. There were 10 small kidneys, five in association with renal artery stenosis; one in a patient with hypertension but without renal artery stenosis or renal insufficiency; four (two pairs) in patients with renal insufficiency but no renal artery stenosis. In conclusion: (1) significant renal artery stenosis was identified in 23% of patients with hypertension and/or renal insufficiency suggesting that more vigorous consideration of renal artery stenosis may be appropriate in hypertensive patients with coronary artery disease, and (2) abdominal angiography in conjunction with coronary angiography appears to be a useful screening test for renal artery stenosis in patients with hypertension and/or renal insufficiency.
Percutaneous Balloon Valvuloplasty of A Porcine Xenograft Bioprosthesis in the Mitral Position: Late (1 Year) Hemodynamic Observations
Authors: DEFELICE CLEMENT A. , MULLINS CHARLES E. , KUMPURIS ANDREW G. , RAIZNER ALBERT E.
Published: June 2007

Balloon valvuloplasty is a procedure recently applied to porcine xenograft bioprostheses. We report the percutaneous dilatation of a critically stenosed Carpentier‐Edwards bioprosthesis in the mitral position via an atrial transseptal approach. Hemodynamic measurements revealed an increase in mitral valve area from 0.88 cm2 to 1.34 cm2 and a decrease in the transvalve gradient from 22 mmHg to 12 mmHg. The patient's symptoms dramatically improved, but recurred 8 months later. Repeat cardiac catheterization at 1 year documented restenosis of the porcine xenograft bioprosthesis with a mitral valve area of 0.87 cm2. Thus, stenosis of porcine bioprostheses may be managed by balloon valvuloplasty. As with native valves subjected to balloon valvuloplasty, restenosis is a concern.
Effect of Implantable Defibrillator Patch Electrodes on Left Ventricular Filling
Authors: MARWICK THOMAS H. , MCALISTER HUGH F. , SALCEDO ERNESTO E. , MORANT VICTOR A. , SIMMONS TONY W. , WILKOFF BRUCE , CASTLE LON W. , MALONEY JAMES D.
Published: June 2007

Although implantation of defibrillator patch electrodes (DP) has been shown not to impair systolic function, their influence on diastolic function has not been elucidated. The aim of this study was to examine left ventricular filling sequentially in a group of patients before and after DP implantation. Doppler evaluation of mitral diastolic flow was used to assess left ventricular (LV) filling. Studies were performed preoperatively, after attaining hemodynamic stability postoperatively, and at subsequent follow‐up (mean 9 weeks) in 13 patients. Patients undergoing cardiac surgery other than DP implantation and coronary artery bypass grafting were excluded, as were those with significant valvular heart disease. Immediately postoperatively, there was a reduction of deceleration time (0.26 ± 0.02 to 0.21 ± 0.01 sec, P < 0.05), consistent with mild impairment of LV filling, but the remaining parameters remained unchanged. At late follow‐up, significant increases were recorded in time to peak filling (0.17 ± 0.01 to 0.25 ± 0.03 sec, P < 0.01), isovolumic relaxation time (0.07 ± 0.01 to 0.13 ± 0.02 sec, P < 0.005), while peak passive filling velocity decreased (1.02 ± 0.09 to 0.82 ± 0.07 m/sec, P < 0.05), all consistent with impairment of LV filling. We conclude that implantation of DP is associated with detectable impairment of LV filling at 2 months after surgery. (J Interven Cardiol 1989:2:3)
Retrieval of Right Heart Fragments from Implanted Venous Access Catheters in Patients with Malignancy
Authors: KAHN JOEL K. , HARTZLER GEOFFREY O.
Published: June 2007

Chronically implanted venous access catheters are frequently used in patients with malignancy. Fracture and embolization of these catheters may occur during placement, chronic use, or removal. We report four consecutive cases of percutaneous retrieval of catheter fragments from the right heart circulation. A snare formed from an exchange length angioplasty guidewire inserted through a guiding catheter was used successfully in all four patients without complications. Resolution of arrhythmias, chest discomfort, and infection followed the retrieval of the fragments. As larger numbers of patients receive chronically implanted venous catheters, the invasive cardiologist must be familiar with methods of removal. (J Interven Cardiol 1989:2:4)
Emergency Treatment of Cardiogenic Shock Employing Combined Iliac and Coronary Angioplasty
Authors: CRAGG DAVID R. , FRIEDMAN HAROLD Z. , PAVLIDES GREGORY S. , GANGADHARAN VELLAPPILLIL
Published: June 2007

Patients with acute myocardial infarction complicated by cardiogenic shock can be stabilized by intra‐aortic balloon pump insertion. Mechanical hemodynamic support also provides a margin of safety that is essential before proceeding with cardiac catheterization and coronary angioplasty. However, the required percutaneous transfemoral technique may be traumatic or impossible when peripheral vascular disease exists. Emergency peripheral balloon angioplasty, in the setting of car‐diogenic shock, can circumvent major procedural limitations imposed by the presence of severe arterial occlusive disease. (J Interven Cardiol 1989:2:4)
Tachycardia Related Cardiomyopathy: Response to Control of the Arrhythmia
Authors: BROMBERG BURT I. , DICK MACDONALD , REBECCA SNIDER A. , SCOTT WILLIAM A. , SERWER GERALD A. , BOVE EDWARD L. , HEIDELBERGER KATHLEEN P.
Published: June 2007

To evaluate the clinical response of five children with automatic atrial tachycardia (AAT) and associated cardiomyopathy to arrhythmia control, we compared pretreatment and posttreatment 24‐hour ECG heart rates, cardiothoracic ratio by chest radiograph, and echocardiographic measures of ventricular function. Two children were treated with amiodarone, two with surgical excision and cryoablation of the ectopic focus, and one with digoxin alone. Significantly slower mean heart rates were achieved, along with a dominant sinus rhythm and improvement in symptoms. Control of the AAT resulted in improved mean cardiothoracic ratio (0.53 pre vs 0.49 post; P = 0.02), as well as improvement in a number of echocardiographic measurements: mean shortening fraction (20% pre vs 34% post; P = 0.006), mean ejection fraction (36% pre vs 50% post; P < 0.01), mean velocity of circumferential fiber shortening (0.62 pre vs 1.20 post; P = 0.003). Mean E‐point septal separation corrected for end‐diastolic dimension also showed a trend toward improvement (0.25 pre vs 0.16 post; P = 0.11). Right ventricular endocardial biopsies in four were nonspecific; an atrial biopsy from surgery showed a Purkinje fiber‐like tissue in one patient, but was nonspecific in another. We conclude that cardiomyopathy can be causally linked to automatic atrial tachycardia and that aggressive medical and/or surgical management is warranted in those patients with signs and symptoms of impaired ventricular function. (J Interven Cardiol 1989:2:4)
A Randomized Trial of Intravenous Streptokinase Versus Tissue Plasminogen Activator for the Treatment of Acute Myocardial Infarction: Results Using an Aggressive Approach
Authors: HARTMANN JOSEPH R. , MCKEEVER LOUIS S. , BUFALINO VINCENT J. , MAREK JOSEPH C. , BROWN ALAN S. , GOODWIN MARK J. , COLANDREA MICHAEL A. , STAMATO NICHOLAS J. , CAHILL JOHN M. , O'DONNELL MICHAEL J. , AMIRPARVIZ FIROUZ. , ENGER ELAINE L.
Published: June 2007

