摘要:

AbstractOf the last 200 consecutive patients undergoing PTCA procedures at our institution, 29 (15%) had unstable angina; and angioplasty was performed at the time of diagnostic coronary arteriography. There were 26 males and three females with an age range of 31–82 (mean 57) years. Factors favoring PTCA at the time of initial coronary arteriography included clinical indications for revascularization, appropriate anatomy based on high‐quality fluoroscopy, and availability of emergency surgery if required. Of 34 coronary lesions in 29 patients, 19 involved the anterior branch of the left anterior descending coronary artery (LAD), eight the circumflex branch (Cx); and seven the right coronary artery (RCA). Five patients had two vessels dilated (one LAD + RCA, two LAD + Cx, and two RCA + Cx). Of the coronary artery lesions, 19 were concentric, seven were eccentric, 20 were single and discrete, six were long or multiple in the same vessel; eight vessels were totally occluded, and in nine patients there was good collateral circulation. Twenty‐nine (85%) arteries were successfully dilated. Of the unsuccessful cases, one was from failure to cross a totally occluded lesion, and three residual lesions and/or postdilatation pressure gradients remained significant. One patient required emergency aortocoronary bypass surgery because of total occlusion of the LAD immediately post‐PTCA. There were no postprocedural myocardial infarcts or deaths. It is concluded that, in selected patients with unstable angina, PTCA can be performed successfully and with low risk at the time of initial diagnostic coronary arteriography. This approach offers certain clinical financial adv

ISSN:0098-6569    

DOI:10.1002/ccd.1810140202

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

年代:1988

数据来源: WILEY

摘要:

AbstractThe purpose of this investigation was to evaluate the efficacy, technique, and follow‐up results of balloon dilation angioplasty for valvular pulmonary stenosis. Percutaneous dilation was performed on 63 patients with pulmonary stenosis (ages 3 months to 76 years, mean = 4.3 years). In 43 patients, a single balloon was used; in 20 patients two balloons were used simultaneously.The pressure gradient across the pulmonary valve was determined with right ventricular and main pulmonary artery catheters. Pressure gradients simultaneously were estimated by continuous wave Doppler (CWD) during catheterization. The peak systolic ejection gradient was obtained by both techniques both pre‐ and postangioplasty. There was excellent linear correlation between the simultaneous catheter pressure gradient and the pressure gradient estimated by Doppler (r = 0.99). Follow‐up pressure gradient estimations by Doppler echocardiogram were obtained in 30 patients between 6 months and 30 months postcatheterization (mean = 13 months).The mean preangioplasty gradient of 64 mm Hg (range 30–160 mm Hg) was reduced to 22 mm Hg (range 2–31 mm Hg). A significant reduction of transvalvular gradient (52–95%, mean 68%) occurred in each patient. A linear correlation was found between the predilation gradient and the pressure gradient drop (r = 0.92). Mean follow‐up gradient by Doppler was 20 mm Hg (range 0–31 mm Hg), and there was no significant difference between these gradients and the postdilation gradient. No important complications were noted. These data confirm that balloon dilation angioplasty for valvular pulmonary stenosis is safe and effective, and suggest that stenosis

ISSN:0098-6569    

DOI:10.1002/ccd.1810140203

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

年代:1988

数据来源: WILEY

摘要:

AbstractPercutaneous transcatheter closure of the patent ductus arteriosus has become a clinically viable procedure in childhood due to the pioneering work of Rashklnd and Mullins. Presented is a modification of the technique to accomplish catheter closure in the small ductus arteriosus.

ISSN:0098-6569    

DOI:10.1002/ccd.1810140204

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

年代:1988

数据来源: WILEY

摘要:

AbstractThe velocity of blood flowing down a coronary artery may provide an index of myocardial perfusion, independent of the need for measuring the amount of myocardium supplied by a vessel. The velocity of the leading edge of contrast material was therefore measured before and after percutaneous transluminal coronary angioplasty in 15 patients utilizing digitized images from routine coronary angiography. The velocity (mean ± SD) before percutaneous transluminal coronary angioplasty in the 15 patients was 11.9 ± 6.0 cm/s, increasing to 21.7 ± 8.7 cm/s after (P<0.01). There was a correlation between the percent change in velocity and the change in percent stenosis before and after percutaneous transluminal coronary angioplasty (r= 0.65;P<0.001). The mean absolute interobserver and intraobserver variabilities for the velocity measurements were 2.1 and 1.8 cm/s, respectively. Measurement of coronary flow velocity from data obtained at the time of routine coronary angiography is an easily performed reproducible technique, which may be used to assess the results of an intervention such as percutaneous transluminal coronary angioplas

ISSN:0098-6569    

DOI:10.1002/ccd.1810140205

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

年代:1988

数据来源: WILEY

摘要:

AbstractA tapered teflon dilator has been applied to 12 cases of percutaneous transluminal coronary angioplasty (PTCA). The technique was first used to predilate stenoses that could not initially be crossed with low profile over the wire PTCA ballons. In the first five cases, three angioplasties that would have been failures were converted to successes by this method. The dilator was used in place of a balloon catheter as an initial step to assess the ability of a guidewire to cross a lesion to reduce cost in five additional cases. Modification of an existing family of peripheral vascular dilators is described. The method of application of this technique to PTCA is outlined.

ISSN:0098-6569    

DOI:10.1002/ccd.1810140206

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

年代:1988

数据来源: WILEY

摘要:

AbstractThis report describes combined aortic balloon valvuloplasty and coronary angioplasty in two critically ill patients with aortic stenosis and coronary artery disease.

ISSN:0098-6569    

DOI:10.1002/ccd.1810140207

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

年代:1988

数据来源: WILEY

摘要:

AbstractEighteen months after coronary artery bypass grafting with a left internal mammary artery (LIMA) graft, a 58‐year‐old woman had a change in the character of her angina to include pain in the left arm, especially with upper extremity work, culminating in an episode of prolonged rest pain. Cardiac catheterization revealed retrograde flow through the LIMA graft to the subclavian artery and stenosis of the left subclavian artery at its origin from the aorta. Restoration of antegrade flow through the LIMA graft to the coronary arteries was achieved by a carotid‐subclavian bypass resulting in a resolution of symptoms. The evaluation of recurrent angina after LIMA bypass grafting should exclude the possibility of subclavian artery stenosis as well as disease of the native and graft coronary an

ISSN:0098-6569    

DOI:10.1002/ccd.1810140208

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

年代:1988

数据来源: WILEY

摘要:

AbstractPrecise diagnosis of aortic composite graft dehiscence may be difficult. We present a case illustrating this problem and its resolution. Two‐dimensional echocardiography and contrast ventriculography revealed a space adjacent to the aortic valve conduit that demonstrated marked systolic expansion. The dynamic variation of this space was secondary to communication with the left ventricular cavity caused by disruption of the composite graft valve ring. Thus, systolic expansion of the aortic root is a useful echocardiographic and angiographic sign of composite graft dehiscenc

ISSN:0098-6569    

DOI:10.1002/ccd.1810140209

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

年代:1988

数据来源: WILEY

摘要:

AbstractWe present a case of acute total aortic occlusion at the time of cardiac catheterization in a 62‐yr‐old female with an acute myocardial infarction and newly diagnosed polycthemia vera. Despite normalization of serum viscosity and red cell mass by phlebotomy, her predisposition to thrombosis persisted. Caution is advised when considering cardiac catheterization in patients with this dise

ISSN:0098-6569    

DOI:10.1002/ccd.1810140210

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

年代:1988

数据来源: WILEY

摘要:

AbstractThe presence of anomalous coronary arteries is observed infrequently during routine coronary angiography. However, their identification is crucial to the management of the patient with associated coronary artery disease. A case is described in which concomitant anomalous origin of the circumflex coronary artery from the right coronary artery, and a right superior septal coronary artery with a separate ostium occurred in association with severe three‐vessel coronary artery disease requiring bypass graft surgery. Clues to the presence of the anomalous vessels were (1) their visualization during left ventriculography and (2) their presence or absence during injection of the normally originating vessels. This particular association of anomalous vessels was previously unreporte

ISSN:0098-6569    

DOI:10.1002/ccd.1810140211

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

年代:1988

数据来源: WILEY