摘要:

AbstractOf a total number of 288 patients with mitral stenosis treated by percutaneous balloon valvuloplasty, 21 patients had a basal mitral area equal to or greater than 1.5 cm2, as measured hemodynamically. The immediate hemodynamic results of this particular group of patients with mild mitral stenosis are described, as well as the clinical and echo doppler findings at follow‐up (22 ± 12 mo). Patients with mild mitral stenosis (group I) had more pliable valves (p<0.01), as assessed by echo, and higher incidence of sinus rhythm (p<0.02) than that observed in the remaining 267 patients (group II). After valvuloplasty the valve area increased in group I from 1.7 ± 0.2 to 3.1 ± 0.7 cm2(p<0.0001). This mean final area was significantly different (p<0.0001) than that observed in group II (1.98 ± 0.6 cm2). No patients with mild mitral stenosis developed progression of mitral regurgitation, and none had any other major complications. Most of them reached a grade I final functional status. At echo doppler follow‐up studies we did not observe significant changes in the mean mitral gradient as compared with the immediate hemodynamic results.These findings suggest that early mitral balloon valvuloplasty could be an alternative in trying to favorably Influence the natural course of the rheumatic mitral disease in selected p

ISSN:0098-6569    

DOI:10.1002/ccd.1810240102

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY

摘要:

AbstractTo assess the severity of mitral stenosis related to the level of transducers, the mitral valve gradient using pulmonary wedge and left ventricle was obtained from 15 patients. The mitral gradient was obtained with both transducers at mid chest level. Then, the level of each transducer was realigned with the catheter tip in the pulmonary capillary wedge and in the left ventricle using lateral fluoroscopy and the mitral gradient was re‐measured. At the mid chest level, the mean mitral valve gradient was 14 ± 6.2 mm Hg with a mitral valve area of 1.3 ± 0.6 cm2. With the adjusted level of transducers, the mitral valve gradient was 18.7 ± 6.8 mm Hg with a valve area of 1.0 ± 0.5 cm2. The difference was that the level of catheter tip in the wedge was 3.5 cm below the mid chest level and the one in the left ventricle was 2.5 cm higher than the mid chest level. This result suggested that the mitral valve gradient obtained at mid chest level underestimated the severity of mitral ste

ISSN:0098-6569    

DOI:10.1002/ccd.1810240103

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY

摘要:

AbstractInvestigations were performed to determine whether prostaglandin E, (PGE1) would cause a favorable change in pulmonary hemodynamics in pediatric patients with congenital heart disease and elevated pulmonary vascular resistance. Twenty‐seven patients (ages 0.5 months to 19 years) were studied. PGE1caused a significant decrease in mean pulmonary artery pressure with 0.05 μg/kg/min and 0.1 μg/kg/min infusions (p= .0004). There were significant increases in pulmonary blood flow (p= .0007), and decreases in pulmonary vascular resistance (p= .0001); changes in systemic pressure, resistance, oxygen consumption, and heart rate were minimal. Twenty‐three patients underwent heart surgery after catheterization, nineteen of these survived. The four nonsurvivors had higher initial pulmonary resistance (PVR) and less decline in PVR with PGE, than survivors. This study shows that PGE, is an effective pulmonary vasodilator in patients with congenital heart disease and elevated pulmonary vascular resis

ISSN:0098-6569    

DOI:10.1002/ccd.1810240104

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY

摘要:

AbstractValve repair and calcium debridement in patients with calcific aortic stenosis, using the Cavitron Ultrasonic Surgical Aspirator (CUSA), results in a reduction in the aortic valve gradient while potentially avoiding long‐term problems inherent to prosthetic valves. Invasive followup data in these patients has not previously been reported. Ten patients in whom CUSA debridement was performed underwent cardiac catheterization prior to and 8.0 ± 2.5 months following the procedure.Compared to baseline, the aortic valve area significantly increased from 0.75 ± 0.2 to 1.1 ± 0.3 cm2(p= 0.009) and the mean gradient was significantly reduced from 54 ± 21 to 27 ± 21 mmHg (p= 0.02) at followup. No significant change was noted in cardiac output, ejection fraction, left ventricular end systolic or diastolic volumes or left ventricular end diastolic pressure. However, 6 patients were found to have at least one grade worsening of aortic regurgitation. The development of increased aortic insufficiency in many patients after CUSA aortic valve debridement will likely limit this procedure's clinical u

ISSN:0098-6569    

DOI:10.1002/ccd.1810240105

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810240106

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY

摘要:

AbstractWe describe a case in which coronary balloon angioplasty failed to improve sequential lesions and resulted in a long area of dissection between the stenoses. Directional coronary atherectomy of the occlusive dissection produced excellent angiographic improvement to achieve a successful result and avoid the need for urgent coronary bypass surgery. Directional coronary atherectomy represents a potentially useful treatment for PTCA‐induced coronary dissectio

ISSN:0098-6569    

DOI:10.1002/ccd.1810240107

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY

摘要:

AbstractThe brachial approach adds a new dimension to rotational atherectomy. The two cases presented included a large ectopic right coronary artery and a right internal mammary graft where both outcomes were successful. These cases demonstrate that the brachial approach can facilitate rotational atherectomy when greater guide support is necessary.

ISSN:0098-6569    

DOI:10.1002/ccd.1810240108

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY

摘要:

AbstractA cardiac transplant patient died of severe left ventricular dysfunction 2 weeks after coronary anglography demonstrated normal coronary arteries. Post mortem examination showed significant and diffuse allograft vasculopathy. Coronary angiography may have limited sensitivity In detecting allograft vasculopathy.

ISSN:0098-6569    

DOI:10.1002/ccd.1810240109

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY

摘要:

AbstractDuring the initial perioperatfve period (1 mo to 1 yr) after saphenous vein coronary grafting, early stenosis and occlusion occurs In 5–8% of grafts due to intimal hyperplasia. We report a patient who developed ostial stenosis within 4 mo of bypass surgery at the aortotomy site of two vein grafts. Balloon angioplasty of the elastic stenoses did not provide significant luminal enlargement, but successful treatment of the lesions was obtained using directional atherectomy. Histological examination demonstrated intimal hyperplasia. Directional atherectomy may be an excellent technique for treatment of elastic ostial vein graft stenoses in lieu of conventional balloon dilatatio

ISSN:0098-6569    

DOI:10.1002/ccd.1810240110

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY

摘要:

AbstractWe report the a case of hugging balloons through an 8‐French guiding catheter to stabilize an ectatic right coronary artery following failed thrombolytic therapy In the setting of acute myocardial infarction. Angiographic follow‐up at 1 wk and 6 mo revealed persistent vessel pate

ISSN:0098-6569    

DOI:10.1002/ccd.1810240111

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1991

数据来源: WILEY