bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability of Transcutaneous Oximeter Electrode Heating Power During Exercise in Patients with Intermittent Claudication
Authors: Gardner Andrew W. , Gardner Andrew W.
Published: July 2008

The purposes of this study were to (1) compare the reliability of transcutaneous oximeter electrode power with the reliability of oxygen tension and (2) compare the relationship of the oximetry measures with exercise performance in claudicants. One hundred ten PAOD patients with stable claudication symptoms performed a treadmill test and had the following exercise measures obtained: foot transcutaneous oxygen tension, oximeter electrode heating power, exercise duration, and peak oxygen consumption. A subset of 30 patients were tested once per week over three successive weeks to assess the reliability of the oximetry measures. The coefficient of variation of foot transcutaneous oxygen tension at peak exercise was 32.8%, whereas the variability of the oximeter electrode heating power was only 5.1%. Oximeter electrode heating power at peak exercise was related to maximal claudication pain time ( r=0.44, P < 0.001) and peak oxygen consumption ( r=0.36, P < 0.001), whereas foot transcutaneous oxygen tension was not related to either ( r=0.15, P=0.119; r=0.13, P=0.189; respectively). Thus, transcuta neous oximeter electrode heating power was six to seven times less variable than tran scutaneous oxygen tension, and the oximeter electrode power at peak exercise was more closely related to exercise capacity. It is concluded that the measurement of transcuta neous oximeter electrode heating power during exercise is more reliable and better corre lated with exercise capacity in PAOD patients with intermittent claudication than the measurement of transcutaneous oxygen tension.
Association of Atrial Septal Defect with Poland-Moebius Syndrome: Vascular Disruption Can Be a Common Etiologic Factor
Authors: Matsui Akemi , Nakagawa Masao , Okuno Masahiko , Nakagawa Masao
Published: July 2008

The authors describe an association of atrial septal defect with partial symptoms of the Poland-Moebius syndrome. Both are thought to be caused by developmental disorders of the mesenchyme and ectodermal derivatives. This anomalous association can be accepted as one concept of the subclavian artery blood supply disruption sequence during embryo genesis.
Continuous Retrograde Cardiac Perfusion Decreases Risk of Reoperative Coronary Artery Bypass Grafting
Authors: Goldman Scott M. , Sutter Francis P. , Priest Brian P. , Wertan Mary Ann C.
Published: July 2008

Embolization of atheromatous debris from old saphenous vein grafts is a major factor that increases the risk of reoperative coronary artery bypass grafting (CABG) when compared with primary CABG. To decrease this risk, a technique consisting of minimal dissection of the heart prior to cross clamping, continuous retrograde coronary sinus perfusion with 32°C blood, and temporary posterior cardiac interventricular vein occlusion, during which time all dissection and anastomoses are performed, was evaluated prospectively in 130 consecutive patients from January 2, 1991, through February 28, 1995. This group was compared with a cohort of 1107 patients undergoing primary CABG performed concur rently. The two groups were similar in age (median sixty-eight years), incidence of hyper cholesterolemia, peripheral vascular disease, smoking history, and left main stem stenosis. More patients undergoing reoperative CABG had previous myocardial infarctions (61.5% vs 54.5%), a higher incidence of triple-vessel coronary artery disease (89.2% vs 77.1%, P=0.002), and a lower ejection fraction (54.0% vs 56.9%). The median interval from primary CABG to reoperative CABG was one hundred twenty-seven months with a range of 2.5 to two hundred seventy-nine months. The cross clamp time (median one hundred three vs sixty-nine minutes, P=0.000001) and perfusion time (median one hundred thirty-four vs ninety-four minutes, P=0.000001) were significantly higher in the reoperative CABG group. The requirements for inotropic support postoperatively, perioperative myocardial infarction (1.5% vs 2.4%, P=0.397), and mortality (3.1% vs 3.4%, P=0.54) were statistically equivalent in the two groups. These data reveal that continuous retrograde coronary sinus perfusion, posterior cardiac interventricular vein occlusion, and single cross-clamping technique improve outcomes of reoperative CABG to that approaching primary CABG.
Percutaneous Balloon Valvuloplasty for Severe Mitral Stenosis in Pregnancy
Authors: Ali Oto M. , Kabukçu Mehmet , Övünç Kenan , Aksöyek Serdar , Kabakçi Giray , Tokgözoğlu Lale , Aytemir Kudret , Oram Erdem , Oram Aysel , Durukan Tekin
Published: July 2008

Four pregnant women with mitral stenosis who did not respond to medical therapy underwent successful percutaneous balloon valvuloplasty with complete resolution of their symptoms. Their clinical features and echocardial and hemodynamic data are presented. The procedures and the remainder of their pregnancy were uncomplicated. Percutaneous balloon valvuloplasty of the mitral valve is a safe and effective alternative to surgical therapy if medical management is unsuccessful.
Venous Insufficiency at Work
Authors: Hobson John , Hobson John
Published: July 2008

Chronic venous disease of the lower limbs is one of the most common conditions affecting humankind. It has been postulated that certain workplace conditions may be risk factors for venous insufficiency and varicose veins in particular. This paper examines the evidence for a link between occupation and the prevalence of venous disease. It also reviews recent French research carried out to estimate the prevalence of chronic venous insufficiency in a working population; work and nonwork risk factors and the cost to industry from this condition are also examined.
Is Dobutamine Stress Echocardiography Useful for Noninvasive Differentiation of Ischemic from Idiopathic Dilated Cardiomyopathy?
Authors: Cohen Ariel , Chauvel Christophe , Benhalima Bouziane , Guyon Philippe , Desert Isabelle , Valty Jean , Cohen Ariel
Published: July 2008

