ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00942.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Since the first case performed by us in September 1985, percutaneous transluminal aortic valvuloplasty (PTAV) has been applied in Rouen in a broad clinical spectrum of patients with aortic stenosis. After our encouraging initial experience, there have been changes in our objectives and technique which have allowed us to proceed more quickly, with less discomfort to the patient, lower risk, and improved results. The development of a new device, a triple lumen‐double size balloon catheter has been a major advance as well as the use of extra‐stiff guidewires and arterial sheaths.Our series has grown to more than 300 patients, mostly elderly (mean age 73 ± 11, 25% at or above 80) and very ill (71% in NYHA functional class HI or IV). Indication for PTA V was either absolute contraindication to valve replacement (30%), increased surgical risk (31%), refusal of surgery (10%), or attempt to postpone surgery (29%).The largest balloon size used has been 20 mm or above (23 mm or even 25 mm) in 70% of the cases. The double‐balloon technique has been used in only 5% of the cases. In our series, PTAV resulted in a decrease in transvalvular peak gradient from 71 ± 26 mm Hg to 28 ± 13 mm Hg and an increase in aortic valve area from 0.54 ± 0.18 cm2to 0.96 ± 0.33 cm2. With gained experience and the use of larger balloon sizes, the results have clearly improved: in the last 100 patients a valve area to or above 1 an2has been obtained in 55% compared to 30% of the cases in our early experience. Patients less than 70 years old had the best results but the aortic stenosis was less severe before PTAV.The total procedural and post‐PTA V mortality was 4% and involved primarily very old patients. The nonfatal complication rate remained low. Clinical information for 204 patients followed for 12 ± 5 months has been obtained and repeat catheterization has been done in 56 patients at an average of 4.5 months after PTA V.The data confirms that PTA V is feasible and can be accomplished with a relatively low risk in an elderly and ill population and in patients with contraindication to valve replacement or very high surgical risk. The procedure alters the natural history of the disease in these patients, improving both symptoms and survival. Indications in other categories of patients deserve fu

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00943.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Densitometric evaluation of digital subtraction angiocardiograms allows the assessment of local myocardial perfusion before and after pharmacological stimulation of coronary flow reserve during the catheterization procedure. This report deals with a case of a severe stenosis of the left coronary artery in which PTCA was regarded successful based on an appropriate increase in luminal diameter while an intima and media dissection at the dilatation site was documented. The perfusion measurements, however, pointed out a clear impairment of poststenotic myocardial perfusion after PTCA.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00944.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

This study was designed to document our results of double balloon pulmonary valvuloplasty and to evaluate if the double balloon technique is preferable to single balloon valvuloplasty in the relief of isolated valvar pulmonic stenosis. Double balloon valvuloplasty in twelve patients reduced the pulmonary valvar gradient from 100.5 ± 28.0 (mean ± SD) to 26.6 ± 12.5 mm Hg (P<0.001) which remained improved, 17.5 ± 10.2 mm Hg (P0.1) in another 12 patients also reduced (P<0.001) the gradient from 96.3 ± 40.1 to 28.3 ± 17.3 mm Hg immediately following the procedure which at 6 to 13 month follow‐up was 12.8 ± 9.9 mm Hg. The right ventricular peak systolic pressures (116.6 ± 24.5 vs 113.8 ± 41.5 mm Hg) and pulmonary valvar gradients (100.5 ± 28.0 vs 96.3 ± 40.1 mm Hg) prior to valvuloplasty, residual right ventricular pressures (47.4 ± 12.2 vs 54.3 ± 14.2 mm Hg) and pulmonary valve gradients (26.6 ± 12.5 vs 28.3 ± 17.3 mm Hg) immediately after valvuloplasty, and residual right ventricular pressures (43.1 ± 10.9 vs 41.1 + 12.5 mm Hg) and pulmonary valvar gradients (17.5 ± 10.2 vs 12.8 ± 9.9 mm Hg) on follow‐up were similar (P ± 0.1) in both groups.These data indicate that results of double balloon valvuloplasty are excellent but not superior to single balloon valvuloplasty. It is suggested that the double balloon valvuloplasty should be used if the pulmonary valve annulus is too large to dilate with a single balloon. There is no need for double balloon valvuloplasty if the pulmonary valve can be dilated with a commerciall

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00945.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Endomyocardial biopsy is a reliable and reproducible technique to confirm or establish a clinical diagnosis in many cases of idiopathic heart muscle disease. Our overall experience of 243 consecutive nontransplant related biopsy procedures (combined experience of previously reported and current series) comparing a new femoral venous (n = 94) with a standard internal jugular venous (n = 149) approach is reviewed. In the current series, the femoral (n = 59) and the internal jugular (n = 80) approaches, performed on 139 consecutive nontransplant‐related procedures (466 myocardial samples), were compared. Vascular access was achieved in all femoral procedures; the internal jugular vein could not be located in 4% (three) of neck approaches (P = NS). Myocardial sampling was sufficient in all internal jugular procedures; sampling was adequate in all femoral procedures except two (3%, P = NS). Two cases of hematoma were observed after an internal jugular approach. Pericardial effusion was observed in one patient after femoral and in one patient after internal jugular approaches (P = NS), and in the latter case, tamponade developed requiring intervention. Transient atrioventricular block (complete in 2 and 2:1 in 1) developed in three patients (femoral procedures), but all of these patients had shown predisposing complete left bundle branch block on their electrocardiogram. No difference in vascular access, sampling efficiency and complication rate between our previous and current series regarding the internal jugular and femoral approaches was observed. Our overall experience with the femoral and internal jugular approaches was similar for complication rate (1% in both). Vascular access was better overall with the femoral approach (100% vs 93%, P<0. 01), reflecting more difficulty with internal jugular access in the first series. Thus, the femoral venous approach described is comparable in efficacy and safety to the standard internal jugular approach and may be especially useful as an alternative to right ventricular biopsy when the internal jugular vein cannot be successfully cannulated or when a cardiac catheterization from the femoral area is being performed at the same time for other reason

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00946.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Direct catheter fulguration of the reentrant circuit of atrial flutter was performed in a 63‐year‐old patient referred for His bundle ablation. Careful right atrial mapping was performed using standard catheter electrodes. Two zones of fragmented potentials were recorded: one in the low posterior right atrial septum and the other one in the sinus node area. Entrainment of the tachycardia was attempted and achieved, while at the same moment the electrograms of the sinus node area dissociated, thereby excluding it as part of the reentrant circuit. Two shocks of100 and 150 J respectively were delivered in the low postero‐septal area without complication. Seventy weeks of follow‐up were uneventful despite persistence of inducibility of a rapid (non clinical) atrial flutter at late control (day 90). Direct catheter ablation in human atrial flutter seems to be a promising procedure if further studies confirm its eff

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00947.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A new technique is presented in which atrioventricular (A V) nodal conduction properties can be altered in a controlled way through the application of radiofrequency current. In 13 patients with supraventricular arrhythmias (maximal heart rate 215/min) radiofrequency current was delivered to the A V node via a catheter. Nine patients had atrial fibrillation, three had A V nodal reentrant tachycardia, and one patient had accessory pathway mediated A V tachycardia. Radiofrequency current application in these patients increased AV nodal conduction time and antegrade A V nodal effective refractory period significantly. In three patients radiofrequency current had no effect, and the A V node was ablated with direct current shocks. During a mean follow‐up period of 10 ± 3 months, all ten patients in whom radiofrequency current application had been successful were asymptomatic without antiarrhythmic medication. No complications were observed, neither during nor after the procedu

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00948.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00949.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY