bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of stenotic valve orifice area: An in vitro study on a bioprosthesis
Authors: Schoephoerster Richard , Yearwood Thomas L. , Chandran Krishnan B.
Published: March 2007

The Gorlin equation for the hemodynamic assessment of valve area is commonly used in cardiac catheterization laboratories. A study was performed to test the prediction capabilities of the Gorlin formula, as well as those of the Aaslid and Gabbay formulas for the effective orifice area of a porcine valve of varying degrees of stenosis. Pressure gradient, flow, and valve opening area measurements were performed on Carpentier‐Edwards porcine valve prostheses (made stenotic by suturing at the commissures) mounted in the aortic position of an in vitro pulse duplicator. With the known valve orifice area, a discharge coefficient was computed for each of the three orifice area formulas. After some theoretical considerations, it was proposed that the discharge coefficient would be a function of the flow rate through the valve. The discharge coefficient was observed to increase with increasing systolic flow rate. An empirical relationship of the discharge coefficient as a linear function of the systolic flow rate was determined through a regression analysis, with a different relationship for each orifice area formula. Using this relationship in the orifice area formulas improved the accuracy of the prediction of the effective orifice area with all three formulas performing equally well.
Balloon dilatation of the very small patent ductus arteriosus in preparation for transcatheter occlusion
Authors: Benson L. N. , Freedom R. M.
Published: March 2007

Balloon dilatation of the very small ductus arteriosus is described, and its application in five patients undergoing catheter occlusion is presented and discussed.
Quantitative regional contraction analysis of cineventriculography: Reporting, filing, and retrieval functions using a personal computer
Authors: Bozzi Giorgio , Verna Edoardo , Skinner Joan M. , Dwyer Mary‐Lynn , Castelfranco Mario
Published: March 2007

A new method for the semiobjective evaluation of left ventricular wall contraction is proposed that uses a percent reduction of areas. The calculation model uses orthogonal coordinates, an internal reference system, and the concept of nonuniform reduction of the cavity, with its obliteration at the apex. From a normal patient population (ten males, four females; aged 45 ± 13 years), a “normal reference curve” of contraction was obtained. A second patient group (56 males, two females, aged 56 ± 7 years) with definite contraction abnormalities was then analyzed. A third group (eight males, one female, aged 56 ± 10 years) was studied before and after nifedipine administration (1 mg over 2 min IV). Specific algorithms compare individual patient contraction curves with the normal reference curve and compute the score point system of contraction analysis. Data are automatically codified and filed during introduction. This saves time and allows a rapid retrieval of data grouped under different coded features. These features include the location and type of wall contraction abnormalities. This method of reading ventriculograms has been shown to be in accordance with the diagnosis of experienced observers and can detect small contraction changes that are induced pharmacologically. The method is proposed as a valuable tool for semiobjective evaluation of left ventricle wall contraction and to facilitate data collection in multicenter collaborative studies.
Weighted ventriculographic wall motion score for improved survival prediction in patients with coronary artery disease
Authors: Schwartz Robert S. , Llstrup Duane M. , Vlietstra Ronald E. , Bove Alfred A. , Smith Hugh C.
Published: March 2007

Global ventricular function parameters such as the ejection fraction and the sum of wall motion scores for segments of the left ventricle are excellent predictors of long‐term survival in patients with coronary heart disease. These are usually determined from a monoplane right anterior oblique view. It was hypothesized that a biplane weighted wall motion score that included the left anterior oblique projection might better predict survival. A new score (BISCORE) was derived for 1,433 Mayo Clinic ventriculograms coded by the methods of the Coronary Artery Surgery Study (CASS). Weighting coefficients for each left ventricular segment were derived by the proportional hazards technique, and this resulted in the equation BISCORE = 120 – (8.6 × anterobasal + 3.4 × basal septum + 2.9 × apical + 2.7 × posterolateral + 2.4*diaphragmatic), which yielded a score from 0 (all segments aneurysmal) to 100 (all segments normal). This score stratified the original 1,433 patients into distinct groups by survival. As a single variable it was better than previous wall motion scores and ejection fraction at predicting survival. When prospectively applied to 5,172 Coronary Artery Surgery Study patients, this new score again proved to be a better predictor of survival than previous unweighted scores.

Since the new score contains terms from the left anterior oblique ventriculographic projection, it is concluded that this projection adds information to that of the right anterior oblique projection regarding survival. Furthermore, this weighted score appears more highly associated with survival than unweighted scores.
Left atrial conduit function for left ventricular filling dynamics in patients with myocardial infarction
Authors: Toma Yoichi , Matsuda Yasuo , Moritani Kohshiro , Ryoke Tsutomu , Katayama Kazuhiro , Miura Toshiro , Ogawa Hiroshi , Matsuda Masako , Matsuzaki Masunori , Kusukawa Reizo
Published: March 2007

This study observed the left atrial function in determining filling dynamics of the left ventricle in patients with myocardial infarction. The study consisted of eight control subjects and ten patients with myocardial infarction. The left ventricular filling volume is considered to be composed of the left atrial passive emptying, active emptying, and conduit volumes. The change of left ventricular filling volume was correlated with that of conduit volume (r = .87, P < .01). However, the change of left ventricular filling volume did not have any correlation to those of left atrial passive emptying and active emptying volumes. These results suggested that the left atrial conduit function was important in determining filling dynamics of the left ventricle.
Gastrointestinal hemorrhage as a complication of cardiac catheterization
Authors: Mukerji Vaskar , Comens Steven M. , Alpert Martin A.
Published: March 2007