Dobutamine stress echocardiography was performed in 56 consecutive patients, mean age: sixty-two ±twelve years. Twenty-two patients had an idiopathic dilated cardiomy opathy (group 1) and 34 had angiographically proven ischemic dilated cardiomyopathy (group 2). Wall motion score index and left ventricular ejection fraction were determined at baseline, 5 μg/kg/min, peak, and ten minutes after stepwise dobutamine infusion. Worsening or no change in global wall motion score was observed in 9 group 2 patients (26%) and 1 group 1 patient (5%, P=.07). No significant difference was observed with regard to wall motion score index decrease between baseline and peak dose. Left ventric ular ejection fraction increase during dobutamine infusion was comparable in both groups. Thus, an ischemic response was observed more often in the coronary artery disease group, yielding a good specificity and positive predictive value although sensi tivity was low. However, left ventricular function improvement did not help to discrimi nate patients with or without significant CAD.
New Stenosis on Proximal Coronary Segment After Directional Atherectomy
Authors: Hsu Nai-Wei , Chen Ching-Iuan , Mar Guang-Yuan , Chan Wan-Leong , Chen Jaw-Wen , Kong Chi-Woon , Wang Shih-Pu , Wang Shih-Pu
Published: July 2008

Two patients with new coronary stenotic lesions subsequently developed proximal to the sites accepting directional coronary atherectomy (DCA) are reported. One lesion developed at the left main coronary artery and the other at the proximal segment of the left anterior descending artery. The mechanisms of the development of such new stenotic lesions after DCA were studied and procedure-related mechanical trauma over the proximal segment of the primary lesion may be the possible mechanism for such complication.
Unusual Bleeding Complications of Thrombolytic Therapy After Cardiopulmonary Resuscitation
Authors: Cafri Carlos , Gilutz Harel , Ilia Reuben , Abu-ful Akram , Battler Alexander , Cafri Carlos
Published: July 2008

The authors present three case reports retrospectively casting doubt on the benefit of thrombolysis after external cardiac massage.
Effects of Serial Percutaneous Application of Carbon Dioxide in Intermittent Claudication: Results of a Controlled Trial
Authors: Hartmann Bernd R. , Bassenge Eberhard , Hartmann Margarete , Hartmann Bernd R.
Published: July 2008

In a prospective, controlled clinical trial, serial application of carbon-dioxide-enriched water was compared with fresh water. Twenty-four patients with peripheral arterial occlusive disease (stable claudication) were randomly allocated to one of two serial inter vention groups, lower extremities immersed in either fresh water or in CO2-enriched water (1000 mg CO2/kg) water under standardized conditions (temperature, 33°C; depth, 40 cm; immersion time, 30 min; five times a week over 4 weeks). The serial appli cation of carbon-dioxide-enriched water increased arterial peak flow (reactive hyperemia), transcutaneous oxygen tension (basal value and half-recovery-time), and pain-free walking distance. The serial fresh water application did not change these values. The authors conclude that serial carbon dioxide application can be clinically effective in patients with arterial obstructions in the lower extremities.
Three-Dimensional Spiral Computed Tomography Angiography as an Alternative Imaging Modality for a Silent Dissecting Aortic Aneurysm
Authors: Saku Keijiro , Takeda Yukiko , Nii Takanobu , Shirai Kazuyuki , Okabe Masanori , Ohta Takao , Arakawa Kikuo , Saku Keijiro
Published: July 2008

The authors report a patient with silent dissecting aortic aneurysm in whom three-dimen sional spiral computed tomography (CT) angiography (3D-CTA) provided important imaging data. Images obtained by 3D-CTA were compared with the results of both conventional angiography and CT. They conclude that 3D-CTA was a powerful diagnostic modality for this patient, in addition to conventional CT and angiography.
Pericarbon Pericardial Valve Prosthesis: Midterm Results of the Aortic Valve Replacement
Authors: Borowiec Jan W. , Dubiel Thomas W. , Hansson Hans-Erik , Landelius Johan , Nyström Sven-Olov , Borowiec Jan W.
Published: July 2008

This clinical study was undertaken to verify the encouraging results of experimental studies regarding a new pericardial bioprosthesis. From May 1989 to November 1993, 204 patients underwent an aortic valve replacement with the Pericarbon® (Sorin Biomedica Cardio S.p.A., Saluggia, Italy) prosthesis. A follow-up was 100% complete and extended to 65 months (total 408 patient-years, average 2.0 ±1.4 years). Mean age at the operation was 75.1 ± 5.5 years and 96% were in NYHA clinical stage III or IV. There were 86 men and 118 women; 73 patients had an isolated aortic valve disease, 131 had a concomitant cardiosurgical procedure (coronary artery bypass grafting in 106 patients).

The operative mortality (30-day mortality) rate was 11.8% (24/204). There were 24 late deaths (5.9 ±1.2% patient-year). The actuarial probability of survival was 68 ±5% at 5 years. Four patients died of valve-related causes (one thromboembolic complica tion, two endocarditis, one anticoagulant-related hemorrhage). Actuarial rate of freedom from valve-related death was 95 ±3% at 5 years. Valve-related morbidity included seven thromboembolic episodes (1.7% patient-year), four anticoagulant-related complications (0.9% patient-year), three endocarditis (0.7% patient-year) and one reoperation (0.2% patient-year). After 5 years freedom from thromboembolic events was 83 ±7%, from anticoagulant-related hemorrhage 96 ±2%, from endocarditis 97 ±2%, and from reop eration 99 ± 1 %.

Echocardiographic study performed in 30 patients showed a paraprosthetic leak in four patients, a central leak in two, and cusp thickening in another three. The clinical data showed that the Pericarbon prosthesis has valve-related morbidity. The echocardio graphic results suggest that the prosthesis can undergo a pathologic process during the first 5 years after implantation. This makes it necessary to continue the follow-up and include the larger number of patients in the echocardiographic investigation.
LDL Apheresis for Arteriosclerosis Obliterans with Occluded Bypass Graft: Change in Prostacyclin and Effect on Ischemic Symptoms
Authors: Mii Shinsuke , Mori Akira , Sakata Hisanobu , Nakayama Masaru , Tsuruta Hiroshi
Published: July 2008

To study the mechanism of efficacy of low-density lipoprotein (LDL) adsorption for arte riosclerosis obliterans (ASO), eight ASO patients without indication for bypass surgery underwent LDL apheresis twice a week for 5 weeks and the change in prostaglandin I2 (PGI 2) and thromboxane A2 (TXA2) due to LDL apheresis was measured. The concentra tion of 6-keto-PGFI,, a metabolite of PGI2, in systemic venous blood significantly increased from 10.4 ± 1.8 to 42.0 ± 10.6 pg/mL (P < 0.05) after one session of LDL apheresis, while no significant change of TXB2, a metabolite of TXA2, was encountered. The ratio of 6-keto-PGF,,,/TXB2 also rose dramatically from 0.213 ±0.044 to 0.522 ±0.128 (P < 0.05) . In five patients, the ischemic clinical symptoms improved and both the concentration of 6-keto-PGF1α and the ratio of 6-keto-PGF1α/TXB2 increased significantly, whereas in three patients there was no effect on clinical symptoms and neither parameter changed. These results suggest that elevated production of PGI 2 from vascular cells due to LDL apheresis might contribute to improvement of ischemic symptoms.
A Comparative Evaluation of Femorofemoral Crossover Bypass and Iliofemoral Bypass for Unilateral Iliac Artery Occlusive Disease
Authors: Nazzal Munier M. , Hoballah Jamal J. , Jacobovicz Claudio , Mohan Chittur R. , Martinasevic Mario , Ryan Stephen M. , Sharp William J. , Kresowik Timothy F. , Corson John D.
Published: July 2008

The purpose of this study was to compare the results of extra-anatomic femorofemoral crossover bypass grafting to the anatomic iliofemoral bypass grafting procedure in the treatment of patients with unilateral iliac artery occlusive disease with respect to patency and limb salvage.

The records of all patients with unilateral iliac artery disease who underwent revas cularization between January 1988 and December 1995 at the University of Iowa Hospitals and Clinics (UIHC) were retrospectively reviewed; 108 patients were identified and divided into two groups. Group I (n=68; male/female=44/24) was composed of all patients who underwent a femorofemoral crossover extra-anatomic bypass. All patients who underwent an iliofemoral anatomic bypass constituted group II (n=40; male/female=24/16). The mean age for group I was 60 years (range 28-87) and for group II, 54 years (range 14-86). The medical risk factors between both groups were comparable. Except for the higher incidence of gangrene in group II the indications for surgery were comparable between both groups. (continued on next page)

A polytetrafluoroethylene graft was used in 88% of group I patients and in 90% of group II patients (NS). In the remaining patients, an autogenous vein conduit was used. Two patients from group I (2.9%) died in the perioperative period (NS). Graft patency was assessed by clinical evaluation, Doppler-derived ankle/brachial indices, and color duplex imaging. The cumulative primary and secondary patency rates, limb salvage, and patient survival were calculated by use of life table analysis (SE<0.1). The need for simultaneous outflow and inflow procedures at the time of surgery was comparable between both groups. The proportion of patients who underwent further revasculariza tion during follow-up was also comparable. The 5-year primary and secondary graft patency rates were 81.7% and 90.3%, in group I and 61.3% and 80.5% in group II. Although the difference between both groups was not significant there was a tendency toward higher rates with femorofemoral bypass. The 5-year survival rates of 80.3% for group I and 73.3% for group II were comparable.

These data suggest that there is no significant difference in the long-term results between the femorofemoral crossover bypass grafts and iliofemoral grafts. Both procedures result in acceptable patency and limb salvage rates. The femorofemoral bypass is, however, more attractive, for it can be performed under local anesthesia if needed and does not involve the creation of the retroperitoneal incision necessary with the iliofemoral bypass.
Entering the Ninth Decade Is Not a Contraindication for Carotid Endarterectomy
Authors: Hoballah Jamal J. , Nazzal Munier M. , Jacobovicz Claudio , Sharp William J. , Kresowik Timothy F. , Corson John D.
Published: July 2008

