ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00643.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Coronary angioplasty using 6 Fr guiding catheters has been described. This study was based on matching a prospective 105 coronary angioplasty procedures performed using 6 Fr guiding catheters (group I) with 100 other prospectively collected procedures performed through 8 Fr catheters (group II). Procedural variables such as quantity of contrast injected, total duration of the angioplasty, and vessel opacification were collected, as well as the success rate and local vascular complications. The two groups were identical regarding the baseline clinical and angiographic characteristics (age, sex, clinical indication, type of the lesion, and the size of the artery attempted). Success rate was similar between both groups (94.2% and 95% for groups I and II, respectively). Cross‐over from 6 Fr to 8 Fr system was needed in two cases (one for inadequate back‐up support, the other for a long dissection and inadequate vessel opacification). The use of 6 Fr guiding catheters was possible in such acute situations as myocardial infarction or scent delivery for coronary dissections. The quantity of contrast injected through the 6 Fr catheters (164 ± 74 mL) was significantly less than through the 8 Fr ones (217 ± 92 mL; P ± 0.01). On the other hand, the mean duration of the procedure was slightly longer using the 6 Fr system (40 ± 18 min vs 34.4 ± 18 min for groups I and II, respectively; P<0.02). There was no difference between the two groups regarding the local vascular complications. This study demonstrates the feasibility of PTCA using 6 Fr guiding catheters in a variety of clinical indications, with a smaller quantity of contrast than in the 8 Fr ones, but a slightly longer duration. The other potential advantages of 6 Fr guiding catheters (lower rate of local complications, less blood loss) have not been proven in this study. (J Interven Cardiol 1996;9

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00644.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Mechanical femoral artery compression devices have several limitations. We compared a novel disposable beltheld pneumatic compression device to manual compression alone in 213 patients randomized into two equal groups. Both were comparable for age, gender, current therapy with aspirin (ASA) and warfarin, diameter of the arterial sheath, previous procedures via the same artery, procedure duration, and blood pressure. Manual compression time was 12 ± 3 minutes. Pneumatic compression was reduced during 60 minutes. Patient discomfort was assessed as none (82% vs 88%), mild (13% vs 8%), moderate (3% vs 4%), or severe (2% vs 0%) for the manual versus pneumatic group, respectively. Bleeding and hematoma occurred in 7.5% of patients with no difference between the treatment groups. However, manual compression was significantly more effective in the higher range of systolic blood pressure, and pneumatic in the lower range, with a cut point of approximately 170 mmHg. Predictors for bleeding were systolic blood pressure and dose of ASA. Among 113 patients with systolic blood pressure<160 mmHg and low dose (75 mg) or no ASA, only / patient (0.9%) experienced bleeding while 31% of 16 patients with both elevated systolic blood pressure and high dose ASA (150–330 mg) bled. We conclude that pneumatic femoral artery compression does not reduce bleeding and hematoma compared with manual compression. The use of low dose (75 mg) or no ASA, as well as giving special attention to patients with elevated systolic blood pressure, may reduce the risk of bleeding after cardiac catheterizati

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00645.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Stenosis of a coronary artery bifurcation is a difficult interventional problem. The principle problem is the risk of damaging the ostium of one vessel while dilating the other. The “kissing” balloon technique and progress in stent technology have made available a number of approaches. The gap opposite the articulation bridge of the Palmaz‐Schatz 153 stent can be used to gain access to an important vessel at a bifurcation. We report a case with significant stenosis involving the left main stem extending to the ostia of anterior descending and circumflex arteries. A stent was inserted into the left main stem and circumflex ostium, and through the gap the left anterior descending artery ostium was successfully dilated by battoon angiop

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00646.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We describe a novel treatment for hypertrophic obstructive cardiomyoparhy, in which septal reduction is achived via transluminal induction of focal septal infarction. The results of the first three patients treated in this fashion have been recently reported; in this preliminary series, intraventricular pressure gradients could be dramatically reduced by the creation of a localized infarction of the ventricular septum. The procedure is well tolerated and effective in reducing the obstruction to left ventricular ourflow. Further studies are underway to fully evaluate the usefulness of the technique. (J Interven Cardiol 1996;9:393–39

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00647.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

This article reviews the present status of intervention in hypertrophic obstructive cardiomyopathy. Interventions include pacing, which is best administered by VDD mode with sufficiently short atrioventricular delay as to assure ventricular capture. Occasionally, this may require the addition of atrioiventricular (AV) junctional ablation in order to achieve 100% ventricular capture. This approach alters the left ventricular (LV) contraction sequence, thereby reducing the left ventricular outflow obstruction. VVI pacing is inadequate because of the necessity for atrial contribution to the hypertrophied ventricle. This contribution may he ineffective even with VDD pacing, without the benefit of AV junctional ablation, because of late activation of the left atrium. Ablation of the left bundle branch may also achieve altered contraction sequence of the LV, but experience with this technique is very limited. Two different methods of reduction of the interventricular septum have been proposed. The first is transaortic laser, which has not gained wide acceptance, and the second is a new and promising method that appears to be less traumatic. This is alcohol delivery to the first septal branch of the left anterior descending coronary artery by an angioplasty technique. Surgical approaches include septal myomectomy directly to reduce the obstruction and mitral valve replacement to eliminate the part played in the obstruction by the anterior cusp of the valve. In conclusion, younger patients, even those who are asymptomatic, should be considered for surgical myomectomy, there being little place now for mitral valve replacement. In older patients, pacing and septal chemoablation offer the greatest promise, but their places are not yet fully established. (J Interven Cardiol 1996; 9:399–40

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00648.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Permanent dual chamber pacing with a shortened AV delay has been increasingly utilized as a therapeutic approach to the problem of drug refractory symptomatic obstructive hypertrophic cardiomyopathy. Such patients are a small proportion of the total patient population, potentially limiting the applicability of pacing. Attention has focused on the effect of pacing on indices of systolic function, primarily the left ventricular outflow tract gradient. The effects of pacing on diastolic function are uncertain, although recent acute catheterization studies suggest an adverse effect. Studies have concentrated on subjective symptomatic improvement. The available data on objective improvement suggests modest improvements at best. The limitations of current pacemakers together with the role of adjunctive techniques such as radiofrequency (RF) ablation of the atrioventricular node and coronary sinus pacing are also reviewed. Current ongoing randomized trials of DDD pacing in hypertrophic cardiontyopathy will resolve many issues, although data comparing myectonty versus pacing is as yet unavailable.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00649.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.tb00650.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.tb00651.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY