ISSN:0098-6569    

DOI:10.1002/ccd.1810350202

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

年代:1995

数据来源: WILEY

摘要:

AbstractDespite the established role of percutaneous balloon mitral valvuloplasty (BMV) in the treatment of mitral stenosis, major controversial issues in the realm of BMV persist. With increased operator experience, BMV has now been extended to include various controversial scenarios, such as mild mitral stenosis, adverse valve morphologies, and highrisk patients with concomitant anatomic distortions which are technically demanding. In skilled hands, however, BMV has yielded a favorable outcome in these settings. Furthermore, the debate on whether the Inoue or the double‐balloon approach is superior continues. Studies to date have shown equal efficacy of the two BMV methods in terms of valve enlargement although the Inoue approach is clearly simpler to execute and may potentially be associated with a lower risk of creating severe mitral regurgitation. Last, because of the lack of consensus on optimal balloon sizing for BMV, perhaps the best method to adopt at this stage is one that is simple and safe to apply across a broad spectrum of valve anatomy. © 1995 Wiley‐Liss,

ISSN:0098-6569    

DOI:10.1002/ccd.1810350203

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.1810350204

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

年代:1995

数据来源: WILEY

摘要:

AbstractThe scaffolding effect of stent implantation has the potential to alter vascular geometry and dimensions. The objective of this study was to determine the impact of intracoronary stent implantation on the reference vessel diameter and the consequences of this on the frequency of restenosis applying the binary definitions of restenosis based on percent diameter stenosis. Routine angiographic follow‐up was performed in 79/80 consecutive patients who had a single elective Palmaz‐Schatz stent implanted in denovo lesions in native coronary arteries 6.5±3.4 mo after the index procedure. Complete quantitative angiographic follow‐up was available in 78 (98%). The mean reference vessel diameter was 2.9±0.6 mm preprocedure, increased to 3.1±0.5 mm immediately poststent implantation and was 2.6±0.6 mm at follow‐up (F = 6.45,P= 0.0001, ANOVA for repeated measures). In view of the varying reference vessel diameter, percent diameter stenosis postangioplasty and at follow‐up was determined by two methods: (1) automatically by the quantitative coronary angiographic analysis system and (2) by expressing the minimal luminal diameter postangioplasty and at follow‐up as a function of the original preprocedural reference vessel diameter. The restenosis rate was significantly greater for all definitions of restenosis when the minimal luminal diameter was determined as a function of the original preprocedure reference vessel diameter (e.g., 34% vs. 18% for the ⩾50% criterion,P= 0.018). Stent implantation results in alterations in reference vessel diameter, which have important consequences for the frequency of restenosis presented as a binary variable based on percent diameter stenosis. © 19

ISSN:0098-6569    

DOI:10.1002/ccd.1810350205

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

年代:1995

数据来源: WILEY

摘要:

Abstractβ‐blocker therapy for mitral stenosis is controversial. This study compares right and left heart hemodynamics at rest and supine submaximal exercise in patients (n = 7) receiving chronic β‐antagonists with untreated patients (n = 17) matched for age (mean ± SD = 51 ± 12 years) and valve area (0.7 ± 0.2 cm2/m2). Little benefit was observed with treatment at rest. Although pulmonary capillary wedge pressures (PCWP) were lower during exercise in the β‐blocker group (22±4 vs. 31 ± 9 mmHg;P>0.05), exercise performance was not enhanced and cardiac output response during exercise was reduced (control = 41% increase vs. 12% for β‐blockade). PCWP rose rapidly when diastolic filling periods were>300 msec in both groups. Pulmonary capillary wedge pressure was found to be a nonlinear functions (P<0.001) of diastolic filling period (PCWP = 15.9 + 5.84 × 105/dfp2). These data suggest that there is a critical heart rate in patients with mitral stenosis above which hemodynamic compromise rapidly occurs. © 1995 Wiley‐Liss, Inc.This article is a US Government work and, as such, is in the public domain in the Unit

ISSN:0098-6569    

DOI:10.1002/ccd.1810350206

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

年代:1995

数据来源: WILEY

摘要:

AbstractThe incidence, angiographic characteristics, and natural history of coronary artery fistulas in patients undergoing diagnostic cardiac catheterization have not been well defined. Of 33,600 patients who had diagnostic cardiac catheterization, 34 (0.1%) had coronary artery fistula. Nineteen fistulas originated from the right, 11 from the left anterior descending, and 4 from the circumflex coronary arteries, respectively. The mean ratio of pulmonary to systemic flow was 1.19 ± 0.33. Only one patient with coexistent atrial septal defect had a pulmonic to systemic flow ratio>1.5. Right and left heart pressures, with the exception of three patients in whom left ventricular end‐diastolic pressure was>12 mm Hg, were within normal limits. During a mean follow‐up period of 6.3 years (range 2–14 years), there were no complications related to coronary artery fistula.It was concluded that the incidence of coronary artery fistulas detected during diagnostic coronary angiography is very low. Coronary artery fistulas originate predominantly from the right coronary artery and are not associated with hemodynamic abnormalities or other congenital heart diseases. The prognosis of coronary artery fistulas in adults is good. © 1995 Wiley‐

ISSN:0098-6569    

DOI:10.1002/ccd.1810350207

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

年代:1995

数据来源: WILEY

摘要:

AbstractTo evaluate the presence and clinical significance of electrical alternans during PTCA, intracoronary electrocardiography (ic‐ECG) was performed in 65 consecutive lesions. ST‐T alternans, defined as a beat‐to‐beat difference in the ST elevation ⩾1 mm, was present in five lesions (7.7%), all in the proximal left anterior descending (LAD) coronary artery. The phenomenon was seen only after 130 sec (mean 174 ± 57) of balloon inflation. Only two of the five showed ST‐T alternans simultaneously on both surface and ic‐ECG. One of five patients had premature ventricular contractions following ST‐T alternans. Three of these five lesions required a second balloon inflation with duration of ⩾ 300 sec; there was no ST‐T alternans on the second inflation in any of these lesions. We conclude: (1) the detection of ST‐T alternans during PTCA is enhanced by use of ic‐ECG, (2) electrical alternans during PTCA was seen only in proximal LAD lesions, implicating a large amount of ischemic myocardium as a requisite for the phenomenon, (3) electrical alternans is not immediate, requiring a certain duration of balloon occlusion and hence ischemia to occur, and (4) the absence of ST‐T alternans during second balloon inflations suggests ischemic preconditioning m

ISSN:0098-6569    

DOI:10.1002/ccd.1810350208

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

年代:1995

数据来源: WILEY

摘要:

AbstractThe angiographic incidence of intramyocardial bridging (MB) is 0.7–4.5% [Angelini et al.: Prog Cardiovasc Dis 25:75–88, 1983]. Morphological and physiological patterns of MB have recently been described, observing coronary flow velocity patterns, intravascular ultrasound, and angiography [Flynn et al.: Cathet Cardiovasc Diagn 32:36–39, 1994; Ge et al.: Circ Res 89:1725–1732, 1994]. We describe a reversal of the normal flow velocity characteristics within a MB, due to a hemodynamically significant stenosis in the proximal left anterior descending artery (LAD). After successful percutaneous transluminal coronary angioplasty (PTCA) of the proximal LAD stenosis, there was normalization of the flow velocity pattern within the MB and the appearance of a spike and dome pattern distal to the MB. © 1995 Wiley

ISSN:0098-6569    

DOI:10.1002/ccd.1810350209

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.1810350210

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

年代:1995

数据来源: WILEY

摘要:

AbstractWe report the use of direct coronary aspiration to remove obstructing thrombus from a proximal right coronary artery after failure of balloon angioplasty to resolve the thrombus responsible for postmyocardial infarction ischemia. © 1995 Wiley‐Liss, I

ISSN:0098-6569    

DOI:10.1002/ccd.1810350211

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

年代:1995

数据来源: WILEY