bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary artery anomalies in 126,595 patients undergoing coronary arteriography
Authors: Yamanaka Osamu , Hobbs Robert E.
Published: March 2007

Coronary artery anomalies were found in 1,686 patients (1.3% incidence) undergoing coronary arteriography at the Cleveland Clinic Foundation from 1960 to 1988. Of the 1,686 patients, 1,461 (87%) had anomalies of origin and distribution, and 225 (13%) had coronary artery fistulae. Most coronary anomalies did not result in signs, symptoms, or complications, and usually were discovered as incidental findings at the time of catheterization. Eighty‐one percent were “benign” anomalies: (1) separate origin of the left anerior descending and circumflex from the left sinus of Valsalva; (2) ectopic origin of the circumflex from the right sinus of Valsalva; (3) ectopic coronary origin from the posterior sinus of Valsalva; (4) anomalous coronary origin from the ascending aorta; (5) absent circumflex; (6) intercoronary communications; and (7) small coronary artery fistulae. Other anomalies may be associated with potentially serious sequelae such as angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure, or sudden death. Potentially serious anomalies include: (1) ectopic coronary origin from the pulmonary artery; (2) ectopic coronary origin from the opposite aortic sinus; (3) single coronary artery; and (4) large coronary fistulae. Coronary artery anomalies require accurate recognition, and at times, surgical correction.
Left main percutaneous transluminal coronary angioplasty with the autoperfusion catheter in an animal model
Authors: Turi Zoltan G. , Rezkella Shereif , Campbell Colin A. , Kloner Robert A.
Published: March 2007

Left main coronary angioplasty is associated with high risk because of interruption of blood flow to much of the left ventricle during balloon inflation. An “autoperfusion” balloon angioplasty catheter that allows blood to flow passively distal to an inflated balloon was tested in dogs and compared with inflations with standard balloon catheters. During 3 min occlusions of the left main coronary artery with the autoperfusion catheter, regional myocardial blood flow was preserved at 0.60 ± 0.14 ml/min/g, compared with 0.07 ± 0.03 ml/min/g during inflation with standard balloon catheters (P < 0.01). Similarly, at the end of 3 min of inflation, left ventricular systolic pressure and dP/dt were maintained with autoperfusion catheter inflation, but they were severely depressed after standard angioplasty balloon inflation. All seven dogs survived autoperfusion balloon inflation, whereas five of seven developed sustained ventricular tachycardia and/or ventricular fibrillation during or after standard balloon inflation. Thus, distal blood flow, hemodynamics, and survival were preserved during autoperfusion balloon inflation in the left main coronary artery.
Influence of catheter technology and adjuvant medication on acute complications in percutaneous coronary angioplasty
Authors: Spielberg Christoph , Schnitzer Luise , Linderer Thomas , Schröder Rolf
Published: March 2007

We report on the complication rates in 660 consecutive coronary angioplasties (725 lesions) performed using four procedures that differed with respect to catheter technology and adjuvant medication. After the PTCA regimen in our laboratory had beem changed from conventional steerable systems to the monorail technique, we observed a significant increase in the incidence of transient vessel occlusions from 2.6% to 7.7%, of permanent occlusions from 3.6% to 8.8%, and of intracoronary thrombus‐formation from 2.6% to 5.5%. This was associated with the frequent observation of thrombotic material on the partially Tefloncoated guidewires. Coronary perfusion with urokinase (1,670‐ 6,670 U/min) lead to a further increase in the complication rates (10.4%/10.3%/6.5%). Our present percutaneous transluminal coronary angioplasty (PTCA)‐regimen (monorail technique with P.E.T. balloons, fully silicon‐coated guidewires, no urokinase) shows an incidence of 3.8% for intermittent and recurrent coronary occlusions and 1.9% for permanent occlusions.

Urokinase did not prevent intracoronary thrombus formation with the monorail technique. Furthermore, we suspect that in the case of PTCA‐induced regional lntimal dissection, fibrinolysis can prevent reestablishment of intima adherence to the vessel wall. Because five procedural deaths were observed in the 212 patients treated with i.c. urokinase as opposed to three deaths in the 448 procedures without urokinase, we feel that i.c. urokinase in PTCA is a potentially harmful regimen. We suggest that the monorail technique should be performed with fully silicon‐coated guidewires and without urokinase.
Balloon rupture due to lesion morphology during coronary angioplasty
Authors: Kahn Joel K. , Hartzler Geoffrey O.
Published: March 2007

We report a case of coronary angioplasty of a left anterior descending artery lesion that was complicated by the rupture of three successive balloon catheters. Each rupture occurred as a pinhole jet of contrast into a diagonal side branch, causing subintlmal staining. This case demonstrates that balloon rupture may result from lesion morphology.
Unusual case of pacemaker lead migration
Authors: Dalvi B. V. , Rajani R. M. , Lokhandwala Y. Y. , Sathe S. V. , Kulkarni H. L. , Kale P. A.
Published: March 2007

Pulmonary artery migration of pacemaker lead is rare and may result in pulmonary emboli originating from the thrombus around the infected catheter and causing multiple pulmonary infarcts. We report an unusual case of pacemaker lead migration to the right pulmonary artery with septic pulmonary embolism. While being treated with intravenous Cefuroxamine, the patient had spontaneous migration of the lead to the left pulmonary artery with subsequent left pulmonary embolism.
Percutaneous puncture of a nondeflatable coronary artery angioplasty balloon
Authors: Forcier Nancy J. , Cascade Philip N. , Maltzman Jerald B.
Published: March 2007

We report a case in which a balloon catheter became permanently inflated in a coronary artery saphenous vein bypass graft. While still inflated, the balloon was forcibly withdrawn from the graft into the external iliac artery and successfully deflated via percutaneous puncture using a CHIBA needle.
Treatment of ventricular tachycardia induced cardiogenic shock by percoronary chemical ablation
Authors: Demaio Samuel J. , Walter Paul F. , Douglas John S.
Published: March 2007

Incessant ventricular arrhythmias pose an especially challenging therapeutic dilemma. We describe the successful treatment and follow‐up of a patient with refractory ventricular tachycardia‐induced cardiogenic shock with percoronary chemical ablation. After endocardial mapping was used to identify the “tachycardia‐related” coronary artery, temporary termination of the arrhythmia with balloon occlusion and subselective intracoronary installation of iced saline as previously advocated was unsuccessful. This was probably due to a dual arterial blood supply to the arrhythmogenic focus. However, infusion of 2 cc ethanol (99%) permanently terminated the arrhythmia. Contrary to previous experience, ethanol‐induced arrhythmia termination did not result in arterial occlusion, further supporting a direct toxic effect on the myocardium as its mode of action. Use of standard angioplasty balloon inflation prevents “backwash” of distally infused ethanol and more generalized cell death. The only complication of this procedure was temporary third‐degree AV block, requiring permanent pacemaker implantation.
Usefulness of digital angiography in the assessment of left ventricular ejection fraction
Authors: Koning Gerhard , Van Den Brand Marcel , Zorn Inge , Loois Geerling , Reiber Johan H. C.
Published: March 2007

With modern digital cardiac systems the image data are digitized on‐line and in real‐time, allowing the replay and subsequent interpretation and analysis during or directly after the cardiac catheterization procedure. In this study we have evaluated the advantages and limitations of a manual tracing technique for left ventricular digital angiograms on the Philips DCI system. Thirty‐three patients who were catheterized for suspected coronary artery disease were studied. The manual tracings were performed by a senior cardiologist and an experienced function‐analyst. It was found that the short‐ and long‐term intraobserver variabilities in the assessment of the global ejection fraction were very small; short‐term mean difference ± standard deviation (correlation coefficient): 0.5±2.7 (r = 0.97) global EF%‐units; long term; 0.7±2.7 (r = 0.96) EF%‐units. The interobserver variabilities (5.1±4.8 (r = 0.93) EF%‐units) were slightly higher than the intraobserver variabilities. A decrease by 25% in the amount of contrast medium administered did not significantly influence the variabilities in the contour tracings, which would suggest the use of smaller doses. At the average, the cardiologist and the function‐analyst required 6 and 11 min of analysis time for a left ventricular study, respectively, emphasizing the need for further developments towards automated contour detection. Finally, an excellent correlation was found with a standard off‐line cinefilm analysis procedure. Thus, it may be concluded that quantitative digital left ventricular angiography based on manual tracing of the outlines performed immediately following the cardiac catheterization (postprocessing) is feasible as a routine procedure for the assessment of left ventricular function.
Reduction in radiation exposure during coronary angiography
Authors: Carpenter Margot L. , Singer Peggy R. , Jain Avanindra , Dehmer Gregory J.
Published: March 2007

In addition to lead shielding, increased distance between the operator and x‐ray source will lower radiation exposure. To utilize this principle, we interposed a 24 in. piece of pressure tubing between the catheter used for coronary angiography and the manifold apparatus. Radiation exposure to the hand of the operator during coronary angiography was compared with and without the extension tubing. When corrected for the differences in exposure time, operator exposure was 5.38 mrem/min without the extension and 4.84 mrem/min with the extension. Although this is a small difference in exposure/min, a substantial reduction in exposure could accumulate over a 1 yr period. Insertion of this extension tube into the catheter system is a simple and safe way to further reduce operator exposure during coronary angiography.
Temporary cardiac pacing using a new, steerable, balloon‐Tipped pacing catheter
Authors: Stefanadis Christodoulos , Gavaliatsis Isidoros , Stratos Costas , Kallikazaros John , Vasiliadis John , Chatzigeorgiou Christoforos , Toutouzas Pavlos
Published: March 2007

A new balloon‐tipped, flow‐directed, steerable pacing catheter for unipolar temporary ventricular pacing is presented. It was successfully and uneventfully tested in 25 patients with acute myocardial infarction in the coronary care unit. The main advantage of the new catheter is the ease with which a stable contact may be achieved between the pacing electrode and the endocardium.
Precertification for percutaneous transluminal coronary angioplasty in medicare beneficiaries: A melting pot or a need for better national standards?
Authors: Butman Samuel M.
Published: March 2007

The Health Care Financing Administration has contracted with state peer review organizations (PROs) in its effort to assure the quality of services and eliminate unreasonable and inappropriate care provided Medicare beneficiaries. By law, each state PRO must select 10 procedures for precertification. Coronary angioplasty has been chosen by 45 PROs for precertification and criteria in each state were developed with the advice of local physicians. This report describes the findings of a survey of these precertification criteria in an effort to determine their variability and to compare the PRO criteria to published national criteria created by expert panels.

Current precertification criteria of Medicare beneficiaries show significant variability in the priorities and the clinical practice of cardiologists in performing coronary angioplasty, despite established and published guidelines for its safe and efficacious use. It is likely that the establishment of locally based criteria for coronary angioplasty will be geographically uneven and probably have a less than expected impact on the care provided to Medicare beneficiaries.
Percutaneous balloon pulmonic valvuloplasty following treated endocarditis in a patient with congenital pulmonary valve stenosis
Authors: Coberly LeAnn , Harrison J. Kevin , Bashore Thomas M.
Published: March 2007

A 36‐year‐old woman with congenital pulmonary valve stenosis developed the rare complication of endocarditis of the valve. After successful sterilization of the valve, the patient underwent percutaneous balloon pulmonic valvuloplasty at a later date. The procedure successfully reduced the peak pulmonary valve gradient from 94 to 45 mm Hg. Percutaneous balloon valvuloplasty is the procedure of choice for treatment of congenital pulmonary valvular stenosis, even in the unusual patient who has healed endocarditis of the pulmonary valve.
Implantation of an endoluminal prosthesis at the distal anastomosis of a bypass graft for abrupt closure following balloon angioplasty
Authors: Strauss B. H. , Leborgne O. , De Scheerder I. K. , Serruys P. W.
Published: March 2007

A coronary Wallstent® was implanted in a 10‐year‐old saphenous vein bypass graft following a PTCA that was complicated by abrupt closure. Anterograde flow was restored and no myocardial necrosis resulted. One week later, bypass surgery was performed due to a bleeding complication associated with the anticoagulation regimen.
Salvage of branch vessels during bifurcation lesion angioplasty: Acute and long‐term follow‐up
Authors: Weinstein Joseph S. , Baim Donald S. , Sipperly Mary Ellen , McCabe Carolyn H. , Lorell Beverly H.
Published: March 2007

To evaluate angiographic success, frequency of branch vessel loss and salvage, and long‐term outcome, we studied the early and late outcomes of 56 consecutive patients who underwent PTCA of bifurcation lesions, which involved the left anterior descending or left circumflex coronary artery, with stenoses > 70% in both the parent and an involved branch vessel. In 35 patients (63%), the PTCA strategy was attempted dilation of both the main vessel and the involved branch vessel using predominantly a double‐wire, sequential balloon technique; in 21 (27%) the PTCA attempt was confined to the main vessel alone. Transient angiographic occlusion of the branch vessel occurred in 32% of patients in whom dilation of both vessels was attempted, and in 38% in whom the main vessel alone was dilated (p = NS); 91% of the occluded branch vessels were then salvaged when sequential angioplasty of both vessels had been initially planned, compared to only 38% when the initial strategy had been dilatation of the main vessel alone (p < .05). Predischarge exercise testing showed residual ischemia in 6% of patients who had both vessels successfully dilated, versus 37% in those in whom dilatation was confined to the main vessel (p < .01). Clinical restenosis, defined as late (> 6 weeks) recurrence of angina or a positive exercise test, occurred in 42% of patients who had both vessels successfully dilated. Thus although bifurcation lesion angioplasty frequently results in transient branch vessel loss, these branches can usually be salvaged using a double‐wire technique but tend to have a higher late restenosis than conventional single vessel PTCA.
Atrial septal occlusion improves the accuracy of mitral valve area determination following percutaneous mitral balloon valvotomy
Authors: Petrossian George A. , Tuzcu E. Murat , Ziskind Andrew A. , Block Peter C. , Palacios Igor
Published: March 2007

We investigated the impact of the atrial communication on the mitral valve area calculation after percutaneous mitral balloon valvotomy in 17 patients (15 women, 2 men; mean age 56 ± 4 years). The hemodynamic measurements and mitral valve area calculations were performed with and without balloon occlusion of the atrial septal puncture site. The mitral valve area determined with balloon occlusion was significantly smaller than the mitral valve area determined without occlusion (1.6 ± 0.1 vs. 1.9 ± 0.1 cm2, P < 0.01), and was similar to the echocardiographically determined valve area (1.6 ± 0.1 cm2). This decrease in the calculated mitral valve area with occlusion was associated with a decrease in the measured cardiac output, without a change in the mitral valve gradient or the diastolic filling period. Occlusion of the atrial septal puncture site may permit more accurate determination of the mitral valve area and thus provide a better reference point for future comparison should the question of restenosis arise.
Coronary angioplasty following cardiac transplantation: A case report and review of the literature
Authors: Prewitt Kerry C. , Wortham Dale C. , Banks Alan K.
Published: March 2007

A 23‐year‐old man underwent successful percutaneous transluminal coronary angioplasty of a severe stenosis of the left anterior descending artery 25 months after orthotopic heart transplantation. Four months later restenosis of the same lesion was treated by repeat PTCA. Angiography 11 months later showed no restenosis. In selected cases, PTCA may be useful in treating allograft coronary disease.
Percutaneous right brachial artery approach with 5f catheters for studying coronary artery disease
Authors: Lupon‐Rosés J. , Domingo E. , Angel J. , Anívarro I. , Soler‐Soler J.
Published: March 2007

We prospectively studied 60 ischemic patients with 5F catheters (Pigtail and Amplatz) using the percutaneous right brachial artery approach (group I), in order to compare this technique with two groups of 100 patients each randomly studied by the femoral route with either 5F (group II) or 8F (group III) catheters (Pigtail and Judkins). The following parameters were analyzed: need to change the initially elected catheter diameter or/and artery approach; technical difficulty for obtaining LV, LCA, and RCA angiograms; total time of X‐ray exposure; quality image of LV, LCA, and RCA angiograms; incidence of arterial puncture related hematomas or total arterial occlusion; and duration of local compression after sheath removal. There were no differences between 5F brachial and femoral approaches except for the arterial compression time (p<0.01) and the X‐ray exposure time (p=0.03) which were longer with the brachial approach. Whatever the route used, 5F showed a mild increased difficulty (brachial p=0.001; femoral p=0.01) and a mild decreased quality image for LCA (branchial p=0.006; femoral p<0.05). Mild hematomas were more frequent with 8F catheters (p<0.05). The procedure could be completed by the elected first artery and type of catheter (5F or 8F) in 57/60 patients in group I, in 95/100 in group II, and in 96/100 in group III (nonsignificant differences). Thus, the percutaneous right brachial artery approach using 5F catheters is similar to the femoral artery approach with the same catheters. Although both of them showed a mild increased technical difficulty and a mild decreased quality image compared to 8F, mainly for LCA angiograms, they allowed complete and reliable angiograms reading and analysis.
Angiographic follow‐up and clinical outcome of 126 patients after percutaneous directional atherectomy (simpson atherocath™) for occlusive peripheral vascular disease
Authors: Dorros Gerald , Iyer Sriram , Lewin Ruben , Zaitoun Rafic , Mathiak Lynne , Olson Karen
Published: March 2007

Angiographic and clinical follow‐up data were obtained in 115/126 patients who underwent directional atherectomy for peripheral vascular disease; of the 126, ten were excluded for appropriate reasons and one was lost to follow‐up. Thus, 115/116 successful atherectomy patients (99%) had follow‐up of 182/213 lesions (86%): 74 patients (64%) with angiography (mean time 5.4 mon), and 41 patients (36%) clinically. One hundred twenty‐eight of 183 lesions (70%) had angiographic follow‐up; the lesion recurrence as a stenosis or as an occlusion was 53%. Lesion distribution did not differ between angiography and clinical follow‐up groups: nearly 85% were within the superficial femoral or popliteal arteries. Despite data stratification, angiographic follow‐up indicated that patients after successful directional atherectomy, at a mean follow‐up time of >5 mos, have more than a 50% lesion recurrence rate. Although directional atherectomy (Simpson AtheroCath™) utilizing present techniques has excellent primary success and acceptable complication rates, angiographic follow‐up statistics are bothersome.
Coronary artery dilatation requiring high inflation pressure
Authors: Bush Charles A. , Ryan James M. , Orsini Anthony R. , Hennemann Willard W.
Published: March 2007

A patient with rigid coronary lesions refractory to balloon dilatation is described. A Cordis Orion fixed wire balloon able to withstand 20 bar was required for successful dilatation.
Coronary angioplasty requiring extraordinarily high balloon inflation pressure
Authors: Willard John E. , Sunnergren Kenneth , Eichhorn Eric J. , Grayburn Paul A.
Published: March 2007

Two cases are presented in which extraordinarily high balloon inflation pressures (20 and 17 atm) were required to successfully dilate a saphenous vein graft stenosis and a right coronary artery stenosis. The clinical application of high balloon inflation pressures and balloon selection is discussed.
Successful treatment of an excimer laser‐associated coronary artery perforation with the stack perfusion catheter
Authors: Parker John D. , Ganz Peter , Selwyn Andrew P. , Bittl John A.
Published: March 2007

A 64‐year‐old woman underwent excimer laser angioplasty of the right coronary artery. The procedure was complicated by perforation, which was successfully managed without complication with a Stack perfusion catheter. This report describes successful non‐surgical treatment of laser‐induced coronary perforation and makes recommendations for avoiding this complication in other patients.
Percutaneous extraction of fractured guidewire from distal right coronary artery
Authors: Savas Vicky , Schreiber Theodore , O'Neill William
Published: March 2007

The incidence of retained hardware components in the coronary artery tree is likely to parallel the growing number and types of percutaneous coronary revascularization procedures being performed. Management has extended from the conservative option of simply leaving behind the retained components to the more aggressive approach of surgical removal. A percutaneous method is described herein which offers the interventional cardiologist an alternative method of managing patients with retained wire fragments contained entirely in the coronary artery.
Treatment of congenital coronary arteriovenous malformations with micro‐particle embolization
Authors: Strunk Brian L. , Hieshima Grant B. , Shafton Eugene P.
Published: March 2007

The successful treatment of a symptomatic coronary arteriovenous malformation (CAVM) by a percutaneous embolization technique with micro‐particles is described. Objective evidence of ischemia and its subsequent disappearance after embolization is presented. The embolization technique and possible indications and contraindications are discussed.
Transseptal catheterization technique: A simple safety procedure
Authors: Bloomfield Dennis A.
Published: March 2007

The major complication of transseptal catheterization, that of inadvertent perforation of other structures, can best be avoided by maintenance of the correct needle tip position during introduction and maneuvering of the assembly. The addition of a needle‐stop to the transseptal needle shaft and a sterile ruler to check its preset position assures the maintenance of the needle tip position, freeing the operator's concern for accurate location of landmarks.

The method of utilizing and setting the needle‐stop is described.
Angioplasty of coronary bifurcation stenoses: Immediate and long‐term results of the protecting branch technique
Authors: Renkin Jean , Wijns William , Hanet Claude , Michel Xavier , Cosyns Jacques , Col Jacques
Published: March 2007

Percutaneous transluminal angioplasty (PTCA) of coronary stenoses involving major bifurcations carries a small but significant risk of side branch occlusion which can be avoided by simultaneously using multiple dilatation systems. Among 1,275 PTCA procedures performed between 1984 and 1988 in 1,035 consecutive patients, 42 double wire procedures were applied (4%) to protect and/or dilate major coronary side branches. A total of 80 coronary stenoses were attempted of which 76 were located on a bifurcation and 4 on other segments. In the first 11 patients (group A), 2 guiding catheters were used and PTCA of each vessel was successfully performed by means of separate double lumen over‐the‐wire balloon catheters. In the next 31 patients (group B), 2 guidewires were advanced through a single guiding catheter and PTCA was attempted using “Monorail” balloon catheters sequentially advanced over the wires. In group B, a successful PTCA was obtained in 29 patients (93%) but twisting of the wires hampered balloon progression in 5 cases, such that dilatation could only be performed by stepping back to a single wire technique. The procedure time in group B was significantly shorter than in group A: 144 ± 30 versus 230 ± 52 minutes (p = .01).

Repeat angiography was performed in 35 out of 40 patients (87%) after a mean of 180 ± 46 days following successful PTCA. Angiographic restenosis was present in 37% (24/65) of bifurcation segments which, in our experience, is not significantly different from the angiographic restenosis rate in less complex lesions (248/740; 34%; NS).

It is concluded that 1) the need for using a protecting branch technique in PTCA practice is uncommon (4%); 2) among other approaches, the use of a “Monorail” system allows successful dilatation in 93% of cases with a shortened procedure time; 3) the restenosis rate at repeat angiography is similar to that of non‐bifurcated lesions.
Ptca of gastroepiploic bypass
Authors: Watson Linley E. , Schoolar E.
Published: March 2007

A technique for percutaneous transluminal coronary angioplasty (PTCA) of gastroepiploic bypass is described using standard PTCA devices. Severe spasm of gastroepiploic bypass occurred. Modification of guide catheter position is suggested to avoid inducing gastroepiploic bypass spasm.
Dual purpose computer aided program for cardiac catheterization laboratory data management
Authors: Weaver Walt F. , Costello Donald F.
Published: March 2007

This communication describes the design criteria used in the early systems analysis activity of the cardiac laboratory. This analysis activity required an understanding of the cardiology laboratory environment, the establishment of needs to be answered by the program, and the goals of the entire system. The rationale for inclusion of various cardiologic, demographic, quality assurance, and personnel safety parameters is discussed. The input forms used, the database structure created, and the information provided by an applications system are described. Since the system is built around a general‐purpose computer (the IBM PC™ or compatible) and widely available powerful general purpose software, the entire system may be used for many other cardiology laboratory data management tasks.
Choice of contrast agents for cardiac angiography: Review and recommendations based on clinically important distinctions
Authors: Matthai William H. , Hirshfeld John W.
Published: March 2007

Low osmolal contrast agents (LOCA) are measurably superior to high osmolal contrast agents (HOCA) in a number of properties. However, LOCA are substantially more expensive than HOCA, and universal use of LOCA for cardiac angiography would strain the health care budget. Therefore, the choice to use LOCA in place of HOCA should be based on clinically important differences. Review of available published data suggests that HOCA can be used safely and effectively for cardiac angiography in patients with mild or moderately severe heart disease. When HOCA are used, those that do not bind calcium should be chosen as they cause fewer clinically important adverse reactions than those that do bind calcium. Use of LOCA may offer added safety in high risk patients, although to date, this conclusion has not been proved with clinical experience. Nonionic LOCA may be safer to use than ionic LOCA.
Balloon diameter of the inoue balloon catheter during percutaneous transvenous mitral commissurotomy: Clinical and experimental study
Authors: Nagata Seiki , Ishikura Fuminobu , Yamabe Takashi , Akaike Masashi , Kimura Kohji , Miyatake Kunio
Published: March 2007

To determine adequate and effective balloon diameters of the Inoue balloon catheter, we reviewed clinical results and characteristics of the Inoue balloon catheter, especially the relationship between the intra‐balloon pressure and the balloon diameter, experimentally and clinically, in 46 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Mitral valve area increased from 1.1 ± 0.3 to 2.1 ± 0.3 cm2 in all patients after PTMC. Based on balloon diameter settings, mitral valve area increased from 1.3±0.4 to 2.3±0.5 cm2 in patients treated with a balloon setting greater than 26 mm in diameter, from 1.1 ±0.3 to 2.0±0.5 cm2 in patients with a balloon setting at 26 mm in diameter, and from 1.1±0.4 to 1.7±0.4 cm2 in those treated with a balloon setting less than 26 mm in diameter, with an increase in mitral valve area of 1.0±0.6, 0.9±0.4, and 0.7±0.2 cm2, respectively. There was a significant difference between the increase in mitral valve area at a setting of 26 mm in diameter and that observed at a setting less than 26 mm in diameter. We next investigated differences between balloon diameter settings and actual balloon diameters measured from cineangiograms at maximum balloon inflation. The ratio of actual balloon diameter to a setting diameter of less than 26 mm was smaller than that of 26 mm. To evaluate the reason for the difference, we investigated the relationship between intra‐balloon pressure and balloon diameter. In the prototype Inoue balloon catheter, intra‐balloon pressure increases from 1.0 kg/cm2 at 20 mm in diameter to 2.2 kg/cm2 at 30 mm in diameter at atmospheric pressure. In conclusion, the increase in mitral valve area was inadequate when the balloon was less than 26 mm in diameter because of inadequate intra‐balloon pressure. We, therefore, recommend a balloon size set above 26 mm to obtain adequate intra‐balloon pressure when using the Inoue balloon catheter.
Proximal rupture and intracoronary entrapment of a rotating device during low‐speed rotational coronary angioplasty
Authors: Juilliere Yves , Danchin Nicolas , Amrein Daniele , Suty‐Selton Christine , Cherrier Francois
Published: March 2007

While attempting to recanalize a right coronary artery obstruction by using a low‐speed rotating catheter (Rotacs), proximal rupture of the catheter body occurred with entrapment of the blunt tip in the obstruction. To retrieve the device, it was necessary to sever the guiding catheter and the flexible tube of the Rotacs. At low‐speed rotation the flexible segment of the catheter was then pulled back.
Multivessel ptca using the hugging balloon technique based on single guide catheter and dual balloon‐on‐a‐wire systems
Authors: Yoshida Satoru , Yabe Yoshimasa , Nakano Hajime , Muramatsu Toshiya , Noike Hirofumi
Published: March 2007

For percutaneous transluminal coronary angioplasty (PTCA) of oversized arteries, oftentimes a satisfactory dilatation cannot be achieved with conventional balloon systems due to the unavailability of adequately sized balloons. This fact has contributed to a higher restenosis rate for this group of patients. We were able to obtain a satisfactory dilatation result in an oversized right coronary artery with a shepherd's crook configuration and eccentric anatomy at the origin using two balloon‐on‐a‐wire systems and an Amplatz type guiding catheter. Although such favorable dilatation of an oversized artery using this „hugging balloon technique'' can be expected, issues do exist such as difficult maneuverability and estimation of the balloon size obtained through simultaneous dual balloon inflation wherein size does not simply equal the sum of the two balloon catheters. It is hoped that there will be further improvements of the technique and development of new systems. At this time, however, it is felt that this is the most effective and reasonable strategy to achieve a high chance of success in oversized vessel lesions.
A new technique for sheathless percutaneous intraaortic balloon catheter insertion
Authors: Nash Ira S. , Lorell Beverly H. , Fishman Robert F. , Baim Donald S. , Donahue Colleen , Diver Daniel J.
Published: March 2007

Intraaortic balloon counterpulsation is helpful for controlling myocardial ischemia and providing hemodynamic support, but its applicability is limited by lower extremity ischemic complications in a significant percentage of patients. We developed a new sheathless technique for percutaneous intraaortic balloon catheter insertion which reduces the effective catheter diameter. A pilot study using this new technique resulted in a 10% rate of limb ischemia, without compromise of balloon function. We conclude that this technique may be useful in reducing the incidence of limb ischemia associated with intraaortic balloon counterpulsation.
Angioplasty of long or tandem coronary artery lesions using a new longer balloon dilatation catheter: A comparative study
Authors: Brymer James F. , Khaja Fareed , Kraft Phillip L.
Published: March 2007

To determine whether or not a new 3 cm long angioplasty balloon was more effective in treatment of long (15–25 mm) or tandem (< 25 mm overall length) coronary lesions, 44 consecutive patients with suitable lesions were alternately assigned to treatment with shorter, standard, 2 cm length, or long, 3 cm balloons. Primary success of PTCA was achieved in 95%. Those treated with long balloons required fewer inflations (3.3 ± 1.5 vs. 5.7 ± 2.1, P=0001) and showed fewer moderate or severe intimal dissections of the lesions (4/22 vs. 12/22, p =.028.) The use of 3cm PTCA balloons in long or tandem lesions appears to be efficacious and less likely to cause dissections than shorter, 2 cm length devices.
Reduction in injection pain using buffered lidocaine as a local anesthetic before cardiac catheterization
Authors: Sapin Peter , Petrozzi Regina , Dehmer Gregory J.
Published: March 2007

Previous reports have suggested that pain associated with the injection of lidocaine is related to the acidic pH of the solution. To determine if the addition of a buffering solution to adjust the pH of lidocaine into the physiologic range would reduce pain during injection, we performed a blinded randomized study in patients undergoing cardiac catheterization. Twenty patients were asked to quantify the severity of pain after receiving standard lidocaine in one femoral area and buffered lidocaine in the opposite femoral area. The mean pain score for buffered lidocaine was significantly lower than the mean score for standard lidocaine (2.7 ± 1.9 vs. 3.8 ± 2.2, P=0.03). The pH adjustment of standard lidocaine can be accomplished easily in the catheterization laboratory before injection and results in a reduction of the pain occuring during the infiltration of tissues.
Accordion right coronary artery: An unusual complication of ptca guidewire entrapment
Authors: Deligonul Ubeydullah , Tatineni Satyanarayana , Johnson Randy , Kern Morton J.
Published: March 2007

The contour of the epicardial coronary vessels may change considerably during coronary angioplasty. We report the extreme and unique „accordion‐like”︁ wrinkling of the mid right coronary artery as a result of distal guidewire entrapment during coronary angioplasty. Recognition of this artifact and its treatment may prevent further complications of coronary angioplasty.
Subacute bilateral coronary ostial stenoses following cardiac catheterization and ptca
Authors: Wilson Vance E. , Bates Eric R.
Published: March 2007

Accelerated coronary ostial stenosis is an infrequent late complication of coronary artery catheter instrumentation during aortic valve surgery, PTCA, or coronary angiography. We report the first case of bilateral coronary artery ostial stenoses developing after cardiac catheterization and right coronary artery PTCA. In patients with worsening angina following cardiac catheterization or PTCA, accelerated ostial stenoses should not be overlooked in the differential diagnosis.
Lack of evidence for small vessel disease in a patient with „slow dye progression”︁ in the coronary arteries
Authors: Van Lierde Johan , Vrolix Matty , Sionis Dimitris , De Geest Hilaire , Piessens Jan
Published: March 2007

A patient with chest pain of recent onset, suggestive for angina pectoris, was referred for diagnostic coronary angiography, which showed the typical phenomenon of „slow dye progression”︁ in the absence of any significant coronary artery stenosis. While intracoronary Doppler measurements confirmed the extremely slow blood flow velocity, the coronary flow reserve and the calculated coronary blood flow proved to be within normal range.

The present findings suggest that, in contrast with a previous hypothesis, the phenomenon of slow dye progression may not always be due to a microvascular cause. Epicardial artery disease, as suggested by the marked coronary artery ectasia, may be linked to the slow dye progression and predispose to coronary artery thrombosis.
Coronary artery narrowing due to extrinsic compression by myocardial abscess
Authors: Wickline Cindy L. , Goli Vasu D. , Buell James C.
Published: March 2007

A case of aortic valve endocarditis complicated by perivalvular abscess extending into myocardium is presented. Echocardiography and aortography failed to detect the abscess, but coronary angiography revealed its presence by extrinsic compression of left anterior descending and diagonal arteries. Morphological features of this rare cause for coronary narrowing are described.
Successful angioplasty of a chronically occluded saphenous vein graft using a prolonged urokinase infusion from the brachial route
Authors: Doorey Andrew J. , Rosenbloom Mark A. , Zolnick Mark R.
Published: March 2007

A 68‐year‐old man who presented with unstable angina had had cardiac bypass surgery 12 years earlier and successful angioplasty of a native circumflex lesion 18 months previously. Repeat catheterization showed a widely patent angioplasty site but interval closure of a saphenous vein graft to a large marginal branch that was totally occluded proximally. A stress test revealed significant myocardial ischemia. Severe peripheral vascular disease with known bilateral iliac artery occlusions mandated a brachial approach. Because of his high risk for repeat cardiac surgery, it was elected to attempt saphenous graft angioplasty following a prolonged urokinase infusion. After an infusion of urokinase for 36 hr, antegrade flow was restored and angioplasty was carried out successfully on a discrete mid‐graft legion. Subsequent stress testing showed resolution of the ischemia. There were no vascular complications.
Multiple coronary artery‐left ventricular fistulae: Clinical, angiographic, and pathologic findings
Authors: Black Mbbs Ian W. , Loo Mbbs Christine K. C. , Allan Mbbs Roger M.
Published: March 2007

Multiple fistulae between all 3 major coronary arteries and the left ventricle were found at cardiac catheterization in a 69‐year‐old woman presenting with typical angina. Subsequent necropsy showed abnormal intramyocardial vessels communicating with the left ventricular lumen. This is the first report to document clinical, angiographic, and pathologic findings in this anomaly.
Clinical factors affecting the immediate outcome of ptca in patients with unstable angina and poor candidates for surgery
Authors: Colle Jean‐Pierre , Delarche Nicolas
Published: March 2007

Percutaneous Transluminal Coronary Angioplasty (PTCA) has been successfully applied in unstable angina to carefully selected patients. In this study, PTCA was performed in 277 consecutive patients suffering from unstable angina and for whom bypass surgery was not a valid alternative because either of inoperable conditions or of emergency, or because surgery was not the best option. All patients were admitted first to the intensive care unit where an attempt was made to control unstable angina under conventional medical therapy using at least iv nitroderivative, heparin, and calcium blockers. After a standardized preparation PTCA was performed either as an emergency procedure in medically refractory unstable angina (107 cases) or as an elective procedure in controlled situations after a 7 to 10 days symptom‐free period. Three hundred fifty‐three coronary vessels were attempted.

Results of this group are compared with those of a control group made of 670 consecutive stable patients recruited during the same period, and clinical characteristics are envisaged as potential predictive factors. Unstable angina is undoubtedly associated with a higher overall complication rate, but the immediate outcome is strongly affected by the clinical context. As an example, respective success and mortality rates are: 93% and 0% when a full revascularization is attempted; 91% and 0% in elective procedures in patients under 60; 87% and 1.2% in elective PTCA for multiple vessel disease; 80% and 6.5% in emergency PTCA; 80% and 11% in the overall triple vessel disease; 84% and 16% in patients with deeply altered ejection fraction; and 58% and 26% in triple vessel disease with 2 previously occluded coronary arteries. Mortality rate can reach as high as 33% in life saving procedures engaged for cardiogenic shock or single patent vessels. Multiple clinical factors are powerful predictive factors, isolated or associated, and they must be taken into account when weighing the risks before any decision to treat.
Protamine allergy reactions during cardiac catheterization and cardiac surgery: Risk in patients taking protamine‐insulin preparations
Authors: Vincent G. Michael , Janowski Mauro , Menlove Ronald
Published: March 2007

Protamine insulin use may immunologically sensitize patients to protamine, leading to anaphylactoid reactions upon subsequent exposure to protamine sulfate during cardiac catheterization or cardiovascular surgery. The risk of such reactions in protamine insulin‐dependent patients is uncertain. One catheterization study reported a 50‐fold greater risk while a second showed no increased risk! To clarify the risk, the records of 7,750 cardiac catheterization procedures between 1984 and 1987 were analyzed for presence of NPH or PZI insulin use, protamine administration, and any complications or adverse reactions. Protamine was administered in 3,341/7,750 procedures (43%), including 171 in diabetics receiving NPH insulin. Adverse reactions to protamine occurred in 2/3,170 noninsulin patients, 0.06%, and adverse reactions due to probable NPH insulin sensitization occurred in 1/171,0.6%, of NPH diabetics, p =.034. Meta‐analysis of risk showed an odds ratio of 7.96 for the NPH diabetic patients, and combining these results with the other large series in the literature (269 NPH diabetics total) showed an odds ratio of 4.19 compared to a non‐NPH insulin group. Meta‐analysis of the surgical literature showed the risk in surgical patients to be 2.1% in NPH patients versus 0.12% with no NPH, with an odds ratio of 15.52. The greater incidence in surgical patients may be due to protamine sensitization at prior catheterization and to the larger dose of protamine administered to surgical patients.
Dislodgement of a vein graft thrombus by angiographic injection of native coronary artery
Authors: Evans Bradley H. , Schapira Jay N. , Eigler Neal L.
Published: March 2007

A case of retrograde dislodgement of thrombus in a saphenous vein graft during injection of the native right coronary artery is presented. Attention to this previously undescribed complication may allow for timely treatment with emergency surgery or thrombolysis.
Holmium laser angioplasty after failed coronary balloon dilation: Use of a new solid‐state, infrared laser system
Authors: Heuser Richard R. , Mehta Stephen S.
Published: March 2007

A new solid‐state laser system was used in a case of saphenous vein graft occlusion untreatable by standard very low‐profile balloon angioplasty. The 2100 nm infrared pulsed thulium/holmium:YAG laser successfully recanalized an obtuse marginal bypass graft without complications. The holmium laser has several advantages over excimer systems and may prove an effective adjunct or alternative to coronary balloon angioplasty.
Total occlusion of the circumflex artery with collateral supply from the conus artery
Authors: Mishkel Gregory J. , Biagioni Eugene , Stolberg Harold
Published: March 2007

The conus artery has long been recognized as an important source of collateral blood supply to a significantly diseased left anterior descending artery. This artery which arises 50% of the time from a separate orifice in the right sinus of Valsalva may also provide collateral circulation to a diseased right coronary artery. To date, there have been no reported instances of the conus artery supplying collateral flow to a totally occluded circumflex artery. In this report we describe such a case in a patient with severe three vessel disease. The implications of such a finding in patient management are also discussed.
Unrecognized stenosis by angiography documented by intravascular ultrasound imaging
Authors: Ehrlich Steven , Honye Junko , Mahon Donald , Bernstein Robert , Tobis Jonathan
Published: March 2007

This report documents how intravascular ultrasound imaging was used to diagnose a short „napkin‐ring”︁ stenosis that was missed by coronary angiography. Intravascular ultrasound revealed a lumen of 2.6 × 2.5 mm in diameter and 5.0 mm2 in cross‐sectional area, with a residual atheroma that occluded 63% of available cross‐sectional area at the stenosis.
Abrupt vessel closure following platelet transfusion post‐PTCA
Authors: Gutowski Ted , Kauffman Gary , Lacy Clifton
Published: March 2007

A successful PTCA was complicated by abrupt closure following a platelet transfusion which was given for control of local bleeding. Possible mechanisms of abrupt closure are discussed. Recommendation is made to avoid giving platelet transfusion following PTCA.
Brachial approach to management of an abdominal aortic occlusion with prolonged lysis and subsequent angioplasty
Authors: Lyer Sriram S. , Hall Patrick , Dorros Gerald
Published: March 2007

The brachial approach for recanalizing an abdominal aortic occlusion utilizing a combination of thrombolysis and balloon angioplasty is described. The patient was deemed too ill to permit any surgical intervention. The unique aspects of the procedure are described including angioplasty of the unmasked (by lytic therapy) aortoiliac bifurcation stenoses utilizing double wires and double balloons through a single arteriotomy site. The advantages of the brachial approach in managing this unusual entity are outlined.
Correlation between the position of transducers and mitral valve gradient in mitral stenosis
Authors: Cha Se Do , Cha Ri Do , Maranhao Vladir
Published: March 2007

To assess the severity of mitral stenosis related to the level of transducers, the mitral valve gradient using pulmonary wedge and left ventricle was obtained from 15 patients. The mitral gradient was obtained with both transducers at mid chest level. Then, the level of each transducer was realigned with the catheter tip in the pulmonary capillary wedge and in the left ventricle using lateral fluoroscopy and the mitral gradient was re‐measured. At the mid chest level, the mean mitral valve gradient was 14 ± 6.2 mm Hg with a mitral valve area of 1.3 ± 0.6 cm2. With the adjusted level of transducers, the mitral valve gradient was 18.7 ± 6.8 mm Hg with a valve area of 1.0 ± 0.5 cm2. The difference was that the level of catheter tip in the wedge was 3.5 cm below the mid chest level and the one in the left ventricle was 2.5 cm higher than the mid chest level. This result suggested that the mitral valve gradient obtained at mid chest level underestimated the severity of mitral stenosis.