This report describes three patients who developed the rare complication of gastrointestinal hemorrhage following cardiac catheterization. These cases illustrate the diverse mechanisms by which bleeding may occur. The important predisposing factors appear to be widespread atherosclerosis, prolonged hypotension, and gastrointestinal disease potentially associated with bleeding.
Investigation of the performance of two types of the doppler catheter in vitro
Authors: Hangiandreou Nicholas J. , Toggart Edward J. , Mistretta Charles A.
Published: March 2007

There is considerable interest in the use of Doppler catheters for measuring coronary flow reserve in humans. Two types are currently available, these being models having side‐mounted or tip‐mounted transducers. The performance of these catheters was carefully observed in Silastic tubing perfused with blood by a roller pump. Each catheter was used with two types of positioning wire: a rigid wire and a standard J‐tip guidewire. Linear regressions of velocity vs. flow rate were performed. Both catheters performed well with the rigid wire (r ≥ 0.992). When used with the J‐tip, the end‐mounted catheter suffered decreased performance because of positioning difficulties, while the side‐mounted catheter performance was within 6% of the ideal. Measurements made with the side‐mounted catheter at low flow rates underestimated the expected response for forward flow. Because of the ease of positioning, the side‐mounted catheter is judged to be more useful in measuring flow ratios.
Percutaneous brachial approach for transluminal coronary angioplasty
Authors: Maouad Joseph , Hebert Jean‐Louis , Guermonprez Jean‐LÉOn
Published: March 2007

Transluminal coronary angioplasty from the arm is performed generally with cutdown and brachial arteriotomy. We describe a brachial percutaneous technique for coronary angioplasty, almost similar to the femoral one, wtih a special focus on the prevention of induced vasoconstriction.

Our preliminary results are satisfactory and without complications: 13 procedures in 11 patients have been performed over a 30 month period, with the sheaths left in place for 4–6 h after the procedure.

This method could be an easy alternative to the Sones technique for operators who are essentially familiar with the femoral percutaneous arterial approach.
Study of the performance of 5 french and 7 french catheters in coronary angiography: A functional comparison
Authors: Kohli Ravinder S. , Vetrovec George W. , Lewis Stephen A. , Cole Sharon
Published: March 2007

The functional efficacy of a conventional 7F (high flow) coronary catheter (hand injection) was compared with a 5F (high flow) catheter using hand and powered injection in 29 patients with ischemic heart disease. Patients were randomized to 5F or 7F catheters as the initial catheter. Consecutive comparative coronary angiograms were performed in the 15° right anterior oblique (RAO) view using Judkin's technique. Visual diagnostic grade (Grade 1 = Diagnostic, Grade 2 = Equivocal, Grade 3 = Nondiagnostic), vessel filling, vessel density (using a densitometer and corrected for background), streaming, and dislodgement were all evaluated independently by two experienced angiographers with correlation of results. Mean diagnostic grade (1.31 ± 0.48) was significantly better with the 7F compared to 5F (hand) 1.72 ± 0.81 and 5F (power) 2.00 ± 0.71 (P < 0.05) for each. Streaming was seen in 55% of injections with 5F (hand) versus 88.5% with 5F (power) and 20.7% with 7F. Measured vessel density was not different for the two catheters. Coronary injection dislodgement occurred significantly more often with 5F power injections than with hand injection of either catheter. Finally, in 6 (30%) of 20 patients in which the 5F was randomly the second catheter used, the operator had to revert to the 7F catheter in order to obtain adequate images. In conclusion, angiographic quality is reduced with 5F catheters compared to 7F high flow in certain patients. Thus, to achieve optimal diagnostic angiograms, larger lumen catheters may be required during certain procedures initially begun with 5F catheters.
Catheter reperfusion for failed emergency coronary angioplasty without subsequent bypass surgery
Authors: Ciampricotti Renzo , Dekkers Petrus J. W. M. , El Gamal Mamdouh I. H. , Van Der Krieken Antonius M. , Relik Theodorus H. F. M.
Published: March 2007

A transluminal intracoronary reperfusion catheter was used in eight patients, seven with acute myocardial infarction and one with unstable angina after failed emergency coronary angioplasty. After placement of the reperfusion catheter across the occlusion, symptoms of ischemia resolved in each patient. Chest pain recurred 3 hr later in a single patient who underwent successful repeat angioplasty. The catheter was withdrawn within 6 hr after introduction. Control coronary angiography showed a patent vessel in all but one. Repeat angioplasty or bypass surgery was unnecessary. During 1 year mean follow‐up time all patients remained free of symptoms. The reperfusion catheter is a safe and effective means of perfusing a coronary artery after failure of thrombolytic therapy and coronary angioplasty in cases where emergency bypass surgery is not performed because operative morbidity is expected to outweigh the benefit of myocardial salvage, or when it cannot be immediately organized.
Cough‐Cardiopulmonary resuscitation in the cardiac catheterization laboratory: Hemodynamics during an episode of prolonged hypotensive ventricular tachycardia
Authors: Miller Brian , Lesnefsky Edward , Heyborne Theresa , Schmidt Betty , Freeman Kathy , Breckinridge Susan , Kelley Kathleen , Mann David , Reiter Michael
Published: March 2007

