bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute myocardial infarction complicating urokinase infusion for total saphenous vein graft occlusion
Authors: Blankenship James C. , Modesto Thomas A. , Madigan N. Patrick
Published: March 2007

Saphenous vein graft occlusions have been successfully treated with extended urokinase infusions. We report a case of myocardial infarction complicating this treatment. A review of reported cases suggests that this complication may not be uncommon. The optional drug, dose, and infusion technique for intra‐graft lytic therapy has not been determined. The costs, risks, and difficulty of this technique may limit its application.
Platelet adhesion/aggregation in an in vitro model of coronary artery stenosis
Authors: Grabowski Eric F. , Rodriguez Marisol , McDonnell Sonam L.
Published: March 2007

Platelet adhesion/aggregation (PAA) at a site of coronary artery stenosis is believed to be a process strongly modulated by local shear rates and the functional state of neighboring endothelium. One purpose of the present work, therefore, is to describe an in vitro model for the direct imaging of such PAA. Another is to apply the model to the question as to whether the use of nonionic vs. ionic contrast media (CM) in the presence of vascular endothelium contributes to PAA at the stenosis site. Toward these ends, we utilized a special flow chamber which incorporates a monolayer of endothelial cells (ECs), a step 66% flowpath constriction at a site preadsorbed with microfibrillar collagen, and arterial shear rates. By epifluorescence microscopy and digital image analysis of video recordings, PAA was found to be greater with dysfunctional ECs (pretreated with lysine acetylsalicylate) than with normal ECs, thereby confirming a modulatory role in PAA of functionally intact ECs. When nonionic (iohexol) or ionic (ioxaglate, diatrizoate) CM was added to the flowing blood at a concentration of 20% by non‐red cell volume, PAA was inhibited in the order diatrizoate > ioxaglate > iohexol > saline control. No inhibition by any CM was seen, however, when chamber prefill culture medium containing 20% by volume CM was displaced by CM‐free blood, in simulation of bolus administration of CM. In terms of inhibition of PAA during percutaneous transluminal coronary angioplasty (PTCA), therefore, our model provides a conceptual basis by which one may anticipate in flowing blood no clear benefit of ionic over nonionic CM. This is because the greater antiplatelet effects of the ionic CM are lost with hemodilution by CM‐free blood, while a greater anti‐EC effect is likely to persist. © 1993 Wiley‐Liss, Inc.
Successful limb salvage after recanalization of an occluded infrapopliteal artery utilizing a balloon expandable (Palmaz‐Schatz) stent
Authors: Dorros Gerald , Hall Patrick , Prince Charles
Published: March 2007

This case describes the first reported successful management of an infrapopliteal artery intimal dissection utilizing the Palmaz‐SchatzTM balloon expandable stent. Stent deployment relieved the compromised blood flow caused by the intimal flap which could not be corrected by prolonged balloon inflation or removed with directional atherectomy, and averted any emergency surgical procedure. © 1993 Wiley‐Liss, Inc.
Pulmonary balloon valvotomy for severe valvular pulmonic stenosis with congestive heart failure beyond infancy
Authors: Shrivastava Savitri , Kumar R. Krishna , Dev Vishva , Kothari S. S. , Saxena A.
Published: March 2007

Isolated valvular pulmonic stenosis (PS) in association with tricuspid regurgitation and congestive heart failure (CHF) is rarely encountered after infancy, and there is very little information available regarding the application of pulmonary balloon valvotomy (PBV) for this subset of patients. Since 1985, 10 patients (5 males, 5 females; mean age: 12.4 ± 7.5 years, range 4–25 years underwent PBV for severe valvular PS with CHF in our institution. All patients had associated tricuspid regurgitation and cardiomegaly. Before PBV, the mean peak systolic gradient across the right ventricular outflow was 131 ± 36 mmHg and the mean right atrial pressure was 14.4 ± 5.4 mmHg. Specific modifications in the PBV technique included the sequential use of progressively larger balloon catheters and the use of an extra stiff guidewire to support the dilatation assembly. One patient underwent PBV via the right internal jugular vein. Problems encountered during PBV included hypotension and bradycardia (2 patients) and respiratory arrest, which was transient in one patient, and prolonged and eventually fatal in one patient. A successful outcome was achieved in 8 patients (4 of these required 2 PBV attempts) with a final residual gradient of 40 mmHg or less, mean 28 ± 7; range: 21–38 mmHg) and complete resolution of CHF. One patient has had no significant change in gradients and awaits repeat dilatation. Patients with isolated severe valvular PS with TR and CHF represent a relatively high risk group for PBV. A successful outcome is, however, feasible if a carefully planned and cautious approach is used. © 1993 Wiley‐Liss, Inc.
Contained rupture following percutaneous transluminal coronary angioplasty: Long‐term outcome
Authors: Chou Tony M. , Amidon Thomas M. , Ports Thomas A.
Published: March 2007

Coronary artery aneurysm formation can occur as a complication of balloon angioplasty. We present a case of a contained rupture of the left circumflex artery following angioplasty which resulted in an unusual pseudoaneurysm on angiography at 3‐year follow‐up. © 1993 Wiley‐Liss, Inc.
Effects of ultrasound energy on thrombi in vitro
Authors: Philippe F. , Drobinski G. , Bucherer C. , Ankri A. , Lacombe C. , Kremer D. , Brisset D. , Montalescot G.
Published: March 2007

Ultrasonic energy may be used for dissolution of venous or arterial thrombi. However, its effects may depend on the mode of ultrasonic vibration and on the length of the probe. We investigated the in vitro effects of an ultrasonic angioplasty device coupled with a 130 cm‐long flexible titanium probe, with an incorporated automatic optimal frequency of resonance scanning function and continuous mode of emission.

Sixteen clots were treated of which eight were whole blood and eight cell‐free. In each of these groups, four were treated in association with streptokinase and four by ultrasound alone. The ages of the clots in these subgroups of four were 1, 3, 7, and 15 days. All thrombi were dissolved in 6 min or less (3′15″ ± 1′35″) at a mean optimal frequency of resonance of 19,444 Hz. Ninety‐six percent of the debris were less than 10 μ. Fewer than 1% of the particulates were larger than 100 μ. These large particulates were observed in disrupted whole blood clots and were almost non‐existent in disrupted cell‐free clots. They were very fragile. Clot dissolution was not speeded by adding streptokinase to ultrasound. Ultrasound did not induce D‐Dimer production, and its effect was most likely to be due to cavitation.

Ultrasound energy could represent an advance for thrombotic vascular occlusion therapy, provided that more flexible probes can be devised. © 1993 Wiley‐Liss, Inc.
Quantitative evaluation of left ventricular shape in anterior aneurysm
Authors: Fantini Fabio , Barletta Giuseppe A. , Baroni Maurizio , Fantini Andrea , Maioli Mauro , Sabatier Michel , Rossi Philippe , Dor Vincent , Di Donato M.
Published: March 2007

The purpose of the study was to analyze left ventricular (LV) shape in post‐infarction anterior aneurysm by utilizing quantitative analysis of wall curvature.

Forty‐one patients (39 men, 2 women; mean age 56 years) subjected to surgical intervention for LV aneurysm complicating an anterior myocardial infarct were retrospectively evaluated. In all patients the presence of resectable aneurysmal tissue had been confirmed by direct surgical examination. Patients with inferior myocardial infarction and patients who had undergone percutaneous transluminal coronary angioplasty (PTCA) or bypass surgery were excluded. Pre‐intervention ventriculograms (RAO projection) were analyzed. LV wall motion was studied by applying the centerline method. Regional curvature of end‐diastolic and end‐systolic outlines was calculated at 90 equidistant points from aortic corner (point 1) to mitral plane (point 90).

Patients with LV anterior aneurysm show a typical pattern of alterations in wall curvature, which is characterized by a shifting of the angiographic apex (the point with the greatest curvature) towards the mitral plane, and by a sharp shift of curvature values at the antero‐basal and infero‐apical regions, marking the borders of the sac. These hinge points closely correspond to the external limits of wall motion abnormalities. Significant correlations were found between degree of regional curvature alterations and severity of global LV dysfunction, as indicated by decrease of ejection fraction and increase of end‐systolic volume.

In conclusion, quantitative evaluation of LV shape by means of wall curvature analysis allows recognition of the characteristic morphologic changes of the aneurysm, i.e., wall expansion and deformation. The alterations of regional curvature correlate with the extent of wall motion abnormalities and the severity of global LV dysfunction. © 1993 Wiley‐Liss, Inc.
A prospective, randomized, and double‐blind trial on the effect of fish oil on the incidence of restenosis following ptca
Authors: Franzen Damian , Schannwell Mira , Oette Kurt , Höpp Hans W.
Published: March 2007

Restenosis after successful coronary angioplasty (PTCA) occurs in 25–35% of all procedures. To date, most pharmacologic strategies have failed to reduce the restenosis rate significantly. However, recent studies have suggested a potential benefit of dietary supplementation with omega‐3 fatty acids (fish oil) on restenosis following PTCA. The benefit of omega‐3 polyunsaturated fatty acids on the incidence of coronary artery restenosis following elective PTCA was assessed in 212 consecutive patients (41 female, 171 male). Following a successful angioplasty, 204 patients a dietary supplementation with either nine capsules containing fish oil (3.15 g omega‐3 fatty acids) or nine placebo capsules containing olive oil. Treatment was started immediately after PTCA and maintained over 4 mon. Compliance was assessed by analysis of lipid fatty acids prior to angioplasty and at 4 mon follow‐up. The angiographically determined incidence of restenosis (stenosis diameter > 50%) was 31.2% per lesion in patients receiving fish oil and 33.7% in patients receiving olive oil. Gross progression of coronary artery disease in vessels not subjected to angioplasty was 17% and 16%, respectively. In conclusion, low dose fish oil supplementation begun on the day of a successful coronary angioplasty failed to demonstrate any effect on coronary artery restenosis. © 1993 Wiley‐Liss, Inc.
Transcatheter coil occlusion for treatment of left internal mammary‐anterior descending artery steal phenomenon
Authors: Nakhjavan Fred K. , Koolpe Harvey A. , Bruss Jeffrey , Najmi Moosa , Radke Timothy
Published: March 2007

A 60‐yr‐old female with previous bypass surgery including LIMA‐LAD graft presented with unstable angina due to steal phenomenon caused by a large pectoral branch of LIMA. Transcatheter coil occlusion of the pectoral branch was successfully performed. This procedure should be considered in similar cases. © 1993 Wiley‐Liss, Inc.
Kissing balloon technique in complex ptca: Single guiding catheter and dual wire rapid exchange system
Authors: Castriz Jorge L. , Canales Mark L. , Reynolds Dwight W.
Published: March 2007

