bluuebunny/crossref_metadata_2025 huggingface dataset:
Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery
Authors: Andersen J , Hjort-Jakobsen D , Christiansen P S , Kehlet H
Published: March 2007

Background

Initial programmes of fast-track open colonic surgery with a planned 2-day postoperative hospital stay have had a high readmission rate (about 20 per cent). The aim of this large, consecutive series was to compare readmission rates after a fast-track open colonic surgery programme with a planned hospital stay of 2 versus 3 days.

Methods

The study included 541 consecutive colonic resections from one surgical department with a structured care programme, including well defined discharge criteria, between April 1997 and December 2005. The planned hospital stay was increased from 2 to 3 days from August 2004. All patients were examined 8 and 30 days after surgery.

Results

Readmission rates fell from 20·1 per cent in 408 patients with a planned 2-day hospital stay (period 1) to 11·3 per cent in 133 patients with a planned 3-day hospital stay (period 2) (P < 0·020). Median length of primary hospital stay was 2 and 3 days, median stay after readmission was 5 and 5·5 days, and median (mean) total stay was 3 (5·6) and 3 (5·7) days in periods 1 and 2 respectively. The readmission rate in period 2 was lower because there were fewer readmissions for short-term observation or social reasons. There was no difference in type and incidence of morbidity between the two periods.

Conclusion

Readmission after fast-track open colonic resection was reduced by planning discharge 3 instead of 2 days after surgery, with the same discharge criteria.
Methodological problems related to the quantitative assessment of stretch, elastic recoil, and balloon‐artery ratio
Authors: Hermans Walter R. M. , Rensing Benno J. , Strauss Bradley H. , Serruys Patrick W.
Published: March 2007

The (inflated) balloon is important to determine the extent of stretch (theoretical maximal gain in diameter or area during PTCA), elastic recoil (the loss in diameter or area immediately after PTCA), and whether under‐ or over‐sizing (balloon‐artery ratio) of the dilated lesion occurred. In these assessments, the inflated balloon is used as scaling device with assumed uniformity along its entire length. In order to assess more accurately stretch, elastic recoil, and the balloon‐artery ratio, the balloon diameter was measured over its entire length with edge detection and videodensitometry in 505 lesions (453 patients). With an average inflation pressure of 8.3 ± 2.6 atm a difference between the minimal and the maximal balloon diameter of 0.59 ± 0.23 mm was measured using edge detection and 1.70 ± 0.90 mm2 difference in area using videodensitometry. This results in large variations in the calculated stretch, elastic recoil, and balloon‐artery ratio depending on the site of the balloon chosen for assessment. The mean difference ± SD between stretch and elastic recoil assessed by edge detection and videodensitometry (using the minimal luminal diameter or area of the balloon) are respectively 0.00 ± 0.19 and 0.00 ± 0.24, suggesting that both methods are appropriate.
Relationship of anticoagulation and radiographic contrast agents to thrombosis during coronary angiography and angioplasty: Are there real concerns?
Authors: Hill James A. , Grabowski Eric F.
Published: March 2007

Radiographic contrast agents are essential for the performance of coronary angiography and angioplasty. Historical data show that thrombosis‐related events have occurred since coronary angiography has been performed. Newer non‐ionic agents have been shown to be safer than conventional high osmolar ionic agents especially in high risk patients, but concern has been raised about a potentially increased risk of thrombosis with the use of these agents. A review of basic and clinical evidence for this perception does not support the view that an increase in thrombosis‐related events has occurred as a result of non‐ionic contrast media use in coronary angiographic procedures.
The vineberg procedure revisited: Angiographic evaluation and coronary artery bypass surgery in a patient 21 years following bilateral internal mammary artery implantation
Authors: Topaz On , Pavlos Stephan , Mackall Judith A. , Nair Ravi , Hsu Jack
Published: March 2007

A patient receiving bilateral internal mammary implantation (Vineberg's operation) in 1969 was symptom free for a period of 21 years. In 1990 he developed acute myocardial infarction followed by post‐infarction angina. Cardiac catheterization revealed severe left main and three vessel disease and patency of both mammary implants which filled the left anterior descending and circumflex coronary arteries via collaterals. Coronary artery bypass surgery was indicated due to the native coronary artery disease and inability of the internal mammary grafts' blood flow to alleviate symptoms. The patient underwent direct coronary artery bypass grafting utilizing femoral vessels for cannulation and saphenous veins for grafting, while preserving the mammary implants. This unique case attests to the longevity of the internal mammary artery grafts. These grafts, even if directly implanted, can serve as a crucial source of blood to an otherwise severely under‐perfused myocardium. Strategy and technical aspects of surgical redo in patients who underwent Vineberg's operation are discussed.
Ischemia‐Induced depressed systolic thickening is transiently augmented by remote coronary occlusion
Authors: Gascho Joseph A. , Copenhaver Gary L. , Davidson William R.
Published: March 2007

To determine if ischemia‐induced depressed myocardial thickening can be augmented by remote coronary occlusion, posterior wall function (pulsed Doppler crystal) was measured before and after left anterior descending coronary artery occlusion in the presence of reduced circumflex coronary artery flow (of sufficient severity to reduce resting function) in an anesthetized open‐chest canine preparation in which the circumflex was pump‐perfused with carotid arterial blood.

Left anterior descending coronary occlusion elicited an immediate significant increase in posterior bed thickening fraction (TF%) (3.7 ± 1.5 to 5.9 ± 1.3%), but by 135 sec TF% had again deteriorated. The transient increase in thickening was not caused by increased flow to the posterior bed (microspheres, n = 3), nor was it related to a Frank‐Starling mechanism (echocardiography, n = 3).

Despite an ischemic‐induced reduction in systolic shortening, systolic thickening can be transiently augmented by remote coronary occlusion. The etiology may be related to systolic unloading.
Balloon angioplasty for complete obstruction of inferior vena cava: Needle puncture followed by balloon dilatation
Authors: Dev Vishva , Kaul Upendra , Sahni Peush , Sharma Sanjiv
Published: March 2007

We report herein 2 cases with complete obstruction of the suprahepatic portion of the inferior vena cava successfully treated by balloon angioplasty after crossing the obstructing segment with the stiff end of the guidewire in 1 case and the Brockenbrough's trans‐septal needle in the other. The gradients across the obstruction fell from 13 and 20 mm Hg to 3 and 4 mm Hg, respectively. Angioplasty resulted in dramatic clinical hemo‐dynamic and angiographic improvement.
Use of balloon occlusion to improve visualization of anomalous pulmonary venous return in an adult with cor triatriatum
Authors: Papagiannis John , Harrison J. Kevin , Hermiller James B. , Harding Michael B. , Armstrong Brenda E. , Ungerleider Ross M. , Bashore Thomas M.
Published: March 2007

Cor triatriatum, although rare in adults, is often associated with anomalous pulmonary venous return. Accurate diagnosis of the pulmonary venous return and its anatomic connections is essential in planning proper surgical correction. This case illustrates the advantage of selective pulmonary artery angiography in obtaining accurate detail of the pulmonary venous anatomy from digital subtraction levophase images. Selective right and left pulmonary angiography was performed using a balloon catheter to simultaneously occlude the opposite pulmonary artery. This technique was well tolerated and greatly enhanced visualization of the anomalous pulmonary venous connections, allowing proper planning for corrective surgery.
Systemic embolism as a complication of percutaneous mitral valvuloplasty
Authors: Drobinski G. , Montalescot G. , Evans J. , Nivet M. , Thomas D. , Grosgogeat Y.
Published: March 2007

Systemic embolism is a potential and severe complication of percutaneous mitral valve dilatation. In our series of 80 cases, the incidence of systemic embolism was 3.75% (3 cases). Two cases occurred during the procedure itself. The cause of embolism was different in each case: cruoric thrombus formation occurred in 2 cases during or after dilatation, and was attributable to inappropriate heparinization, and catheter and guidewire thrombogenicity. In both cases heparin administration was delayed or given at a lower dosage. In the third case, calcific embolism occurred several days after valve dilatation. We think that the embolic calcified fragment was detached from the mitral leaflet at the time of or after balloon inflation. In these 3 cases, intraatrial thrombus mobilization was not the mechanism of systemic embolism. In 2 cases, transeosophageal echocardiography had been performed before dilatation and excluded the presence of an atrial thrombus the day before the procedure. It is concluded that, together with mobilisation of left atrial thrombi, which can be adequately detected by transeosophageal echocardiography, catheter‐induced thrombi represent a significant cause of embolic complications and must be prevented by giving full‐dose heparin during the total duration of the procedure. Calcific embolism may also occur, and may become more frequent if mitral valve balloon dilatation is proposed to a larger number of patients with valvular and subvalvular calcifications.
Left ventricular diverticulum: Case report and review of the literature
Authors: Walton‐Shirley Melissa , Smith Steven M. , Talley J. David
Published: March 2007

We describe two patients with left ventricular diverticula which were seen during routine left ventriculography. The diverticula were probably incidental findings and asymptomatic. A review of the literature to determine associated cardiac and extra‐cardiac abnormalities and related morbidity and mortality with emphasis of potential treatment strategies is presented. © 1992 Wiley‐Liss, Inc.
Rotational ablation of coronary artery lesions using single, large burrs
Authors: Zacca Nadim M. , Kleiman Neal S. , Rodriguez Arsenio R. , Heibig Jacques , Warth David , Harris Scott , Minor Steven T. , Raizner Albert E.
Published: March 2007

Previous clinical use of the Rotablator(TM) In coronary artery disease has involved a sequential increase in burr sizes up to 2 mm in diameter and has often utilized balloon adjunct to achieve an optimal result. We report our experience and describe our technique using a single, large burr (2.25, 2.5, or 2.75 mm diameter) without balloon assistance. The burr size was selected to approximate 70–90 percent of the apparent normal lumen diameter. Thirty‐one patients with 36 lesions of complex morphology (eccentric, irregular, calcified, ulcerated, at bends, at bifurcations, completely occluded, as well as balloon failures) were successfully treated with the Rotablator(TM). Results were assessed by computerized quantitative angiography. The percent diameter stenosis (mean ± SD) for the group was reduced from 69.8 ± 11.3% to 30.9 ± 10% (p < 0.001). The mean absolute diameter stenosis increased from 0.9 ± 0.3 mm to 2.2 ± 0.3 mm (p < 0.001). Angiographically visible dissections were seen in 4 patients and were uncomplicated in 2. One patient had a non‐Q‐wave myocardial infarction. A fourth patient had a presumed acute occlusion 36 hr after the procedure, necessitating emergency bypass surgery, but without Q waves on the electrocardiogram or wall‐motion abnormalities on the echocar‐diogram. Nitroglycerin was infused through the Rotablator(TM) catheter and has considerably lowered the degree and frequency of spasm. No other acute complications occurred. The mean procedure time using a single burr was shorter than when multiple burrs were used: 56.5 vs. 97.3 min, respectively (p < 0.05). The use of a single, large‐size Rotablator(TM) burr is an effective method of treating complex coronary stenoses without balloon assistance and has an encouragingly low complication rate and short procedure time. © 1992 Wiley‐Liss, Inc.
Accelerated coronary artery stenosis at a site proximal to coronary angioplasty
Authors: Voyce Stephen J. , Carey Kevin T. , Weiner Bonnie H. , Laifer Lawrence I. , Folland Edward D.
Published: March 2007