Cough‐CPR, a deep rhythmic forceful cough repeated 30–60 times per minute, can be an effective resuscitative technique during emergencies occurring in the cardiac catheterization laboratory. We provide documented evidence on the potential of cough‐CPR to maintain adequate systemic arterial blood pressure and consciousness during malignant ventricular arrhythmias, including the longest cough‐CPR episode (75–90 sec), with continuous hemodynamics recorded. Results in three patients disclose that (1) mean arterial pressure during cough‐CPR was 47–66% of nonarrhythmic baseline at a cough rate of 38–46% of normal sinus rhythm heart rate; (2) mean arterial pressure during hypotensive ventricular tachycardia was 17–60 mm Hg higher with than without cough‐CPR; (3) at comparable diastolic pressures (33 vs. 31 mm Hg), systolic arterial pressure during cough‐CPR was 40 mm Hg higher than basic CPR; and (4) consciousness can be maintained with cough‐CPR during prolonged malignant ventricular arrhythmias. Thus cough‐CPR can be a valuable adjunct in maintaining patient stability while definitive therapy for the malignant ventricular arrhythmia is administered.
Percutaneous transluminal coronary angioplasty using a combined “balloon‐on‐a‐wire” system and exchange guidewire technique
Authors: De Marchena Eduardo , Stang R. Brian , Schob Alan , Topaz On , Chakko Simon , Mallon Stephen , Kessler Kenneth M.
Published: March 2007

New balloon‐on‐a‐wire dilation systems allow crossing of severely stenosed coronary arteries owing to their ultra‐low profile. However, these systems do not allow for over‐the‐wire exchange to a larger balloon catheter or insertion of perfusion catheters, should the vessel close abruptly during dilation. Therefore, if the need for such catheters arises, the vessel must be left unprotected during attempts to recross the lesion. We describe a new technique using a combined balloon‐on‐a‐wire system and an exchangeable guidewire, which permits the crossing and dilation of severely stenosed coronary arteries, while at the same time offering vessel protection and balloon catheter exchange.
Percutaneous transluminal coronary angioplasty using a steerable guiding catheter: A new technique
Authors: Stefanadis Christodoulos , Kourouklis Costas , Stratos Costas , Kastellanos Stamatis , Toutouzas Pavlos
Published: March 2007

A new type of steerable guiding catheter is described for use in percutaneous transluminal coronary angioplasty (PTCA). It is simple to use and externally steerable. The catheter incorporates a steering system by means of which the catheter tip can be made to assume the form of either a right or left Judkins catheter or to be fixed in any intermediate configuration, entirely through external manipulation. We used this new guiding catheter to perform PTCA on 15 patients.

Single lesions were found in the left anterior descending branch in seven patients, in the right coronary artery in four, and in the circumflex artery in two, whereas stenosis of a coronary bypass graft was found in two patients. Angioplasty was successful in all cases. There were no complications, during either the procedure or the postoperative hospitalization.

The steerable guiding catheter described here may prove useful for PTCA in cases where a conventional catheter cannot be placed accurately or in cases with multi‐vessel coronary disease.
Coronary occlusion after failed closure of coronaro‐pulmonary fistula with detachable balloon
Authors: Meier Bernhard
Published: March 2007

An attempt to occlude a fistula between the right coronary artery and the pulmonary trunk with a detachable balloon resulted in balloon dislodgment and occlusion of the right coronary artery. The dislodged balloon could be retrieved by suction with the help of a guiding catheter for coronary angioplasty.
First use of a 5 french diagnostic catheter as a guiding catheter for percutaneous transluminal coronary angioplasty
Authors: Salinger Michael H. , Kern Morton J.
Published: March 2007

We report the first use of a 5 French thin‐wall, large‐lumen diagnostic angiographic catheter as a guiding catheter for emergency angioplasty with an angioplasty balloon on a wire (PROBE™) for patients with acute circumflex coronary occlusion and hemodynamic compromise.
Ventricular fibrillation during coronary angiography: Reduced incidence with nonionic contrast media
Authors: Missri Joseph , Jeresaty Robert M.
Published: March 2007

Ventricular fibrillation during coronary angiography with Renografin‐76 has been attributed to the high osmolar ionic and calcium binding additive properties. Isovue‐370 is a new low osmolar nonionic contrast medium lacking calcium binding additives. The present investigation compared the incidence of contrast media‐induced ventricular fibrillation in patients undergoing coronary angiography with Renografin‐76 to that with Isovue‐370. Group I consisted of 2,000 consecutive patients undergoing coronary angiography with Renografin‐76, and group II consisted of 2,000 subsequent consecutive patients in whom lsovue‐370 was employed as the contrast medium. There was no significant difference between groups I and II with respect to volume of contrast media used per patient (125 ± 35 vs. 140 ± 45 ml), age (63.5 ± 15 vs. 60 ± 17 years), sex (74% male vs. 76% male), ejection fraction (55% vs. 55%), valvular heart disease (8% vs. 9%), prior coronary artery bypass graft surgery (5.8% vs. 5%), or extent of coronary artery disease. Contrast media‐induced ventricular fibrillation occurred in 20 patients in group I (incidence 1%), whereas eight episodes occurred in group II (incidence 0.4%) (P < 0.03). Thus the present investigation suggests that the incidence of ventricular fibrillation during coronary angiography can be significantly decreased by using low osmolar nonionic contrast media lacking calcium binding additives.
Nonselective preoperative digital subtraction angiography of internal mammary arteries
Authors: Finci Leo , Meier Bernhard , Steffenino Giuseppe , Doriot Pierre‐André , Rutishauser Wilhelm
Published: March 2007

In preparation for coronary bypass surgery, digital subtraction angiography (DSA) was used to assess the caliber of the left and right internal mammary arteries and to exclude stenoses of their feeding arteries. In 100 patients (86 males, mean age 56 ± 9 years) DSA was performed with a Siemens Digitron 2 device. A frontal projection was used in 18 patients, and a 10–20 degree right anterior oblique projection was used in 82 patients. The flow was 10 to 25 ml/sec; 20 ml was injected in 45 patients, 30 ml in 41, 40 ml in 5, 50ml in 8, and 60 ml in 1 patient, Judged on the proximal third, visualization of the left and the right internal mammary artery was good in 80 and 72, fair in 17 and 20, and bad in 3 and 8 arteries, respectively. The diameter (mm) was 2.7 ± 0.4 (range 1.8–3.4) and 2.7 ± 0.3 (range 2.0–3.5), and visible length (cm) was 8 ± 5 (range 1–24) and 9 ± 4 (range 2–22) for the two arteries, respectively. The 10–20 degree right anterior oblique view separated the left internal mammary artery better from the descending aorta than the frontal view. In more pronounced right anterior oblique views the ascending aorta interfered with the right internal mammary artery. The quality was not different with 20 ml or 30 ml injections. The feeding arteries could not be assessed in 4 patients. One left subclavian artery was found occluded at the orifice. Incidentally, 2 distal right subclavian stenoses and 2 carotid stenoses were detected. In conclusion, DSA with 20 ml (10 ml/sec) of contrast medium, injected into the ascending aorta in a 15 degree right anterior oblique view, sufficiently visualizes the internal mammary arteries and their feeding vessels before bypass surgery in most patients. Any catheter inserted for coronary or left ventricular angiography can be used.
Restenosis after transluminal coronary angioplasty: A risk factor analysis
Authors: Arora Rohit R. , Konrad Katherine , Badhwar Kavita , Hollman Jay
Published: March 2007

In order to determine the relationship of restenosis following percutaneous transluminal coronary angioplasty (PTCA) to risk factors such as hypercholesterolemia, hyperglycemia, smoking, and weight, we performed a univariate analysis to test the association of these variables with restenosis in 723 patients who had percutaneous transluminal coronary angioplasty and follow‐up catheterization.

Cholesterol levels were higher in younger and female subjects (<0.0001). Initial cholesterol did not predict restenosis, and follow‐up cholesterol levels showed an inverse relationship with restenosis (P <.02). There was a trend (P <.09) toward decreased restenosis in those who were active smokers at the time of follow‐up catheterization. No differences were seen in diabetics with hyperglycemia, in both treated and untreated groups (P = NS). A stepwise multiple logistic regression was used to simultaneously test the association of the above risk factor variables to restenosis. None of the interactions were found to be significant, except cholesterol at follow‐up (P =.001).

Therefore, the status of serum cholesterol, blood sugar, smoking, and weight during the time of PTCA and at follow‐up catheterization may be unimportant in predicting restenosis. Thus, we conclude 1) that to better determine the effect of these variables on restenosis, they should be estimated at times other than follow‐up and 2) that the pathophysiological mechanism of restenosis may have different risk factors than progression of atherosclerotic coronary artery disease.
Venobronchial fistula: A complication associated with central venous catheterization for chemotherapy
Authors: Beauregard John F. , Matsumoto Alan H. , Paul Martin G. , Holt Richard W.
Published: March 2007

We report a case in which a venobronchial fistula developed 4 months after insertion of a silicone rubber chronic central venous catheter for chemotherapy administration. In retrospect, the tip of the catheter was in the azygous vein rather than in the superior vena cava. The suboptimal position of the catheter tip, in combination with the infusion of sclerosing chemotherapeutic agents and hyperalimentation solution, may have predisposed the patient to this complication. Accurate localization of the tip of central venous catheters at the time of placement should minimize catheter‐related complications, including the rare complication of venobronchial fistula. After placement of chronic central venous catheters, biplanar chest X‐rays should be obtained to determine catheter tip location prior to the instillation of chemotherapeutic agents. Any residual questions concerning the catheter tip location after biplanar X‐rays should be addressed by prompt venography through the catheter.
Atrialization of right ventricular pressure during acute cardiac allograft rejection
Authors: de Marchena Eduardo , Madrid William , Wozniak Paula , Futterman Laurie , Mitrani Alberto , Bolooki Hooshang
Published: March 2007

We describe a patient who, during an episode of acute cardiac rejection, developed such severe systolic dysfunction that there was transient near‐adynamic function of the right ventricle. This right ventricular dysfunction was reflected hemodynamically by the unusual finding of atrialization of right ventricular pressures. The patient's cardiac function returned to normal after treatment with extensive immunotherapy.
Pinhole balloon rupture during coronary angioplasty causing rupture of the coronary artery
Authors: Lemay Michel R. , Beanlands Donald S.
Published: March 2007

We report a case of pinhole balloon rupture during percutaneous transluminal coronary angioplasty using one of the newer catheters. Pinhole balloon rupture resulted in rupture and occlusion of the vessel being dilated.
Unusual guidewire maneuver to enter an acute angulation during complex percutaneous transluminal coronary angioplasty
Authors: Avedissian Michael G. , Angelini Paolo
Published: March 2007

Guidewire manipulation may be the deciding factor for success in percutaneous transluminal coronary angioplasty (PTCA). A case involving a complex lesion forming an acute angle within the left anterior descending (LAD) coronary artery, which precluded guidewire advancement, is presented. Successful dilatation was achieved after an unusual guidewire maneuver.
Spontaneous reversal of flow through jeopardized collateral vessels during non–Q wave myocardial infarction
Authors: Klutstein Marc W. , Lefkowitz Charles A. , Goldman Bernard , Adelman Allan G.
Published: March 2007

This case report documents that, when a severely diseased donor artery occludes, sufficient spontaneous reversal of flow through the collaterals can occur to prevent an extensive and possibly fatal transmural infarction.
CO2 Power‐assisted hand‐held syringe: Better visualization during diagnostic and interventional angiography
Authors: Krieger Richard A. , Furst Ariel E. , Hildner Frank J. , Midwall Jay , Kieval Joshua
Published: March 2007

Recent technology has produced high‐flow and large‐lumen catheters as well as other angiographic accessories to enhance the visualization of the coronary arteries during diagnostic and percutaneous transluminal coronary angioplasty (PTCA) procedures. In spite of these technological advances, there are still many cases in which the quality of the coronary angiography could be significantly improved. This paper reports on a clinical evaluation of a hand‐held power syringe. The syringe offers the ability to power inject contrast safely and effectively during routine angiograms as well as through guiding catheters with the balloon catheter present during PTCA. At the same time, control of the injection is equal to that associated with manual syringes.
Analysis of risk factors for restenosis after PTCA
Authors: Rupprecht Hans J. , Brennecke Rüdiger , Bernhard Gudrun , Erbel Raimund , Pop Tiberius , Meyer Jürgen
Published: March 2007

To identify risk factors for restenosis, we evaluated data in 473 patients with singlevessel percutaneous transluminal coronary angioplasty (PTCA) and control angiography after 6 months. Restenosis, defined as (1) loss >50% of the initial gain, and (2) stenosis >50% was found in 138 patients (29.2%). Univariate analysis revealed eight factors related to restenosis: (1) duration of symptoms <1 month (P = 0.005), (2) unstable angina (P = 0.004), (3) high‐grade stenosis before PTCA (P = 0.014), (4) large residual stenosis after PTCA (P = 0.001), (5) insufficient improvement of stenosis (P = 0.042), (6) prolonged single inflation time (P = 0.017), (7) prolonged total inflation time (P = 0.055), and (8) low inflation pressure (P = 0.028). Multivariate analysis revealed four factors significantly related to restenosis: (1) large residual stenosis after PTCA (P = 0.0001), (2) prolonged single inflation time (P = 0.0047), (3) unstable angina (P = 0.0127), and (4) high‐grade stenosis before PTCA (P = 0.0179). Modification of procedural factors might be helpful to reduce the risk of restenosis after successful PTCA.
“High‐risk” percutaneous transluminal coronary angioplasty with preventive intra‐aortic balloon counterpulsation
Authors: Voudris Vassilis , Marco Jean , Morice Marie‐Claude , Fajadet Jean , Royer Thierry
Published: March 2007

Between January 1987 and February 1988, 1,385 patients underwent percutaneous transluminal coronary angioplasty; 27 procedures were performed using prophylactic intraaortic balloon counterpulsation. Twenty‐four patients had poor left ventricular function (EF < 40%), and coronary dilatation was performed in arteries opposite to an occluded myocardial necrosis related vessel. In three patients of advanced age with distal stenoses and normal left ventricular function a multivessel dilatation was performed. Primary success rate was achieved in all patients. There were no deaths, myocardial infarctions or emergency bypass operations in the hospiatilation period. During the follow‐up (9 to 21 months) there were 2 deaths, 1 cardiac transplantation, and 6 restenosis with repeated dilatation. If revascularization is warranted, in high‐risk patients, coronary angioplasty can be performed safely and successfully with protection by intraaortic balloon counterpulsation. However the long‐term prognosis of these patients is complicated by the presence of other high‐risk variables, such as advanced age or poor left ventricular function.
Percutaneous balloon valvuloplasty of pulmonary valve stenosis, dysplasia, and residual stenosis after surgical valvotomy for pulmonary atresia with intact ventricular septum: Long‐term results
Authors: Ballerini Luigi , Mullins Charles E. , Cifarelli Alberta , Pasquini Luciano , De Simone Giuseppe , Giannico Salvatore , Guccione Paolo , Di Donato R. , Di Carlo Duccio
Published: March 2007

Eighty‐six children (aged 20 days to 14 years, 20 under age 1 year) underwent 94 percutaneous balloon valvuloplasty for pulmonary valve stenosis. The patients were divided into three groups: typical pulmonary valve stenosis (71), pulmonary valve dysplasia (9), and residual stenosis after surgical valvotomy for pulmonary atresia with intact ventricular septum (PAIS) (6).

Each of the three groups was divided into two subgroups. In the early cases, balloon catheters with diameter 10‐20% exceeding pulmonary valve annulus were used and the drop of the gradient was 39.5%. In the later cases, balloon diameters 30‐40% greater than the valve anulus or double balloons were used and a drop of 66.7% in the RV‐PA pressure gradient was achieved.

The dilation in patients with dysplastic valve and residual stenosis after surgical valvotomy for PAIS was less effective. Doppler echocardiography was the technique used to evaluate residual gradient. Six months to 4 years follow‐up demonstrated a persistent decrease of the valve gradient.
Splenic abscess due to Peptostreptococcus spp. as a complication of cardiac catheterization
Authors: Conley Thomas D. , Vernino Lisa A.
Published: March 2007

We describe the development of a splenic abscess, due in part to Peptostreptococcus, as a complication of cardiac catheterization. The etiologies of splenic abscess should include Peptostreptococcus, and splenic abscesses should be added to the list of complications of cardiac catheterization.
Iatrogenic aorto‐sinus of Valsalva fistula: Angiographic and cine computerized tomography delineation
Authors: Blaker Alan M. , De Marchena Eduardo , Hansen Patricia , Schob Alan , Janowitz Warren , Chakko Simon , Kessler Kenneth M.
Published: March 2007

A patient is reported who underwent cardiac catheterization 4 years following coronary artery bypass grafting. Cardiac catheterization revealed the presence of a fistulous tract in the wall of the ascending aorta, originating at the site of aortic anastomosis of a saphenous vein bypass graft and ending in the superior aspect of the right sinus of Valsalva. This complication was felt to have resulted from a inadvertent localized dissection of the aorta during bypass surgery. The fistula was also imaged by ultrafast cine computerized tomography which proved a useful non‐invasive method for follow‐up examination.
Torsion of an internal mammary graft during percutaneous transluminal angioplasty: A case report
Authors: Grewe Kathy , Presti Charles F. , Perez Jose A.
Published: March 2007

A successful percutaneous transluminal angioplasty of the distal anastomosis of a tortuous left internal mammary artery graft to the left anterior descending coronary artery was complicated by the development of a focal lesion in the mid‐graft region. Dilatation at the site failed to improve the angiographic appearance. Withdrawal of the guidewire resulted in immediate resolution of the apparent mid‐graft lesion. The abnormality is felt to have been due to torsion of the graft upon itself, caused by guidewire and balloon catheter manipulation.
Systemic and local saphenous vein graft thrombolysis using a tissue plasminogen activator
Authors: Salinger Michael H. , Lopez Alvaro , Frohlich Thomas G. , McDonough Timothy J. , Hueter David C. , Stagl Richard D.
Published: March 2007

Many studies are currently evaluating the potential role of thrombolytic therapy in patients with ischemic syndromes who have undergone previous coronary artery bypass grafting. Limited experience has been published regarding the use of local urokinase and streptokinase infusions and the use of systemic recombinant tissue‐type plasminogen activator as thrombolytic agents in patients with previous coronary artery bypass surgery. To date, however, there has been no published experience regarding the use of recombinant tissue‐type plasminogen activator (rt‐PA) either systemically or locally in the post‐bypass patient where angiographic demonstration of aortocoronary saphenous vein graft obstruction was available pre‐ and post‐therapy. Similarly there has been no previous report of the use of rt‐PA infused locally to recanalize an occluded aortocoronary saphenous vein graft. This report describes successful thrombolysis and subsequent balloon angioplasty of saphenous vein grafts with angiographically documented thrombus using systemic and local rt‐PA infusion.
Accuracy of 20‐MHz doppler catheter coronary artery velocimetry for measurement of coronary blood flow velocity
Authors: Tadaoka Shinichiro , Kagiyama Mitsuyasu , Hiramatsu Osamu , Ogasawara Yasuo , Tsujioka Katsuhiko , Wada Yoshifumi , Sawayama Toshitami , Kajiya Fumihiko
Published: March 2007

The accuracy of 20‐MHz Doppler catheter coronary artery velocimetry (Millar Instruments) was evaluated by model experiments using a turntable and a flow tube. In the turntable experiments, the flow away from the catheter tip (away flow) was significantly lower than that toward the catheter (toward flow), but the measured velocities for both away and toward flows were always lower than the known velocities. Nevertheless, the blood velocities measured at a sampling point 4 mm from the catheter tip showed excellent correlation with the known velocities irrespective of flow direction. The shape of the FFT spectra of the Doppler shift frequency from blood was broadened, and the frequency corresponding to the known velocity was always close to the maximum Doppler shift frequency. We concluded that zero‐cross detection of blood velocity by the 20‐MHz pulsed Doppler catheter provides a reliable measure for evaluating relative velocity changes, although it underestimates the blood velocity.
Attempted balloon catheter obstruction of pulmonary arterial flow in ventricular septal rupture
Authors: Webb John G. , Daly Paul A.
Published: March 2007

Leaving a standard balloon flotation catheter inflated in the main pulmonary artery has been recommended as a temporizing measure in patients with post‐myocardial infarction ventricular septal rupture. Potential benefit has been ascribed to effective “banding” of the pulmonary artery as in congenital ventricular septal defects. We attempted this technique in five patients with post‐infarction septal rupture and shock. In no patient was a significant hemodynamic benefit or reduction in shunt observed. Because of the lack of clearly documented efficacy, the inadequate size of standard pulmonary balloons to produce significant obstruction to pulmonary flow, and the inherent risks of this technique we recommend that it not be lightly attempted.
Removal of retained intracoronary percutaneous transluminal coronary angioplasty equipment by a percutaneous twin guidewire method
Authors: Gurley John C. , Booth David C. , Hixson Clair , Smith Mikel D.
Published: March 2007

Balloon rupture during percutaneous transluminal coronary angioplasty (PTCA) resulted in embolization of a guidewire‐balloon fragment into the distal circumflex artery. Access to the circumflex was technically difficult because of aortic root dilation. The fragment was removed by inserting two PTCA guidewires into the artery and twisting them together to produce a helix. The helix propagated distally, entrapping the embolized fragment for removal. This report describes an unusual mode of failure for a balloon‐ona‐ wire dilating catheter and a new percutaneous removal technique that may be applied to retained catheter debris in small, inaccessible vessels.
Distal embolization during mechanical thrombolysis: Rotational thrombectomy vs. balloon angioplasty
Authors: Titus Bradley G. , Auth David C. , Ritchie James L.
Published: March 2007