This report is a description, based on four cases, of a variation from previously described approaches for accomplishing the “kissing balloon” technique for complex PTCA. We describe a case in which a single guiding catheter is utilized in combination with two over‐the‐wire monorail type balloon catheters allowing use of standard length (175 cm) guidewires. Various combinations of balloon diameters are described. We believe this approach has significant advantages over other techniques, principally in its rapid and easy usage. © 1993 Wiley‐Liss, Inc.
Subclavian angioplasty: Immediate and late results in 50 patients
Authors: Millaire Alain , Trinca Manuel , Marache Philippe , Groote Pascal De , Jabinet Jean‐Louis , Ducloux Gérard
Published: March 2007

In order to assess the therapeutic outcome of percutaneous transluminal angioplasty for subclavian stenosis, 50 patients were followed up clinically as well as with a velocimetric Doppler after attempted angioplasty. A minimal clinical follow‐up of 9 months was expected. Subclavian stenoses were due to atheroma in 49 patients and to Takayasu's disease in 1 case. Indication of angioplasty was curative in 34 (68%) symptomatic patients (posterior fossa ischemia and/or upper limb ischemia) and preventive in 16 (32%) asymptomatic patients (severe difference of blood pressure between the 2 arms and/or association with carotid stenosis or axillo‐femoral bypass). Angioplasty was successful in 45 patients (primary success rate = 90%). Three (6%) thrombosis occurred due to the percutaneous approach, one of the axillary and one of the brachial artery without any significant sequelae, and one of the aorta requiring an aorto‐bifemoral bypass. A complication occurred in 2 unsuccessful angioplasties (4%): an ischemic stroke occurred in 1 case and a thrombosis of the dilated site requiring a surgical bypass. Clinical follow‐up over a period of 9–101 months (mean = 41) was performed in 43 out of the 45 patients who had undergone angioplasty successfully. Two patients had a follow‐up shorter than 9 months: one died after 5 months, the other was lost to follow‐up. By the end of the clinical follow‐up, 37 (84%) out of the 44 followed‐up patients had benefitted from the procedure. Doppler study performed in 35 out of the 44 followed‐up patients (80%) over a period of 2–90 months (mean = 39) showed 5 restenosis (14%). This study demonstrates the good long‐term results of angioplasty in case of subclavian artery stenosis. Though there are complications, angioplasty could be proposed as a first choice treatment for subclavian stenosis as compared to surgery. Indications in asymptomatic patients should be carefully weighed as complications may occur. © 1993 Wiley‐Liss, Inc.
Left main coronary angioplasty in a 10‐year‐old boy with homozygous familial hypercholesterolemia
Authors: Mehan Vivek K. , Salzmann Christian , Pfammatter Jean‐Pierre , Stocker Franco P. , Meier Bernhard
Published: March 2007

Homozygous familial hypercholesterolemia is a rare cause of premature coronary artery disease. A young boy with this disorder who underwent successful coronary angioplasty for left main stem stenosis is presented. © 1993 Wiley‐Liss, Inc.
Percutaneous treatment of post catheterization massive retroperitoneal hemorrhage
Authors: Mak Gary Y. K. , Daly Barry , Chan Wilson , Tse K. K. , Chung H. K. , Woo K. S.
Published: March 2007

We describe a patient on anticoagulant therapy with massive retroperitoneal and intraperitoneal bleeding complicating femoral catheterization. Balloon tamponade of the actively bleeding femoral artery was effective in sealing off the leakage after failed surgical exploration. © 1993 Wiley‐Liss, Inc.
New treatment approach for chronic total occlusions of saphenous vein grafts: Thrombolysis and intravascular stents
Authors: Eagan John T. , Strumpf Robert K. , Heuser Richard R.
Published: March 2007

Balloon dilation of saphenous vein graft (SVG) occlusions has a lower success rate than angioplasty of native coronary arteries. To improve this outcome, a new therapy for chronic total SVG occlusions was developed.

In three aortocoronary bypass graft patients with class III‐IV angina and chronic occlusion of the SVGs to the left anterior descending artery (age of occlusions: 2–24 wk, age of graft 1–13 yr), standard recanalization was achieved with a guide wire and intracoronary urokinase infusion (0.5–1.0 million unit bolus followed by 100,000 IU/hr for 11–24 hr; mean infusion time: 19.7 hr). In each patient, a residual focal stenosis (average 82.5%) was successfully dilated and stented (single 4.0 mm Pal‐maz‐Schatz in two patients and a 3.5 mm Strecker stent in the other).

All patients had complete relief of symptoms and no sequelae. During a mean 7.7 mon follow‐up, 6‐mon arteriographic evaluation in two patients showed minimal intra‐stent narrowing (26% and 34%). In the Strecker stent patient, the device proved too small for the vein graft, leading to an 89% stent stenosis found on follow‐up arteriography at 5 mon. The stent was redilated successfully with a 5% residual narrowing.

After urokinase recanalization of chronic total SVG occlusions, intravascular stents may improve the long‐term results seen with conventional SVG angioplasty. © 1993 Wiley‐Liss, Inc.
Management of typical and dysplastic pulmonic stenosis, uncomplicated or associated with complex intracardiac defects, in juveniles and adults: Use of percutaneous balloon pulmonary valvuloplasty with eight‐month hemodynamic follow‐up
Authors: David Shukri W. , Goussous Yousef M. , Harbi Narmeen , Doghmi Faris , Hiari Aktham , Krayyem Mohammed , Ferlinz Jack
Published: March 2007

To alleviate large fixed right ventricular (RV) outflow gradients, percutaneous balloon dilatation of pulmonic stenosis (PS) was performed in 38 patients with mean age of 14 ± 14 years (median: 9 years, age range: 9 months to 63 years). There were 21 males and 17 females. Thirty‐four patients had typical PS (5 of them also having other complex congenital cardiac anomalies, while 13 additional patients had a patent foramen ovale); 2 further subjects had subpulmonic, and 2 dysplastic pulmonary valvular obstructions. Sixteen patients were in the New York Heart Association (NYHA) Class I, 15 in Class II, 6 in Class III, and 1 in Class IV. Electrocardiographic (ECG) evidence of right ventricular hypertrophy (RVH) was present in 29 patients (76%); 3 patients had right bundle branch block (RBBB). For the entire group, there was a marked decrease in the mean systolic transpulmonic gradient in the immediate post‐valvuloplasty period (from 97 ± 43 to 26 ± 17 mmHg; P < 0.0001). One patient expired 8 hours post‐valvuloplasty (he was in the NYHA Class IV, and had severe RV failure). No other cardiovascular complications were encountered; the median hospital stay was 3 days (range: 1–10 days).