Rapid progression of coronary stenosis has been described in patients undergoing percutaneous transluminal coronary angioplasty (PTCA), typically resulting in symptomatic angina 3 to 30 months postprocedure. We report a case of accelerated coronary stenosis in the instrumented vessel resulting in angina 3 days post‐PTCA. © 1992 Wiley‐Liss, Inc.
Percutaneous fenestration of dissecting intima with a transseptal needle. A new therapeutic technique for visceral ischemia complicating acute aortic dissection
Authors: Saito Shigeru , Arai Hidekazu , Kim Kunikane , Aoki Naoto , Tsurugida Masanobu
Published: March 2007

Noncardiac visceral ischemia is a major complication with acute aortic dissection and is caused by obstruction of the major visceral arteries by dissecting intima. Two patients with this condition underwent emergency percutaneous fenestration of dissecting intima, and the blood flow to the lower extremity and kidney was restored. A transseptal needle and peripheral angioplasty balloon catheter were used for fenestration. There were no associated complications in either patient. One patient was treated medically and another had ascending aortic replacement surgery the day after percutaneous fenestration. Clinical follow‐up of 10 and 5 months, respectively, revealed good clinical outcomes. Percutaneous fenestration should be considered the treatment of choice for visceral ischemia due to acute aortic dissection. © 1992 Wiley‐Liss, Inc.
Progression of Takayasu's aortitis in a young japanese woman: Serial angiographic study
Authors: Iga Kanji , Hori Kenjiro , Matsumura Tadashi , Gen Hiromitu , Tamamura Toshitake
Published: March 2007

Progression of Takayasu's aortitis was observed by serial angiography over 2 years. Acute aortic regurgitation due to marked dilatation of the proximal ascending aorta was followed by aneurysmal dilatation of the distal ascending aorta. Aneurysmal dilatation of the carotid arteries then developed, with subsequent obstruction of both the bilateral vessels by thrombosis. © 1992 Wiley‐Liss, Inc.
Initial and long‐term results of percutaneous transluminal coronary angioplasty in patients 75 years of age and older
Authors: ten Berg J.M. , Bal E.T. , Joe Gin R.M. Tjon , Ernst J.M.P.G. , Mast E.G. , Ascoop C.A.P.L. , Defauw J.J.A.M. , Plokker H.W.M.
Published: March 2007

In 212 patients aged 75 years and older the immediate and long‐term results of percutaneous transluminal coronary angioplasty (PTCA) were assessed. For 293 stenoses the primary angiographic success rate was 96% and the overall clinical success rate was 90.6%. Angioplasty caused a myocardial infarction in 7 patients (3.3%), 2 patients (0.9%) needed emergency aorto coronary bypass surgery, and 4 patients (1.9%) died following the procedure. Actuarial 7 year survival was calculated at 69.3% with a standard deviation (SD) of 8%. Actuarial cardiac survival at 7 years was 92.1% (SD 3%), whereas non‐cardiac survival at 7 years was 75.3% (SD 9%). Actuarially, at 7 years 98.5% (SD 1%) were estimated to remain free from myocardial infarction in the angioplasty‐related area, 95.7% (SD 2%) to remain free from any myocardial infarction, 93.9% (SD 2%) to remain free from re‐PTCA because of a recurrence, 84.7% (SD 5%) to remain free from any re‐PTCA, and 97.1% (SD 2%) to remain free from (re)‐operation. Fifty‐two point three percent (SD 8%) were estimated to remain free from any cardiac event. If recurrence of angina is taken into account, only 25.8% (SD 13%) remain asymptomatic during 7 years follow‐up. After successful angioplasty in patients aged 75 and older the chance of remaining free from any event or angina at 7 years actuarial follow‐up gets as low as 15.7% (SD 9%).

We conclude that in selected elderly patients angioplasty can be performed with a high success rate, although the periprocedural mortality and morbidity appear to be higher than in the younger age group. During long‐term follow‐up, most of the patients remain free of cardiac events and survival appears to be largely dependent on non‐cardiac factors. However, long‐term relief from angina is probably less than in younger patients. © 1992 Wiley‐Liss, Inc.
Coronary stenting: Single institution experience with the initial 100 cases using the Palmaz‐Schatz stent
Authors: Colombo Antonio , Maiello Luigi , Almagor Yaron , Thomas Jack , Zerboni Santino , Summa Michele Di , Finci Leo
Published: March 2007

We studied 100 patients who had coronary implantation of Palmaz‐Schatz stents in our institution from November 1989 until March 1991. A total of 126 standard and 6 short stents were implanted. The patients' mean age was 58 ± 5 years, and 97 were males. The indications were lesions with high risk of restenosis (29 patients), restenosis (27 patients), suboptimal result of angioplasty (24 patients), dissection (16 patients), and recanalized chronic total occlusion (6 patients). In 17 patients a brachial cut‐down approach was used. Stents were correctly placed in 98 patients. Stent related complications occurred in 9 patients: major ischemic complications in 7 patients (acute myocardial infarction in 2 patients, emergency bypass surgery in 3 patients and emergency angio‐plasty in 2 patients); in 3 of these patients there was a subacute closure of the stent and in 2 patients there were delivery problems. Vascular complications at the site of arterial puncture occured in 3 patients (some patients had more than one complication). A learning curve was observed. There was a decrease in the complication rate with the higher number of patients treated: 28% for the first 50 patients and 6% for the last 50 patients. Clinical follow‐up was available in all patients. Of the 92 patients eligible for follow‐up (7 ± 2 months), 69 patients were asymptomatic and 23 had recurrence of angina: 19 patients for stent restenosis and 4 patients for coronary artery disease progression. Follow‐up angiogram was done in 79/92 (86%) patients: 21 had restenosis (27%). Restenosis rate was higher in patients with multiple stents 40% (6/15) than with the single stent 23% (15/64), and when the indications were for dissection 35% (6/17). These differences did not reach statistical significance. The global incidence of restenosis appears to be lower when compared to balloon coronary angloplasty, although there is no garantee these populations are comparable. Stenting seems to be a good alternative to coronary angioplasty in lesions which are not considered ideal for the balloon dilatation and to treat occlusive dissections. The use of multiple and partial overlapping stents is associated with a high restenosis rate. These impressions need to be tested in a large, randomized, multicenter study. © 1992 Wiley‐Liss, Inc.
Multicenter dose‐finding trial for thrombolysis with urokinase preactivated pro‐urokinase (TCL 598) in acute myocardial infarction
Authors: Gulba Dietrich C. , Bode Christoph , Sen Semi , Topp Jürgen , Fischer Klaus , Wolf Helmut , Hecker Hartmut
Published: March 2007

In a multicenter dose‐finding study, the thrombolytic potency of urokinase preactivated pro‐urokinase was evaluated. Sixty‐two patients were randomly assigned to receive 250,000 U of urokinase plus either 4.5 mega U (group I: n=33) or 6.5 mega U (group II: n = 29) of pro‐urokinase. Patency rates were 36.4% (20.4–54.9%) vs. 54.5% (36.3–71.9%) (n=27) at 60 minutes and 55.6% (32.5–70.6%) vs. 62.1% (42.3–79.3%) at 90 min into thrombolysis (n.s.). In a third group of 12 patients treated with 500,000 U of urokinase plus 6.5 mega U of pro‐urokinase patency was achieved in 33.3% (9.9–65.1%) and 41.7% (15.2–72.3%) at 60 and 90 min, respectively. Patency rates at 24 hr follow‐up angiography (n= 35) were 78.6% (49.2–95.3%), 85.7% (57.2–98.2%), and 85.7% (42.1–99.6%). Coagulation analysis in 37 patients revealed similar alterations in the three treatment groups with minor decreases in fibrinogen levels, moderate drops in plasminogen and α‐2‐antiplasmin levels, and moderate increases in the concentrations of the total fibrino‐gen/fibrin degradation products, the differences between the groups not being significant. Bleeding complications were observed in 12.9%, 13.8%, and 25% of patients in groups I, II, and III, respectively, mainly related to catheter sites. Hence, the safety profile of urokinase preactivated pro‐urokinase seems comparable to other thrombolytic regimens. Reopening of occluded coronary arteries, however, is achieved relatively slowly. Thus, in its use for thrombolysis in myocardial infarction, urokinase preactivated pro‐urokinase does not seem to offer superior advantages. © 1992 Wiley‐Liss, Inc.
Maximum stress‐volume index ratio of the left ventricle in hypertrophic cardiomyopathy
Authors: Nakagawa Makoto , Shirato Kunio , Sakuma Masahito , Ishigaki Hidehiko , Ohe Masatoshi , Ikeda Jun , Takishima Tamotsu
Published: March 2007

To evaluate the left ventricular contractile state in patients with nonobstructive hyper‐trophic cardiomyopathy (HCM), we analyzed the maximum stress‐volume index ratio (MSVR) using catheter‐tip cineangiography in 11 patients with HCM and 16 normal subjects. The value of the MSVR in normal subjects was 6.48±1.25 kdyn/cm5/m2 (mean±SD) and we defined the range of the mean±2 SD as the normal MSVR range. Six patients with HCM placed inside the normal MSVR range (IN), but the other 5 patients placed outside and to the right of the normal range (RIGHT). This suggests that the contractile states of the patients of the RIGHT group were depressed. Compared with IN, the end‐diastolic and end‐systolic volume Indices of RIGHT were larger (EDVI; 69.3±6.9 vs. 96.1 ±11.1 ml/m2, p<0.01, ESVI; 18.2 ± 3.2 vs. 29.1 ±8.3 ml/m2, p<0.05), but the ejection fraction did not differ (IN 73.5±5.7 vs. RIGHT 69.6±8.3%, NS). End‐diastolic pressure of IN and RIGHT was higher than that of normal subjects (IN 16.5±4.5, RIGHT 16.7±4.6 vs. 8.3±2.5 mm Hg, both p<0.05), but there was no difference between the two groups in HCM. End‐systolic pressure did not differ among the three groups. End‐diastolic, mean systolic, and end‐systolic stresses of IN were similar to those of RIGHT Left ventricular wall thickness (RIGHT 1.66±0.22 vs. IN 1.36±0.14 cm, p<0.05) and mass index (RIGHT 272.2±25.5 vs. IN 176.1 ±19.0 g/m2, p<0.01) of RIGHT were larger than those of IN. Furthermore, there were linear inverse relations between the MSVR and the end‐diastolic volume index (r= −0.84) and between the MSVR and mass index (r=‐0.91) in the 11 patients with HCM. These results suggest that there were two groups among the HCM patients, that is, those with normal (or preserved) and those with depressed contractile states, and patients with large end‐diastolic volume indices and increased mass indices tended to have depressed contractile states. © 1992 Wiley‐Liss, Inc.
Ambiguous coronary angiography: Clinical utility of intravascular ultrasound
Authors: White Christopher J. , Ramee Stephen R. , Collins Tyrone J. , Jain Ashit , Mesa Juan E.
Published: March 2007

We report the use of intravascular ultrasound (IVUS) in situations where angiography was ambiguous or uncertain in assessing the significance of coronary stenoses. The indications for performing intravascular ultrasound were (1) angiographic findings did not correlate with the clinical presentation (n = 5) and (2) the lesion was not seen well by angiography because of overlapping vessels at the site of suspected stenosis (n=3). We studied eight lesions in seven patients. Six nonobstructive stenoses on angiography were shown by IVUS to be significant. In two patients, stenoses were thought to be significant on angiography, but, due to overlapping of the vessels, there was doubt regarding the severity of the narrowing. In these two patients, IVUS clearly showed that the lesions were nonobstructive. As seen from the above results, angiography underestimated 6/8 stenoses and overestimated in 2/8 stenoses when compared to IVUS. We conclude that IVUS can be used to clarify ambiguous angiographic findings which can have a major impact on the clinical decision making. © 1992 Wiley‐Liss, Inc.
Complete heart block complicating retrograde left‐heart catheterization of patients with cardiac allografts
Authors: Sack Jeffrey B. , MaCalpin Rex , Gerber Richard , Gupta Vinod K. , Sherman C. Todd , Yeatman Larry
Published: March 2007

The development of complete heart block during left‐sided cardiac catheterization is an uncommon event. We describe three cases of complete heart block complicating leftsided cardiac catheterization of patients with cardiac allografts. Review of the cases performed at our institution suggests that complete heart block during left‐sided cathe‐terization may be more common in patients with cardiac allografts. © 1992 Wiley‐Liss, Inc.
Transseptal catheterization update 1992
Authors: Clugston Richard , Lau Francis Y.K. , Ruiz Carlos
Published: March 2007

Resurgence of the transseptal procedure in the last decade has occurred coincident with the advent of therapeutic catheterizations and in particular mitral balloon valvuloplasty. As larger numbers of these procedures have been performed, experience shows that the position of intended septal puncture varies for each anticipated procedure and need not lie at the fossa ovalis, which is frequently displaced or inaccessible. Recognizing the dynamic alterations in septal and atrial anatomy that accompany the various combinations of valvular heart disease, the experienced interventionalist will use precatheterization echo and radiological techniques to enable precise and localized transseptal puncture. Using these techniques in 597 patients for valvular heart disease, we have had no deaths and a morbidity of 1.8% with the transseptal puncture. © 1992 Wiley‐Liss, Inc.
Prolonged intravenous urokinase infusion: An alternative pharmacologic approach in the treatment of thrombus‐containing saphenous vein graft stenoses
Authors: Cospito Peter D. , Popma Jeffrey J. , Satler Lowell F. , Leon Martin B. , Kent Kenneth M. , Pichard Augusto D.
Published: March 2007

A subtotally occlusive saphenous vein graft stenosis resolved after rapid intracoronary and prolonged intravenous urokinase infusion. Additional therapy was unnecessary, avoiding the attendant risks of saphenous vein graft angioplasty. Combined intracoronary and intravenous urokinase infusion should be considered prior to coronary angioplasty of saphenous vein graft stenoses, particularly when diffuse degeneration is present or the risk of underlying thrombus is high. © 1992 Wiley‐Liss, Inc.
New approach to management of intraaortic balloon pumps in patients with peripheral vascular disease: Case reports of four patients requiring urgent IABP insertion
Authors: Lewis Bruce E. , Sumida Colin , Hwang Ming H. , Loeb Henry S.
Published: March 2007

Four selected cases of emergent IABP insertion in PV patients are presented. After angiographic documentation of critical iliac stenosis, conservative peripheral angioplasty was performed prior to IABP insertion. No patient experienced a peripheral ischemic event associated with IABP use. © 1992 Wiley‐Liss, Inc.
Guidelines for the performance of outpatient catheterization and angiographic procedures
Authors: Clark David A. , Moscovich Michael D. , Vetrovec George W. , Wexler Lewis
Published: March 2007

Cardiac catheterization and angiography is a safe procedure performed on patients with suspected or potentially serious cardiovascular disorders. Complications of the procedure are related both to heart disease itself and to elements of the procedure. For a variety of social and financial reasons, the performance of cardiac catheterization and coronary angiography on an outpatient basis has increased recently. The purpose of this paper is to state the guidelines of The Society for Cardiac Angiography and Interventions regarding the performance of outpatient catheterization in a hospital setting.© 1992 Wlley‐LIM, Inc.
Pressure wave fidelity in catheter introducers
Authors: Tock Christine L. , Hyman William A.
Published: March 2007

Pressure waveform fidelity was examined in two sizes of the Bard catheter introducer. The purpose of this endeavor was to determine whether accurate blood pressure measurements could be achieved directly via the catheter introducers. The introducers were incorporated into a mock circulatory system for the study. The effects of supporting dilators and catheters within the introducer sheath during pressure measurements were also considered. Parameters used to explain pressure waveform response within the catheter introducers included the damping coefficient and the natural frequency of the catheter introducer, and the effects of impedance mismatching between the transducer and the mock circulatory system. Overall, the pressure measurements obtained from the catheter introducer were distorted. Mean pressure levels measured in the introducers were up to 15 mmHg higher than the true mean pressure. The distortion in the pressure measurements can be attributed for the most part to impedance mismatching. In sum, the pressure measurements obtained from catheter introducer‐manometer systems should be used only referentially, and not as an absolute standard.
Clinical results and quality of life after percutaneous transluminal coronary angioplasty: A preliminary report
Authors: McKenna Kryss T. , McEniery Paul T. , Maas Frederick , Aroney Constantine N. , Bett John H. N. , Cameron James , Garrahy Paul , Holt Geoffrey , Hossack Kenneth F. , Murphy Allan L.
Published: March 2007