To determine the incidence and extent of distal embolization during percutaneous transluminal balloon angioplasty (PTA) and rotational thrombectomy (PRT), we collected, filtered, and weighed the distal effluent of acute thrombotically occluded canine arteries following mechanical thrombolysis. PRT (n = 11) and PTA (n = 10) were equally effective in recanalizing occluded vessels (91% vs. 90%) and reduced percent diameter stenosis to a similar degree (97 ± 6% to 8 ± 11% and 100 ± 0% to 17 ± 23%, respectively). Distal embolization following mechanical intervention was observed in 10 of 10 and 8 of 9 arteries recanalized with PRT and PTA, respectively. The mean weights of collected emboli were similar between the two groups (18 ± 24 mg vs. 37 ± 79 mg, PRT vs. PTA, P = NS), although the range of size and weight of thromboemboli was larger in the PTA group (0–206 mg vs. 2–51 mg, PRT). Angiographically defined residual thrombus was significantly less frequent in arteries recanalized with PRT as compared with PTA (10% vs. 55%, P = 0.03). In summary, PRT and PTA are equally effective in recanalizing acutely occluded canine arteries and result in similar reductions in percent diameter stenosis. Each intervention results in distal embolization of thrombi. PRT is associated with a reduced incidence of angiographically evident residual thrombus at the site of arterial injury and may avoid embolization of large fragments occasionally produced by PTA. Thus PRT may serve as a useful alternative to coronary angioplasty during acute myocardial infarction.
Acute infarction during triple‐vessel coronary angioplasty due to acute occlusion of a nonattempted vessel
Authors: Ricou Fraņlois , Nukta Emad , Meier Bernhard
Published: March 2007

During angioplasty of the left coronary artery, an acute thrombotic occlusion of the right coronary artery occurred at the site of a borderline stenosis. The source of the unexplained chest pain at the end of the procedure was identified but the next day when inferior Q‐waves appeared. It was documented by repeat angiography. The coronary angiogram of the right coronary artery preceding the angioplasty of the left coronary artery is likely to have triggered the occlusion. Chest pain during or after angioplasty without apparent cause in the dilated artery must prompt a contrast medium injection into the nonattempted artery, paricularly if the latter had undergone a diagnostic sutdy at the beginning of the procedure.
Exit block: A new technique for difficult side branch angioplasty
Authors: Nakhjavan Fred. K. , Najmi Moosa
Published: March 2007

Angioplasty of a stenosis at the origin of a diagonal branch was initially unsuccessful because of the straight course of the anterior descending artery and a sharp bend at the diagonal branch. Therefore, in a second attempt, the anterior descending artery was blocked by inflating a balloon distal to the diagonal branch, thereby facilitating the passage of guidewire and ballooninto the diagonal branch.
Coronary artery spasm and Myocardial infarction in a patient with normal Coronary arteries: Temporal relationship to pseudoephedrine ingestion
Authors: Wiener Isaac , Tilkian Ara G. , Palazzolo Michael
Published: March 2007

A 28 yr‐old male presented with chest pain and acute ST elevation following ingestion of pseudoephedrine. The pain and electrocardiographic changes disappeared after the administration of sublingual Nitroglycerin. Myocardial enzymes did show some evidence for myocardial necrosis. A subsequent coronary arteriogram showed no occlusive lesions. Pseudoephedrine, a sympathomimetic agent, may be implicated in the initiation of coronary spasm and myocardial infarction in some patients.
Thrombus aspiration in acute myocardial infarction
Authors: Kahn Joel K. , Hartzler Geoffrey O.
Published: March 2007

A 57 yr‐old man suffered an in‐hospital inferior myocardial infarction 9 yr following coronary artery bypass surgery. Emergency cardiac catheterization demonstrated a large, occlusive thrombus in the saphenous vein graft to the right coronary artery. Multiple balloon dilitations failed to lyse the thrombus. A guiding catheter was used to aspirate the thrombus from the graft andthere was immediate pain relief.
Coronary artery aneurysm formation following percutaneous transluminal coronary angioplasty: Treatment of associated Restenosis with repeat percutaneous transluminal coronary angioplasty
Authors: Walford Gary D. , Midei Mark G. , Aversano Thomas R. , Gottlieb Sidney O. , Chew Paul H. , Brinker Jeffrey A.
Published: March 2007

Restenosis following coronary angioplasty can usually be treated effectively and safely by repeated angioplasty. However, the presence of a complex lesion morphology may bias the clinician away from angioplasty toward either recommending bypass surgery or continuing medical therapy alone in spite of recurrence of the symptoms which were sufficient indication for the initial angioplasty. One type of complex morphology at the site of the restenosis is due to the presence of a focal, eccentric aneurysmal dilatation similar in appearance to a saccular aneurysm. In two previously reported cases in the literature both were referred to bypass surgery. We report eight additional cases including the use of repeat successful angioplasty in six of the cases in spite of the potential problems posed by the complexity of the restenosed lesion.

In addition, this case review suggests that this type of complex lesion morphology with restenosis may be more common when the initial angioplasty was associated with deep arterial injury, as in patients whose initial angloplasty was done in an infarct‐related vessel or was associatedwith evidence of a large dissection.
Diagnosis of unexpected atrial septal defect by inspired hydrogen appearance time in adult patients referred for cardiac catheterization
Authors: Schwinger Matthew E. , Tunick Paul A. , Glassman Ephraim , Kronzon Itzhak
Published: March 2007

Atrial septal defects may have clinical consequences regardless of their size. We evaluated the incidence of clinically unsuspected atrial septal defects in 4,411 consecutive adult patients referred for cardiac catheterization by the previously validated method of inspired hydrogen appearance time. Oximetry was performed only when an abnormally short inspired hydrogen appearance time was measured. Seventy‐five patients (1.7%) were discovered to have a left‐to‐right shunt by this method. The shunting was at the atrial level in 65 patients. Thirty‐five of these patients (0.8% of all catheterizations) were not suspected of having any form of congenital heart disease by history, physical examination, chest X‐ray, EKG, or echocardiogram. In 19 cases there was no significant oxygen step‐up and the diagnosis would have been missed by oximetry. The atrial septum was explored during open heart surgery in 7 patients. Atrial septal defects were detected and closed in all. Four patients had the finding confirmed by echocardiography after the catheterization. Small atrial septal defects are frequently not detected by clinical evaluation, noninvasive testing, or oximetry and are easily detected by the rapid, safe, and accurate method of inspired hydrogen appearance time.
Assessment of the sensitivity of hydrogen inhalation in the detection of left‐to‐right shunting
Authors: Flores Eduardo D. , Lange Richard A. , Bedotto John B. , Danziger Robert S. , Hillis L. David
Published: March 2007

For the detection of left‐to‐right intracardiac shunting, the oximetric and standard indocyanine green techniques are relatively insensitive, in that neither can reliably detect a shunt with a ratio of pulmonary to systemic flow (Qp/Qs) < 1.3 (percentage shunt, 23%). Although the hydrogen inhalation method is said to be much more sensitive in this regard, no previous study has measured its sensitivity. Accordingly, in 15 patients (4 men, 11 women, aged 38 to 67 years) without intracardiac shunting, hydrogen inhalation was performed 1) without and 2) with an artificially created femoral arteriovenous shunt of known size, and cardiac output was measured by thermodilution. For the 15 subjects with cardiac outputs of 3.64 to 8.10 liter/min, shunts of 22 to 248 ml/min were created, so that the shunts ranged from 0.5% to 3.3%. Hydrogen inhalation detected all shunts ≥ 1.3% (Qp/Qs ≥ 1.01). Of the 10 shunts < 1.3%, it detected 5, with the smallest being 0.7%. Thus, the hydrogen inhalation technique is extremely sensitive in identifying the presence of left‐to‐right shunting, far more sensitive than the oximetric and standard indocyanine green methods.
Orion™, an improved balloon on a wire system: Initial experience
Authors: Corcos Thierry , Favereau Xavier , Poirot Géarard , Souffrant Géarard
Published: March 2007

The OrionTM coronary angioplasty improved balloon on a wire system was used in 42 patients (53 stenoses) including 5 patients with acute myocardial infarction, 18 patients with unstable angina, and 4 patients with kissing balloon angioplasty via a single guiding catheter. All stenoses were crossed successfully and the immediate and in‐hospital success rates were 98 and 93%, respectively. The simple construction, low prcfile, and improved steerability allowed successful and quick angioplasty of high grade stenotic lesions. This balloon catheter represents a significant advance in angioplasty technology.
Reproducible uniform coronary vasomotor tone with nitrocompounds: Prerequisite of quantitative coronary angiographic trials
Authors: Jost Stefan , Rafflenbeul Wolfgang , Rell Gert‐Hinrlch , Gulba Dietrich , Knop Ingo , Hecker Hartmut , Lichtlen Paul R.
Published: March 2007

In quantitative analysis of repeated coronary angiograms, a variable vasomotor tone of the epicardial coronary arteries may influence the accuracy of the results. Therefore, we evaluated the extent and reproducibility of coronary artery dilation with nitrocompounds.

In 32 patients with coronary artery disease, the vasodilatory response of angiographically normal coronary segments to different nitrocompounds was analyzed with the computer‐assisted contour detection system CAAS. Twenty patients received 5 mg or 10 mg of isosorbide dinitrate sublingually. After 10 to 15 min, a maximal diameter increase was measured with an average of 16 ± 11% (5 mg: P<0.01) and 28 ± 13% (10 mg:P<0.001) from control. Another 12 patients received 0.025 mg per kg body weight of SIN‐1, the active metabolite of molsidomine, as an intravenous infusion over 5 min. A comparable maximal dilation (29 ± 5%;P<0.001) occurred after 10 to 15 min and could not be enhanced further with 0.8 mg nitroglycerin administered sublingually (28 ± 7%; n.s.). One hour after \documentclass{article}\pagestyle{empty}\begin{document}$\sqrt {Sin-1}$\end{document}, coronary dilation was still 24 ± 8% (P<0.001 compared with control), and 0.8 mg of nitroglycerin sublingually reestablished the previous maximal dilation of 28 ± 8%.

We conclude that high doses of nitrocompounds induce a reproducible maximal coronary dilation that eliminates a substantial source of error in quantitative analysis of repeated coronary angiograms. At present, sublingual administrations of either 10 mg isosorbide dinitrate once or 0.8 mg nitroglycerin repeatedly seem to represent the easiest practicable modes to achieve maximal coronary vasodilation for an adequate period.
Coronary artery pseudothrombus: Angiographic filling defects caused by competitive collateral flow
Authors: Weinberg Bradley A. , Bourdillon Patrick D. V.
Published: March 2007

Two cases are described of intraluminal coronary artery filling defects resembling thrombus caused by nonopacifed collateral blood flow mixing with injected contrast just distal to a severe coronary artery stenosis. The term pseudothrombus is ascribed to this appearance to emphasize this differential diagnosis of intraluminal filling defects.