bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary valve morphology after balloon dilatation of pulmonary valve stenosis
Authors: Benson L. N. , Smallhorn J. S. , Freedom R. M. , Trusler G. A. , Rowe R. D.
Published: March 2007

Percutaneous balloon valvuloplasty (BV) for pulmonic valve stenosis (PS) is increasingly becoming a nonsurgical alternative in patient management [1–3]. However, the mechanism by which BV dilates the obstructive lesion has not been firmly established [4]. We have had the opportunity to examine the effects of BV in the setting of PS and present two illustrative cases documenting the morphology after BV of the stenotic bicuspid and tricuspid pulmonary valve.
Percutaneous transfemoral catheterization in aortic stenosis with a USCI sones catheter curve a type 1 (7540)
Authors: Chow Joseph S. F. , Wong Philip H. C. , Lee P. K. , Wang Rebecca Y. C. , Chen Walter W. C.
Published: March 2007

We report our experience with the use of a USCI Sones catheter curve A type 1 (7540) to cross the aortic valves of 45 patients with clinically signficant aortic stenosis. The technique was successful in all our patients with a fluoroscopic time of less than 3 min. A gradient of up to 200 mmHg across the aortic valve area was recorded, and the smallest valve area calculated was less than 0.2 cm2. The method obviated the need for a guidewire and satisfactory left ventriculograms were obtained. No major complication was observed. We conclude that the technique is a simple, rapid, and safe means of obtaining left ventricular hemodynamic and angiographic information in patients with aortic stenosis of various degrees of severity.
Electrocardiographic st‐t wave patterns, extent of coronary artery disease, and left ventricular performance following non‐q‐wave myocardial infarction
Authors: Gash Arnold K. , Warner Howard F. , Zadrozny John H. , Carabello Blase A. , Spann James F.
Published: March 2007

Subendocardial, nontransmural, or non‐Q‐wave myocardial infarction (NQMI) carries a serious prognosis. Many previous studies of NQMI include only patients without new Q waves at the time of infarction. Since the site of transmural MI (by Q waves) has implications concerning extent of coronary disease (CAD) and left ventricular (LV) dysfunction, we wondered what the extent of CAD and LV dysfunction is among acute MI patients who have neither new nor old Q waves. Furthermore, we sought to determine whether ST‐T wave patterns or resting LV ejection fraction (EF), alone or combined, could separate NQMI patients with significant CAD from those with normal or nearly normal coronaries. Therefore, we retrospectively examined angiographic and electrocardiographic data in 55 symptomatic patients with NQMI.

ST‐T wave patterns on admission were classified as either ischemic (transient ST elevation, persistent horizontal ST depression, or persistent deep T wave inversion) or nonspecific.

Eleven patients (20%) had normal or nearly normal coronaries (N); ten patients (18%) had one, seven patients (13%) had two, and 19 patients (34%) had three vessel CAD; eight patients (15%) had left main (LM) disease. Six of the 11 N patients had ergonovine tests and all six were negative.

Segmental LV wall motion abnormalities (WMA) were commonly observed; however, diffuse LVWMA were present only among patients with three vessel and LM disease. EF was below 0.50 in 48% of patients with three vessel or LM disease.

Although ischemic ST‐T wave patterns were more common (P < 0.05) among patients with significant CAD than among N patients, neither the ST‐T wave pattern nor EF, alone or in combination, allowed confident separation of N patients from significant CAD patients.

We conclude 1) A large proportion of NQMI patients have LM disease, three vessel disease, or normal or nearly normal coronaries. 2) Despite the absence of Q waves, LV dysfunction is common and the degree of LV impairment is worse among patients with more extensive CAD. 3) NQMI patients who may have normal or nearly normal coronaries cannot be reliably separated from NQMI patients with significant CAD on the basis of ST‐T wave patterns or resting LVEF. 4) Coronary angiography appears warranted to assess the extent of CAD in symptomatic NQMI patients.
Failure of percutaneous transluminal coronary angioplasty to stimulate platelet and prostaglandin activity
Authors: Stine Ronald A. , Magorien Raymond D. , Bush Charles A. , Kolibash Albert J. , Leier Carl V. , Fertel Richard H. , Brandt John , Unverferth Donald V.
Published: March 2007

Platelet function and prostaglandin activity were evaluated in nine patients with coronary artery disease undergoing percutaneous left anterior descending coronary artery angioplasty (PTCA) and compared to nine normal controls. Transcoronary measurements (arterial‐coronary sinus) of platelet counts, mean platelet volume, platelet factor 4 (PF4), beta thromboglobulin, thromboxane (B2), and 6‐keto‐PGF were made. When compared to normal controls, the patients with coronary artery disease had higher circulating baseline levels of PF4 in the coronary sinus. There was no transcardiac production of any factor at baseline or immediately after infusion of nitroglycerin or performance of PTCA. These results suggest that PTCA does not grossly alter arachidonic acid metabolism or platelet activity.
The radiographic appearance of arterial sheath kinking
Authors: Feit Alan , Sedlis Stephen , Khan Rahman , Reddy C. V. R. , El‐Sherif Nabil
Published: March 2007

A case of arterial sheath kinking is reported. Radiographically, sheath kinking has some features which mimic sheath fracture. The radiographic appearance of sheath kinking is, however, distinctive and clearly separable from sheath fracture, the hallmark of which is extravasation of contrast at the fracture site.
Relief of pressure damping during coronary angioplasty: A device for creating side holes in ptca guiding catheters
Authors: Chua K. G. , Feldman Ted , Fromes Bernard
Published: March 2007

Percutaneous coronary angioplasty guiding catheters occasionally wedge in the coronary orifice and obstruct blood flow, making completion of the balloon dilatation difficult. Side holes may be made in the catheter, but when created free‐hand may not be ideal. This report describes a device for creating side holes of small size, with uniform shape, and without rough edges. The disadvantages of dye extravasation and loss of strength in the catheter are minimized.
Coronary thrombolysis with urokinase infusion in acute myocardial infarction: Multicenter study in Japan
Authors: Kambara Hirofumi , Kawai Chuichi , Kammatsuse Katsuo , Sato Hikaru , Nobuyoshi Masakiyo , Chino Masao , Miwa Hiroshi , Uchida Yasumi , Kodama Kazuhisa , Mitsudo Kazuaki , Hayashi Takeo , Kajiwara Nagao , Sekiguchi Morie , Yasue Hirobumi
Published: March 2007

The efficacy of intracoronary administration of urokinase was evaluated in 514 patients with acute myocardial infarction (anterior, 296 patients; inferior, 195; lateral or posterior, 18; and anterior and inferior, five). The time between onset of chest pain and coronary arteriography was 0.5 to 81.0 hr with an average of 5.0 hr. Initial administration of nitrates resulted in recanalization of the coronaries in 9.3%. Subsequently, urokinase was infused into the coronary arteries, and coronary thrombolysis was successfully achieved in 66.8%. The success rate was low in a group with average infusion speed of more than 30,000 units/min or with a total dose of urokinase of 480,000 units or less. Complications, mainly arrhythmias, were present in 111 patients (33.2%) of the 334 who had successful thrombolysis and in 18 patients (10.8%) of the 166 with unsuccessful thrombolysis, but serious hemorrhage was rare and no fatal case was reported. Patients who had successful thrombolysis had less in‐hospital mortality than those who did not (6.3 vs 13.3%). Thus, coronary thrombolysis can be achieved effectively and relatively safely with a sufficient amount of intracoronary urokinase administration in acute myocardial infarction.
Acute anterior myocardial infarction complicated by mural thrombus and peripheral thromboembolism despite anticoagulation
Authors: Hwang Ming H. , Pacold Ivan , Loeb Henry S.
Published: March 2007

A 43‐year‐old man had transmural anterior wall myocardial infarction complicated by hypotension and anterior‐apical aneurysmal formation. Despite continuous anticoagulation with heparin sodium (heparin) and warfarin sodium (coumadin), a large pedunculated left ventricular thrombus was formed. Four hours after uneventful left ventriculography, the patient experienced acute superior mesenteric embolism. An emergency mesenteric embolectomy and then left ventricular aneurysmectomy with clot evacuation were performed to save the bowel and to prevent further embolization.
A modified catheter system for retrograde left ventricular catheterization in aortic valve stenosis
Authors: Macdonald Robert G. , Feldman Robert L. , Pepine Carl J.
Published: March 2007

Conventional retrograde catheterization of the left ventricle using a single large catheter through severely stenotic aortic valves or prostheses has recognized difficulties. An alternative method is described. This method incorporates a coronary angioplasty guide catheter and coronary probing catheter attached to separate pressure transducers allowing simultaneous recording or aortic and LV pressures. This technique was used in seven patients with aortic stenosis in whom a conventional approach had failed. The movable probing catheter permits alterations of the catheter orientation and angulation while the guiding catheter stabilizes the system within the high velocity jet formed in the ascending aorta. This stabilization and the small size of the coronary probing catheter permit exploration of the valve surface and allow for insertion through a tilting disc valve or a severely stenotic valve without significantly altering hemodynamic function. In our laboratory this technique allowed us safely and reliably to assess aortic valve dynamics in each of the patients in whom the technique was attempted without resorting to either transseptal or direct left ventricular puncture.
Percutaneous left heart catheterization and coronary arteriography with and without an arterial sheath in patients without peripheral vascular disease
Authors: Ilia Reuben , Kimbiris Demetrios , Hakki A‐Hamid , Edlin Dale , Iskandrian Abdulmassih S. , Bemis Charles E. , Mintz Gary S. , Segal Bernard L.
Published: March 2007

The advantages and disadvantages of an arterial sheath to introduce catheters percutaneously through the femoral artery were prospectively studied in 184 consecutive patients without peripheral vascular disease undergoing routine diagnostic left heart catheterization and coronary arteriography. The arterial sheath was used randomly in 91 patients (sheath group) and the standard Seldinger technique in 93 (control group). There were no differences in age or sex between the two groups. All patients were studied with no premedication and had the same dose of lidocaine local anesthesia and heparin. No major complication occurred in any of the patients in the sheath or control groups. There were no significant differences in groin hematomas between the two groups. The patients in the control group more commonly had severe or moderately severe discomfort requiring additional local anesthesia. We conclude that the use of an arterial sheath percutaneously for introduction of catheters for left heart catheterization and coronary arteriography is advisable, particularly for anxious patients who have a low pain threshold.
Coronary atherosclerosis and the bypass grafts: Twenty‐year follow‐up of a case
Authors: Singh Ram N.
Published: March 2007

A 44‐year‐old man was diagnosed as having coronary artery disease (CAD) by arteriography in 1964. In the subsequent 20 years, he has undergone seven angiographic studies and four coronary bypass operations. Close scrutiny of the clinical events and the angiographic studies in this patient offers important clues to the behavior of CAD and the bypass grafts, both internal mammary artery (IMA) and saphenous vein grafts (SVGs).
Late recanalization at the site of failed percutaneous transluminal coronary angioplasty
Authors: Slack John D. , Pinkerton Cass A. , Vantassel James W.
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) was performed unsuccessfully, resulting in disruption and near‐total closure of the proximal right coronary artery at the site of stenosis following balloon inflation. The artery could not be reopened in the catheterization laboratory despite intracoronary nitroglycerin, sublingual nifedipine, and multiple balloon inflations. Myocardial revascularization surgery was immediately performed with excellent graft flow. No apparent myocardial infarction resulted. Catheterization performed at one year showed normal left ventriculography, total occlusion of the bypass graft, and reopening and normalization of the right coronary artery at the site of PTCA‐induced occlusion. Possible mechanisms for this phenomenon and its clinical implications are discussed.
The value of coronary artery visualization during routine intravenous digital subtraction ventriculography
Authors: Haggman Dale , Detrano Robert , Simpfendorfer Conrad
Published: March 2007

Right anterior oblique intravenous digital subtraction ventriculograms and selective coronary angiograms were performed on 71 consecutive patients. The intravenous ventriculograms were reviewed by two blinded observers with close examination of the right and left anterior descending coronary arteries. These were considered abnormal if they failed to opacify or if luminal irregularities suggested > 50% obstruction. Significant (< 50% obstruction) occlusions of the right coronary artery were found in 16 patients according to a blinded reading of the selective angiograms. The observers correctly identified 13 of these on the digital subtraction ventriculograms (sensitivity 81%(. Of the 55 nondiseased right coronary arteries, correct identification was made in 47 (specificity 85%). Likewise, 17 patients had angiographically significant obstructions of the left anterior descending coronary artery and 15 were correctly identified by digital subtraction ventriculography (sensitivity 88%). However, only 20 of the 54 nondiseased left anterior descending coronary arteries were correctly identified (specificity 37%). Nonopacification or visualization of a severe obstruction of the right coronary artery is a useful finding and should be sought during examination of routine intravenous digital subtraction ventriculograms. This technique is not adequate at the present time to replace selective coronary arteriography in the assessment of coronary anatomy.
Flow disturbance due to venous valves: A cause of graft failure
Authors: Singh Ram N.
Published: March 2007

Late (greater than 1 year) postoperative angiographic studies in five patients revealed evidence of flow disturbance at the distal valve, when two valves were present in the body of a saphenous vein graft (SVG(. This was associated with delayed clearance of radiopaque dye due to reduced velocity of flow. On follow‐up, occlusion, thrombus formation, or development of atherosclerosis seemed to have occurred in anatomic relation to these valves. All five patients had one additional graft in a good state of preservation; three internal mammary artery (IMA) grafts, and 2 SVGs. The latter had only one venous valve, and the velocity of flow was good.

It appears that good velocity of flow is essential to the integrity of coronary bypass grafts. The presence of more than one venous valve in a graft appears to cause flow disturbance and sluggish velocity, factors adversely affecting their integrity.
Detection of atrial septal defect by contrast‐enhanced ultrafast computed tomography
Authors: Skotnicki Robert , Macmillan Robert M. , Rees Michael R. , Maranhao Vladir , Murphy David , Flicker Stephanie , Eldredge W. Jay , Clark Donald L.
Published: March 2007

A 53‐year‐old man with previous surgically corrected pulmonic valve stenosis was evaluated for central cyanosis. A right‐to‐left shunt at the atrial level was diagnosed by contrast‐enhanced ultrafast computed tomography. Cardiac catheterization confirmed the CT findings and provided quantitation of the shunt.
Partial left anomalous pulmonary venous return: A diagnostic dilemma
Authors: McGaughey Mark D. , Traill Thomas A. , Brinker Jeffrey A.
Published: March 2007

Two adults were seen with left partial anomalous pulmonary venous return with intact atrial septum. Both cases had remained undiagnosed despite medical attention since childhood, including previous cardiac catheterization in one patient. Noninvasive tests, indocyanine green dye injections, pulmonary artery angiography, and venous sampling for oximetry high in the superior vena cava above the entry of the innominate vein will help establish the diagnosis of this disorder.
Percutaneous transluminal coronary angioplasty in patients over the age of 70 years
Authors: Dorros Gerald , Janke Lynne
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) was attempted in 109 patients over the age of 70 years (mean age 75.9). The patients' clinical characteristics showed 55% with multivessel coronary disease, 86% with significant angina pectoris (Class II to IV), 16% with prior bypass surgery, and 2.7% with left ventricular dysfunction. Angioplasty data showed the mean percent diameter stenosis was reduced from 83 ± 12% to 15 ± 16%. One lesion was dilated in 67%, two lesions in 30%, and three lesions in 3% of the patients. A successful dilatation was achieved in 138/148 lesions (89%) with 90/109 patients (83%) clinically improved at hospital discharge. Significant complications were encountered in six patients (5.5%): three transmural infarctions (2.8%), two mortalities (1.8%), and one emergency surgical procedure (0.9%). Follow‐up data (≥1 year) are available in 77 patients: 68 patients (92%) had an improved anginal status {49 patients (65%) had no angina}. During a mean follow‐up of 23 ± 10 months, there were two myocardial infarctions and three deaths. A clinically apparent recurrence occurred in 14 patients (17%). Repeat angioplasty was successfully performed in 13/14 patients. Bypass surgery was performed during the follow‐up in three patients (two of whom had had a recurrence after a second successful angioplasty; one patient died during elective surgery). Transluminal coronary angioplasty can be performed in patients over age 70 with a good success rate, an acceptable complication rate, a relatively low clinically apparent recurrence rate, and should be considered as a therapeutic modality and alternative for the selected geriatric patient.
Percutaneous angioplasty of internal mammary artery graft stenosis using the brachial approach: A case report
Authors: Salinger Michael , Drummer Eric , Furey Kevin , Bott‐Silverman Corinne , Franco Irving
Published: March 2007

Cannulation of the internal mammary artery (IMA) via the ipsilateral brachial approach offers a complementary alternative to the transfemoral approach for IMA graft angioplasty and can offer potential advantage in terms of catheter stability and ease of IMA cannulation. This report describes successful IMA graft stenosis angioplasty using the ipsilateral brachial approach.
Percutaneous left brachial catheterization usingl 5‐French preformed (Judkins) catheters
Authors: Eugster George S. , Reisig A. Henry , Ugaldea C. Tim
Published: March 2007

A method is described combining percutaneous brachial catheterization techniques with the use of 5‐French (F) preformed (Judkins) catheters. This method was used in 50 patients with one unsuccessful attempt to cannulate the brachial artery. There was one lost pulse requiring surgical thrombectomy but no other cardiac, vascular, or neurologic complications. Two moderately large hematomas occurred, which resolved without sequelae. Manipulation of 5‐F Judkins catheters from the left arm was found to be quite acceptable with adequate visualization of the coronary arteries in all cases.

We believe this technique to be an excellent alternative to brachial cutdown or transaxillary methods in patients with severe occlusive ileofemoral disease as well as an improved technique for out‐patient catheterization.
Dipyridamole versus intracoronary injection of contrast medium for the evaluation of coronary reserve in man: A comparative study
Authors: Foult Jean‐Marc , Nitenberg Alain
Published: March 2007

Coronary reserve can be assessed by the ratio of coronary blood flow after “maximum” vasodilation to control flow. The intravenous infusion of dipyridamole (0.56 mg × kg−1) is considered to elicit maximum coronary vasodilation. The present study was designed to compare coronary flow and resistance responses to intravenous dipyridamole and intracoronary injection of contrast medium (ioxaglate), this latter technique being frequently used in digital radiology to stimulate hyperemia. The comparison was performed in seven normal patients, nine patients with coronary artery disease, and 16 patients with dilated cardiomyopathy. Coronary flow reserve was calculated as the ratio of peak flow after dipyridamole or contrast medium to control flow, and coronary resistance reserve was calculated as the ratio of minimal to control coronary resistance after each stimulus. Although flow reserve after dipyridamole was approximately twice that obtained after contrast medium in the normal group (4.01 ± 0.56 vs 2.02 ± 0.24) there was a close and linear relationship between coronary flow and resistance reserve estimated by both techniques (r = 0.846, p < 0.001 for flow reserve ratios, and r = 0.844 p < 0.001 for resistance reserve ratios). However, contrast‐induced hyperemia identified 13/25 (52%) of patients with coronary artery disease or dilated cardiomyopathy as having a reduced flow reserve, while dipyridamole revealed a restrained coronary flow reserve in 20/25 (80%) of these patients. Similar proportions were obtained when using coronary resistance reserve (56% for contrast vs 80% for dipyridamole). Thus, although contrast medium and dipyridamole provide closely correlated values of coronary flow and resistance reserve, a better separation between normals and patients is achieved after dipyridamole. These results should be considered in the estimation of coronary reserve by means of digital angiography and contrast agents, since the obtention of maximum coronary blood flow appears as a prerequisite for an adequate evaluation of the human coronary circulation functional status.
Relation between left ventricular diastolic function and exercise tolerance in patients with left ventricular dysfunction
Authors: Heo Jaekyeong , Iskandrian Abdulmassih S. , Hakki A‐Hamid
Published: March 2007

Previous studies show no correlation between resting systolic left ventricular performance assessed as the ejection fraction and exercise tolerance. This study examined the relation between left ventricular diastolic performance and exercise tolerance in 63 patients with left ventricular dysfunction (ejection fraction < 50%) due to known or suspected coronary artery disease. The 51 men and 12 women, aged 54 ± 8 years (mean ± standard deviation), underwent symptom‐limited upright exercise testing on a bicycle ergometer. The exercise end‐points were angina (n:5), dyspnea (n:16), and fatigue (n:42). The patients were divided into three groups: group 1 (n:28) with normal exercise tolerance (9.5 ± 2.4 minutes), group 2 (n:18) with mild exercise intolerance (5.8 ± 0.5 minutes), and group 3 (n:17) had severe exercise intolerance (3.7 ± 0.9 minutes). The three groups did not differ in age, ejection fraction, end‐diastolic volume, exercise end‐point, exercise heart rate, and left ventricular peak filling rate at rest. The exercise peak filling rate was, however, significantly higher in group 1 (p = 0.03). Stepwise multivariate discriminant analysis of important variables identified the exercise peak filling rate as the only predictor of exercise tolerance (F = 6.0).

Thus, variation in exercise peak filling rate may in part explain the variability of exercise tolerance in patients with left ventricular dysfunction; patients with preserved exercise capacity have higher exercise peak filling rate than those with exercise intolerance.
Intravascular blood velocity in simulated coronary artery stenoses
Authors: Kilpatrick David , Webber Stephen B.
Published: March 2007

The profiles of blood velocity within arterial stenoses have been measured using fiber optic laser Doppler anemometry (FOLDA). The arterial stenoses were created in arteries and tubes of similar size to human coronary arteries and were perfused in vitro at pressures and flows typical of those in the human circulation.

At very low flow rates, flow and peak velocity are linearly related, and thus peak velocity measurement can predict internal cross‐sectional areas accurately. With higher flow rates, the intravascular velocities are not linearly related to flow and cannot be used to measure internal cross‐sectional area. This is due to flattening of the velocity profile at both more severe stenoses and higher flow rates.
New triple‐lumen balloon catheter for percutaneous (pulmonary) valvuloplasty
Authors: van den Berg Eduard J. M. , Niemeyer Menco G. , Plokker Thijs W. M. , Ernst Sjef M. P. G. , de Korte Jos
Published: March 2007

Percutaneous transluminal balloon pulmonary valvuloplasty has been performed since 1982. In publications, the most critical problems mentioned are severe systemic hypotension and bradycardia due to stasis of blood flow.

A triple‐lumen balloon was developed to allow more rapid inflation and deflation and to preserve the preexistent forward blood flow during maximal inflation. Only a slight systemic hypotension and no bradycardia were seen in the first two patients with pulmonary valve stenosis treated with this type of balloon. Thus, the maximal inflation time is not a critical parameter, whereas with the former types of balloon, maximal inflation times were critical, and, if longer than 5 to 10 sec, severe systemic hypotension was registered.

We conclude that the triple‐lumen pulmonary valve‐dilatation balloon catheter is superior to the single‐lumen balloon catheter used up to now.
Cigarette smoking during coronary angiography: Diffuse or focal narrowing (spasm) of the coronary arteries in 13 patients with angina at rest and normal coronary angiograms
Authors: Maouad Joseph , Fernandez Francisco , Hebert Jean Louis , Zamani Karen , Barrillon André , Gay Jean
Published: March 2007

To evaluate the acute effects of cigarette smoking on coronary arteries (CA), repeated coronary angiograms were performed in 13 patients with angina at rest and with normal coronary angiograms at basal state, during smoking, and then after methylergometrine (MEM) and after intracoronary nitroglycerin. Smoking induced anginal pain in three patients, triggered spasm (focal narrowing) in six, and/or an abnormal segmental diffuse narrowing (> 30%) in eight. The narrowing of the left CA was on average −21 ± 13% (P < 0.001), with more important narrowing of the mid‐left anterior descending (−29 ± 19%, P < 0.001). The mean of the maximal segmental narrowing by patient was −34 ± 13% (P < 0.001). MEM produced similar effects and induced focal CA spasms in nearly the same patients at the same sites. Cigarette smoking may induce vasoconstrictive effects on CA in patients with rest angina and normal coronary angiograms. This action is not dose‐dependent and may be initiated by less than one cigarette. These observations offer a new perspective for the understanding of the role of smoking in the precipitation of coronary events.
Thrombus formation in the ascending aorta: A complication of angioplasty
Authors: Wang Shih‐Pu , Chiang Benjamin N.
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) is recognized as an effective therapeutic procedure for nonsurgical relief of critical coronary stenosis. However, this procedure has the inherent traumatic risk of thromboembolic phenomenon in treated patients. This paper describes a hiterto unreported complication. In two patients a thrombus appeared in the ascending aorta during PTCA performed in the left anterior descending artery (LAD). Mechanisms involved are postulated. It is emphasized that particular attention should be paid to the lateral view in dilatation to treat LAD lesion, especially if the procedure is prolonged.
Early experience with balloon angioplasty of internal iliac arteries for vasculogenic impotence
Authors: Angelini Paolo , Fighali Sayid
Published: March 2007

Five patients with vasculogenic impotence underwent balloon angioplasty of internal iliac and/or internal pudendal artery obstructions in an attempt to increase the blood pressure in the dorsalis penis artery and thus improve erectile function. Four patients had bilateral obstructions, and one patient had unilateral iliopudendal arterial disease. Balloon angioplasty was used to dilate bilateral lesions in three patients and unilateral lesions in two patients. Four of the five patients had improvement in erectile function for 2 to 18 months (mean, 12 months) after angioplasty. We conclude that balloon angioplasty is an adequate, expeditious, and relatively inexpensive method for treating subtotal obstruction of the internal iliac and/or internal pudendal arteries in patients with vasculogenic impotence.
Percutaneous transluminal coronary angioplasty in situs inversus
Authors: Moreyra Abel E. , Saviano George J. , Kostis John B.
Published: March 2007

A case of percutaneous transluminal coronary angioplasty to the right coronary artery in a patient with situs inversus is presented. The selection of the guiding catheter is discussed.
Hemodynamic monitoring and pacing with one catheter: A pilot study
Authors: Gessler Carl J. , Jaffe Allan S.
Published: March 2007

Attempts to incorporate the monitoring of central pressures and pacing into one catheter have heretofore been unsuccessful. Recently, a new catheter for monitoring central hemodynamic pressures, which has a right ventricular port (Chandler pacing port), has been devised, which has been reported to allow for simultaneous acquisition of hemodynamic data and reliable pacemaker function as well. To assess the reliability of this catheter, we studied ten consecutive Swan‐Ganz catheterizations utilizing this new catheter system. In all instances, hemodynamic monitoring was established without difficulty. In three instances, because of right heart enlargement, fluoroscopy was necessary to position the pacing probe at the right ventricular apex. In all ten instances, a threshold of less than 2.5 mV was obtained. Isolated PVCs and nonsustained ventricular tachycardia were common during insertion. After initial placement, the threshold for sensing and pacing was assessed every 6 hr. Malfunction occurred in three patients. In all, repositioning was accomplished without marked difficulty; in one it required fluoroscopy. In three instances, the Swan‐Ganz pacing catheter system malfunctioned. These data are similar to data utilizing other modalities of temporary pacing and suggest that this catheter may be capable of providing hemodynamic monitoring and pacing from a single percutaneous procedure.
Quantitative validation of cineangiographic axial oblique biplane left ventricular volume measurement
Authors: Pietras Raymond J. , Kondos George T. , Juska Jonas
Published: March 2007

Axial oblique left ventriculography allows unique visualization of acquired and congenital cardiac lesions. However, validation of the accuracy of left ventricular (LV) volume with axial oblique projections is limited and clouded by orthogonal violations between biplane projections. Biplane cineradiographic volume measurement of 17 LV casts employing the axial projection 35° right anterior oblique/55° left anterior oblique/30° cranial (35°RAO/55°LAO/30°Cr) was performed and compared to the conventional postero‐anterior/lateral (PA/Lat) and 30° right anterior oblique/60° left anterior oblique (30°RAO/60°LAO) views. LV volume was calculated from biplane cineradiograms by area length and Simpson's rule method. True LV volume by water displacement was 33 ± 28 (mean± S.D.), range 15 to 112 ml. LV cast volume calculated by the area length method from cineradiograms was overestimated (p < 0.002) but no different by Simpson's rule method (pNS). The ideal correlation was best approximated by the 35° RAO/55°LAO/30°Cr biplane view calculated by Simpson's rule, r = 0.99, y = 3.5+ 0.9 ×, and standard error of estimate (SEE) = 4.3 ml. Biplane LV angiography with the axial projection permitted accurate LV volume measurement, and Simpson's rule provided the best representation of true volume.
Thermodilution measurement of the right ventricular ejection fraction
Authors: Morrison Douglass A. , Stovall Ray , Sensecqua James , Friefeld Geoffrey
Published: March 2007

This study addressed the clinical reproducibility and validity of the thermodilution (TD) measurement of the right ventricular ejection fraction (RVEF). Forty‐one patients underwent right heart catheterization, including TD RVEF, within 2 h of gated first pass (GFP) and gated blood pool (GBP) radionuclide ventriculography; 21 had single plane contrast right ventricular angiography (ANGIO) during the same catheterization. Analysis of variance showed no difference among three successive TD RVEF measurements. magnified image

Stroke volume by RV ANGIO correlated with Fick (n = 10, r =.86) and thermodilution stroke volume (n= 21, r=.88). It is concluded that although the thermodilution method is an accurate way to measure flow, it is not an accurate way to measure right ventricular ejection fraction, and by inference, ventricular volumes. The most likely explanation for this finding is incomplete mixing as in previous studies of indicator methods of measuring left ventricular volumes.
Left atrial and ventricular transseptal catheterization review: Losing skills?
Authors: Schoonmaker Fred W. , Vijay Nampalli K. , Jantz Richard D.
Published: March 2007

Transseptal catheterization has been routinely done at this institution for the past 19 years to evaluate the left heart. Reviewing the last 250 consecutive transseptal heart catheterizations between 1978 and 1986, the left atrium and ventricle were entered in all but six patients. One death occurred with four other major complications. There were 177 males and 73 females ranging from 18 to 84 years of age. Of these 250 studies, 31 were in association with direct left ventricular apical puncture; 42 were in patients with subaortic stenosis; 101 were in aortic stenosis; 26 were in patients with combined aortic and mitral disease; and four were in patients with triple prosthetic valve replacements. No attempts were made to cross the prosthetic mitral valves.

A decline in the number of transseptal studies at this institution has been noted over the past 8 years and the technique is no longer taught routinely to Fellows. The reduction is due to increased emphasis on coronary artery anatomy, fewer rheumatic and prosthetic valvular admissions, and improved evaluation by non‐invasive echocardiography and doppler studies. This has resulted in a loss in proficiency among invasive cardiologists.

In conclusion, the transseptal technique is potentially hazardous, but continued usage will maintain proficiency and a low major and minor complication rate.
Optimal ECG monitoring during percutaneous transluminal coronary angioplasty of the left anterior descending artery
Authors: Feldman Ted , Childers Rory W. , Chua K. G.
Published: March 2007

During percutaneous transluminal coronary angioplasty (PTCA) frontal ECG leads are routinely monitored. The detection of ST segment deviation during the procedure is important for decisions regarding guiding catheter seating and the timing of balloon inflation and deflation. ST segment deviation appears on intracoronary electrograms in the absence of changes on the surface ECG in many patients, while the reverse is true in some individuals. When a precordial lead is employed, V5 or V6 is most commonly selected. The surface ECG leads most sensitive for monitoring ischemia during left anterior descending angioplasty are not known. In nine lead surface ECGs recorded during balloon inflation, a small degree of ST segment elevation occurred in leads I, aVL, and V5. Lead V2 demonstrated an increase in ST displacement from 0.0 ± 0.03 mV to 0.29 ± 0.25 mV during coronary occlusion (p<0.01). We conclude that if V5 or V6 is used as a single precordial lead, surface ECG alterations are easily overlooked. During left anterior descending occlusion the most sensitive surface lead is V2. Optimal ECG monitoring during PTCA in some cases should involve surface lead V2 or the intracoronary lead.
Efficacy and safety of outpatient cardiac catheterization
Authors: Mahrer Peter R. , Young Charlie , Magnusson Peter T.
Published: March 2007

Outpatient cardiac catheterization has become the standard in our laboratory. The only exclusion for outpatient study is current hospitalization for cardiac symptoms. Thus, any patient well enough to be at home is studied on an outpatient basis. We reviewed our experience on 4,094 diagnostic studies of which 3,537 (86%) were done on a same‐day basis. The complication rates were generally lower than in published series with a mortality of 0.05%. There were no admissions for late bleeding. Ninety‐seven percent of the procedures were done by the percutaneous technique utilizing 7‐French catheters. Patients were heparinized, and protamine was not used. The low complication rate is to a large extent due to meticulous postoperative care by critical care nurses in an outpatient observation unit contiguous to the laboratory. Outpatient cardiac catheterization is a safe, cost‐saving approach applicable to a large majority of cardiac patients.
Coronary collateral blood flow in a patient with angiographically normal coronary arteries
Authors: Celano Charles , Peters Robert W. , Fisher Michael L.
Published: March 2007

A 36‐year‐old man underwent coronary anteriography for evaluation of chest pain. His coronary arteries were smooth and free of obstructive disease. Selective right coronary injection revealed a large collateral vessel that opacified distal and proximal portions of the left circumflex coronary artery. Our case supports the view that coronary collateral vessels may occur in the absence of obstructive lesions.
Multiple coronary thromboses in previously normal coronary arteries treated with streptokinase
Authors: Renlund Dale G. , Chandra Nisha Chibber , Gottlieb Sidney O.
Published: March 2007

A patient is presented with normal coronary arteries in whom total occlusions in three branches of two epicardial coronary arteries developed in association with chest pain and electrocardiographic evidence of transmural ischemia. A combination treatment strategy addressing both coronary vasoconstriction and thrombosis is illustrated.
Reporting, filing, and retrieval of coronary angiographic findings: A new personal computer‐based system
Authors: Bozzi G. , Casolo F. , Ferrante M. , Presti F. Lo , Terranova P.
Published: March 2007

A software system for semiautomatic reporting and automatic filing of coronary angiographies has been developed and is suitable for an IBM Personal Computer (PC) with graphic tablet and printer. Coronary angiographic findings referring to the native anatomy, pathology, and post‐surgical status can be easily recorded. The data is automatically coded and filed according to category of information. This system can analyze previously filed data and perform searches under one or more angiographic findings. This allows for a comparison of different series of patients.
Comparative safety and efficacy of percutaneous transluminal coronary angioplasty in men and in women
Authors: McEniery Paul T. , Hollman Jay , Knezinek Valerie , Dorosti Khosrow , Franco Irving , Simpfendorfer Conrad , Whitlow Patrick
Published: March 2007

In early reports of percutaneous transluminal coronary angioplasty (PTCA) in women, the complication rate was higher and the success rate lower than in men. From December, 1980, to December, 1986, 969 women aged 61 (32––84) years and 2,727 men aged 57 (27––84) years underwent PTCA, at our institution. At the time of PTCA 26% of the women had functional class IV angina pectoris compared to 16% of the men (P<0.005). Women more often had hypertension (56% vs 39%), left ventricular hypertrophy, diabetes mellitus (19% vs 11%; P<0.0005), and family history of coronary artery disease than men. Significantly more of the men (74%) smoked than did the women (53%). The success rate in women was 93% as compared to an angiographic success rate in 2,727 men of 93.5% (ns). The rate of emergency bypass surgery in women was 3.8% as compared to 3.2% in men (ns). The death rate was 0.3% in women as compared to 0.09% in men. Women underwent more PTCA of the left anterior descending coronary artery (52% vs 48% of lesions in men; P<0.05) and right coronary artery (32% vs 27% in men; P<0.0005). Fewer of the women (9%) had had previous bypass surgery than had the men (15% P<0.0005). Procedural details, including balloon diameter, vessel diameter, lesion response pressure, inflation number, and maximum inflation pressures used at PTCA, were not different between men and women. Women had significantly more ST segment shift of 1 mm of more at the time of balloon inflation than men (P<0.0005). Thirty‐five percent of women demonstrated intimal tear at the site of PTCA as compared to 30% of men (P<0.0005). Men and women demonstrated similar angiographic change following successful PTCA, with reduction of stenosis from 79% ± 13% and reduction in gradient from 52 ± 19 mmHg to 11 ± mmHg. Women demonstrated more guiding catheter problems with PTCA (14% vs 11% in men; P<0.05) and more damping of the pressure with the guiding catheter (6% vs 3% in men; P<0.0005). One percent of women had a problem with vascular access compared to 0.3% of men (P<0.05). Of the first 300 women undergoing PTCA at our institution, 94% underwent single‐vessel PTCA, whereas 86% of the last 300 women underwent single‐vessel PTCA. The emergency bypass surgery rate declined from 5.7% to 3.7%. At follow‐up of 20 ± 12 (1––69) months, chest discomfort was improved in 90% of women and in 89% of men; 2.9% of women had suffered a myocardial infarction as compared to 2% of men; 4.9% of women had undergone repeat PTCA as compared to 5.3% of men; and 7% of women underwent open heart surgery late after PTCA as compared to 6.8% of men. In summary, PTCA in women did not carry an increased rate of emergency bypass surgery or death as compared with that in men. The long‐term efficacy is similar to that seen in men.
Nitroglycerin‐induced coronary vasodilatory responses in patients during isometric handgrip exercise
Authors: Kern Morton J. , Henry Rodney L. , Miller John T.
Published: March 2007

Intracoronary nitroglycerin is frequently administered during invasive procedures such as coronary angioplasty or thrombolysis which may be associated with pain and sympathetic neural stimulation. Whether sympathetic‐mediated reflex vasoconstriction interferes with nitroglycerin‐induced augmentation of coronary blood flow is unknown. Therefore, coronary and systemic hemodynamics were measured in 19 patients during isometric handgrip exercise (3 min × 25% maximal effort), during intracoronary nitroglycerin, and during handgrip plus intracoronary nitroglycerin. Nine patients had no significant left anterior descending coronary artery stenosis (group 1) and ten patients had > 70% left anterior descending coronary artery stenosis (group 2). Handgrip exercise increased heart rate, mean arterial pressure, and coronary sinus and great vein flow 15% while increasing coronary resistance 10%. Intracoronary nitroglycerin (200 μg) reduced mean arterial pressure ‐ 4 ± 6% and increased great cardiac vein flow 35–72%. Anterior left ventricular regional coronary flow responses to intracoronary nitroglycerin were unaffected by sympathetic stimulation for group 1. Group 2 had a greater increase in great vein flow with intracoronary nitroglycerin plus handgrip compared to nitroglycerin alone due to increased mean arterial pressure with no change in the great vein resistance. These data indicate that sympathetic stimulation does not alter the nitroglycerin‐induced augmentation of coronary sinus and great vein blood flow in patients with and without significant left anterior descending coronary artery stenosis. In patients undergoing invasive interventions who may have increased circulating catecholamines, mild sympathetic (isometric) stimulation does not appear to interfere with the coronary vasodilatory responses to intracoronary nitroglycerin.
Percutaneous transluminal coronary angioplasty in patients with unstable angina pectoris refractory to medical therapy: Long‐term clinical and angiographic results
Authors: Thijs Plokker H. W. , Ernst Sjef M. P. G. , Bal Egbert T. , Van Den Berg Eduard C. J. M. , Mast Gijs E. G. , Van Feltz Taco A. Der , Ascoop Carl A. P. L.
Published: March 2007

The purpose of this study was to assess the results of percutaneous transluminal coronary angioplasty (PTCA) in 469 consecutive patients with unstable angina pectoris refractory to medical therapy. The primary success rate was 88%, but, since the introduction of the steerable wire system, the success rate has increased to 90%. Mortality was 1%. There were no statistically significant differences in success rates per vessel. Actuarial total 5 year survival was 94%. After 5 years, actuarially, 79% of the patients were free of events (recurrence of angina, residual myocardial infarction, re‐PTCA, coronary artery bypass surgery or death). Aortocoronary bypass surgery was performed in 9% of the 469 patients. The angiographic recurrence rate was 28%, but, of the patients who were symptom‐free and who had a follow‐up angiogram, only 3% had an angiographic recurrence, whereas 98% of the patients who did not have a repeat angiogram were symptom‐free. It is concluded that, in a selected group of patients with the clinical syndrome of unstable angina pectoris refractory to medical therapy, the long‐term clinical results are good and survival is excellent.
The safety of protamine sulfate in diabetics undergoing cardiac catheterization
Authors: Reed David C. , Gascho Joseph A.
Published: March 2007

The frequency of anaphylactoid reactions to protamine sulfate was examined by reviewing the records of diabetic patients undergoing cardiac catheterization over a 5‐year period, and by prospectively monitoring diabetic patients receiving NPH insulin during the infusion of protamine sulfate.

No anaphylactoid reactions were noted after protamine administration (48 ± 5 mg) in the retrospective study in either patients with prior exposure to protamine (74 catheterizations) or in diabetics with no exposure to protamine (132 catheterizations). In the prospective study, no anaphylactoid reactions were seen in the 24 NPH insulin‐dependent diabetics during the infusion of protamine sulfate (45 ± 5 mg). Five of the 42 patients (12%) from the retrospective study who underwent vascular surgery developed severe reactions to much larger doses of protamine (380 ± 118 mg).

Diabetics with prior exposure to protamine sulfate do not appear to be at increased risk of anaphylactoid reaction after the administration of protamine sulfate in the dose range of < 50 mg at the time of cardiac catheterization.