ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00392.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A new 100 cm long 16.5 French valvuloplasty introducer was used in 12 consecutive patients (mean age 73 years, five males and seven females) undergoing aortic balloon valvuloplasty for severe aortic stenosis. The long‐sheath was introduced into the ascending aorta along the stiff part of an exchange guidewire. The valvuloplasty procedure, which included a complete diagnostic catheterization in three patients, lasted 113 ± 47 min (211 ± 81 min in the previous 18 procedures performed with a conventional approach, P<0.05). Introduction of balloon catheters (3 × 12 mm trefoil balloon in the 12 cases and 2 × 19 mm bifoil balloon in 2 of these cases) was possible in all patients and an increased stability of the balloon during inflation was observed. No systemic embolization or vascular complications occurred at the puncture site. The long‐sheath technique appears to be a valuable adjunct for aortic valvuloplasty in that it provides easier and quicker access for even the largest balloons and additional support and stability during balloon inflation. In our experience, this reduced the practical difficulties and the duration of the pr

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00393.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Thin‐slice contiguous computed tomographic scanning was performed in four postmortem hearts with calcific aortic valve stenosis (mean weight: 583 ± 78 g; mean age: 65 ± 10 years) before, during, and after balloon valvuloplasty. Balloons of increasing diameter (15–19 mm single balloons, and 3 × 12‐mm trefoil‐shaped balloon) were positioned across the aortic valve and manually inflated to pressures of 3 to 4 atmospheres. During inflation of the 3 × 12‐mm balloon a larger residual orifice, potentially free for blood passage, was observed in the two cases with bicuspid valves and in one case with a fused tricuspid valve, while the reverse was noted in one case with a tricuspid valve without fusion. In most cases valvular orifice enlargement only occurred with larger diameter balloons. After valvuloplasty aortic valve area increased from 0.72 (range 0.20–0.95) cm2to 2.36 (range 0.95–3.14) cm2. The smallest orifice enlargement after dilatation occurred in case 1, where valvular calcified deposits had the largest volume and the highest computed tomographic attenuation value. In each patient macroscopic changes (fracture of nodular calcifications, commissural splitting, tearing of the central raphe) were noted. No calcium dislodgement or aortic ring damage was observed. In autopsy specimens computed tomography provided accurate evaluation of aortic valve morphology, extent of valve calcification, balloon‐leaflet relationship during inflation, and effects of the dilatation on valve leaflets and commissures. Advances in computed tomographic cardiovascular imaging may achieve similar results in the clinical setting, and allow a more rational, individualized approach to the valvuloplasty procedure. (J Interv

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00394.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Wide clinical application of intravascular stenting devices is currently limited by occlusion or intraluminal narrowing caused by thrombosis and neointimal thickening in a considerable percentage of implantations. We studied the possibility of seeding one of the currently availiable stents, a stainless steel, self‐expandable wire‐mesh, with endothelial cells in vitro. Endothelial cells, derived from human umbilical cord veins, could be successfully attached to stent filaments. In vivo stent implantations in porcine femoral arteries showed complete covering of stent wires by endothelium after 1 week. We conclude that coating of stents with autologous endothelial cells prior to implantation might protect against early thrombosis during the period in which a neointima is formed. (J Interven Cardiol 1988:

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00395.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Percutaneous transluminal coronary angioplasty (PTCA) may improve coronary vasomotor responses after relief of flow limiting luminal narrowings. To evaluate the effects of PTCA on nitro‐glycerin‐induced augmentation of coronary blood flow, great cardiac vein (thermodilution) blood flow and systemic hemodynamic responses to low (50 meg) and high (200 meg) dose intracoronary nitroglycerin (NTG) before and after PTCA were measured in 20 patients undergoing left anterior descending artery (LAD) balloon dilatation. Before PTCA, low dose NTG increased great vein flow 44 ±31% (from 56 ± 21 to 81 ± 33 mL/min, P<0.01). High dose NTG increased great vein flow 55 + 30% (56 ± 23 to 87 ± 38 mL/min, P<0.01). PTCA reduced LAD stenosis (79 ± 13 to 20 ± 9%, P<0.01) and translesional pressure gradient (49 ± 10 to 15 ± 13 mmHg, P<0.01) increasing post‐PTCA basal great vein flow 45% (56 ± 21 mL/min to 81 ±27 mL/min, P<0.01).After PTCA, low dose NTG increased great vein flow only 26 ± 23% (81 ± 27 to 101 ± 39mL/min, P<0.01; P<0.05 versus 44 ± 31% before PTCA). The high dose NTG‐induced coronary hy‐peremic responses were unchanged after PTCA (55 ± 30, 55 ± 34%, P = ns). When compared to dose related NTG hyperemic responses in 10 patients with normal LAD, the post‐PTCA responses remained attenuated.These data indicate that NTG‐induced augmentation of coronary blood flow remains unchanged or attenuated and does not appear to be improved by PTCA. These findings should be considered when evaluating pharmacological coronary blood flow responses after PTCA. These data also suggest that epicardial coronary resistance plays a limited role in NTG‐induced augmentation of coronary blood flow inpatients with atherosclerotic coronary disea

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00396.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The use of continuously monitored pulmonary artery oxygen saturation (PAOS)for the assessment of transient myocardial ischemia was examined in a controlled human model during coronary angioplasty, producing brief reversible episodes of myocardial ischemia. Clinical and anatomic variables were prospectively recorded and correlated with changes in continuous PAOS during repeated episodes of coronary artery occulsion. Forty‐seven patients underwent left anterior descending (LAD, n = 43) or circumflex (n = 4) coronary balloon occlusion. Patients were subgrouped by PAOS responses: group 1, 22 patients with ± 10% drop in PAOS during balloon inflation and group 2, 25 patients in whom the PAOS signal was stable or only minimally affected during transient ischemia. Anatomical features analyzed included normal coronary diameter, location of lesion (e.g., proximal to the first septal branch) and extent of myocardium supplied by an occluded artery (LAD extending beyond the apex of the left ventricle [LV] or a large diagonal after the occlusion point). Left ventricular wall motion abnormalities, presence of other coronary artery disease, diabetes and hypertension were also analyzed. Groups were similar with respect to age (61 ± 13, 62 ± 10 years), LV ejection fraction, LV score, incidence of hypertension and diabetes or anatomic scores (2.2 ± 1.0, for group 1 vs 2.0 ± 0.9 for group 2), normal angiographic arterial diameter and presence of coronary collateral supply.Although some episodes of myocardial ischemia in electively studied stable patients may be associated with significant reducitons in PAOS, the occurrence or degree of PAOS reduction is not predicted by coronary anatomy, LV function or other clinical variables. Use of PAOS to identify ischemic events in more critically ill patients is potentially useful, but must be assessed individually during the clinical situation. (J Interven Cardiol 19

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00397.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Balloon angioplasty of a severe recurrent coarctation was performed in a 4‐month‐old infant using an anterograde approach not previously described for this lesion. The entire procedure was performed transvenously. After transseptal entry into the left atrium, the transseptal sheath was placed across the mitral valve and the angioplasty catheter advanced across the recurrent coarctation. Angioplasty reduced the systolic gradient from 65 mmHg to 22 mmHg, without acute complications. We feel that the anterograde transvenous approach should be considered as an alternative to retrograde transarterial angioplasty in infancy, since femoral artery injury is avoided. (J Interven Cardiol 1988:

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00398.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A new angiographic method of determining the anatomy of a patent ductus arteriosus (PDA) preparatory to its surgical or nonsurgical closure has been developed and compared to conventional angiographic techniques in 17 patients using a new low pressure balloon catheter (Edwards). The balloon, 5 cm long, is filled with contrast material and expanded to any diameter up to 20 mm. It may be passed into the ductus from either the arterial (14 patients) or venous (3 patients) side. The balloon is expanded by radiopaque material adjacent to the aortic orifice of the PDA and advanced (or pulled) through the ductus. Deformation of the balloon identified the length and caliber of the PDA providing virtually identical estimates thereof in all 17 patients when compared to conventional angiography. On the other hand, visualization of the PDA was good in only 41 (62%) or tolerable in 14 (21%) of 66 conventionally studied patients. (J In‐terven Cardiol 1988:1:

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00399.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.tb00400.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY