摘要:

Our objective was to evaluate, in a French multicenter study, the results of implantation of Wiktor tantalum wire coronary stents in stenosed or occluded coronary vessels or in saphenous vein bypass grafts. The study was a retrospective analysis of clinical and angiographic data from patients treated with tantalum wire stent implanted at five centers. Stenting of native coronary arteries or saphenous vein bypass grafts was attempted in 272 patients after acute or threatened closure of the target vessel, or because the lesions concerned were considered to be at particularly high risk of becoming restenosed, or because the result of primary angioplasty was inadequate. Successful stent deployment was achieved in 261 95.9%) of 272 patients. The incidence of major complications such as death, myocardial infarction (MI), or a condition requiring urgent bypass surgery was 8.1%. Major vascular complications occurred in 2.6% and actually decreased with a new anticoagulant regimen. Angiographic follow‐up at a mean of 6 months after stenting showed restenosis in 23.6% with a more frequent restenosis in the group with stent size equal to 3 mm than in the group with stent size superior to 3 mm (46.1% vs 13.7%, P<0.01). Stenting with the Wiktor tantalum wire stent is an effective means of treating acute complications and suboptimal results after angioplasty. This stent seems to offer hope of a significant reduction in the rate of late restenosis in native coronary vessels, but a prospective comparison of balloon angioplasty and stenting is neede

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00630.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

In a prospective, randomized, and double‐blinded protocol, the effect of oral diltiazem (180 mg) over placebo on the restenosis rate was assessed in 189 consecutive patients (150 males. 39 females, 57.6 ± 8.4 years) eligible for follow‐up angiography after 3.6 ± 0.6 months (diltiazem 90.4%, placebo 89.6%). Pre‐PTCA stenoses were similar in both groups (diltiazem 83.9%; placebo 84.4%). Immediately after PTCA, the remaining stenoses were identical in both groups (22.6% vs 22.8%). At follow‐up angiography there was a highly significant difference (P50% of the initial gain) was significantly (P<0.03) reduced by diltiazem (18 [21.4%] of 84 patients) compared to placebo (33 [38.4%]of 86 patients). Diltiazem was superior to placebo in all vessels: (1) left anterior descending coronary artery: 21.6% vs. 32.7%, (2) right coronary artery: 25% vs 46.7%; and (3) left circumflex. 16.7% vs 36%. The benefit of diltiazem was most pronounced in calcified plaques (33.3% vs 47.1%), in diabetics (15% vs 46.2%), in hypercholesterolemia (20.4% vs 44.2%, P<0.05), in the age range of 41–50 years (21.4% vs 44.4%), and in patients with CCS Class 2 (11.1% vs 64%, P<0.01). In stratified analysis, the effect was apparent in both sexes, independent from concomitant therapy, regardless of whether or not coronary artery disease had progressed in segments other than the dilated ones. Thus, in this limited series of patients, diltiazem significantly reduced the number and extent of restenosis. Confirmation in a larger cohort i

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00631.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The presence of single coronary artery is a very rare finding on coronary arteriography. This type of coronary artery anomaly was revealed in a 54‐year‐old patient with exertional angina refractory to full medical treatment and positive exercise test. The unique coronary vessel presented significant stenosis in the distal segment of circumflex artery—which continued as right coronary artery—and was successfully dilated with conventional balloon angi

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00632.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

A 58‐year‐old woman presented with a new rapidly progressive lesion distal to a stent. This lesion was treated with atherectomy through the stem in order to characterize it pathologically. The aggressive proliferative response discovered suggested that this unusually distal lesion was produced by the trauma of her previous angiopla

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00633.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00634.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00635.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The history of pacing in hypertrophic obstructive cardiomyopathy (HOCM) begins in 1964 and ends in the early 1990s when several well‐documented articles confirmed that pacing the apex of the right ventricle could be considered as an effective primary therapy of severe, drug resistant HOCM. The first pacemaker implantation was reported in a patient with HOCM who developed a complete AV block. The efficacy of right ventricular (RV) pacing on the gradient was enhanced, but the concept of pacing in the absence of conduction abnormalities was not suggested. In 1967, Hassenstein was the first to demonstrate that right apex ventricular pacing in HOCM with intact AV conduction induced gradient reduction. He subsequently performed the first hemodynamic implantation several years later. The largest series confirming the undoubted efficacy of pacing in HOCM were reported by Jeanrenaud in Switzerland and Fananapazir in the USA in the early 1990

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00636.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

In patients with hypertrophic obstructive cardiomyopathy (HOCM), ventricular pacing improves the hemodynamic situation from the first paced beat, while a further improvement is obtained at continuation of pacing over months and years. The mechanisms responsible for the acute and chronic improvement are not yet completely understood. This article summarizes a number of experimental studies, the results of which may improve our insight into myocardial adaptations during ventricular pacing. Experiments in anesthetized dogs showed that abnormal, asynchronous electrical activation due to epicardial ventricular pacing results in specific and even more asynchronous sequences of onset of fiber shortening. Compared to sinus rhythm, fiber shortening during ejection (by ∼ 100%), mechanical load (by – 50%), and blood flow and oxygen consumption (by – 30%) were reduced in early activated regions of the ventricular wall. These variables were increased to a similar extent in late activated regions. Subsequent studies in dogs paced for 3 months at the epicardium of the left ventricular (LV) free wall showed a ∼ 20% decrease in free‐wall thickness. In patients with left bundle branch block, the early activated septum was up to 10% thinner than the late activated free wall. These findings support the hypothesis that abnormal electrical activation causes regional differences in mechanical load, which, in the long run, may result in different local growth responses. These functional and structural adaptations may explain the progressive improvements observed during ventricular pacing in hypertrophic obstructive cardiomyopathy (HOCM)

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00637.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Permanent atrial synchronized right ventricular pacing (RVP) has been shown to induce subaortic pressure gradient reduction and to lead to clinical improvement in patients suffering from hypertrophic obstructive cardiomyopathy (HOCM). It has therefore been proposed as an alternative therapy to surgery for patients refractory to drug therapy. The mechanisms underlying these beneficial effects are, however, unclear, but the electrically induced alteration of left ventricular (LV) activation sequence appears to play a major role. In this article, I summarize the data relative to the specific effects of RVP and left bundle branch block on LV contraction in normal subjects and in cardiomyopathies other than hypertrophic. I also review the characteristics of regional wall motion in HOCM, then the current data on left ventricular wall‐motion changes during eccentric ventricular activation in HOCM patients equipped with a dual chamber pacemaker. On the basis of the most recent studies, preexcitation of the interventricular septum by a RV apical stimulation alters septal motion by reducing its motility or by inducing a paradoxical motion, which enlarges the LV outflow tract and thereby reduces subaortic obstructio

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00638.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Hypertrophic cardiomyopathy is a primary myocardial disease characterized anatomically by left ventricular (LV) asymmetric hypertrophy and pathophysiologically by normal or even supernormal systolic ejection performance contrasting with impaired diastolic function. Altered ventricular relaxation tends to reduce the contribution of rapid ventricular filling to total LV filling volumes. Consequently, the contribution of left atrial (LA) contraction can be significantly increased. In some patients LV filling, and thus stroke volume, critically depend upon atrial systole. These data may have important clinical implications especially in patients treated with permanent cardiac pacing. Preserving a fully efficient LA contribution to LV filling is probably a key point in those patients.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00639.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY