bluuebunny/crossref_metadata_2025 huggingface dataset:
Video‐assisted transportal pericardial window
Authors: Selig Michael B. , Jafari Nercy , Sipes Earl
Published: March 2007

Pericardial interventions for the diagnosis and treatment of pericardial disease has been evolving since the 17th century. The controversy over opened or closed procedures, the optimal guidance modality, and techniques for the creation of pericardial windows continues to be debated. This report describes two patients who the endoscopic approach to creating a pericardial window. © Wiley‐Liss, Inc.
Directional atherectomy of left main stenoses
Authors: Laster Steven B. , Rutherford Barry D. , McConahay David R. , Giorgi Lee V. , Johnson Warren L. , Shimshak Thomas M. , Huber Kenneth C. , Hartzler Geoffrey O.
Published: March 2007

Balloon angioplasty (PTCA) of left main (LM) stenoses is limited by frequent clinical restenosis. Directional coronary atherectomy (DCA) may be an effective alternative to PTCA due to its ability to achieve a greater postprocedural luminal diameter when treating bulky, eccentric plaques and aorto‐ostial lesions. We analyzed the acute and long‐term results following 24 DCA procedures in 22 patients with “protected” LM lesions. Acute success (residual stenosis ≤ 40%, no major ischemic complications) was 88% overall, 100% in 13 planned procedures, and 73% in 11 adjunctive DCA procedures that followed suboptimal PTCA. Mean LM stenosis was reduced from 86% to 13% (P < 0.01). There were no procedural complications directly attributed to DCA. At a mean of 24 ± 3 months, the clinical restenosis rate was 16%, survival was 100%, and event‐free survival (freedom from death, MI, or repeat lesion‐related interventions) was 89%. We conclude that DCA in protected LM lesions (1) can achieved excellent angiographic results with low procedural complication rates, (2) may succeed where PTCA yields subopitimal results, and (3) may provide late clinical outcomes superior to those of balloon angioplasty. © Wiley‐Liss, Inc.
Acute coronary occlusion during early post‐PTCA exercise testing: A rare but avoidable risk
Authors: Shah Dipen , Lal Parshottam
Published: March 2007

We describe here one instance of an acute occlusion of an angioplastied LAD coronary artery occurring during a treadmill stress test performed 2 d after the procedure. The occlusion occurred during the recovery period after a reasonably high level of stress was achieved without evidence of ischaemia. Similar instances described in the literature are summarized and discussed. In the light of these data, it might be prudent to avoid early post‐PTCA exercise stress testing. © Wiley‐Liss, Inc.
Intracoronary thrombus: Still a risk factor for ptca failure?
Authors: Reeder Guy S. , Bryant Sandra C. , Suman Vera J. , Holmes David R.
Published: March 2007

Pre‐existing intracoronary thrombus has been associated with an increased risk of percutaneous transluminal coronary angioplasty (PTCA) failure. Whether intracoronary thrombus is an independent risk factor for failure is uncertain, as conflicting data exist in the literature. Additionally, given advances in patient selection and angioplasty ballon design, it is uncertain whether the current risk posed by intracoronary thrombus is as substantial as that in the early angioplasty experience.

The primary objective of this study was to first assess whether pre‐existing coronary thrombus was an independent predictor of angioplasty failure and if so, whether the risk due to thrombus had changed from the early angioplasty experience to the present time. Our prospectively collected angioplasty data base was used to identify individuals undergoing single‐vessel angioplasty of a thrombus‐containing segment from January 1, 1984 through December 1, 1991. Univariate and multivariate stepwise logistic regression techniques were utilized to analyze clinical, angiographic, and procedural characteristics associated with angioplasty failure. The study period was divided into three separate time periods and these used as variables in our multivariate analysis.

In the study population that consisted of 2,699 patients with single‐vessel angioplasty, univariate analysis demonstrated that among many factors, thrombus was importantly associated with angioplasty failure (P < 0.0001). A multivariate logistic model of angioplasty failure was developed and thrombus achieved independent predictive significance in this model. Analysis with respect to time showed no variation in the importance of thrombus between our earliest angioplasty experience and that achieved in the last 2 years of the study period.

Pre‐existing coronary thrombus is a risk factor for angioplasty failure which is independent of other clinical, anatomic, and procedural factors. The importance of this risk factor has not changed in our practice between 1984 and 1991.
Clinical experience with intracoronary tissue plasminogen activator: Results of a multicenter registry
Authors: Ferguson James J.
Published: March 2007

Clinical experience with the use of intracoronary tissue plasminogen activator (t‐PA) is limited. We therefore undertook this study to document current clinical usage of intracoronary t‐PA during a 2‐yr period in a multicenter registry. Intracoronary t‐PA was utilized on 206 occasions in 198 patients (154 men and 44 women; mean age, 59 ± 12 yr). The mean dose of intracoronary t‐PA was 31 ± 15 mg. Indications for use included acute myocardial infarction (MI) (n = 83), preexisting thrombus with (n = 49) or without (n = 41) percutaneous transluminal coronary angioplasty (PTCA), unstable angina (n = 14), abrupt vessel closure (n = 11), and post‐PTCA “clean‐up” (n = 8). The Thombolysis in Myocardial Infarction (TIMI Phase I) criteria were used to assess perfusion and degree of thrombus formation. Overall, the mean TIMI flow grade increased from 1.2 ± 1.1 before treatment to 2.3 ± 1.0 after treatment (P<0.0001); the mean TIMI thrombus grade decreased from 3.2 ± 1.0 before treatment to 1.6 ± 1.4 after treatment (P<0.0001). Complications included bleeding (9.2%), MI (17.6%), need for coronary artery bypass grafting (CABG) (9.2%), need for repeat PTCA/atherectomy/stents (4.9%), and ventricular fibrillation (1.7%, all associated with opening totally occluded vessels). There were 14 subsequent in‐hospital deaths: 13 of the patients who died had originally presented with MI; the other had experienced abrupt vessel closure during a PTCA procedure.

Intracoronary t‐PA appears to be effective in improving distal flow and decreasing thrombus burden; however, intracoronary delivery of t‐PA has associated risks. Further prospective evaluations of intracoronary t‐PA will be necessary to determine the optimal clinical situations for its use, as well as the appropriate dose regimen.
Coronary dissection resulting from angioplasty with slow oscillating vs. rapid inflation and slow vs. rapid deflation
Authors: Blankenship James C. , Ford Alan C. , Henry Sheldon D. , Frey Carolin M.
Published: March 2007

To determine if slow inflation or slow deflation (compared to standard rapid inflation/ deflation) would minimize coronary arterial dissection, we randomized 162 lesions from 136 patients undergoing coronary angioplasty with polyolefin copolymer balloons to slow oscillating (1 atmosphere/20 sec) vs. rapid (over 30 sec) inflation and slow (over 15 sec) vs. rapid deflation. The incidence of any dissection was nearly identical in the four inflation/deflation groups. The incidence of severe dissection, however, was significantly higher for the slow inflation/slow deflation group compared to the other three groups (38% vs. 15%, P = .024). For angioplasty performed with polyolefin copolymer balloons, slow deflation combined with slow oscillating inflation is associated with more frequent severe dissections.
Coronary artery fistula coexisting with a ventricular septal defect due to a penetrating gunshot wound
Authors: Kwan Tak , Salciccioli Louis , Elsakr Ashraf , Burack Joshua , Feit Alan
Published: March 2007

We describe a patient who survived a penetrating gunshot wound to the chest. Cardiac evaluation including echocardiography and cardiac catheterization revealed a coronary artery fistula and a ventricular septal defect. This combination has been rarely reported in patients with penetrating cardiac injury. Follow‐up echocardiography performed 15 mo later showed persistent left‐to‐right shunt. This is the first case in the literature demonstrating the natural history of combined coronary artery fistula and ventricular septal defect without surgical correction.
Patient selection reduces thrombotic complications of emergent stenting for failed ptca
Authors: Herrmann Howard C. , Malosky Steven A. , Guidera Steven A. , Deangelo Debbie , Hirshfeld John W.
Published: March 2007

A comparison of consecutive initial and later patients receiving emergent coronary artery stents to salvage failed PTCA procedures was made to determine whether experience with this procedure can improve patient outcome. Twenty‐six consecutive patients underwent emergent, unplanned implantation of one or more Palmaz‐Schatz coronary stents at our institution over a 3‐1/2 year period. Indications for stent insertion included impending vessel closure (decrease in TIMI flow grade and clinical evidence of ischemia) or acute occlusion (TIMI flow grade 0 or 1 and ≥99% stenosis) after PTCA. Immediate and final success (30 day) were determined, and the results in the first (Initial) 13 patients were compared to the remaining (Later) 13 patients. Baseline characteristics of the study population included a male predominance (69%) with a mean (±SD) age of 57±10 years. Conventional balloon PTCA was performed in all three native coronary arteries with an increase in mean percentage stenosis from 76±13 to 85±s14% (P<0.05). Twelve patients developed acute occlusion and 14 patients impending closure after PTCA due to the appearance of thrombus (12%), dissection (46%), or both (35%). Palmaz‐Schatz stents were successfully inserted in all patients restoring TIMI grade 3 antegrade flow; however, major complications developed in almost 50% of patients.

Comparison of initial and later patients showed no differences in demographic or pre‐PTCA angiographic characteristics. Later patients had less severe stenoses post‐PTCA (before stenting) and were less likely to have thrombus present at the angioplasty site (15% vs. 77%, P<0.05). These patients were also more likely to have stents inserted for impending closure rather than acute occlusion. Patients in the later experience had fewer complications (15% vs. 77%, P<0.05) including subacute thrombosis. Final success was 23% in the initial patients and increased to 85% (P<0.05) in the later experience.

We conclude that emergency coronary artery stenting with the Palmaz‐Schatz balloon‐expandable stent is an effective technique to salvage failed angioplasty procedures. Improved results and lower rates of complications were achieved by using the device for impending closure due to intimal dissection, avoiding vessels containing thrombus, and careful attention to post‐stent anti‐coagulation.
Comparative analysis of saphenous vein bypass vs. native coronary artery balloon angioplasty: Technical differences and angiographic response
Authors: Kimball Brian P. , Bui Sanh
Published: March 2007

To evaluate technical differences and angiographic response of saphenous vein bypass graft angioplasty in comparison to native coronary arteries, we retrospectively analyzed 54 patients undergoing this procedure at The Toronto Hospital between February 1988 and May 1993. These subjects were temporally matched to a cohort of successful native coronary angioplasties, with comparison of technical parameters, pre‐existing qualitative/quantitative (Cardiac Measurement System) stenotic morphology, and angiographic response; including changes in minimum lumen diameter.

