摘要:

AbstractA total of 533 patients with acute myocardial infarction of less than 4‐h duration were enrolled in the multicenter randomized trial of intracoronary thrombolysis compared to conventional treatment. In two of the five participating centers, an additional coronary angioplasty immediately after thrombolysis was attempted in 46 patients. According to the treatment allocation and early and late patency of the infarct related vessel, patients were subdivided into three groups: conventionally treated (group A); successful coronary angioplasty following thrombolysis with persistent patent infarct related vessel (group B); and late patency of the infarct related vessel postthrombolytic therapy without angioplasty (group C). The highest global ejection fractions were observed in group B (54% ± 10%) and group C (55% ± 13%), while the lowest ejection fraction was found in group A (47% ± 14%). The sequential changes in global ejection fraction from the acute to the chronic stage was + 4% (p = 0.05) in group B, while no significant changes could be demonstrated in group C. Furthermore, in the group successfully treated by angioplasty, the improvement in global ejection fraction was more pronounced and persisted up to three months after the intervention. This was supported by analysis of regional myocardial function of the infarct zone (+16% improvement, p = 0.01). The long‐term clinical follow‐up (median 24 months) of the patients successfully treated by combined procedure of thrombolysis and angioplasty (group B) was most favourable with a lower incidence of re‐infarction (6%), and late coronary bypass surgery (13%) and/or (re)‐percutaneous transluminal coronary angioplasty (3%) was performed less frequently.These results suggest that reperfusion may need to be supplemented by additional revascularization procedures in order to optimize the chances of obtaining full functional recovery and so to improve t

ISSN:0098-6569    

DOI:10.1002/ccd.1810130402

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

年代:1987

数据来源: WILEY

摘要:

AbstractTransseptal catheterization has been routinely done at this institution for the past 19 years to evaluate the left heart. Reviewing the last 250 consecutive transseptal heart catheterizations between 1978 and 1986, the left atrium and ventricle were entered in all but six patients. One death occurred with four other major complications. There were 177 males and 73 females ranging from 18 to 84 years of age. Of these 250 studies, 31 were in association with direct left ventricular apical puncture; 42 were in patients with subaortic stenosis; 101 were in aortic stenosis; 26 were in patients with combined aortic and mitral disease; and four were in patients with triple prosthetic valve replacements. No attempts were made to cross the prosthetic mitral valves.A decline in the number of transseptal studies at this institution has been noted over the past 8 years and the technique is no longer taught routinely to Fellows. The reduction is due to increased emphasis on coronary artery anatomy, fewer rheumatic and prosthetic valvular admissions, and improved evaluation by non‐invasive echocardiography and doppler studies. This has resulted in a loss in proficiency among invasive cardiologists.In conclusion, the transseptal technique is potentially hazardous, but continued usage will maintain proficiency and a low major and minor complication rat

ISSN:0098-6569    

DOI:10.1002/ccd.1810130403

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

年代:1987

数据来源: WILEY

摘要:

AbstractWe compared visual estimate and digital caliper measurement of coronary stenoses, utilizing both a 50% and 70% diameter reduction as a definition of significance and both experienced angiographers and cardiology fellows as readers. Ten angiograms were interpreted twice, using the different methods, by four readers, two months apart. The angiograms were divided into 12 vessel segments. Stenoses were judged more severe by visual estimate in 11 segments. Seven of twelve segments had significant differences between readers using the visual estimate, but no significant differences were obtained using caliper measurements. Variability was highest for fellows using the visual method. Interobserver agreement was highest using the digital caliper and the 70% criteria. Intraobserver agreement was most dependent on the amount of time taken in film interpretation. The digital caliper appears to be preferable in interpreting angiograms, particularly for cardiology fellows.

ISSN:0098-6569    

DOI:10.1002/ccd.1810130404

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

年代:1987

数据来源: WILEY

摘要:

AbstractReduced left ventricular diastolic filling (Df) has been noted in coronary disease (CD) patients with normal left ventricular systolic function (NLVF). However, previous studies have included patients with regional wall disease, hypertension, or left ventricular hypertrophy. In the absence of these factors, only a subgroup of patients who had>75% luminal obstruction of the left anterior descending artery (LAD) demonstrated DF abnormalities. Using 60 frames/sec biplane contrast ventriculography, we evaluated the left ventricular filling curve and its derivative in 21 patients with normal coronary arteries and NLVF (group 1), 17 CD patients with NLVF and no LAD disease (group 2), and 18 patients with LAD disease and NLVF (group 3). The peak filling rate (PFR) as end diastolic volumes/sec (EDV/S) was reduced in group 3 patients (group 3: 3.00 ± 0.51 EDV/S vs group 1: 3.59 ± 0.84 EDV/S, p<.05; and group 2: 3.61 ± 0.91 EDV/S, p<.05). There was marked overlap in the Pfr's between the normal and LAD group. DF may be normal in CD patients with NLVF in the absence of LAD disease. LAD patients have abnormal DF, but these abnormalities lack predictive val

ISSN:0098-6569    

DOI:10.1002/ccd.1810130405

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

年代:1987

数据来源: WILEY

摘要:

AbstractThe relative positions of the left ventricular apex and base in end‐diastole (ED) and end‐systole (ES) were determined in a group of normal individuals using cross‐sectional echocardiography (group A) and in a group of patients with normal hemodynamics and angiographic parameters using cine‐computed tomography (group B). In both groups no change was detected in the position of the epicardial aspect of the apex from ED to ES. The base moved in direction of the apex by 10.2% ± 1.9% (mean ± standard deviation) of the longitudinal dimension of the chamber in group A and by 12.9% ± 5.1% in group B. In both groups the apical cavity was obliterated by the peri‐apical walls. Apical obliteration is responsible for the apparent movement of the apical segment seen in cinevent

ISSN:0098-6569    

DOI:10.1002/ccd.1810130406

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

年代:1987

数据来源: WILEY

摘要:

AbstractThis report describes a lethal complication which occurred during retrograde catheterization of the left ventricle across a Björk‐Shiley prosthesis. The authors were called upon to testify as experts in malpractice proceedings in this case.After an 8F Sones catheter had been passed through the small side orifice of the prosthesis and three ventriculograms had been carried out, it was apparent that the movement of the tilting disc valve was considerably impaired and that the catheter had become irreversibly trapped. As a consequence the patient died of irreversible left heart failure before an operation could be performed.Consequently passing a tilting disc valve can no longer be considered as completely safe. This procedure should only be used under exceptional circumstances requiring very strict indication. If such an intervention is necessary, then it should only be performed by experienced cardiologists, who should take all possible precautions to reduce ris

ISSN:0098-6569    

DOI:10.1002/ccd.1810130407

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

年代:1987

数据来源: WILEY

摘要:

AbstractPercutaneous transluminal coronary angioplasty has emerged as a mode of treatment in patients with both chronic and acute coronary syndromes. Among the recognized complications of coronary angioplasty is coronary embolism. This case report describes a case of acute anterior myocardial infarction which was treated with angioplasty of the left anterior descending coronary artery. Postdilation angiography revealed obstruction of the posterior descending artery (in a left dominant system). The use of thrombolytic therapy previous to angioplasty is briefly discussed.

ISSN:0098-6569    

DOI:10.1002/ccd.1810130408

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

年代:1987

数据来源: WILEY

摘要:

AbstractA patient with severe isolated right‐sided cardiac failure of unknown origin is presented in whom three right ventricular endomyocardial biopsies obtained in different bioptome positions disclosed a yellowish material which was confirmed at histological examination as fat. At operation, a complete replacement of atrial and ventricular myocardium by fat was noted. This previously unreported use of endomyocardial biopsy is emphasized, especially when the differential diagnosis of isolated right‐sided heart failure is conside

ISSN:0098-6569    

DOI:10.1002/ccd.1810130409

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

年代:1987

数据来源: WILEY

摘要:

AbstractDuring percutaneous transluminal coronary angioplasty (PTCA) frontal ECG leads are routinely monitored. The detection of ST segment deviation during the procedure is important for decisions regarding guiding catheter seating and the timing of balloon inflation and deflation. ST segment deviation appears on intracoronary electrograms in the absence of changes on the surface ECG in many patients, while the reverse is true in some individuals. When a precordial lead is employed, V5 or V6 is most commonly selected. The surface ECG leads most sensitive for monitoring ischemia during left anterior descending angioplasty are not known. In nine lead surface ECGs recorded during balloon inflation, a small degree of ST segment elevation occurred in leads I, aVL, and V5. Lead V2 demonstrated an increase in ST displacement from 0.0 ± 0.03 mV to 0.29 ± 0.25 mV during coronary occlusion (p<0.01). We conclude that if V5 or V6 is used as a single precordial lead, surface ECG alterations are easily overlooked. During left anterior descending occlusion the most sensitive surface lead is V2. Optimal ECG monitoring during PTCA in some cases should involve surface lead V2 or the intracoronary lea

ISSN:0098-6569    

DOI:10.1002/ccd.1810130410

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

年代:1987

数据来源: WILEY

摘要:

AbstractIn order to determine whether the use of a smaller catheter would allow day‐case cardiac catheterization by the femoral route, the performance of the Superflow (5F) and the 8F catheters was compared in 34 adults who underwent left ventriculography and coronary angiography. As shown by the significantly lower fluoroscopy time [2.8 ± 1.2 min vs 4.5 ± 2.7 min, (m ± SD), p = 0.027] the 8F catheter was more maneuverable than the Superflow (5F) catheter. Poor left ventriculograms were obtained in a higher proportion of patients in whom the Superflow (5F) catheter was used. There was no significant difference in the time to achieve hemostasis at the puncture site in the two groups of patients (13 ± 5 min vs 10 ± 3 min, p = 0.09). It is concluded that the use of the Superflow (5F) catheter confers no advantage, while it is associated with longer screening time and poorer left ventricul

ISSN:0098-6569    

DOI:10.1002/ccd.1810130411

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

年代:1987

数据来源: WILEY