At an 8‐month follow‐up, 12 patients who were reevaluated invasively had a median transpulmonic gradient of 27 mmHg (range: 5–92 mmHg) as compared to their pre‐valvuloplasty values of 84 mmHg (range: 49‐142 mmHg; P <0.004). Two patients restenosed; 1 required open‐heart surgical valvulotomy with simple shaving, and 1 had successful redilatation with balloon valvuloplasty. Our results indicate that balloon pulmonary valvuloplasty (BPV) is a safe and effective procedure in most patients with PS. Percutaneous BPV should therefore be currently considered to be an excellent alternative form of treatment for most, if not all, subjects with a significant pulmonic valvular obstruction who might otherwise likely become the prime candidates for a severely compromised hemodynamic status if these defects were not expeditiously corrected. © 1993 Wiley‐Liss, Inc.
Double‐lumen catheter assessment of aortic stenosis: Comparison with separate catheter technique
Authors: Jayne John E. , Catherwood Edward , Niles Nathaniel W. , Friedman Bruce J.
Published: March 2007

Hemodynamic assessment of aortic stenosis in the catheterization laboratory requires accurate determination of the transvalvular gradient. A commercially available doublelumen pigtall catheter can be used to obtain this gradient via a single arterial puncture. The catheter has several advantages over other methods used to measure the gradient in aortic stenosis, but it has not been critically evaluated. In order to assess the performance of this catheter compared to the traditional standard of separate catheters above and across the aortic valve, we studied 10 patients with aortic stenosis using both catheter systems. Aortic valve areas ranged from 0.34 cm2 to 1.1 cm2. Linear regression analysis confirmed excellent correlation between the two methods in measurement of the mean transvalvular gradient (r = 0.98) and calculation of the aortic valve area (r = 0.99) using the Gorlin formula. We conclude that the double‐lumen pigtail catheter provides accurate data in the hemodynamic evaluation of aortic stenosis. © 1993 Wiley‐Liss, Inc.
Coronary angioplasty with gradual versus rapid balloon inflation: Initial results and complications
Authors: Ilia Reuben , Cabin Henry , McConnell Susan , Cleman Michael , Remetz Michael
Published: March 2007

Although a variety of coronary angioplasty balloon inflation protocols are employed, prior studies have not evaluated the relation of rate of inflation to the type and extent of arterial damage produced by angioplasty. We randomized 103 patients to either a gradual (gradual, incremental increase to peak inflation pressure) or rapid inflation protocol (rapid increase to peak inflation pressure). Fifty‐one patients with 72 lesions underwent gradual and 52 patients with 73 lesions received rapid inflation protocols. There were no significant group differences with regard to age, sex, artery dilated, number of diseased vessels, presence of unstable angina and lesion morphological characteristics except for more lesions located on a bend in the gradual inflation group (p < 0.02). Although there was a tendency towards a higher success rate in patients with gradual inflation, the complete success rates were high in both groups (100% vs. 93%, p < 0.08). The dissection rate was higher in patients with rapid inflation (43/73 [59%] vs. 26/72 [36%], p < 0.01). The collective complication rate was higher in patients with rapid inflation (19% vs. 6%, p < 0.03). No deaths occurred in either group. Thus a gradual compared to rapid coronary angioplasty balloon inflation protocol reduces the frequency of dissection despite similar inflation pressure and balloon/vessel diameter ratio. Gradual inflations may reduce the frequency of procedure‐related complications. © 1993 Wiley‐Liss, Inc.
Coronary angioplasty of anomalous right coronary arteries
Authors: Charney Richard , Spindola‐Franco Hugo , Grose Richard
Published: March 2007

We report 2 cases of successful angioplasty of anomalous right coronary arteries originating above the sinotubular line at the junction of the right and left sinus of Valsalva. The use of Amplatz left guiding catheters provided optimal support for performing angioplasty. © 1993 Wiley‐Liss, Inc.
Coronary angioplasty using an autoperfusion balloon catheter through a 6 french guiding catheter
Authors: Wolff Matthew R. , Prewitt Kerry C. , Brinker Jeffrey A. , Resar Jon R.
Published: March 2007

Use of 6 French guiding catheters for elective percutaneous transluminal coronary angioplasty has been limited by lack of a compatible autoperfusion balloon catheter for management of complications such as acute vessel closure and large subintimall dissections. We describe the successful use of a lower profile autoperfusion balloon catheter through large internal lumen 6F guiding catheters for elective coronary angioplasty. These cases demonstrate the feasibility of the use of autoperfusion balloon catheters with 6F guiding catheters in elective, and presumably also in emergent, settings. © 1993 Wiley‐Liss, Inc.
Late outcome and quality of life following percutaneous transluminal coronary angioplasty in octogenarians
Authors: Little Thomas , Milner Mark R. , Lee Kenneth , Constantine Janeen , Pichard Augusto D. , Lindsay Joseph
Published: March 2007

Limited data are available concerning the long‐term survival and quality of life of octogenarians treated with percutaneous transluminal coronary angioplasty (PTCA). We retrospectively compared the results of PTCA in 118 octogenarians to that of 500 younger subjects. Among the octogenarians, long term follow‐up was obtained including survival, relief of angina, assessment of quality of life, and capacity for independent living. These results were compared between men and women.

