摘要:

AbstractRecent studies have evidenced an association between the time of heparin discontinuance and coronary artery reocclusion. Some investigators have concluded that inadequate heparinization was responsible, and further heparin infusion or an increase in dose would have been indicated. However, several investigators (Rao:Thrombosis Research24:181–186, 1981; Marciniak and Gockerman:LancetSeptember 17:581–584, 1977; Fisken et al.:LancetDecember 10: 1231, 1977; Conard et al.:Thrombosis Research22:507–511, 1981; Kakkar et al.:LancetJanuary 12:103–104; Green:LancetFebruary 16:374,375; Harborne and Nicolaides:Thrombosis Research43:657–662, 1986; Bonen et al.:Thrombosis Research27:123–124, 1982; Blomback et al.:Acta Physiologica Scandinavica58:306–318, 1963; Holm et al.:Scandinavian Journal of Haematology35:564–569, 1985; Andersson et al.:Thrombosis Research34:333–340,1984) have demonstrated that antithrombin III levels are reduced in patients on intravenous heparin. Both reduced antithrombin III levels and reduced rate of antithrombin inhibition of thrombin at the time of heparin discontinuance may increase the risk of coronary rethrombosis. If this theory is correct, increasing heparin infusion may exacerbate this risk. We propose an investigation that will provide evidence for or against the decreased antithrombin III theory, and in doing so, test an experimental therapy designed to prevent coronary reocclusion upon heparin discontinuance. In a randomized, placebo‐controlled double‐blinded study, we will determine whether simultaneous administration of warfarin with heparin initiation provides more time to increase antithrombin III levels and prevent coronary reocclusion upon heparin discontinuance, compared to heparin wit

ISSN:0098-6569    

DOI:10.1002/ccd.1810200202

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

年代:1990

数据来源: WILEY

摘要:

AbstractRestenosis following coronary angioplasty can usually be treated effectively and safely by repeated angioplasty. However, the presence of a complex lesion morphology may bias the clinician away from angioplasty toward either recommending bypass surgery or continuing medical therapy alone in spite of recurrence of the symptoms which were sufficient indication for the initial angioplasty. One type of complex morphology at the site of the restenosis is due to the presence of a focal, eccentric aneurysmal dilatation similar in appearance to a saccular aneurysm. In two previously reported cases in the literature both were referred to bypass surgery. We report eight additional cases including the use of repeat successful angioplasty in six of the cases in spite of the potential problems posed by the complexity of the restenosed lesion.In addition, this case review suggests that this type of complex lesion morphology with restenosis may be more common when the initial angioplasty was associated with deep arterial injury, as in patients whose initial angloplasty was done in an infarct‐related vessel or was associatedwith evidence of a large dissectio

ISSN:0098-6569    

DOI:10.1002/ccd.1810200203

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

年代:1990

数据来源: WILEY

摘要:

AbstractAtrial septal defects may have clinical consequences regardless of their size. We evaluated the incidence of clinically unsuspected atrial septal defects in 4,411 consecutive adult patients referred for cardiac catheterization by the previously validated method of inspired hydrogen appearance time. Oximetry was performed only when an abnormally short inspired hydrogen appearance time was measured. Seventy‐five patients (1.7%) were discovered to have a left‐to‐right shunt by this method. The shunting was at the atrial level in 65 patients. Thirty‐five of these patients (0.8% of all catheterizations) were not suspected of having any form of congenital heart disease by history, physical examination, chest X‐ray, EKG, or echocardiogram. In 19 cases there was no significant oxygen step‐up and the diagnosis would have been missed by oximetry. The atrial septum was explored during open heart surgery in 7 patients. Atrial septal defects were detected and closed in all. Four patients had the finding confirmed by echocardiography after the catheterization. Small atrial septal defects are frequently not detected by clinical evaluation, noninvasive testing, or oximetry and are easily detected by the rapid, safe, and accurate method of inspired hydrogen appe

ISSN:0098-6569    

DOI:10.1002/ccd.1810200204

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

年代:1990

数据来源: WILEY

摘要:

AbstractProgression of native coronary artery disease proximal to the placement of saphenous vein grafts may leave arterial segments isolated by stenoses on either side. In 16 patients, we attempted coronary angioplasty in a retrograde direction through saphenous vein grafts to revascularize 17 isolated arterial segments. The retrograde dilatation was successful in 12 of 17 attempts (71%). Failure in 5 attempts was due to severe angulation between the graft insertion site and the retrograde proximal arterial limb. There were no major complications of these procedures. Symptoms and signs of myocardial ischemia were relieved following successful retrograde dilatation. Thus, retrograde dilatation through saphenous vein grafts provides another means of achieving complete revascularization using coronary angioplasty in patients with prior coronary bypass surgery.

ISSN:0098-6569    

DOI:10.1002/ccd.1810200205

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

年代:1990

数据来源: WILEY

摘要:

AbstractFor the detection of left‐to‐right intracardiac shunting, the oximetric and standard indocyanine green techniques are relatively insensitive, in that neither can reliably detect a shunt with a ratio of pulmonary to systemic flow (Qp/Qs)<1.3 (percentage shunt, 23%). Although the hydrogen inhalation method is said to be much more sensitive in this regard, no previous study has measured its sensitivity. Accordingly, in 15 patients (4 men, 11 women, aged 38 to 67 years) without intracardiac shunting, hydrogen inhalation was performed 1) without and 2) with an artificially created femoral arteriovenous shunt of known size, and cardiac output was measured by thermodilution. For the 15 subjects with cardiac outputs of 3.64 to 8.10 liter/min, shunts of 22 to 248 ml/min were created, so that the shunts ranged from 0.5% to 3.3%. Hydrogen inhalation detected all shunts ≥ 1.3% (Qp/Qs ≥ 1.01). Of the 10 shunts<1.3%, it detected 5, with the smallest being 0.7%. Thus, the hydrogen inhalation technique is extremely sensitive in identifying the presence of left‐to‐right shunting, far more sensitive than the oximetric and standard indocyanine gr

ISSN:0098-6569    

DOI:10.1002/ccd.1810200206

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

年代:1990

数据来源: WILEY

摘要:

AbstractWe investigated whether clinical and laboratory variables can predict perfusion status after t‐PA administration, by using the data from 138 patients who received t‐PA during the Thrombolysis in Myocardial Infarction (TIMI) I study. All clinical and laboratory variables that were collected at baseline or during perfusion for TIMI I were evaluated by the current study. Via stepwise discriminant analysis, 7 variables were closely associated with perfusion status at 90 minutes (listed in the order of their discriminant effect): baseline grade of stenosis in the infarct‐related coronary artery, whether nausea was present during the infusion, baseline aspartate aminotransferase (SGOT) concentration, whether arrhythmias were present during the infusion, baseline fibrinogen concentration, baseline partial thromboplastin time, and baseline diastolic blood pressure. Baseline severity of stenosis and the likelihood of there being reperfusion were inversely related. Eighty‐four percent of patients with adequate perfusion after 90 minutes of t‐PA infusion were classified correctly, but only 50% of those without perfusion at 90 minutes were classified correctly. In addition, since 70% of the TIMI I patients, on average, did achieve perfusion, the use of these 7 variables added little predictive information. Our findings suggest that 1) there is as yet no practical way to predict reperfusion after t‐PA therapy and 2) the severity of coronary stenoses, if known ahead of time, should be considered when selecting patients for thromboly

ISSN:0098-6569    

DOI:10.1002/ccd.1810200207

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

年代:1990

数据来源: WILEY

摘要:

AbstractThe OrionTMcoronary angioplasty improved balloon on a wire system was used in 42 patients (53 stenoses) including 5 patients with acute myocardial infarction, 18 patients with unstable angina, and 4 patients with kissing balloon angioplasty via a single guiding catheter. All stenoses were crossed successfully and the immediate and in‐hospital success rates were 98 and 93%, respectively. The simple construction, low prcfile, and improved steerability allowed successful and quick angioplasty of high grade stenotic lesions. This balloon catheter represents a significant advance in angioplasty technolog

ISSN:0098-6569    

DOI:10.1002/ccd.1810200208

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

年代:1990

数据来源: WILEY

摘要:

AbstractWe report our initial experience with a new percutaneous transluminal coronary angioplasty (PTCA) balloon catheter and compare it to a similar over‐the‐wire system in a retrospective, nonrandomized fashion. There was no statistical difference in pre‐PTCA angiographic indices and post‐PTCA angiographic and clinical success rates between the two groups. There was a trend toward a decrease in length of fluoroscopy (P= 08) and a significant decrease in the amount of contrast utilized (P= .007) with the new balloon catheter. Several new construction features of the new catheter account for this improvement and are discussed. The long‐term success of this balloon catheter remains to be inv

ISSN:0098-6569    

DOI:10.1002/ccd.1810200209

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

年代:1990

数据来源: WILEY

摘要:

AbstractThe MonorailTMPiccolino coronary angioplasty balloon catheter (MBC) was evaluated on 118 patients at two centers. Technical success was achieved in 110 patients (93%). Time for catheter exchange and total fluoroscopy time were significantly lower for the Monorail catheter than with standard equipment (exchange time 97 vs. 170 secondsP<.05 and fluoroscopy time 17 vs. 88 secondsP<0.001). The advantages of rapid exchange and the ability of utilize 2 Monorail balloon catheters through one 9F guiding catheter for simultaneous inflations allowed for maximal flexibility in treating patients with bifurcation lesions. The double wire approach utilizing one Monorail balloon catheter with a 7F guiding catheter was also technically successful. The MonorailTMPiccolino balloon catheter has unique features that allow for greater ease of operator use, rapid catheter exchange, and optimal angiographic visualization. It is felt that this catheter design provides distinct advantages over standard angioplasty equipment.

ISSN:0098-6569    

DOI:10.1002/ccd.1810200210

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

年代:1990

数据来源: WILEY

摘要:

AbstractPatients with critical aortic stenosis have an increased risk of complications during diagnostic cardiac catheterization, and those who arrest are particularly difficult to resuscitate. Recent advances in therapeutic techniques may change this unfavorable prognosis, as it is illustrated in the presented case. A 68 year‐old women with critical aortic stenosis sustained a cardiac arrest during diagnostic cardiac catheterization. Conventional cardiopulmonary resuscitation for 45 minutes failed to restore cardiac function and rhythm, which had degenerated to ventricular fibrillation, electromechanical dissociation, and asystole. Peripheral cardiopulmonary support system restored cardiac rhythm and blood pressure, with a subsequent successful aortic valve replacemen

ISSN:0098-6569    

DOI:10.1002/ccd.1810200211

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

年代:1990

数据来源: WILEY