Saphenous bypass graft angioplasty utilized larger balloons (CABG, 3.27 ± 0.65 vs. native, 2.90 ± 0.37 mm, P < .05), and higher inflation pressures (CABG, 10.1 ±3.7 vs. native, 8.8 ± 2.5 atm, P < .05), although in a relative sense, balloon/artery ratios were similar (CABG, 1.09 ± 0.20 vs. native, 1.03 ± 0.15, pNS). Pre‐procedural bypass graft lesions were more complex, with more frequent ACC/AHA type B1 lesions [CABG, 24/54 (44%) vs. native, 16/54 (30%), P < .05] and luminal thrombus [CABG, 17/54 (31%) vs. native, 6/54(11%), P < .05]. Quantitative angiography revealed larger “reference” diameters within saphenous veins (CABG, 3.41 ± 0.76 vs. native, 3.04 ± 0.51 mm, P < .05), although minimum lumen diameter was less severe (CABG, 0.83 ± 0.41 vs. native, 0.77 ± 0.36, P < .05). In terms of balloon angioplasty response, greater improvemnet in luminal diameter was seen in bypass graft lesions (CABG, 1.55 ± 0.53 vs. native, 1.32 ± 0.44 mm, P < .05), with the largest changes within the “body” of the saphenous vein (ostial, 1.53 ± 0.37; body, 1.68 ± 0.50; anastomosis, 1.37 ± 0.57 mm).

In conclusion, technical differences do exist during the performance of balloon angioplasty in degenerative saphenous vein bypass grafts, often dictated by morphologically complex lesions. Bypass grafts demonstrate a larger intrinsic lumen, although preexisting stenoses tend to be less severe, with greater improvement in minimum lumen diameter. Some of these differences may be attributable to intrinsic differences in the compliance characteristics of saphenous vein bypass grafts and to differing characteristics of the relatively accelerated atherosclerosis.
Femoral artery catheterization complications: A study of 503 consecutive patients
Authors: Bogart Douglas B. , Bogart Martha A , Miller John T. , Farrar Michael W. , Barr W. Kent , Montgomery Michael A.
Published: March 2007

This report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids.
Partial and transient relief of conduit obstruction by low‐pressure balloon dilation in patients with congenital heart disease
Authors: Sohn Sejung , Kashani Iraj A. , Rothman Abraham
Published: March 2007

Seven patients underwent attempted low pressure balloon dilation of stenotic conduits or homografts from right ventricle to pulmonary artery (n=5), in the aortic valve position (n=1), or from right atrium to left pulmonary artery (n=1). In the right ventricle to pulmonary artery group, mean gradient reduction was only 17%. At follow‐up, two patients underwent surgical conduit replacement, one had a stent implanted at cardiac catheterization, the other two are awaiting surgical intervention. The patient with a homograft in the aortic valve position had a good initial result but restenosed within 1 year and underwent a pulmonary autograft operation. The patient with the Fontan homograft stenosis had transient obstruction relief but subsequently required stent implantation. Low‐pressure balloon dilation of conduits or homografts is only partially and transiently successful. Whether stent implantation will offer better long‐term results remains to be determined.
Repeat use of occludidng spring coils to close residual patent ductus arteriosus
Authors: Moore J. W.
Published: March 2007

Recent studies have shown that small‐ and moderate‐size patent ductus arteriosus (PDA)may be closed with occluding spring coils. As with other percutaneous devices, a low incidence of residual PDAs has been observed in medium‐term follow‐up. This report describes experience with closing residual PDA by repeat use of occluding spring coils. © 1995 Wiley‐Liss, Inc.
Management of balloon rupture during rigid stent deployment
Authors: Keelan Edward T. , Nunez Boris D. , Berger Peter B. , Holmes David R. , Garratt Kirk N.
Published: March 2007

Balloon rupture may occur during stent placement and will only become apparent when the stent has been manouvered across the target stenosis and deployment is attempted. Withdrawal may be complicated by displacement of the stent off the balloon. We describe two cases in which a power injector was used to momentarily inflate the balloon and partially expand the stent in place. The punctured balloon could then be withdrawn and the stent fully deployed, using a new balloon. © 1995 Wiley‐Liss, Inc.
Perforation of nontarget artery during directional coronary atherectomy
Authors: Cohen Eric A. , Naqvi Salim Z. , Fremes Steven E.
Published: March 2007

We report a case of perforation of an intermediate branch during attempted directional atherectomy of an ostial left anterior descending artery lesion, resulting from disruption of the cutter drive cable. Potential contributing factors and means of avoiding this complication are discussed. © 1995 Wiley‐Liss, Inc.
Importance of a non‐dominant right coronary artery occlusion presenting as sudden cardiac death with prolonged right ventricular dysfunction and malignant arrhythmias
Authors: Karim M. Asad , Wong Christopher , Armbruster Robert , Windle John , Deligonul Ubeydullah
Published: March 2007

We report a case of a patient who presented with sudden cardiac death secondary to a subtotal occlusion of a small non‐dominant right coronary system. Catheterization several weeks following the initial episode revealed persistent severe right ventricular dysfunction with moderate hemodynamic compensation. Continued unstable arrhythmogenic potential at this point led to placement of an AICD device. The case highlights the potential hazard and often complacency involved in dealing with benign appearing lesions as this one. © 1995 Wiley‐Liss, Inc.
Intracoronary doppler flow to monitor the results of selective saphenous vein graft thrombolytic therapy
Authors: Gershony Gary , Cishek Mary Beth , Galloway Michael
Published: March 2007

Selective intracoronary thrombolytic therapy has recently been advocated as a technique to recanalize occluded coronary bypass grafts. We report a novel approach for monitoring the results of this treatment utilizing a coronary artery doppler flow guidewire. This approach may optimize the duration of thrombolytic treatment in these patients. © 1995 Wiley‐Liss, Inc.
Angioscopy guided intracoronary thrombolysis and stent deployment in a patient with postinfarction angina
Authors: Eltchaninoff Hélène , Cribier Alain , Letac Brice
Published: March 2007

We describe a case where the combined use of quantitative coronary angiography and angioscopy directed the therapeutic strategy in a patient with postinfarction angina, and helped understand the pathology underlying an unusual angiographic image at baseline and after stent implantation. © 1995 Wiley‐Liss, Inc.
“Balloon impasse”: A marker for severe mitral subvalvular disease and a predictor of mitral regurgitation in inoue‐balloon percutaneous transvenous mitral commissurotomy
Authors: Lau Kean‐Wah , Hung Jui‐Sung
Published: March 2007

In certain instances of percutaneous transvenous mitral commissurotomy, the Inoue catheter balloon, although deflated and properly aligned, becomes held up or checked at the mitral valve. This “balloon impasse,” observed in 13 of 760 patients undergoing the commissurotomy, reflects severe obstructive subvalvular disease even though echocardiographic evidence suggests otherwise. Our experience shows that the sign portends severe mitral regurgitation if the usual balloon sizing method is used. Such a situation occurred with four of the first six patients. In the next seven patients, the use of smaller balloon catheters (PTMC‐18 or PTMC‐20) for the initial set of stepwise dilatations averted creation of severe mitral regurgitation. When the “balloon impasse” sign is encountered during the commissurotomy procedure, the catheter selection and balloon sizing method should be judiciously altered. © 1995 Wiley‐Liss. Inc.
Assessment of transplant arteriopathy by intracoronary two‐dimensional ultrasound imaging and coronary flow velocity
Authors: Wolford Thomas , Kern Morton J.
Published: March 2007

Transplant coronary arteriopathy is the major impediment to the long‐term survival of cardiac allografts. This report highlights two‐dimensional imaging and Doppler flow to assess transplant coronary arteriopathy. © 1995 Wiley‐Liss, Inc.
A novel approach to the placement of Palmaz‐Schatz biliary stents in saphenous vein grafts
Authors: Núñez Boris D. , Simari Robert D. , Keelan Edward T. , Menke Kris K. , Garratt Kirk N. , Holmes David R.
Published: March 2007

The placement of Palmaz‐Schatz biliary stents has become a successful method to treat stenoses in large saphenous vein grafts. Unlike coronary stents, the biliary stents are not routinely delivered with a selective delivery sheath and may be more difficult to deliver and prone to detachment from the balloon and even embolization during delivery. In order to enhance the ability to deliver these stents, a guide‐within‐a‐guide system was developed. A 7F guiding catheter was used as a selective delivery sheath within a standard guiding catheter. Nineteen biliary stents were successfully placed in vein grafts in 15 patients using this system. One procedure was complicated by an embolic event documented angiographically following intragraft delivery of urokinase but prior to stent implantation.
Left heart catheterization by direct puncture with two‐dimensional echocardiographic guidance: A case report
Authors: Havranek Edward P. , Sherry Paul D.
Published: March 2007

In patients with mechanical valves in both the mitral and aortic positions, direct ventricular puncture is the recommended approach to catheterization. We report a case in which two‐dimensional (2D) echocardiography was used to guide left heart catheterization by direct ventricular puncture and propose that the use of 2D echocardiography might reduce the risks historically associated the procedure. © 1995 Wiley‐Liss, Inc.
Anterograde perfusion in acute limb ischemia secondary to vascular occlusive cardiopulmonary support
Authors: Jaski Brian E. , McClendon Philip S. , Branch Kelley R. , Favrot Laurence K. , Smith Sidney C. , Lamphere Jeff , Dembitsky Walter P.
Published: March 2007

Cardiopulmonary support (CPS) can resuscitate a patient with circulatory collapse during high‐risk interventional procedures, although vascular complications may accompany its use. We report a patient with cardiogenic shock secondary to myocardial infarction who required extended CPS support associated with acute infarct‐related coronary artery angioplasty and stent placement. Leg ischemia due to an occlusive cannula was resolved using a percutaneous anterograde perfusion device. In general, such devices may have application in patients dependent on mechanical support associated with limb ischemia. © 1995 Wiley‐Liss, Inc.
Bacteremia associated with percutaneous transluminal coronary angioplasty
Authors: Shea Kevin W. , Schwartz Richard K. , Gambino Anthony T. , Marzo Kevin P. , Cunha Burke A.
Published: March 2007

Bacteremia after diagnostic cardiac catheterization is uncommon, but bacteremia after percutaneous transluminal coronary angioplasty (PTCA) has not been studied prospectively. Unlike diagnostic cardiac catheterization, PTCA involves the use of an indwelling arterial sheath after completion of the procedure, which is connected to a pressurized heparin solution, both of which increase the risk of local infection and/or bacteremia. During a 16‐week period, we prospectively evaluated patients undergoing 164 PTCA procedures in order to determine the frequency of bacteremia and the significance of fever in this patient population. Blood cultures were obtained from the femoral catheter at the conclusion of the procedure and again 30 min later from the indwelling arterial sheath. Temperature was recorded every 30 min for 2 h following PTCA, then every 4 h over the subsequent 36‐hr period. Bacterial isolates were recovered from 23/286 blood cultures (8.0%), with Staphylococcus epidermidis the most common organism present (74%). Only one isolate of Staphylococcus aureus was considered to represent true bacteremia and corresponded with the only documented infectious complication. Fever, defined as ⩾101°F developed in four (2.4%) patients but was procedure related in only one case. The use of the ipsilateral femoral artery for repeat procedures was not associated with either positive blood cultures or difference in maximum temperature elevation. We conclude the overall risk of bacteremia after PTCA is low; therefore, antimicrobial prophylaxis is not warranted. © 1995 Wiley‐Liss, Inc.
Use of intra‐aortic nitroglycerin in the cardiac catheterization laboratory
Authors: Marshall Timothy M. , Dodek Arthur
Published: March 2007

The purpose of this study was to determine whether nitroglycerin (NTG) injected into the ascending aorta or left ventricle would safely and effectively lower blood pressure in hypertensive patients undergoing cardiac catheterization. Fifty bolus injections of 297 ± 67 μg (mean ± SD) NTG were given to patients with a systolic blood pressure (SBP) of ⩾140 mm Hg (mean SBP 188 ± 20.1 mm Hg). An average drop in systolic blood pressure of 36 ± 16 mmHg (P < 0.001), diastolic blood pressure of 19 ± 7 mm Hg (P < 0.001), and left ventricular end‐diastolic pressure of 4.7 ± 4 mm Hg (P = 0.001) was well tolerated in each patient. The mean time to response was 11 ± 3 sec. Intra‐aortic injection of NTG is a safe and effective means to treat hypertensive patients in the cardiac catheterization laboratory. © 1995 Wiley‐Liss, Inc.
Effectiveness of balloon valvuloplasty in the young adult with congenital aortic stenosis
Authors: Sandhu Satinder K. , Lloyd Thomas R. , Crowley Dennis C. , Beekman Robert H.
Published: March 2007

The objective of this study was to assess the effectiveness of balloon valvuloplasty in the young adult with congenital aortic stenosis and to compare its effectiveness with children. Percutaneous balloon valvuloplasty is effective in children with congenital aortic stenosis, but not in adults with acquired calcific aortic stenosis. Because effectiveness of balloon valvuloplasty in young adults with congenital aortic stenosis is not well defined, we evaluated the outcome in 15 patients aged 16–24 years (18 ± 0.6; mean ± SEM) who underwent balloon valvuloplasty from 1985 to 1993. The aortic valve annulus diameter ranged from 18.5 to 30 mm (24 ± 0.9). The aortic valve was bicuspid in 12 and tricuspid in 3 patients, and calcification was present in one patient. Balloon valvuloplasty was performed using a double balloon technique in 12 patients and a single balloon technique in three patients. Three patients had inadequate relief of gradient with a residual peak systolic gradient ⩾70 mm Hg. Three patients required valve replacement—two patients for a residual gradient ⩾70 mg Hg, and one patient 4 years later for severe aortic valve regurgitation. Eight of the remaining 12 have undergone elective follow‐up catheterization 1.2–2.5 years (1.5 ± 0.1) later. The peak systolic aortic valve gradient decreased by 55% from 73 ± 5.8 mm Hg to 35 ± 5.4 mm Hg immediately postvalvuloplasty, and was 30 ± 4.4 mm Hg at follow‐up (P <0.001). The left ventricular systolic pressure decreased from 179 ± 7.5 to 147 ± 6.5 mm Hg immediately postvalvuloplasty and was 147 ± 4 mm Hg at follow‐up. Aortic insufficiency was unchanged after valvuloplasty in 9, increased by 1 + in 4, and by 2 + in 2 patients. Balloon valvuloplasty was as effective in these young adults as in 70 children (age 6 ± 0.7 years) with congenital aortic stenosis (peak systolic gradient pre‐ 79 ± 3 mm Hg versus post‐ 34 ± 2 mg Hg; at 1–2 years follow‐up 34 ± 4 mm Hg).

Balloon valvuloplasty provides effective treatment in most young adults with congenital aortic stenosis, without early restenosis. Balloon valvuloplasty is as effective in young adults as in children, where it is currently the treatment of choice. © 1995 Wiley‐Liss, Inc.
Early restenosis following percutaneous transluminal balloon angioplasty for the treatment of the superior vena caval syndrome due to pacemaker‐induced stenosis
Authors: Marzo Kevin P. , Schwartz Richard , Glanz Sidney
Published: March 2007

Superior vena caval syndrome (SVC) following transvenous pacemaker insertion is an uncommon complication that has been treated with percutaneous transluminal balloon angioplasty. We report a case of SVC syndrome following pacemaker implantation that was treated with angioplasty. Several days after the initial balloon dilation, the patient had recurrent symptoms and evidence of restenosis on catheterization. Following repeat balloon dilation of this restenotic lesion, the patient had a favorable clinical response evidenced on hemodynamic and angiographic follow‐up at 6 months. © 1995 Wiley‐Liss, Inc.
Management of coronary artery rupture: Covered stent or microcoil embolization
Authors: Dorros Gerald , Jain Aditya , Kumar Krishna
Published: March 2007

The management of three cases of coronary artery rupture is described: (1) after high‐pressure balloon angioplasty following uneventful placement of three Gianturco‐Roubin stents, (2) following balloon angioplasty of an occluded diagonal branch, and (3) subsequent to rotational ablation of a left main and proximal circumflex arteries. Placement of an autologous veincovered Palmaz stent or microcoil embolic vessel occlusion solved each problem. In each case, emergency surgery was avoided; subsequent management, including anticoagulation (when indicated), was performed without incident. This is the first communication detailing correction of a coronary vessel rupture with an autologous vein‐covered stent or by microcoil embolic vessel occlusion.
Nonselective angiography of the internal mammary artery: A fast, reliable, and safe technique
Authors: Bhatt Samir N. , Jorgensen Michael B. , Aharonian Vicken J. , Mahrer Peter R.
Published: March 2007

Selective cannulation of the mammary artery can be time consuming and carries a risk of arterial injury. The nonselective technique described here is faster, safer, and as reliable as the standard selective technique.

A consecutive series of patients with previous coronary atery bypass graft surgery (CABG) were randomized to undergo either selective or nonselective mammary artery angiography. Selective angiography was performed using the standard selective technique. Nonselective angiography was performed by placing a standard catheter in the subclavian artery and hand injecting 10 ml of contrast while inflating a blood pressure cuff 10 mm above the systolic pressure in the ipsilateral arm.

Fifty‐six patients were studied, 30 patients selectively, and 26 patients nonselectively. The time to visualize adequately both native and grafted mammary arteries in the selective group was 4.83 + 5.00 min and in the nonselective group 1.76 + 1.16 minutes (P = 0.006).

A nonselective technique for visualizing the mammary artery is significantly faster and as reliable as the standard selective technique. © 1995 Wiley‐Liss, Inc.
Balloon mitral valvotomy in patients with systemic and suprasystemic pulmonary artery pressures
Authors: Bahl Vinay K. , Chandra Subhash , Talwar Kewal K. , Kaul Upendra , Sharma Sanjiv , Wasir H. S.
Published: March 2007

Mitral stenosis with severe pulmonary artery hypertension constitutes a high risk subset for surgical commissurotomy or valve replacement. Balloon mitral valvotomy has been proposed as a technique for treating high risk surgical patients with mitral stenosis. The efficacy of this technique in patients with severe pulmonary artery hypertension, however, has not been fully evaluated. Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 450 consecutive patients. Of these, forty‐five (10%) patients had systemic or suprasystemic systolic pulmonary artery pressures (110 ± 20, range 96 to 170 mm Hg). The baseline characteristics and immediate hemodynamic results of these 45 patients with systemic/suprasystemic systolic pulmonary artery pressures (group I) were analysed and compared with those of 405 patients with subsystemic systolic pulmonary artery pressures (group II). Patients in group I were more symptomatic (New York Heart Association functional class < lll, 96 vs. 55%, P < 0.001) and had severe subvalvular fibrosis (mitral subvalvular distance ratio [MSDR], 0.14 ± 0.04 vs. 0.22 ± 0.04, P < 0.01). Before PTMC, mean transmitral gradient was higher (34 ± 8 vs. 25 ± 4 mm Hg, P < 0.02) and mitral valve area smaller (0.5 ± 0.3 vs. 0.9 ± 0.4 cm2, P < 0.02) in group I patients, who also had higher pulmonary vascular resistance (16 ± 5 vs. 9 ± 5 U, P < 0.005). After PTMC final mean transmitral gradients (7 ± 3 vs. 5 ± 3 mm Hg) and mitral valve areas (1.9 ± 0.4 vs. 2.0 ± 0.4 cm2) were similar in both groups (P = NS). Group I patients had a greater decrease in pulmonary artery pressures (34 ± 4 vs. 25 ± 2%, P < 0.05) but final systolic pulmonary artery pressures (82 ± 20 vs. 50 ± 14 mm Hg) and pulmonary vascular resistance (12 ± 4 vs. 6 ± 4 U) remained significantly higher in this group (P < 0.005). Thus, in patients with severe pulmonary artery hypertension, PTMC is a safe and effective technique providing good immediate hemodynamic results, © 1995 Wiley‐Liss, Inc.
Primary angioplasty using a urokinase‐coated hydrogel balloon in acute myocardial infarction during pregnancy
Authors: Glazier James J. , Eldin Adel M. , Hirst Jeffrey A. , Dougherty James E. , Mitchel Joseph F. , Waters David D. , McKay Raymond G.
Published: March 2007

A 38‐year‐old multigravid white female presented at 16 weeks gestation with an acute inferoposterolateral myocardial infarction. Emergent coronary angiography demonstrated a total proximal occlusion of a large dominant left circumflex artery with a filling defect at the site of the occlusion suggestive of thrombus. Primary angioplasty using a urokinase‐coated hydrogel balloon resulted in successful recanalization of the vessel with restoration of normal TIMI Grade III flow and, most notably, apparent complete lysis of the intracoronary thrombus. After a subsequently uneventful pregnancy, a healthy baby was delivered. © 1995 Wiley‐Liss, Inc.
Transcatheter closure of residual ductus arteriosus shunting after the rashkind occluder device using single or multiple gianturco coils
Authors: Hijazi Ziyad M. , Geggel Robert L. , Ai‐Fadley Fadel
Published: March 2007

Transcatheter closure of a patent ductus arteriosus (PDA) using the Rashkind occluder or the buttoned device is accompanied with a 7–38% incidence of residual shunt. Closure of the residual shunt with a second device is expensive, associated with possible morbidity, can be technically challenging, and occasionally does not completely eliminate the shunt. Our objective was to assess the immediate and short‐term results of transcatheter closure of residual PDA after the Rashkind device using single or multiple Gianturco coils. Five patients (one male/four female) underwent transcatheter closure of residual PDA at a median age of 8.4 yr (range 2–10.1 yr) and median weight of 23 kg (range 11.8–32 kg). A 4F catheter was used for delivery of the coils in all patients. Three patients underwent multiple coil and two single coil closure with complete elimination of the shunt. There was complete elimination of the shunt as documented by repeat angiography immediately after the coil closure. The median fluoroscopy time was 24 min (range, 22–55 min). All patients were discharged home on the same day. There were no complications Follow‐up evaluation was performed with color flow mapping of the main pulmonary artery within 4 hr after closure and 6 weeks later with echocardiography and chest radiography. We conclude that transcatheter closure is an effective therapy for patients with residual PDA after the Rashkind device using the single or multiple coil technique. This technique can be performed on an out‐patient basis without the need for general anesthesia and at a lower expense than a repeat occluder device or surgery. © 1995 Wiley‐Liss, Inc.
Stenting for pulmonary artery stenosis following the ross procedure
Authors: Lima Valter C. , Lazzam Charles , Benson Lee N.
Published: March 2007

A 34‐year‐old woman showed the development of significant main pulmonary artery obstruction along the supravalvar suture line 18 months following a Ross procedure. The patient underwent unsuccessful balloon angioplasty, followed by successful stent implantation. The angiographic narrowing disappeared postprocedure, and the excellent hemodynamic result maintained at 4 month follow‐up. © 1995 Wiley‐Liss, Inc.
Use of a snare‐loop device as an adjunct to palmaz stent placement
Authors: Sapoval M. R. , Gaux J. C. , Beyssen B. , Hoffman O. , Raynaud A. C.
Published: March 2007

A patient was treated by PTA for a tight excentric stenosis in the external iliac artery. Following angioplasty, appropriate placement of a Palmaz stent over the lesion was impossible because of arterial curves and irregular aspect of the residual stenosis. To overcome this problem, the stent was grasped and pulled over the lesion using a snare loop device by contralateral approach. © 1995 Wiley‐Liss, Inc.
Abnormal diastoiic unopacified blood front: A useful marker of mitral stenosis
Authors: Shapira Yaron , Wurzel Mordechai
Published: March 2007

The left ventriculograms of 113 patients, divided into seven groups, were reviewed for the detection of unopacified front (UOF) of blood entering the left ventricle (LV) during diastole. Normal UOF was detected in all the patients without left‐sided valvular heart disease (regardless of the existence of coronary artery disease), constrictive pericarditis, aortic stenosis, and mitral regurgitation, although in the last group the UOF faded after several beats in 70% of cases. Only 5% of the patients with isolated mitral stenosis (MS) had an UOF, 75% had an abnormal UOF (< 60% of LV inflow tract), and 20% (with the greatest degree of MS) had only a dilution effect. A dilution effect was found in 62.5% of the patients with severe (⩾3°) aortic regurgitation (AR). An abnormal UOF is a sensitive and specific marker of significant MS. A dilution effect is indicative of either a significant MS or severe AR. © 1995 Wiley‐Liss, Inc.
Differential neuronal and glial expression of GluR1 AMPA receptor subunit and the scaffolding proteins SAP97 and 4.1N during rat cerebellar development
Authors: Douyard Jessica , Shen Lei , Huganir Richard L. , Rubio Maria E.
Published: March 2007

In neurons, AMPA glutamate receptors are developmentally regulated and selectively targeted to synaptic sites. Astroglial cells also express AMPA receptors, but their developmental pattern of expression and targeting mechanisms are unknown. In this study we investigated by immunocytochemistry at the light and electron microscopy level the expression of GluR1 and its scaffolding proteins SAP97 (synapse‐associated protein) and 4.1N during cerebellar development. In cerebellar cortex the GluR1 AMPA receptor subunit is expressed exclusively in Bergmann glia in the adult rodent. Interestingly, we observed that GluR1 was expressed postsynaptically at the climbing fibers (CF) synapse at early ages during Purkinje cell dendritic growth and before the complete ensheathment of CF/Purkinje cell synapses by Bergmann glia. However, its expression changed from neurons to Bergmann glia once these glial cells had completed their enwrapping process. In contrast, GluR2/3 and GluR4 AMPAR subunits were stably expressed in both Purkinje cells (GluR2/3) and Bergmann glia (GluR4) throughout postnatal development. Our data indicate that GluR1 expression undergoes a developmental switch from neurons to glia and that this appears to correlate with the degree of Purkinje cell dendritic growth and their enwrapping by Bergmann glia. SAP97 and 4.1N were developmentally regulated in the same pattern as GluR1. Therefore, SAP97 and 4.1N may play a role in the transport and insertion of GluR1 at CF/Purkinje cell synapses during early ages and at Bergmann glia plasma membrane in the adult. The parallel fiber (PF)/Purkinje cell synapse contained GluR2/3 but lacked GluR1, SAP97, and 4.1N at the time of PF synaptogenesis. J. Comp. Neurol. 502:141–156, 2007. © 2007 Wiley‐Liss, Inc.
Organization of the sensory input to the telencephalon in the fire‐bellied toad, Bombina orientalis
Authors: Laberge Frédéric , Roth Gerhard
Published: March 2007

The functional organization of sensory activity in the amphibian telencephalon is poorly understood. We used an in vitro brain preparation to compare the anatomy of afferent pathways with the localization of electrically evoked sensory potentials and single neuron intracellular responses in the telencephalon of the toad Bombina orientalis. Anatomical tracing showed that the anterior thalamic nucleus innervates the anterior parts of the medial, dorsal, and lateral pallia and the rostralmost part of the pallium in addition to the subpallial amygdala/ventral pallidum region. Additional afferents to the medial telencephalon originate from the thalamic eminence. Electrical stimulation of diverse sensory nerves and brain regions generated evoked potentials with distinct characteristics in the pallium, subpallial amygdala/ventral pallidum, and dorsal striatopallidum. In the pallium, this sensory activity is generated in the anterior medial region. In the case of olfaction, evoked potentials were recorded at all sites, but displayed different characteristics across telencephalic regions. Stimulation of the anterior dorsal thalamus generated a pattern of activity comparable to olfactory evoked potentials, but it became similar to stimulation of the optic nerve or brainstem after bilateral lesion of the lateral olfactory tract, which interrupted the antidromic activation of the olfactohabenular tract. Intracellular bimodal sensory responses were obtained in the anterior pallium, medial amygdala, ventral pallidum, and dorsal striatopallidum. Our results demonstrate that the amphibian anterior pallium, medial amygdala/ventral pallidum, and dorsal striatopallidum are multimodal sensory centers. The organization of the amphibian telencephalon displays striking similarities with the brain pathways recently implicated in mammalian goal‐directed behavior. J. Comp. Neurol. 502:55–74, 2007. © 2007 Wiley‐Liss, Inc.
Two types ofDrosophilaR7 photoreceptor cells are arranged randomly: A model for stochastic cell‐fate determination
Authors: Bell Melanie L. , Earl James B. , Britt Steven G.
Published: March 2007

The R7 photoreceptor cells of theDrosophilaretina are ultraviolet sensitive and are thought to mediate color discrimination and polarized light detection. In addition, there is growing evidence that the color sensitivity of the R8 cell within an individual ommatidium is regulated by a genetic switch that depends on the type of R7 cell adjacent to it. Here we examine the organization of the two major types of R7 cells by three different rigorous statistical methods and present evidence that they are arranged randomly and independently. First, we performed L‐function analyses to test whether the organization of R7 cells (and the relationship between them) is regular, clustered, or completely spatially random. Next, we used generalized linear mixed models to test whether the proportion of R7 cell neighbors differs from their prevalence within the eye as a whole. Finally, we conducted a series of simulations to test whether the proportion of R7 cell neighbors differs from that in a random simulation. In each case, we found evidence that the organization of the two types of R7 cells is random and independent, suggesting that R7 cells in neighboring ommatidia are unlikely to interact and influence each other's identity and may be determined stochastically in a cell‐autonomous manner. Compared with traditional lineage or inductive mechanisms, this may represent a novel mechanism of cell fate determination based on noisy or stochastic gene expression in which the differentiation of an individual R7 cell is a random event but the proportions of R7 cell subtypes are regulated. J. Comp. Neurol. 502:75–85, 2007. © 2007 Wiley‐Liss, Inc.
Homogeneity of intrinsic properties of sexually dimorphic vocal motoneurons in male and female zebra finches
Authors: Roberts Todd F. , Wild J. Martin , Kubke M. Fabiana , Mooney Richard
Published: March 2007

Sex differences in behavioral repertoires are often reflected in the underlying electrophysiological and morphological properties of motor neurons. Male zebra finches produce long, spectrally complex, learned songs and short calls, whereas female finches only produce short, innate, and spectrally simple calls. In both sexes, vocalizations are produced by using syringeal muscles controlled by motoneurons within the tracheosyringeal part of the hypoglossal motor nucleus (XIIts). We asked whether the sexually dimorphic vocal repertoire of adult zebra finches is paralleled by structural and functional differences in syringeal motoneurons. By using immunohistochemical and intracellular staining methods, we describe sex differences in the morphology of XIIts and its surrounding neuropil (suprahypoglossal region; SH). Although the overall number of XIIts neurons and the proportions of somata/neuropil were not sexually dimorphic, the volumes of both XIIts and SH were larger in males, in part because male XIIts neurons had larger somata. In contrast, female XIIts motoneurons had a more complex dendritic structure than did male neurons, suggesting that the larger volume of the male XIIts is due in part to increased numbers of afferents. Intracellular recordings in brain slices revealed that the intrinsic electrophysiological properties of female XIIts neurons were similar to published values for male XIIts motoneurons. We also show that female neurons received glycinergic inputs from the brainstem respiratory premotor column, similar to those described in males. These findings indicate that male and female zebra finches produce their disparate vocal repertoires using physiologically similar motoneurons. Thus, sites upstream of the motoneuron pool may be the major determinants of sexually dimorphic vocal behaviors in this species. J. Comp. Neurol. 502:157–169, 2007. © 2007 Wiley‐Liss, Inc.