Seventy‐six patients presenting within 6 hours of the onset of an acute myocardial infarction were randomized to either treatment with 1.5 million units of Streptokinase or 100 mg of recombinant tissue plasminogen activator intravenously. Patients not demonstrating clinical reperfusion within 1 hour were taken emergently for “salvage” angioplasty or coronary bypass surgery. Those patients demonstrating clinical reperfusion underwent early (12 to 72 hours) elective angiography and either elective angioplasty or bypass surgery. The mean time from pain onset to treatment was 149 minutes in the Streptokinase group and 134 minutes in the recombinant tissue plasminogen activator group (P = NS). There were no statistical differences between groups with regard to prior myocardial infarction, infarct location, prior coronary bypass surgery and Killip classification. Clinical reperfusion was demonstrated in 56% of the Streptokinase group and 53% of the recombinant tissue plasminogen activator group (P ‐ NS). Angiographic patency was demonstrated in 70% of the Streptokinase group and 66% of the recombinant tissue plasminogen activator group (P = NS). Left ventricular ejection fraction at discharge was no different: 47% in the Streptokinase group and 43% in the recombinant tissue plasminogen activator group (P = NS). Recurrent ischemic events were found more often in the recombinant tissue plasminogen activator group, 18%, versus the Streptokinase group 3% (P = 0.05). Treatment outcomes did not differ between groups. There was one (3%) death in the Streptokinase group versus two (6%) deaths in the recombinant tissue plasminogen activator group (P = NS). There was a trend toward a greater need for emergent coronary bypass surgery after attempted angioplasty in the recombinant tissue plasminogen activator group, four of 18 patients (22%) versus one of 23 patients (4%) in the Streptokinase group (P = 0.14). In summary, in the setting of acute myocardial infarction treated by thrombolysis, those patients treated with recombinant tissue plasminogen activator experienced significantly more recurrent ischemic events and required emergent coronary bypass surgery more frequently for failed angioplasty compared to those treated with Streptokinase. The results suggest there may be agent specific increases in complications dependent upon the thrombolytic agent of choice when salvage or early coronary angioplasty is used.
Transaortic Valve Gradient Determined by a Dual Lumen Pressure Monitoring Catheter
Authors: CRAGG DAVID R. , FRIEDMAN HAROLD Z. , O'NEILL WILLIAM W.
Published: June 2007

Simultaneous recordings of left ventricular (LV) and central aortic pressures (AO) provide the greatest accuracy for determination of the transaortic pressure difference. We describe a very simple technique for simultaneous measurement of LV and AO pressures using a new, dual lumen pressure monitoring catheter. Using this device, we compared simultaneous LV and AO as well as LV and femoral artery (FA) pressures before and after aortic valvuloplasty in seven consecutive patients. The difference between the mean aortic gradient or aortic valve area determined by the LV‐AO and LV‐FA measurement techniques was not statistically significant. Our initial experience with the double lumen pigtail catheter indicates that this device facilitates direct measurement of the LV‐AO pressure gradient and eliminates the need for two arterial punctures, a transseplal approach or alignment of LV and FA pressure curves.
Disappearance of Spontaneous Echographic Contrast after Balloon Mitral Valvuloplasty: An Indicator of Sustained Hemodynamic Improvement
Authors: SLAGBOOM TON. , TAAMS MEINDERT. , VLETTER WIM D. , SUTHERLAND GEORGE. , DE FEYTER PIM J. , SERRUYS PATRICK W.
Published: June 2007

In three patients undergoing mitral balloon valvuloplasty for mitral stenosis transesophageal echocardiography was performed before, immediately after, and 6 months after the procedure. In the one patient with persistent hemodynamically favorable result, the spontaneous echocardiographic contrast, which was seen in all three preoperatively, did not recur; in the other two patients the phenomenon was observed again after 6 months. We conclude that the disappearance of spontaneous echocardiographic contrast might be a functional morphological measure of sustained hemodynamic improvement after balloon mitral valvuloplasty.
The Ideal Thrombolytic Agent: GISSI‐2 and ISIS‐3
Authors: MAGGIONI ALDO PIETRO. , FRESCO CLAUDIO. , FRANZOSI MARIA GRAZIA. , TOGNONI GIANNI. ,   GISSI‐2 INVESTIGATORS
Published: June 2007

Streptokinase (SK) and tissue plasminogen activator (alteplase [tPA]) are by far the most intensively studied thrombolytic agents, but only recently a direct head‐to‐head comparison (GISSI‐2 Trial, in which 12,490 patients have been randomized) has become available to the scientific community. This trial, with its international extension (the International tPA/SK Mortality Trial) recruited more than 20,000 patients, showed that the two drugs tested (SK and tPA) were substantially comparable as far as the clinical events were considered. ISIS‐3, the largest randomized clinical trial ever performed, compares SK, tPA, and APSAC in a factorial design. Its results will be available before spring, 1991. It is likely that these two studies, if the results will be consistent, will give a definitive answer about comparison among thrombolytic drugs. As a consequence of that achievement, the interest of the scientific community will possibly be directed towards the long‐term prevention of the infarct complications, namely ventricular remodeling and infarct expansion or life‐threatening arrhythmias.
The “Learning Steps” of Angioplasty: Or On Becoming an Interventional Cardiologist
Authors: TALLEY J. DAVID.
Published: June 2007

During the initial application of percutaneous transluminal coronary angioplasty (PTCA), experience was concentrated in the hands of relatively few operators at a small number of centers. With relatively crude equipment by today's standards, these operators established the current levels of excellence of PTCA by careful patient selection and procedural skill. These operators taught that the “learning curve” of PTCA consisted of two parts, an initial steep upward slope composed of careful patient selection and procedural skill, and a flatter plateau phase which centered on assimilating gradual technical development. As PTCA technology advanced, there has been a suggestion that similar success rates of PTCA could be achieved by lower frequency operators. This concept implies that technical improvements have diminished the importance of operator skill and experience prerequisite to perform “routine” cases. The purpose of this article is to review the initial two “steps” of the learning curve of PTCA and to discuss additional levels of development required to become an interventional cardiologist. To facilitate understanding, I have chosen the staircase as a model. Each step will be discussed.
Intraoperative XeCl Excimer Laser Coronary Artery Endarterectomy: Clinical Experience.
Authors: BUSSIÈRE J. L. , AVRILLIER S. , DELETTRE E. , GANDJBAKHCH I. , TINET E. , OLLIVIER J. P.
Published: June 2007

We present the results of 12 XeCl laser coronary artery endarterectomies performed in ten patients during CABG surgery. The results are very encouraging and led us to the development of a new and more efficient laser catheter delivery system, which is described in the latter part of this article.
Laser‐Tissue Interactions With the Pulsed Dye Laser
Authors: NATHAN ANTHONY W. , SCRIVEN ANTHONY J. I.
Published: June 2007

The laser‐tissue interaction of the pulsed dye laser was assessed. The histological appearance of the craters showed precise margins with no evidence of collateral thermal tissue damage. The ablation of soft yellow atheroma was consistently about two‐ to threefold that of normal wall, but fibrous white atheroma was resistant to laser energy, and was ablated less than normal wall. The maximum probe tip temperature in air was 197°C, but there was relatively little heating of the coronary artery wall during lasing, and this was minimized by saline perfusion at low flow rates. Lasing produces up to 1012 irregularly shaped debris particles per liter. Debris from thrombus and normal aorta caused significant platelet aggregation in vitro, but atheromatous debris did not. In conclusion, the characteristics of the pulsed dye laser are suitable for intravascular lasing, but selective ablation of atheroma was not achieved.
Prothrombin Time and Partial Thromboplastin Time Tests Are Unnecessary Before Routine Cardiac Catheterization
Authors: VINCENT G. MICHAEL , BROWN WAYNE
Published: June 2007

Prothrombin time and partial thromboplastin time tests are commonly obtained prior to cardiac catheterization but the usefulness of the tests in these patients has not been examined. The records of 1,462 consecutive patients undergoing diagnostic catheterization were reviewed. All patients had received prothrombin time and partial thromboplastin time tests. The prevalence of abnormal test values was determined. The coagulation test values were correlated with history and physical evidence of bleeding risk, and also with bleeding complications. Abnormal coagulation values were found in 72/1,462, a prevalence of 4.9%. The history and physical exam predicted 63/72 (87.5%) of abnormal values, yielding a sensitivity of 87.5%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 99.3%. The nine unpredicted abnormal values (0.6%, 9/1,462) were minimally abnormal and clinical decision making was not affected by the test result in any of the nine patients. There was no correlation between abnormal values and bleeding complications. Abnormal test values have a low prevalence in catheterization patients, 4.9% in this series, are highly predictable from history and physical exams, and in the absence of history or physical findings do not predict procedural bleeding complications. The tests should, therefore, be obtained only in a small percentage of patients, 4.3% in this series, who have an increased bleeding risk indicated by history or physical findings of anticoagulant use, excessive bleeding, liver disease, or malabsorption.
Guidewire Facilitation of Internal Mammary Artery Cannulation
Authors: SCHREIBER THEODORE L. , GANGADHARAN V. , O'NEILL WILLIAM W.
Published: June 2007

With the advent of widespread use of the internal mammary artery for coronary revascularization, high quality delineation of this conduit during angiography is necessary. We describe herein a safe, easy method to selectively cannulate the internal mammary artery based on a steerable angioplasty guidewire technique.
Permanent Pacemaker Implantation in Patients with Persistent Left Superior Vena Cava
Authors: NANAS JOHN N. , ANASTASIOU‐NANA MARIA I. , BOUFAS DIMITRIS , ZAKOPOULOS NICHOLAS , MOULOPOULOS SPYRIDON D.
Published: June 2007

A world survey of 34 patients with persistent left superior vena cava who required permanent pacing is reviewed and one case of ours with dominant left superior vena cava is reported. Based on these cases, we conclude that the transvenous, rather than epicardial placement of a permanent pacemaker lead is the procedure of choice in patients with persistent left superior vena cava, with or without coexisting right superior vena cava.
Holmium YAG Laser Coronary Angioplasty with Multifiber Catheters
Authors: GESCHWIND HERBERT J. , TOMARU TAKANOBU , NAKAMURA FUMITAKA , KVASNICKA JAN
Published: June 2007

Excimer lasers are being extensively used for coronary angioplasty along with multifiber over‐the‐wire catheters. To determine whether another wavelength could be an alternative, the laser‐tissue interaction and the clinical usefulness of an infrared laser were studied. The laser consisted of a Holmium YAG pulsed laser coupled into a multifiber catheter. Experimental data from our laboratory showed that this solid stale laser had the ability to cut calcified tissue, to be preferentially absorbed by atheroma, and to ablate tissue even when the catheter tip was positioned at a distance from the target. These results were obtained with only minimal thermal effects. After assessment of the efficacy and safety of this technique, laser angioplasty was performed in 53 consecutive patients with totally occluded (40%) or stenosed (mean percent 94) coronary arteries with a mean length of 6 mm. The primary laser and the procedure success rate were 64% and 94%, respectively. Failures were due to inability to advance the catheter against the lesion or to cross the obstruction. Stand‐alone laser therapy could be achieved in only 18% of patients. In previous dilatation failures, laser irradiation allowed for subsequent balloon angioplasty to be successfully performed at a lower inflation pressure than that used in the failed dilatation. Complications included abrupt (during the procedure) and early (within 24 hours) vessel closure in 19% of cases, dissection without hemodynamic consequence in 28% and spasm. Reoccluded arteries could all be recanalized with dilatation. There was no death, myocardial infarction, and no urgent coronary artery bypass surgery (CABG). Thus, infrared laser angioplasty is effective in difficult lesions for dilatation. The results are obtained with a reliable, easy to use and to maintain laser source.