摘要:

AbstractCoronary angioplasty is an effective method to achieve myocardial reperfusion in acute myocardial infarction (AMI). We reviewed our experience in 132 patients (pts) who underwent percutaneous transluminal coronary angioplasty (PTCA) of a totally occluded infarct‐related artery (IRA) within 24 h after the onset of symptoms (mean delay 10±7 h), in order to identify the predictors of primary success and of major complications. PTCA was successfully performed in 113 patients (86%). Failure without complications occurred in 12 patients (8.4%); untoward events (death and emergency CABG) occurred in seven patients (5.3%). Pts in the failure group were more likely to have cardiogenic shock (53 vs. 8.8%,P<.0005), longer time to reperfusion (15±6 vs. 9±6 h,P<.0005), lower ejection fraction (EF) (42±16 vs. 54±12%,P<.0005), multivessel disease (74 vs. 43%,P<.03), and a smaller IRA diameter (2.8±0.6 vs. 3.1± 0.6 mm,P<.03). Sex, age, previous bypass surgery, previous thrombolytic treatment, IRA, and infarct location were similar in both groups. Absence of cardiogenic shock (P<.0001), decreasing time to reperfusion (P<.005) and increasing EF (P<.02) were independent predictors of successful PTCA. Presence of cardiogenic shock (P<.0001) and decreasing EF (<.05) were independent predictors of untoward events. Repeat angiography was performed 24 h after the procedure in the success group. Angiographic deterioration (stenosis ⩾ 50% and/or TIMI flow grade ⩽ 1) was present in 18 pts (16%), among whose 5 pts (4.4%) had re‐occlusion of the IRA. Pts with early angiographic deterioration were more likely to have a lower IRA diameter (2.8±0.5 vs. 3.1±0.6 mm,P<.02). Conclusion: Emergency PTCA is an effective method for establishing reperfusion in AMI. Pts with high‐risk baseline characteristics show the highest rate of untoward events, but are the most likely to benefit from aggressive reperfusion therapy. © 1

ISSN:0098-6569    

DOI:10.1002/ccd.1810360302

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

年代:1995

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810360303

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

年代:1995

数据来源: WILEY

摘要:

AbstractMitral stenosis with severe pulmonary artery hypertension constitutes a high risk subset for surgical commissurotomy or valve replacement. Balloon mitral valvotomy has been proposed as a technique for treating high risk surgical patients with mitral stenosis. The efficacy of this technique in patients with severe pulmonary artery hypertension, however, has not been fully evaluated. Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 450 consecutive patients. Of these, forty‐five (10%) patients had systemic or suprasystemic systolic pulmonary artery pressures (110 ± 20, range 96 to 170 mm Hg). The baseline characteristics and immediate hemodynamic results of these 45 patients with systemic/suprasystemic systolic pulmonary artery pressures (group I) were analysed and compared with those of 405 patients with subsystemic systolic pulmonary artery pressures (group II). Patients in group I were more symptomatic (New York Heart Association functional class

ISSN:0098-6569    

DOI:10.1002/ccd.1810360304

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

年代:1995

数据来源: WILEY

摘要:

AbstractA 38‐year‐old multigravid white female presented at 16 weeks gestation with an acute inferoposterolateral myocardial infarction. Emergent coronary angiography demonstrated a total proximal occlusion of a large dominant left circumflex artery with a filling defect at the site of the occlusion suggestive of thrombus. Primary angioplasty using a urokinase‐coated hydrogel balloon resulted in successful recanalization of the vessel with restoration of normal TIMI Grade III flow and, most notably, apparent complete lysis of the intracoronary thrombus. After a subsequently uneventful pregnancy, a healthy baby was delivered. © 1995 Wiley‐L

ISSN:0098-6569    

DOI:10.1002/ccd.1810360305

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

年代:1995

数据来源: WILEY

摘要:

AbstractIn patients with coarctation of the aorta arterial hypertension frequently persists when surgical repair is performed after age 20 years. There are little data on the long‐term effect of angioplasty and the question remains to be determined whether hypertension is sufficiently treated by this procedure.Twenty‐nine consecutive patients (9 females and 20 males) 14 to 54 years old (median, 25) underwent angioplasty for native coarctation of the aorta. Twenty‐five patients (86%) had pre‐existing systolic arterial hypertension (>140 mm Hg). The mean peak systolic pressure gradient decreased from 62 ± 18 to 21 ± 13 mm Hg immediately after angioplasty. At hospital discharge 13 patients still had hypertension. After a mean follow‐up interval of 4.0 years (range, 0.3–9.5) the residual peak pressure gradient was 14 ± 13 mm Hg. Blood pressure was normal without antihypertensive therapy in 23 patients (79%). In the six hypertensive patients the pressure gradients were 7,13,30,30,35, and 60 mm Hg. One patient died 8 months after angioplasty and another underwent surgery for aortic aneurysm.Although this was an uncontrolled study the data suggest that normalization of blood pressure may occur more frequently after angioplasty than after surgery in adolescents and adults with native coarctation. © 1995

ISSN:0098-6569    

DOI:10.1002/ccd.1810360306

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

年代:1995

数据来源: WILEY

摘要:

AbstractAcute aortic dissection during balloon angioplasty for coarctation of the aorta or aneurysm formation during follow‐up are well‐known complications of this procedure. Dissecting aneurysm development during long‐term follow‐up after balloon angioplasty of a native coarctation has not been previously reported. We report a case in which a huge dissecting aneurysm developed 3 years after the native coarctation angioplasty procedure. The aneurysm required surgical repair. © 1995 Wiley

ISSN:0098-6569    

DOI:10.1002/ccd.1810360307

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

年代:1995

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810360308

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

年代:1995

数据来源: WILEY

摘要:

AbstractAn improved 10 Fr version of the atrial septal defect (ASD) occlusion system consisting of two umbrellas for transvenous introduction over the long veno‐arterial guide‐wire was used to attempt closure in five adult patients with large defects (26–35 mm). The umbrellas are made of nitinol wire frame and a thin membrane of microporous polyurethane. Supported by the metal cannula and guided by selective left atriography, the umbrellas of 45–60 mm were placed individually into the atria and screwed together at the septum level by means of a torquer catheter. Positioning and screwing on, unscrewing, separating, and repositioning the umbrellas up to 17 times were needed to anchor the prosthesis correctly in a patient. The prosthesis could be implanted primarily in all patients (in one at second session). Dislodgement of a 60 mm prosthesis and left atrial perforation with a 55 mm prosthesis required surgery in two patients 8 hours and 2 weeks post procedure, respectively. A single umbrella‐arm fracture was noticed in one patient 4 months after the implantation. All five patients were free of symptoms at follow‐up after 7–10 months. Transcatheter closure of large ASDs is technically feasible with this system. The morbidity is mainly associated with the implantation of very large umbrellas. © 1995 W

ISSN:0098-6569    

DOI:10.1002/ccd.1810360309

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

年代:1995

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810360310

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

年代:1995

数据来源: WILEY

摘要:

AbstractWe report a case in which residual shunting after a buttoned device occlusion of atrial septal defect (ASD) was eliminated by transcatheter retrieval of a portion of the device, followed by implantation of a second device. This method may be helpful for those patients with residual ASDs who decline surgical device retrieval and defect closure. © 1995 Wiley‐Liss, I

ISSN:0098-6569    

DOI:10.1002/ccd.1810360311

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

年代:1995

数据来源: WILEY