The clinical success rate was 93% for the octogenarians and 88% for the younger patients (p = NS). The lesion success rates were 89% and 88% for these groups, respectively. Results of multilesion PTCA and dilatation of coronary occlusions were similar in both age groups. Major complication rates were 5.9% for the elderly and 3.8% for the younger patients (p < 0.008). Hospital mortality was higher among the octogenarians (4.6% vs 0.2%, p < 0.
05). Among long‐term octogenarian survivors, < 90% indicated a high level of satisfaction with their quality of life and health status. If needed, 88% would undergo the procedure again. Independent living was possible for 66% of these patients and automobile driving for 55%.

Octogenarian men and women had similar baseline clinical characteristics, procedural success, complications, relief of angina, and survival. Women indicated a slightly lower level of satisfaction and capacity for independent living.

PTCA can achieve a success rate in octogenarians comparable to that of younger patients but with an increased risk of serious complications. Patient satisfaction remains high and a majority of octogenarians remain physically active and capable of independent living. © 1993 Wiley‐Liss, Inc.
Coronary angioplasty through 4 french diagnostic catheters
Authors: Mehan Vivek K. , Meier Bernhard , Urban Philip , Verine Vitali , Haine Emmanuel , Dorsaz Pierre‐André
Published: March 2007

In 50 consecutive patients subjected to coronary angioplasty immediately following a 4 French (F) diagnostic study, the technical feasibility and economical aspects of angioplasty through 4F catheters of 54 lesions were assessed. The patients were selected, but multiple, eccentric, and long lesions were not a priori excluded. 4F diagnostic catheters (Cordis), and fixed‐wire dilatation catheters (Ace, Scimed) were used in all cases. The procedure was successful in 43 lesions (80%) using 4F catheters. For 11 stenoses (20%), a change over to a larger French size was required. Two of these lesions could not be crossed with the balloon despite the larger sized guiding catheter. The final overall success rate was 96%, and there were no major complications. The use of diagnostic 4F catheters for angioplasty in these 50 patients resulted in the saving of 39 guiding catheters and 19 introducer sheaths. For 12 lesions (22%), an additional 4F catheter became necessary since the shape used for the diagnostic study was inadequate for angioplasty. In 7 cases, more than 1 balloon was used, but 5 of these balloon exchanges were independent of the use of 4F catheters. Three exchanges were performed through the 4F catheter (1 for need of a larger balloon to improve on an unsatisfactory angiographic result and 2 for a crimped guide wire tip of the Ace balloon). In the remaining 4, a larger catheter was used; in 2 of them, angioplasty eventually failed (failure to cross lesion) and in the remaining 2, a Monorail system solved the problem, which is incompatible with 4F catheters. In these 4 cases, a balloon could have been saved if the procedure had been started with a larger catheter and a movable wire system. We conclude that angioplasty through diagnostic 4F catheters completing a 4F coronary angiography is technically feasible and represents an economically viable alternative in selected patients. © 1993 Wiiey‐Liss, Inc.
Pseudocoarctation of the aorta: A magnetic resonance imaging correlation
Authors: Shah Dipen C. , Sathyamurthy I. , Raje Millind , Ahmed Iqbal
Published: March 2007

We present here the clinical and angiographic features in a patient with pseudocoarctation of the aorta and aortic valvular stenosis. An MRI study performed to delineate the aorta provided valuable correlations and highlighted the potential of this noninvasive modality for the diagnosis of pseudocoarctation of the aorta. © 1993 Wiiey‐Liss, Inc.
Retrieval techniques for managing flexible intracoronary stent misplacement
Authors: Foster‐Smith Karl W. , Garratt Kirk N. , Higano Stuart T. , Holmes David R.
Published: March 2007

With the increasing use of flexible intracoronary stents, the likelihood of complications, including stent misplacement, will tend to rise. We describe the successful use of three commercially available retrieval devices: the nitinol gooseneck snare, the biliary forceps, and the multipurpose basket. We recommend the availability of these devices to operators involved in intracoronary stent placement. © 1993 Wiiey‐Liss, Inc.
Experience with a double loop guiding catheter for angioplasty of the right coronary artery
Authors: El Gamal M. , Bracke F. , Bonnier J. , El Biltagiu S. , Michels R. , Relik T. , van Gelder L.
Published: March 2007

An 8 French (F) double loop guiding (DLG) catheter was developed for percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) and tested in 80 patients: primary use in 59 patients, and after failure of an 8 F right Judkins guiding (RJG) catheter in 21 patients. Primary use resulted in stable intubation of RCA in 55 patients (93%), but PTCA was successful in 50 (91%). Five failures resulted from inability to cross or dilate the lesion. After failure of an 8 F RJG in 21 patients, successful stable intubation of RCA with a DLG was achieved in 19 patients (90%), but PTCA was successful in 17 patients (81%). Failure of RJGs in 21 patients resulted from inability to intubate the RCA in 12 patients, or inadequate back up support by the guiding in 9 patients. Conclusion: DLGs increased the success rate of PTCA of the RCA after failure of RJGs. © 1993 Wiiey‐Liss, Inc.
Placement of “biliary” stents in saphenous vein coronary bypass grafts
Authors: White Christopher J. , Ramee Stephen R. , Collins Tyrone J. , Escobar Alvaro , Jain Suresh P.
Published: March 2007

Angioplasty of coronary saphenous vein grafts has been associated with less favorable results than in native coronary arteries owing to a higher acute complication rate and an increased incidence of restenosis. We placed 16 nonarticulated balloon expandable stainless steel “biliary” stents at the sites of 13 stenotic or occluded aortocoronary saphenous vein graft lesions in 11 patients. All of the lesions were stented successfully. There were no instances of stent thrombosis or stent embolism. The percent diameter stenosis was reduced from 85.5 ± 14.1% to 3.5 ± 4.4% (p < .001), and the minimal lumen diameter of the lesion increased from 0.7 ± 0.7 mm at baseline to 3.7 ± 0.2 mm (p < .001) after stent placement. We conclude that this noncoronary stent appears to be safe and effective for treating saphenous vein coronary bypass grafts. The high procedural success rate and excellent anglographic results are very encouraging, while the restenosis rates remain to be determined. © 1993 Wiiey‐Liss, Inc.
High‐Speed rotational ablation (rotablator®) for unfavorable lesions in peripheral arteries
Authors: White Christopher J. , Ramee Stephen R. , Escobar Alvaro , Jain Suresh , Collins Tyrone J.
Published: March 2007

A strategy of using a single, conservatively sized percutaneous transluminal rotational ablation device with or without adjunctive balloon angioplasty was employed in 18 vessels in 17 patients selected because of unfavorable lesion morphology for balloon angioplasty alone. Fifteen patients had lower extremity occlusions and/or heavily calcified lesions and two patients had ostial renal artery stenoses. We were able to achieve a 94% (17/18 lesions) technical success rate, and a 94% (16/17 patients) clinical success rate. In the patients with lower extremity lesions, the baseline ankle‐brachial blood pressure index increased from 0.55 ± 0.15 to 0.90 ± 0.19 (p < .001) 1 day after the procedure. Follow‐up at 6.8 ± 2.8 months revealed clinical evidence of restenosis in only one patient. We conclude that a cost‐effective strategy of treating unfavorable lesions with a single Rotablator® burr and adjunctive balloon angioplasty is safe and effective. © 1993 Wiiey‐Liss, Inc.
Closure of a coronary cameral fistula following endomyocardial biopsies in a cardiac transplant patient with a detachable balloon
Authors: Hartog J. M. , van den Brand M. , Pieterman H. , di Mario C.
Published: March 2007

Endomyocardial biopsy is the reference standard for the diagnosis of cardiac allograft rejection and is performed frequently in cardiac transplant patients. Biopsies are taken percutaneously via the right internal jugular or femoral vein [1,2]. Fistulas from coronary arteries into the right ventricle following endomyocardial biopsies are a relatively frequent finding (5–14%) [3–6]. Most of these fistulas are small angiographically, haemodynamically insignificant [5,6], and tend to disappear. We report a case of a haemodynamic significant coronary fistula, closed by a percutaneously introduced detachable balloon. © 1993 Wiiey‐Liss, Inc.
Retrieval of a migrated coronary stent by means of an alligator forceps catheter
Authors: Eeckhout Eric , Stauffer Jean‐Christophe , Goy Jean‐Jacques
Published: March 2007

Stent migration and embolization are well‐known complications of intracoronary stenting with balloon‐mounted stents. During an elective stenting procedure of a proximal right coronary artery stenosis, a 3.5 mm Wiktor stent (Medtronic Inc., Minneapolis) was displaced from its delivery balloon. The guiding catheter and the delivery system were withdrawn, leaving the stent around a 3 m 0.014 inch High Torque floppy guidewire (ACS, Santa Clara, CA) in the abdominal aorta. An 40 cm 5F Alligator Forceps catheter (Cook OB/Gyn., Spencer, IN), introduced through a cut‐off 8F coronary guiding catheter, allowed improved torque control of the retrieval catheter and a safe and successful withdrawal of the stent through the arterial introducer Sheet. © 1993 Wiiey‐Liss, Inc.
Guidelines for continuous quality improvement in the cardiac catheterization laboratory
Authors: Heupler Frederick A. , Ai‐Hani Arfan J. , Dear Wayne E.
Published: March 2007

The Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions has compiled guidelines for a quality improvement program for the cardiac catheterization laboratory. The first step is to identify “quality indicators” in order to quantify the results. The indicators must be risk‐adjusted to assure validity of comparative data.

The second step is development of a data collection process that continues after the patient has left the catheterization laboratory. The third step, data evaluation, requires determination of normal ranges of occurrence rates and identification of adverse events that exceed these rates. An investigation should be undertaken to determine the processes and systems that may produce the undesirable outcome.

The fourth step is creation of a solution to correct the deficiency. This may involve education, administrative intervention, or feedback. The final step is reassessment of the quality indicators to determine if the corrective action has been effective.© 1992 Wlley‐Liss, Inc
Deep venous thrombosis and pulmonary embolism following cardiac catheterization
Authors: Shammas Ronny L. , Reeves William C. , Mehta Prabodh M.
Published: March 2007

We report 4 cases of deep venous thrombosis and/or pulmonary embolism after diagnostic cardiac catheterization. Two of these cases followed left heart catheterization alone.© 1993 Wlley‐Liss, Inc
Effect of catheter positioning on the variability of measured gradient in aortic stenosis
Authors: Assey Michael E. , Zile Michael R. , Usher Bruce W. , Karavan Mark P. , Carabello Blase A.
Published: March 2007

The purpose of this study was to quantify the variation in measured aortic valve gradient and calculated aortic valve area when different techniques of cardiac catheterization were utilized. Hemodynamic assessment of aortic stenosis severity requires an accurately determined pressure gradient. In aortic stenosis, the presence of intraventricular pressure gradients and downstream pressure recovery within the aorta means that a range of aortic valve gradients could be measured in a given patient depending upon catheter position and measurement technique. To quantify the degree of variation in measured gradient and calculated aortic valve area, we generated transvalvular gradients by nine different techniques in 15 patients (11 men, 4 women; 29‐86 years old). Patients were divided into those with severe aortic stenosis (aortic valve area ≤ 0.6 cm2, n = 6) and those with moderately severe aortic stenosis (aortic valve area 0.61‐0.90 cm2, n = 9). Considerable variation in measured gradient and calculated aortic valve area was observed. The maximum variation in gradient was similar in severe and moderately severe aortic stenosis groups (33 mm Hg. vs. 32 mm Hg., p = NS). However, the variation in gradient as a percent of maximum gradient was greater (P < 0.05) in the moderately severe aortic stenosis group. The maximum variation in calculated aortic valve area was 0.1 cm2 in the severe group and 0.3 cm2 in the moderately severe group (P < 0.01). An intraventricular gradient, present in 13 of 15 (87%) patients, was partially responsible for the variation in pressure gradient measurement and calculated aortic valve area.

We conclude that in patients with valvular aortic stenosis, catheterization technique has an important impact on the hemodynamic assessment of aortic stenosis severity. This is particularly true in patients with moderately severe aortic stenosis where any variation tends to represent a larger percentage of the total gradient.
© 1993 Wlley‐Liss, Inc
Selective injection of a left coronary artery arising anomalously from the posterior aortic sinus
Authors: Lawson Mark A. , Dailey Sharon M. , Soto Benigno
Published: March 2007

Six cases of anomalous origin of the left main coronary artery arising from the posterior or noncoronary aortic sinus have been previously found at autopsy by nonselective aortic sinus injection and only once by selective injection. The seventh known case of this anomaly is demonstrated by selective injection that also reveals distal severe coronary artery disease.
© 1993 Wlley‐Liss, Inc
Right coronary artery cirsoid with fistulous connection to the coronary sinus
Authors: Tomai Fabrizio , Sommariva Luigi , Nudi Francesco , Gioffrè Gaetano , Chiariello Luigi
Published: March 2007

A 61‐yr‐old woman was referred to our hospital for evaluation of a suspected right atrial myxoma. The transesophageal echocardiogram suggested the presence of an anomalous right coronary artery with fistulous connection to the coronary sinus. At cardiac catheterization, an oxygen stepup in the right atrium indicated a 1.3:1.0 left‐to‐right shunt. Aortic root angiography showed a large and calcified right coronary artery cirsoid draining to the coronary sinus, which appeared remarkably dilated. In this rare anomaly, cardiac catheterization is necessary, not only to quantify the magnitude of the left‐to‐right shunt, which is an important requirement for the indication to surgical treatment, but also to confirm the echocardiographic diagnosis.© 1993 Wlley‐Liss, Inc
Spontaneous coronary dissection treated with directional coronary atherectomy
Authors: Charney Richard , Breitbart Sheldon , Menegus Mark A. , Feld Michael , Golier Francis , Spindola‐Franco Hugo , Greenberg Mark A.
Published: March 2007

We report a case of spontaneous coronary dissection occurring in a middle aged male which was treated with thrombolytic therapy and directional coronary atherectomy. This technique provides a new option for treating this entity in the cardiac catheterization laboratory.© 1993 Wlley‐Liss, Inc
Mobile cardiac catheterization: Comparison with outpatient and inpatient catheterization at tertiary facilities
Authors: Elliott Charles M. , Bersin Robert M. , Elliott Allison V. , Fedor John M. , Gallagher John J. , Sellers Lisa J. , Simonton Charles A. , Svenson Robert H. , Hadley Wilson B. , Zimmern Samuel H.
Published: March 2007

The study group included 1,553 consecutive patients from areas serviced by our mobile catheterization laboratories: 719 procedures were performed in the mobile unit at their local hospitals, 277 were performed at a tertiary hospital with less than a 24 hr hospital stay, and 557 were performed at a tertiary hospital as inpatients. The indications for mobile catheterization were predominantly atypical chest pain, angina pectoris, or positive treadmill stress test, whereas patients with less than 24 hr hospitalization at the tertiary center had their catheterization performed for additional reasons. The majority of the inpatient indications were for recent myocardial infarction or unstable angina. Using the American College of Cardiology/American Heart Association (ACC/AHA) criteria for outpatient catheterization, the mobile catheterizations were performed safely with a complication rate of only 0.7% compared to a complication rate of 3.1% for inpatients demonstrating that a low risk group of patients can be prospectively identified and catheterized safely in the mobile setting. An extremely high risk group of patients with ongoing unstable angina and recent myocardial infarction was also identified which should undergo catheterization only at a tertiary center.
Combined spontaneous postpartum coronary artery dissection and pulmonary embolism with survival
Authors: Efstratiou Alain , Singh Baikunth
Published: March 2007

A young woman who survived after suffering in the immediate postpartum period a spontaneous coronary dissection with resultant myocardial infarction and a pulmonary embolism with pulmonary infarct is presented. Diagnostic and therapeutic considerations for this unique occurrence are discussed and reviewed.
Bail‐Out stenting for left main coronary artery occlusion following diagnostic angiography
Authors: Sathe Sunil , Sebastian Martin , Vohra Jitu , Valentine Peter
Published: March 2007