The role of carotid endarterectomy (CEA) in stroke prevention is now better defined. However, its role in patients older than 79 years of age is controversial. This group of patients has been excluded in most clinical trials. In this study the authors reviewed their experience with CEA patients >79 years old. The records of all patients older than 79 years of age who underwent a CEA in a recent time period from January 1988 to December 1996 were retrospectively reviewed. Forty-one patients (31 men, 10 women) were identified by computer search. The indication for operation included transient ischemic attack in 12 (29.3%), amaurosis fugax in nine (22%), stroke in two (4.9%), and nonhemispheric symptoms in three (7.3%). Fifteen patients (36.6%) were asympto matic. Medical risk factors included coronary artery disease in 26 (63.4%), hypertension in 22 (53.7%), and smoking in 12 (29.3%). The procedure was performed under EEG monitoring in all patients. General anesthesia was administered in 37 (90%) and regional anesthesia in four (10%). Shunts were used in four (10%) patients. The internal carotid artery was patched in 16 patients (39%). One patient (2.4%) developed a perioperative stroke and only one patient developed perioperative myocardial infarction (MI). None of the patients died within 30 days of surgery. In addition to the one MI case, five patients developed minor complications. The average length of time for stay after CEA was 3.4 days. Patients were followed up for an average of 20.7 months. Six patients died during follow-up. Four of those died from an MI and two from a stroke. The authors conclude that with proper selection of patients, CEA is safe in the octogenarian. Age alone should not be a contraindication for CEA.
Clinical Characteristics and Follow-up of Patients with Chest Pain and Normal Coronary Arteries
Authors: Foussas S.G. , Adamopoulou E.N. , Kafaltis N.A. , Fakiolas C. , Olympios C. , Pisimissis E. , Siogas K. , Pappas S. , Cokkinos D.V. , Sideris D.
Published: July 2008

The authors identified 160 men and women from all 3,700 patients with anginal pain between 1990 and 1994 who were subsequently found to have normal coronary arteries at diagnostic cardiac catheterization with follow-up to the present (mean follow-up 2.5 years). The group comprised 50 women and 110 men. Mean age was significantly greater in women (53.1 ± 7. 7 vs 47.2 ± 9.2 years, p<0.001). Forty percent of the women but only 10% of the men had a positive exercise test. At follow-up, a larger proportion of patients continue to experience chest pain (95 patients, 59%) of whom 65 patients (41%) continue antianginal therapy. Furthermore one patient suffered a sudden cardiac death and two patients had a nonfatal myocardial infarction. Of patients referred with chest pain, women were more likely to have normal coronary arteries, compared with men. All patients have an excellent prognosis. A large proportion of women had a positive exercise test in the absence of coronary artery disease. On the other hand, morbidity remains high in these patients, despite the reassurance of a normal-appearing coronary arteriogram.
Self-Terminating Ventricular Fibrillation During Variant Angina
Authors: Cafri Carlos , Ilia Reuben , Battler Alexander
Published: July 2008

The authors present a case report of self-terminating ventricular fibrillation during an episode of variant angina. The causes of ventricular fibrillation in this disorder and the possible mechanisms for its rare spontaneous interruption are discussed.
Doppler Echocardiography in Suspected Lone Atrial Fibrillation
Authors: Galanti Giorgio , Bertini Giovanni , Olivo Giuseppe , Gensini Gian Franco , Rostagno Carlo
Published: July 2008

Echocardiography is frequently required in patients with atrial fibrillation (AF) to exclude underlying heart disease. In the present investigation the authors evaluated 56 patients with paroxysmal AF (PAF) (27 men, 29 women, mean age 54 ±11.3 years) in whom lone AF was suspected on clinical grounds. M-mode, B-mode, and Doppler examination were performed and measurements taken according to American Society of Echo cardiography criteria. Left atrial diameter, left and right atrial volumes, left ventricular (LV) diameters, LV fractional shortening, and Doppler indexes of LV diastolic function were not different in patients with PAF in comparison with those of a control group of 56 age-matched subjects free from cardiovascular diseases. Echocardiographic examination results were entirely normal in 32/56 patients (57%) vs 39/56 of the control group (69%) . Mitral valve prolapse was found in five patients (9%), but only one showed mild mitral regurgitation. Doppler examination disclosed a mild (+/++) mitral regurgitation in eight patients and a small aortic or pulmonary diastolic flow in four and two patients, respectively, in the absence of significant morphologic valvular abnormalities. In these patients the sizes of heart chambers were entirely normal. Aneurysm of the interatrial septum was found in one patient and an increased thickness of the epipericardial junction in another two patients. Finally two patients had a small increase of right atrial volume without demonstrable causes. The results suggest that lone AF can be correctly suspected on the basis of clinical findings (history, physical examination, and ECG) and that in these patients echocardiography rarely discloses organic heart disease.
Fast Rotating Atherectomy Catheter Tip Inhibits Platelet Aggregation and ATP Release: A Study Using Platelet-Rich Plasma
Authors: Latif A.B. , Rees M.R. , Gehani A.A.
Published: July 2008

The interaction of atherectomy devices with the arterial wall is the focus of many studies, but their effect on the surrounding blood is largely unknown. This is a detailed investi gation on the effects of a rotational atherectomy device with a fast rotating tip on platelet structure and function. Platelet-rich plasma (PRP) was obtained from six volunteers, divided into 5 mL samples, and subjected to the atherectomy tip rotating at 20, 40, or 80 thousand rpm for 30 or 60 seconds. Platelet aggregation to collagen or adenosine diphos phate (ADP) was obtained in all samples by means of a dual-chamber optical aggre gometer. The fast rotating catheter tip caused marked inhibition of platelet aggregation to both collagen and ADP. The maximum extent of aggregation was reduced from 85% ±2.8 in control to 46% ±4.8 with collagen (p<0.01) and from 86.1% ±6.9 to 25.1% ±4.3 with ADP (p<0.01). The rate of aggregation (measured at 4 minutes) dropped from 81.3% ±2.7 to 40% ±4.5 and from 73.9% ±8.5 to 12.5% ±2.6 (p<0.005) with collagen and ADP, respectively. These effects were related to rotating speed and duration of exposure. ATP release in response to collagen fell from 2.63 ±0.13 nMol in control to 0.7 ±0.1 nMol, p<0.001 after exposure to the rotating tip. There was no significant change in platelet count, nor was there formation of platelet aggregates (platelet aggregate ratio remained unchanged) to account for these phenomena. Furthermore, transmission electron microscopy showed no significant platelet disruption or release of granules, and little signs of activation were seen even after addition of collagen.

This is the first study to demonstrate that exposure to a fast rotating catheter tip inhibits in vitro platelet aggregation and ATP release. There were no apparent loss of integrity of platelet structure, release of granules, or formation of platelet aggregates. This phenomenon and its clinical implication justify further investigation.
Acquired Atrial Septal Defect as a Complication of Endocarditis
Authors: Akosah Kwame O. , Jackson Paul , Mohanty Pramod K. , Prinz Andy
Published: July 2008

Bacterial endocarditis predominantly involves cardiac valves and is associated with many potential complications. Valvular dysfunction resulting from disruption of the structural integrity of valves are not infrequent. This report illustrates a rare case of endocarditis involving the interatrial septum which subsequently produced destruction of the structure resulting in an acquired atrial septal defect.
Vascular Remodeling in Varicose Veins
Authors: Kockx Mark M. , Knaapen Michiel W. M. , Bortier Hilde E. , Cromheeke Kristel M. , Boutherin-Falson Odile , Finet Michel
Published: July 2008

The present study describes the histopathologic aspects of varicose (n=29; mean age, 52 ± 12 years) and normal saphenous veins (n=17; mean age, 51 ± 12 years) of patients from a similar age group. We focused on the changes that occur in the circular layer of the venous wall. We examined the venous walls by light microscopy and transmission electronmicroscopy. A semiquantitative grading system was used to assess the smooth muscle cell (SMC) hypertrophy and the change that occurs in the elastin pattern. The volume densities (Vv) of SMC and collagen were measured as well as the diameter of the SMC, and the nuclei of SMC per fixed area were counted. The varicose vein wall differed from the normal saphenous vein by the presence of hypertrophic SMC as well as disor ganized elastin patterns. A correlation between the hypertrophic SMC and an abnormal elastin pattern was observed (r=0.658, p<0.001). Ultrastructurally, the SMC show prominent microherniations and vesicles that bud from the cell. These vesicles contain microfilaments and microtubuli, although no other organelles could be detected. The elastin fibers are disrupted from the hypertrophic SMC. No significant difference could be detected in both the Vv of SMC and the Vv of collagen. The diameter of the SMC in the varicose vein (d=9.45 ± 1.22 μm) differs significantly from that in the normal saphenous vein (d=6.22 ± 1.47 μm) (p<0.001). Also, the nuclei of SMC per fixed area differs signif icantly between the varicose (87 ± 18) and nonvaricose (117 ±24) veins (p<0.001). We conclude that the cellular hypertrophy of the SMC and the microherniations could be the basis for disruption of the elastin fibers connected to the SMC in varicose veins. Disrupted connections between SMC and elastin fibers could in turn induce the weakness of the venous wall observed in varicose vein disease.
Contrast Echoes Detected During Percutaneous Mitral Balloon Commissurotomy with Inoue Balloons and Their Relation to Cerebral Microembolic Signals
Authors: Gencbay Murat , Turan Fikret , Degertekin Muzaffer , Yaymaci Bengi , Dindar Ismet
Published: July 2008

The aim of this study was to find out the mechanism of genesis of contrast echoes detected with echocardiography during percutaneous mitral balloon commissurotomy (PMBC) procedures with Inoue balloons and to assess their association with cerebral microembolic signals with transcranial Doppler examinations.

Ten Inoue balloons (Toray Instruments) were used in 10 patients (mean age 36 ± 10 years). In all patients transesophageal echocardiographies with a multiplane 5 MHz probe were performed immediately before and during the PMBC procedure. None of the patients had left atrial thrombus during the PMBC. All of the balloons were inflated within the left atriums and left ventricles and were tested in saline to see whether there was a visible air leak after the PMBC procedures. Transcranial Doppler examinations were done with 2 MHz probes from the middle cerebral artery.

Contrast echoes were detected in all patients during inflation and/or deflation, independent of the intracardiac sites. After a few cardiac cycles there was a very intense shower of microembolic signals detected with the transcranial Doppler examination, which persisted for all inflations and/or deflations. All balloons yielded visible air leaks from the two small holes at the waist of the balloons in saline. There were a few contrast echoes recorded in some of the patients during the exchange of equipment, and one patient had a transient neurologic and coronary ischemic event following the introduction of the stretcher tube of the Inoue balloon.

Intracardiac contrast echoes and transcranial microembolic signals during the PMBC procedure were detected in all PMBC procedures and were due to air that was entrapped between the two latex layers of the Inoue balloons and air introduced from outside during the exchange of the equipment.
POEMS Syndrome with Vascular Lesions: A Role for Interleukin-1beta and Interleukin-6 Increase
Authors: Bova Giovanni , Pasqui Anna Laura , Saletti Marco , Bruni Fulvio , Auteri Alberto
Published: July 2008

The authors describe the case of a 60-year-old man with POEMS syndrome associated with vascular lesions. The patient had osteosclerotic myeloma IgA (λ), polyneuropathy, endocrinopathy, and skin changes. Subsequently, he developed gangrene of the lower limbs with no response to heparin therapy. The humoral study showed thrombocythemia, high levels of interleukin-1beta (IL-1beta) and IL-6 and of some coagulative/fibrinolytic and endothelial factors (von Willebrand factor, plasmin-antiplasmin complexes, plasminogen activator, and endothelial adhesion molecule ICAM-1). The authors suggest that these factors, induced by the increased levels of cytokines, could be responsible for microvascular damage, gangrene, and heparin resistance.
Replacement of Aortic Root with Valved Tubular Prosthesis in a Ten-Year-Old Child with Infective Endocarditis
Authors: Demircin Metin , Doğan Riza , Güvener Murat , Yilmaz Mustafa , Çeliker Alpay , Paşaoğlu Ilhan
Published: July 2008

Aortic root abscess, aneurysm of sinus Valsalva, severe aortic valve insufficiency, and a fragile aortic wall caused by infective endocarditis were found in a 10-year-old child. Aortic valve replacement was intended as a preoperative strategy, but one of modifications of Cabrol had to be used urgently because of aortic root rupture between right atrial and aortic connection just after pericardiotomy.
The Effect of Indirect Calorimetry Measurement on Claudication Pain in Patients with Peripheral Arterial Occlusive Disease
Authors: Womack Christopher J. , Gardner Andrew W.
Published: July 2008

The effect of indirect calorimetry measurement on the duration to onset and maximal claudication pain and hemodynamic measures was evaluated. Fifteen male patients with peripheral arterial occlusive disease (PAOD) performed two graded exercise tests (GXTs) in random order, one with and the other without the use of indirect calorimetry measure ment. During the tests the time to onset and maximal claudication pain was recorded. Before and after the tests, ankle/brachial systolic pressure index (ABI) was determined. The time to onset of claudication pain was shorter for the test with indirect calorimetry (4:49 ±3:50 vs 5:44 ±4:39 min:sec, p < 0.005). Time to maximal claudication pain was not significantly different between the two conditions (8:58 ± 3:01 min:sec with indirect calorimetry, 9:39 ±3:36 min:sec, without). There were no significant differences in ABI between the two testing sessions at any time point. Results of this study suggest that indirect calorimetry measurement can be utilized without compromising maximal clau dication pain time or hemodynamic measurements but that time to onset of claudica tion pain is hastened with indirect calorimetry measurement in patients with PAOD.
Symptomatic Hypertrophic Obstructive Cardiomyopathy: The Role of Dual-Chamber Pacing
Authors: Park Myung H. , Gilligan David M. , Bernardo Nelson L. , Topaz On
Published: July 2008

Background and Purpose: The management of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) has traditionally consisted of beta blockers and calcium channel blockers. Surgical treatment has been employed for operable patients who became refractory to medical therapy. However, associated complications, mortality rate, and recurrence of functional limitations have shifted the focus toward alternative therapy modalities. Recently, permanent dual-chamber (DDD) pacemaker has been intro duced as an alternative treatment option.

Patients and Methods: This study comprises clinical, angiographic, echocardiographic, and electrophysiologic data obtained at a single center on 10 symptomatic patients with HOCM who received a DDD pacemaker after medical therapy failed to relieve symptoms. Presenting symptoms were exertional dyspnea and chest pain (60%), syncope (20%), and presyncope (20%). These symptoms were documented for 8.9 ± 7.1 years before pacemaker implantation. All patients were in New York Heart Association functional class III or IV before pacemaker therapy Results: Placement of a permanent DDD pacemaker decreased the left ventricular outflow tract gradient from 83 ± 44 mm Hg (range: 35-180 mm Hg) to 47.1 ± 25.3 mm Hg (range: 10-75 mm Hg) in these patients. Within 1 to 30 months, follow-up found that the functional status of eight out of the 10 patients had improved to New York Heart Association class 0 or I.

Conclusion: In selected patients with symptomatic HOCM who fail to respond to medical therapy, DDD pacemaker may offer a nonsurgical alternative treatment option. Large- scale multicenter, prospective, randomized trials are needed to establish the role of this modality in the treatment of hypertrophic obstructive cardiomyopathy.
Fibromuscular Dysplasia Involving Coronary Arteries
Authors: Ogawa Takanori , Nomura Akikazu , Komatsu Hiroshi , Fujii Satoshi , Urasawa Kazushi , Okamoto Hiroshi , Kitabatake Akira , Fujii Satoshi
Published: July 2008

The authors report a young patient with fibromuscular dysplasia involving multivessels including coronary arteries. If young patients have chest pain on effort, fibromuscular dysplasia of coronary arteries must be considered. As fibromuscular dysplasia is a chronic progressive disease and some cases progress rapidly in a few months, careful follow-up and comprehensive medical management may be necessary in such patients.
Limb-Threatening Lower Extremity Ischemia Successfully Treated with Intra-Arterial Infusion
Authors: D'Amore Martin J. , Borge Marc A. , Messersmith Richard N. , Borge Marc A.
Published: July 2008

The authors present two patients with acute arterial vasospasm of the lower extremities causing marked ischemia. One patient had a history of Raynaud's disease, the second had been taking Cafergot for migraine headaches. Both patients's were given a test dose of intra-arterial tolazoline (50 mg). The patient with Raynaud's disease demonstrated marked improvement diffusely and was successfully treated with overnight infusion of papaverine. The second patient, taking Cafergot, demonstrated no angiographic response to tolazoline. It was speculated that the arteries of this patient were thrombosed. The patient was successfully treated with urokinase and remained free of pain at the 15- month follow-up.
Primary Venous Aneurysms
Authors: Uematsu Masahisa , Okada Masayoshi , Uematsu M.
Published: July 2008

Venous aneurysms are rare lesions that may be the source of pulmonary emboli and can result in death. The authors have recently treated several patients who had venous aneurysms of the upper extremity, lower extremity, and jugular system. Venous aneurysms usually appear to have a safe natural history in these locations, although all of the reported patients required surgery after the development of symptoms owing to complaints of pain, and/or cosmetic appearance, and/or a diagnosis of thrombosis. These cases are presented, along with a review of venous aneurysms occurring at other sites and their causes.
Bifurcating Aneurysm of the Left Main Coronary Artery Involving Left Anterior Descending and Left Circumflex Arteries
Authors: Rahmatullah Syed I. , Khan Ijaz A. , Nair Vinod M. , Vasavada Balendu C. , Sacchi Terrence J. , Khan Ijaz A.
Published: July 2008

Coronary artery aneurysm is a rare coronary abnormality, usually diagnosed incidentally by coronary angiography. Major causes of coronary aneurysms include coronary ectasia, Kawasaki disease, and atherosclerosis. Most of the discrete coronary aneurysms are of atherosclerotic origin. The incidence of atherosclerotic coronary aneurysms is about 0.2%, and the left main coronary artery is the least frequently involved artery. Only a few cases of left main coronary artery aneurysm have been reported in the literature, and a left main coronary artery aneurysm involving the proximal segments of the left anterior descending and the left circumflex arteries has not been reported previously. The authors describe this finding in a man who presented with worsening exertional angina pectoris. Coronary angiography demonstrated an aneurysm of the distal left main coronary artery extending into the proximal segments of the left anterior descending and the left circum flex arteries. In addition, a significant flow-limiting atherosclerotic lesion was present in the proximal portion of the left anterior descending artery distal to the aneurysm.
Cerebral Venous Thrombosis in Patients with Nephrotic Syndrome
Authors: Sung Sheng-Feng , Jeng Jiann-Shing , Yip Ping-Keung , Huang Kou-Mau
Published: July 2008

The authors describe two cases of cerebral venous thrombosis (CVT) in patients with nephrotic syndrome. The main clinical features of CVT were persistent headache, hemi paresis, and seizure, and the diagnosis was based on magnetic resonance imaging and magnetic resonance angiography. Both showed acquired deficiency of free protein S. The neurologic symptoms remained stationary in the first patient, who received no anticoag ulation therapy, but resolved rapidly in the second, treated with intravenous heparin and supplemented with fresh frozen plasma. CVT should be suspected in patients with nephrotic syndrome who present with symptoms of intracranial hypertension or any focal neurologic deficit.
Intravenous Hydroxyethylrutosides Combined with Long-Term Oral Anticoagulation in Atherosclerotic Nonreconstructable Critical Leg Ischemia: A Retrospective Study
Authors: Lund Fredrik , Glenne Per-Olov , Inácio Jorge , Larsson Ulla-Britt , Lavstedt Stig , Qian Zhaomei , Schiötz Jörn , Tillgren Carl
Published: July 2008

Objective. To evaluate in a group of seriously diseased patients with nonreconstructable chronic critical leg ischemia (CLI), treated by a combination of IV hydroxyethylrutosides (HR)* and oral anticoagulation (AC) by warfarin, the short-term effects on the cutaneous microvascular blood perfusion of the soles of feet and especially the long-term clinical outcome in terms of amputation and death.

Design. A retrospective comparison between two groups of patients, HR + AC and a comparable reference group, fulfilling the same inclusion and exclusion criteria corre sponding to the definition of CLI according to the Second European Consensus Document (1991). Clinical follow-up in both groups was made after 1, 3, 6, 12, and 24 months.

Setting. Patients were examined at university departments of clinical physiology with special interest in peripheral vascular disease, in cooperation with colleagues at univer sity departments of surgery, internal medicine and dermatology of Karolinska Hospital, Södersjukhuset and Huddinge Hospital. (continued on next page) Patients. A total of seventy patients with CLI according to the definition of the Second European Consensus Document, 1991, ie, besides severe rest pain or ischemic lesions also a toe blood pressure < 30 mg Hg. Group with HR + anticoagulation (AC): 42 patients (19 diabetics, 23 nondiabetics). Reference group: 28 patients (18 diabetics, 10 nondiabetics). For distribution of age and toe blood pressure at baseline, see Table I.

Interventions. Therapy group: besides ordinary standard therapy, daily HR infusions for a mean period of 3.6 weeks + oral anticoagulation continued to the end of the study at 24 months. A comparable reference group on the same basic therapy but without the combination HR + AC.

Parameters In Evaluation. Short-term parameters: clinical data, skin temperature, and fluorescein imaging. Long-term outcome: amputation or death.

Results. Short-term and long-term results with HR + AC indicated that patients with severe CLI and very poor prognosis benefited in terms of survival and limb salvage from initial therapy with HR infusion combined with long-term oral anticoagulation. Results of this combined treatment seem at least comparable with those with IV prosta cyclin analogies.
Successful Transcatheter Closure of a Patent Ductus Arteriosus: Using Two Gianturco Coils in a 41-Year-Old Woman
Authors: Shamsham Fadi , Kwan Tak , Safi Arshad M. , Clark Luther T.
Published: July 2008

Patent ductus arteriosus (PDA) is a form of congenital heart disease uncommonly diagnosed in adult patients. Transcatheter closure of PDA has been widely used in children. However, the experience is limited in adults especially with use of Gianturco coils. The authors describe a case of successful transcatheter closure of a PDA, inciden tally diagnosed in a 41-year-old woman, by successively deploying two coils by a transar terial approach. No residual shunting was seen angiographically after the procedure. A literature review of similar procedures in adult patients is discussed.
Evaluation of Left Atrial Wall Elasticity Using Acoustic Microscopy
Authors: Masugata Hisashi , Mizushige Katsufumi , Senda Shoichi , Xin Lu  , Kinoshita Aki , Sakamoto Haruhiko , Nozaki Shiro , Sakamoto Seiji , Matsuo Hirohide
Published: July 2008

Left atrial wall elasticity is one of the important factors regulating left atrial stiffness and functions. The authors evaluated left atrial wall elasticity by measuring the sound speed through the left atrial wall, based on the hypothesis that high elasticity tissues will yield larger sound speed values through the tissue, and examined age-associated changes in left atrial wall elasticity. Left atrium specimens were obtained from 30 normal subjects (age, 15-95 years) at autopsy. An acoustic microscope, operating at 450 MHz, was used to measure the sound speed in the endocardium and the myocardium of the left atrium. The sound speeds in endocardium and myocardium demonstrated significant correlation with age (r=0.74, p<0.0001 and r=0.47, p<0.01, respectively). These findings indicate that left atrial wall elasticity increased with advancing age. These changes may lead to deterioration of left atrial compliance and eventual left atrial failure in older subjects.

Katsufumi Mizushige, MD Second Department of Internal Medicine Kagawa Medical University 1750-1, Miki-cho, Kita-gun Kagawa 761-0793, Japan
Cardioversion with Sotalol in Selected Patients with Vagally and Adrenergically Mediated Paroxysmal Atrial Fibrillation
Authors: Yeşil Murat , Bayata Serdar , Postaci Nursen , Yücel Özcan , Aslan Özgür , Bayata Serdar
Published: July 2008

This study was designed to evaluate and compare the effects of oral sotalol for the treatment of vagal and adrenergic paroxysmal atrial fibrillation (PAF). Thirty-five eligible patients with atrial fibrillation of > 12 hours and < 7 days were enrolled in the study. Patients were classified as vagally mediated (group I, n: 14) and adrenergically mediated (group II, n: 21) PAF groups. All patients were given racemic sotalol at a dose up to 120 mg bid for 2 days. At the end of the observation period of 48 hours, 36% of patients (n: five) in group I returned to sinus rhythm. Conversion rate in group II was 71% (n: 15), and this figure was significantly higher than the success rate in group I. Mean times to cardioversion were 22 ± 15 hours in group I and 16 ± 14 hours in group II (p < 0.05). The result of this study suggests that oral sotalol is more effective for adren ergic PAF. This beneficial effect of sotalol is not apparent in vagal PAF patients.
Successful Stenting on Tortuous Coronary Artery with Accordion Phenomenon: Strategy
Authors: Ishikawa Shiro , Asakura Keiko , Okabe Teruo , Kanki Hideaki , Ito Shinji , Shibata Masaru , Sakamoto Munehisa , Takagi Shunsuke , Mitamura Hideo , Ogawa Satoshi , Asakura Yasushi
Published: July 2008

Guidewire manipulation through tortuosities is difficult. Straightening a tortuous coronary artery by using a stiff guidewire has been recognized to induce vessel wall shortening referred to as an "accordion phenomenon." With inappropriate identification as dissection or thrombus formation, the risk of performing unnecessary dilation at the pseudo-narrowing site exists. The authors describe here two cases showing the accordion phenomenon induced by a stiff guidewire during successful stenting at a tortuous right coronary artery. In another case, the authors experienced an "accordion phenomenon" at the proximal edge of the Palmaz-Schatz stent implanted in a tortuous right coronary artery. The stent edge was better positioned at the straight portion than at the contour portion in a tortuous coronary artery.
Coronary Stent Deployment Without Predilation in Acute Myocardial Infarction: A Feasible, Safe, and Effective Technique
Authors: Herz Itzhak , Assali Abid , Solodky Alejandro , Shor Nurit , Ben-Gal Tuvia , Adler Yehuda , Birnbaum Yochai
Published: July 2008

Direct percutaneous transcatheter revascularization (PTCR) is becoming an acceptable therapy for acute myocardial infarction (AMI). Stenting in the setting of AMI, once consid ered contraindicated, is emerging as a suitable option in this situation. Coronary stenting without predilation (SWOP) may potentially shorten the procedure and radiation time, reduce costs, and decrease procedural complications such as coronary dissection and distal embolization. It is expected to cause less vascular injury, with a reduction in the rate of in-stent restenosis. In this preliminary study the authors evaluated the feasibility of the SWOP procedure in 22 selected patients with AMI. Indications for catheter-based myocardial reperfusion were the following: extensive anterior wall MI (68%), inferior wall and right ventricular MI (23%), and inferior wall MI with contraindication for thrombolytic therapy (9%). Patients with cardiogenic shock or with contraindications for aspirin or ticlopidine were excluded. SWOP was successful in 21 attempts (95%), and final procedural success was achieved in all. Proximal or distal dissections were seen in three cases and were treated by additional three stents. Thrombolysis in myocardial infarction (TIMI) flow 3 was restored in all patients. There were no distal embolizations, side branch occlusions, coronary perforations, procedure-related emergency bypass operations, or deaths. It is concluded that in selected patients with AMI, coronary artery stenting without predilation is feasible and safe and does not introduce additional risk to the patients.