To evaluate the effect of percutaneous transluminal coronary angioplasty (PTCA) on quality of life, data on symptomatic status, functional capacity, life satisfaction, and psychological wellness were collected on 102 patients at 1 day pre‐PTCA and 2 months post‐PTCA, and on the first 50 of these patients at 10 months post‐PTCA. There were highly significant changes (p <0.001) in all quality of life measures between pre‐PTCA and the 1st follow‐up measurements. No further significant changes occurred in these measures between the 1st and 2nd follow‐up measurements, indicating that the initial improvement in quality of life was sustained over this period. Data on primary success rate, complications, and pre‐ and post‐PTCA risk factor scores are also reported.
Coronary artery aneurysm formation following directional coronary atherectomy
Authors: Krolick Merrill A. , Bugni William J. , Walsh John W.
Published: March 2007

Directional coronary atherectomy has recently become available to treat coronary stenosis by excision and removal of tissue. The optimal depth of resection by this method has not been determined and complications have occurred. This report describes the formation of a coronary aneurysm at an atherectomy site in an asymptomatic patient, a finding not reported previously.
Case report: Formation of vessel aneurysm after stand alone coronary excimer laser angioplasty
Authors: Preisack Melitta B. , Voelker Wolfram , Haase Karl K. , Karsch Karl R.
Published: March 2007

Formation of aneurysms in coronary arteries can be observed following percutaneous transluminal balloon angioplasty but has not been reported previously after coronary excimer laser angioplasty in humans. Stand alone coronary excimer laser angioplasty was performed in a 49‐year‐old man with a 75% left anterior descending artery stenotic lesion and exertional angina, documenting a good angiographic result postintervention. Control angiography 6 months after the procedure revealed an aneurysm distal to a 90% restenosis in the area of ablation.
Aneurysmal formation after successful pulsed laser coronary angioplasty
Authors: Nakamura Fumitaka , Kvasnicka Jan , Decoster Hans L. , Geschwind Herbert J.
Published: March 2007

We report two cases of coronary artery aneurysmal formation as long term consequences of Ho: YAG and excimer laser coronary angioplasty. This case report suggests that pulsed laser angioplasty may result in severe vessel wall damage that may lead ultimately to aneurysmal formation.
Detachable balloon embolization of an latrogenic aortocoronary arteriovenous fistula combined with aortocoronary bypass PTCA: A case report
Authors: Peregrin J. H. , Želízko M. , Kováčc J.
Published: March 2007

Coronary artery bypass surgery was performed in a 54‐year‐old male, and one of the grafts was inadvertently sutured to the vena cordis magna instead of to the left anterior descending coronary artery (LAD). Four years later the patient observed a progression of symptoms including episodes of angina pectoris at rest. Coronary angiography showed stenosis of one of the bypass grafts and notable dilatation of an iatrogenic arteriovenous (A‐V) fistula. The stenosed bypass graft was dilated and the A‐V fistula occluded by use of a detachable balloon. Embolization was performed rather than surgery, as the LAD was found to be a poor surgical target. The patient's symptoms improved after the procedure; he was followed for 18 months during which time his condition remained stable.
Combined PTCA and microcoil embolization of a left internal mammary artery graft
Authors: Mishkel G. J. , Willinsky R.
Published: March 2007

Internal mammary arteries are increasingly common conduits for coronary revascularization. Although infrequent, cardiologists are faced with a number of technical failures. We describe a case of combined PTCA to a LIMA insertion stenosis, along with coil embolization of a large unligated intercostal side branch. A complication of embolization is described along with angiographic follow‐up.
Excimer laser ablation before autoperfusion balloon inflation: A novel therapeutic approach to high grade stenoses in vessels supplying substantial myocardium at risk
Authors: Krause Philip B. , Schaer Gary L. , Parrillo Joseph E. , Klein Lloyd W.
Published: March 2007

The utility of a novel approach employing excimer laser ablation to form a channel for subsequent autoperfusion balloon angioplasty is presented. Two important advantages of this strategy are highlighted: (1) applicability to severe stenoses in vessels supplying substantial myocardium at risk and (2) ability to allow prolonged inflation time to minimize procedure related ischemia and optimize revascularization of the heart. We prospectively selected and studied five patients and performed excimer laser coronary angioplasty using either a 1.3 mm or 1.6 mm laser catheter followed by autoperfusion balloon dilatation. Procedural success was documented by a significant reduction in mean percent diameter stenosis from 89 ± 4% (S.D.) to 53 ± 4% after laser angioplasty (p<0.0001) and subsequently to 20 ± 4% after autoperfusion balloon angioplasty (p<0.0001). Clinical success was attained and characterized by resolution of anginal symptoms for at least 4 weeks after hospital discharge. There were no major acute complications encountered; however, restenosis has occurred in 2 out of 5 patients. We therefore recommend this novel pre‐dilation strategy with excimer laser followed by autoperfusion balloon angioplasty in selected patients with an extensive amount of myocardium at risk.
Ventricular standstill complicating left heart catheterization in the presence of uncomplicated right bundle branch block
Authors: Gaglani Rajesh D. , Turk Ashfaq A. , Mehra Mandeep R. , Lach Ralph D.
Published: March 2007

We report the unusual occurrence of complete heart block during attempted right coronary artery cannulation in a patient with pre‐existing uncomplicated right bundle branch block (RBBB). This complication occurred due to accidental impingement of the Judkin's right coronary catheter on the left bundle when it transiently slipped across the aortic valve. The block resolved without any complication.
Anomalous origin of the left coronary artery from the pulmonary artery: Direct assessment of anomalous and collateral coronary flow by pulsed doppler echocardiography
Authors: Takeshita Satoshi , Yamaguchi Tetsu , Kuwako Kenji , Isshiki Takaaki
Published: March 2007

We directly assessed the anomalous and collateral coronary flow profiles of a 58 year‐old‐man with Bland‐White‐Garland syndrome using pulsed Doppler echocardiography. Doppler recordings in this patient document the utility of pulsed Doppler echocardiography in the assessment of a cardiac shunt associated with a congenital coronary anomaly in an adult.
Endomyocardial biopsy: Advantages of adding a posterior bend to the bioptome
Authors: Hauptman Paul J. , Gass Alan , Cohen Marc , Goldman Martin E. , Israel Douglas , Ambrose John A.
Published: March 2007

A modification of the distal end of a flexible bioptome used for endomyocardial biopsy is described which facilitates the approach to the interventricular septum. Contact with the right ventricular free wall is avoided.
Cardiac catheterization laboratory survey: 1990 Society for cardiac angiography and interventions laboratory performance standards committee
Authors: Cameron Airlie , Sheldon William C. , Balter Stephen
Published: March 2007

A survey of 117 member cardiac catheterization laboratories was undertaken by the Society for Cardiac Angiography and interventions. The survey included numbers and types of procedures, both diagnostic and interventional, in adult as well as pediatric age groups. Radiation safety, various laboratory policies, frequency of short stay, and outpatient procedures were tabulated. Report generation, training programs, administrative organization, and laboratory equipment were all included. The results were compared with a 1978 survey. Areas of concern in terms of safety of the patient and possible underutilization of laboratories were identified.
PTCA with side‐by‐side balloon using fixed guide wire systems: A potential alternative autoperfusion device‐an in vitro study
Authors: Colle Jean‐Pierre , Delarche Nicolas
Published: March 2007

The use of “hugging balloons” for the implementation of a coronary angioplasty is a well‐known and much‐written‐about technique. It has not, on the other hand, ever been stressed that two inflated hugging balloons are not totally obstructive, leaving enough space, between the balloons and the arterial wall, for perfusion. The cross section of this free area can be as much as 12% of the total arterial cross section, when the side‐by‐side balloons are of a relatively similar size.

Calculations show that similar total conduit cross sections are achieved when inflating either a 3.0 balloon or two 2.0 side‐by‐side balloons.

An in vitro experiment compares how systems using 2.0 double balloons and a 3.0 autoperfusion balloon affect the distal flow of a 3 mm internal diameter conduit. A semirigid silastic tubing is perfused with a 5% glucose isotonic solution at various predetermined proximal pressure levels. Distal pressures and flows are measured at different stages: with no balloon, with deflated balloons, and with inflated balloons.

Comparison shows that (1) the double balloon system offers little resistance to flow compared to the autoperfusion balloon; (2) this system's rate of perfusion run‐off is hardly affected and is constantly better than with the autoperfusion balloon; (3) this difference is all the more marked, the lower the proximal perfusion.

These results suggest that the use of a double balloon could, in some cases, provide an alternative solution to autoperfusion equipment. Further clinical studies are needed to test this hypothesis.
Mitral balloon valvuloplasty with transesophageal echocardiography without using fluoroscopy
Authors: Kültürsay Hakan , Türkoǵlu Cüneyt , Akin Mustafa , Payzin Serdar , Soydas Cahide , Akilli Azem
Published: March 2007

Balloon mitral valvuloplasty with Inoue technique was performed in two group of patients. In group I (n = 40) valvuloplasty was performed under fluoroscopy without using echocardiography, whereas in group II (n = 13) valvuloplasty was performed under the guidance of transesophageal echocardiography alone, without using fluoroscopy. Patients in two groups were comparable with regard to clinical variables and hemodynamic parameters. Two female patients in group II were pregnant.

Transmitral pressure gradient decrease did not differ significantly between two groups (pressure gradient: 17 ± 5 to 4 ± 1 in group I and 15 ± 4 to 3 ± 1 mm Hg in group II). Mitral valvular area increase was also not different in two groups (1.09 ± 0.2 cm2 to 2.3 ± 0.5 cm2 in group I and 0.9 ± 0.2 to 2 ± 0.3 cm2 in group II). In 14 cases from group I and 2 cases from group II mitral regurgitation increased after valvuloplasty (p < .05). Left atrial perforation occurred in one patient from group I and 2 patients from group II.

In conclusion, mitral balloon valvuloplasty under transesophageal echocardiographic guidance alone is a safe and effective procedure in the treatment of mitral stenosis.
Early ambulation following diagnostic 7‐french cardiac catheterization: A prospective randomized trial
Authors: Lau Kean Wah , Tan Arthur , Koh Tian Hai , Koo Chee Choong , Quek Susan , Ng Amy , Johan Abdullah
Published: March 2007

There is a paucity of randomized studies concerning transfemoral cardiac catheterization and its complications, in particular that of 7F catheterization. Accordingly, we conducted a prospective, randomized trial comparing early ambulation (group A) 6 hr after diagnostic 7F cardiac catheterization versus late ambulation (group B) the following morning. A total of 273 patients were randomized in the study; 142 in group A and 131 in group B (NS). Except for a difference in the indications for catheterization, the baseline and procedure‐related parameters were similar between the 2 groups. Early hematoma (formed within 6 hr) developed in 6 (4%) and 7 (5%) patients in groups A and B, respectively (NS). Similarly, there was no difference in the incidence of late hematoma formation (2% in each group). All hematomas detected were small and required no surgical intervention or extension of hospital stay. Our data showed that early ambulation following 7F left heart catheterization is feasible and safe. The access site complication rate is acceptably low and minor in nature.
Coronary artery rupture and pseudoaneurysm formation resulting from percutaneous coronary angioscopy
Authors: Wolff Matthew R. , Resar Jon R. , Stuart R. Scott , Brinker Jeffrey A.
Published: March 2007

We describe a case in which coronary angioscopy was complicated by inability to deflate the device's occlusion balloon. Rapid over‐inflation to rupture the balloon resulted in massive dissection of the artery, pseudoaneurysm formation, and ultimately coronary bypass. While the cause of failure of balloon deflation remains obscure, deliberate over‐inflation to cause rupture may be hazardous. © 1993 Wiley‐Liss, Inc.
Limitations of the zero crossing detector in the analysis of intracoronary doppler: A comparison with fast fourier transform analysis of basal, hyperemic, and transstenotic blood flow velocity measurements in patients with coronary artery disease
Authors: Di Mario Carlo , Roelandt Jos R. T. C. , De Jaegere Peter , Linker David T. , Oomen Jan , Serruys Patrick W.
Published: March 2007

The current clinical standard for the analysis of intracoronary Doppler signals is the application of a zero‐crossing (ZC) detector. However, the accuracy of the method is questionable, especially in areas of disturbed flow, as confirmed by in vitro studies, animal experiments, and intraoperative observations. The aim of this study is the comparison of a conventional ZC detector and a custom‐designed spectral analyzer (fast Fourier transform, FFT) in the analysis of intracoronary Doppler signals obtained in 19 patients undergoing coronary angioplasty.

A 3F catheter with an end‐mounted Doppler ceramic crystal was placed over an 0.014″ guidewire in a normal or near‐normal segment proximal to the lesion to be dilated. The Doppler signal was recorded before and after intracoronary infusion of 12.5 mg of papaverine. In 9 patients high flow velocities could be recorded when the catheter was advanced across the stenosis.

The blood flow velocity measurements obtained with ZC were significantly lower than the maximal FFT flow velocity measurements (16±12 cm/s vs. 29±18 cm/s, p < .001). In all the conditions of Doppler signal acquisition (baseline, hyperemia, stenosis) a large scattering of the signed differences between corresponding measurements was observed. The standard deviation of the difference ZC‐FFT was ±11 cm/s and ±5 cm/s for the maximal and mean FFT flow velocity, corresponding in both cases to ±37% of the mean of the ZC and FFT measurements. Large differences were also observed in the values of coronary flow reserve (CFR) calculated as the ratio between ZC and FFT flow velocity measurements 30 s after papaverine intracoronary and at baseline. The standard deviation of the difference ZC‐FFT based CFR was ±1.3 and ±1.2 for the values derived from the maximal and mean FFT flow velocities (percent difference ±32% and ±37%, respectively).

In conclusion, the measurements obtained from the same intracoronary Doppler signal analyzed with a ZC detector and an FFT technique showed large differences in various conditions of flow and also in the assessment of relative flow velocity derived indices such as CFR. Spectral analysis should replace the current use of a ZC detector for the evaluation of coronary Doppler signals, even for the assessment of relative flow velocity changes. © 1993 Wiley‐Liss, Inc.
Comparison of shortening with timing of wall motion in detecting regional abnormalities of the left ventricle in coronary disease
Authors: Natarajan A. , Bove A. A.
Published: March 2007

Clinical observations suggest that ischemic myocardium may demonstrate delayed wall motion while absolute shortening remains normal. Wall motion timing and percent shortening were examined in 25 patients (7 normal, 18 coronary disease) with 35 mm biplane left ventriculograms and coronary arteriography. Mean age was 63 ± 2.4 years. Of 17 males and 8 females, 13 had 3 vessel, 4 had 2 vessel, and 1 had 1 vessel disease. Left ventricular regions were analyzed using the Coronary Artery Surgery Study nomenclature and quantitative computer‐based analysis as well as visual based qualitative analysis. Regional percent shortening and ejection fraction were calculated from end systolic and end diastolic frames. Regional shortening times were related to global ejection time from 30 frame/sec, frame by frame analysis. Feeder arteries were stenosed (>70%) in 135 of 225 left ventricular regions analyzed. Computer detection (shortening and timing) identified 97/225 as abnormal (P < 0.01 vs. feeder artery stenosis) while physicians identified 79/225 as abnormal (p < 0.01 vs. feeder artery stenosis). Of the 97 computer detected abnormal regions, shortening alone detected 47, timing alone detected 39, and 11 showed both abnormalities. Timing analysis increased detection of wall motion abnormalities from 58/225 (26%) to 97/225 (43%) (p < 0.001). Timing abnormalities were noted more (92%) in basal segments, while shortening abnormalities dominated (88%) in apical segments (p < 0.001). Use of temporal measurements in wall motion analysis significantly increases the likelihood of detecting abnormal left ventricular regional wall motion when compared to shortening measurements alone. © 1993 Wiley‐Liss, Inc.