We report a case of acute left main coronary artery occlusion treated with stenting of the left main artery. The patient had a severe ostial left main stenosis and after diagnostic coronary angiography developed a total occlusion of the left main artery with life threatening hemodynamic consequences. Stenting of the unprotected left main coronary artery was successfully performed as a salvage procedure.
Dilation of intra‐atrial baffle fenestrations: Results in vivo and in vitro
Authors: Nishimoto Kei , Keane John F. , Jonas Richard A.
Published: March 2007

Spontaneous closure of intra‐atrial baffle fenestrations occurred early postoperatively following a Fontan procedure in three patients (ages 0.8–2 yr) and were reopened using transvenous balloon dilation. Following this clinical experience with this complication we studied the effects of high pressure balloons of different sizes on fenestrations created in polytetrafluoroethylene (PTFE) patches.

The intra‐atrial baffle fenestration was found closed within hours after surgery in two patients and 32 days postoperatively in the other. Increasing edema, chest tube drainage, and renal dysfunction ensued rapidly. At catheterization the balloon dilation in two patients reduced the elevated right atrial pressure, edema, and pleural effusion and allowed an acceptable arterial saturation. In the other patient, with acidosis and a low cardiac output, transient cardiac arrest occurred following passage of the catheter through the fenestration and during later unsuccessful operation the fenestration, although open, was traversed by strands of clot. In the experimental study, a total of 45 fenestrations 4 mm in diameter were dilated with 5, 6, 7, 8, and 9 mm balloons. The fenestration areas remained increased significantly during the 14 days of observation in room air, with the larger balloons producing larger holes.

Balloon dilation may be effective for spontaneous fenestration closure occurring in the early postoperative period after a fenestrated Fontan procedure. Our experimental data may be useful in selecting the balloon size in this setting.
Is intravascular ultrasound better than quantitative coronary arteriography to assess cardiac allograft arteriopathy?
Authors: Lowry R. W. , Kleiman N. S. , Raizner A. E. , Young J. B.
Published: March 2007

Optimal methods to detect and quantify allograft arteriopathy have not been established. Both arteriography and intravascular ultrasound have been used to evaluate vessel lumen diameter and area and arterial wall thickness in patients following cardiac transplantation, although due to the anatomically diffuse nature of this disease, neither technique has been accepted as the diagnostic “gold standard”. To determine the usefulness of quantitative angiography to detect transplant‐related coronary artery disease compared to intravascular ultrasound, 25 patients underwent both procedures following cardiac transplantation (20 < 1 year, 5 > 1 year). Lumen diameter and area measurements of proximal coronary artery segments were compared using both techniques. Overall, lumen diameter and area measurements correlated closely between the two procedures, both for the early and late follow‐up patients. However, because of the ability to characterize changes more precisely in coronary vessel shape and wall thickness, intravascular ultrasound offered distinct advantages over routine coronary angiography and is probably the technique of choice to evaluate allograft arteriopathy.
Complete heart block complicating retrograde left ventricular catheterization: Case report and review
Authors: Shammas Nicolas W. , Lee John K. , Daubert James P. , Pomerantz Richard M.
Published: March 2007

Complete heart block (CHB) following retrograde left ventricular catheterization is uncommon. We report a case of transient CHB in a patient with severe aortic stenosis and bifascicular block on the baseline surface electrocardiogram during retrograde left ventricular catheterization. The block resolved spontaneously without sequelae. A review of the literature using MedLine was performed and recommendations for temporary and permanent pacing are outlined.
Coronary revascularization directed by results of coronary doppler flow measurements
Authors: Nicholas John , Kipperman Robert
Published: March 2007

We present a case where Doppler coronary flow velocity and Doppler reserve measurement directed the decision to proceed with coronary artery revascularization. Measurement of coronary Doppler flow velocity and flow reserve can be useful to help evaluate angiographic “intermediate lesions.” The following case involves an indeterminate lesion. A patient was felt likely to have a high‐grade stenosis which could not be adequately visualized angiographically because of overlapping vessels. Largely based on the flow velocity and reserve data, the patient was referred for coronary artery bypass grafting.
The crumpled coronary: An enigma of arteriographic pseudopathology and its potential for misinterpretation
Authors: Hays John T. , Stein Bernardo , Raizner Albert E.
Published: March 2007

A series of angioplasty cases is presented in which dynamic alterations in coronary artery configuration developed. These changes were suggestive of extensive, complex dissections. Several common features emerged in these cases of which interventional cardiologists should be aware. These features included complex vessel morphology (tortuous segments, anomalous takeoffs, and complex stenoses) and the use of certain types of PTCA hardware (Amplatz guiding catheters and 0.018‐inch wires).

This phenomenon, termed pseudo narrowing, remains largely unrecognized. Identification of these characteristics and employment of proper management strategies will ensure a good outcome in these situations when they arise.
Microcoil embolization of large intercostal branches of internal mammary artery grafts
Authors: Sbarouni Eftihia , Corr Laura , Fenech Albert
Published: March 2007

Coronary artery steal via a large unligated intercostal sidebranch of the internal mammary artery graft has been previously described in two case reports. We report a series of 7 patients with post‐operative angina in whom microcoil embolization of such branch was performed. In 5 patients in whom complete occlusion of the branch was achieved, anginal symptoms were relieved; in contrast the 2 patients with persistent flow through the intercostal branch remained symptomatic despite all their grafts being widely patent. We conclude that large unligated intercostal branches of the IMA graft may be related with post‐operative angina and their embolization is a simple, safe, and effective procedure.