ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00588.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The approach toward treatment of stenotic lesions in the coronary arteries is standardized. There are two principle approaches: as closed techniques, by means of percutaneous transluminal coronary angioplasty (PTCA); and open techniques, by means of direct revascularization in extracorporeal circulation. The Institute of Cardiac Survey of the European Academy of Sciences and Arts has monitored the different approaches since 1990. In Europe, an average of 343 PTCA procedures per million population were performed in 1993, compared to 300 coronary artery bypass graft procedures per million population. Great differences in cardiac care can be observed within Europe. Despite revascularization, closed techniques (PTCA) are increasing by 12% and open techniques by 14%. (J Interven Cardiol 1996;9:3–

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00589.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Recent experiments have demonstrated that pressure waves of several hundred atmospheres, which occur during excimer laser coronary angioplasty (ELCA), are reduced while ablating in saline in comparison to blood or contrast medium. We report the procedural outcome of ELCA (XeCI laser operating at 308 nm, 25–40 Hz, 40–60 mJ/mm2fluence, and 135 nsec/pulse) performed with a modified saline infusion protocol (two operator technique, flush, and continuous application of saline through the guiding catheter immediately prior and during the whole losing procedure). We studied 48 patients (34 males, 14 females; mean age: 61 ± 6 years; 18 occlusions, 30 stenoses [>60% diameter stenosis]) with 10 type A, 17 type B, and 21 type C lesions. Laser success (>20% increase in minimal luminal diameter [MLD]) was achieved in 41 patients (85.4%), and procedural success (<50% residual stenosis) in 44 patients (91.6%). The MLD increased from 0.37 ± 0.12 to 1.63 ± 0.35 mm (P0.01) after percutaneous transluminal coronary angioplasty (PTCA). The mean percentage stenosis decreased from 81%± 6% (baseline) to 48%± 12% (P<0.001) after laser ablation, and to 29%± 10% (P<0.01) following PTCA. The mean diameter of the laser‐catheter (LC) was 1.54 ± 0.2 and the mean diameter of the inflated balloon at maximum pressure was 2.7 ± 0.25 mm. Thus, the elastic recoil (ER) following balloon deflation was 15%± 9%, and below the reported ER for PTCA. Two major dissections occurred following ELCA; one patient required bypass surgery and developed a Q wave myocardial infarction (Ml), and one patient was successfully treated with stent implantation following abrupt closure. There were no in‐hospital deaths, further Q wave MIs, and/or perforation. In conclusion, ELCA with concomitant saline infusion is effective, safe, and easy to perform. The use of this ablation procedure reduces the rate of significant dissections, favors effective tissue ablation, and thus may in part be responsible for a reduced amount of elastic recoil following additional balloon angioplasty. (J Interven Ca

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00590.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:There was a controversy regarding the effectiveness of balloon pulmonary valvuloplasty as palliation in tetralogy of Fallot.Objective:To report our experience of the procedure, review literature, and discuss feasibility of the procedure.Patients:Seven consecutive patients were examined. Their ages ranged from 1—26 months (mean 12.3 months) and the male to female ratio was 5:2. One of the seven patients had. Down syndrome with tricuspid valve straddling. Hypoxic spells had been observed and β blackers had been given in three of the seven patients before dilation.Methods:A standard technique of balloon pulmonary valvuloplasty was used as previously described. The size of balloon diameter was selected as I20%‐140% larger than the diameter of pulmonary valve annulus. The changes in oxygen saturation level, clinical symptoms, and sizes of pulmonary artery and annulus were examined before and after the dilation and follow‐up.Results:One patient who had had a severe pulmonary stenosis associated with tetralogy of Fallot died of ductal shock during the catheter manipulation. The angioplasty catheter could not be crossed in this patient. Cyanosis was improved in all remaining six patients after the procedure. Hypoxic spells ceased in three patients and withdrawal of propranolol was possible in two patients. The oxygen saturation increased significantly from 74%± 10% to 79%± 8% (P<0.005) immediately after the procedure. In follow‐up angiographies, the values of pulmonary artery index and valve annulus were not significantly increased compared with those, before, dilation. Only two patients had significant increase of pulmonary artery and annulus sizes during follow‐up periods, and consequently, successfully underwent total correction without systemic to pulmonary shunt operation.Conclusion:Balloon pulmonary valvuloplasty is an effective alternative for relief of deep cyanosis and hypoxic spells during short‐term periods, but is not always effective in terms of long‐term growth of the pulmonary artery and annulus. (J Interven Card

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00591.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:The current use of collagen vascular hemostasis devices to percutaneously seal femoral arteriotomy sites is limited by a significant incidence of vascular complications. The purpose of the present study was to assess the efficacy of new collagen plug specifically designed to avoid these complications by accurately gauging the depth of the femoral artery and by minimizing the risk of intra‐arterial collagen deployment.Methods:The hemostasis device used in this study consists of a multicomponent collagen plug with an external rigid collagen tube lined by an inner layer of absorptive sponge collagen. Placement of this plug is facilitated with a specialized two‐lumen dilator, which localizes the arterial surface using a “bleedback” mechanism from one of the lumens, and prevents the placement of collagen through the arteriotomy site. The acute efficacy of this device was assessed in 26 adult dogs in which 36 collagen plugs were used to seal 8Fr femoral arteriotomies. An additional 16 arteriotomies treated with standard manual compression served as study controls. Following plug placement or manual compression, all puncture sites were observed for bleeding and hematoma formation over a 45‐minute period. Patency of each instrumented artery was assessed with serial femoral angiography and localization of each plug was confirmed with surgical cutdown at the puncture site. The chronic efficacy of this device was assessed in three pigs in which three collagen plugs were used to seal 8Fr femoral arteriotomies. The three animals were subsequently sacrificed at 7,14, and 30 days, respectively, for histologic analysis. Results:In acute animals, all 36 plugs were successfully placed without evidence of vascular compromise or intra‐arterial collagen deployment. In nonanticoagulated animals, hemostasis was achieved within 5 minutes in 10 of 10 plugs placed with a skin‐to‐arlery distance>1.8 cm, in 4 of 7 plugs with a skin‐to‐artery distance of 1.2–1.7 cm, and in 0 of 9 plugs with a skin‐to‐artery distance100 seconds. Time to hemostasis was significantly less for collagen plugs than manual compression in both nonanticoagulated animals (plug 17 ± 16 minutes; manual compression 28 ± 5 minutes; P<0.03) and anticoagulated animals (plug 6 ± 2 minutes; manual compression 42 ± 4 minutes; P1.8 cm and the anticoagulation profile was not excessive. At 1 month postplacement, there is no histologic difference between plug use and standard manual compre

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00592.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Atrial flutter is a reentrant tachycardia that originates in the right atrium. The wave front of atrial flutter travels craniocaudally along the anterolateral wall of the right atrium, surrounds the inferior vena cava, and crosses the region between this structure and the tricuspid ring before closing the. circuit after upward septal propagation. The area located between the tricuspid annulus and the inferior vena cava has been proposed as an ideal target for ablation because it appears to be an isthmus that is an obligatory route for closing the inferior part of the arrhythmia circuit. Various publications dealing with radiofrequency ablation of this tachycardia have dealt with different approaches, and a wide range of acute and chronic success rates have been reported. The main difficulty in interpreting the results of this series is the lack of a carefully defined patient selection, technique description, and follow‐up protocol. In almost all of these series it clearly appears that a significant number of late flutter recurrences occur in these patients, in addition to the emergence of previously unknown atrial fibrillation. Many recent reports, where ablation has been targeted at the inferior vena cava‐tricuspid annulus isthmus, have shown a high rate of acute, success. In our experience, the procedure seems to be facilitated by the use of extra large tip (8‐mm) ablation catheters that allow the use of higher power outputs. Careful mapping of the ablation site has shown that creation of complete bidirectional block at the isthmus is important for prevention of late recurrences. Further technological improvements should aim at developing energy delivery systems that allow controlled destruction of wide areas of the atrial myocardium. (J Interven Cardiol 1996;9:

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00593.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives:To evaluate the expansion ratio of a self‐expanding stem over time, and the chronic effect of stent pressure on the vessel wall. Methods:Self‐expanding stents, developed by Medtronic Inc. (Minneapolis, MN, USA) and the Rouen group (Letac, Cribier, France), were implanted in 21 normal pig coronary arteries. Animals were sacrificed after recatheterization at 1 day (group I, n = 4), I week (group 2, n = 3), 3 weeks (group 3, n = 5), or 8 weeks (group 4, n = 4). Histological morphometry of the vessel medial and neointimal layers was performed. Changes were related to the, stent diameter and. its force on the vessel wall. Results:The stent expansion ratio gradually increased from 73% to 93% after 8 weeks, which implicates that radial force decreased concomitantly from 0.10 N to 0.03 N. Media compression under the rods ranged from 4l%‐66% immediately after stent implantation. The mean compression was unrelated to stent expansion and remained nearly the same (40%‐50%) during follow‐up. Individual media rod compression ranged from 5%‐95%. The neointimal layer on top of the rods increased until the third week after stent implant (neointimal thickness 211 ± 108 μm). The layer significantly decreased at 8 weeks (neointimal thickness 65 ± 9 μm). The cross‐sectional neointimal area increased gradually only at the end of the stent during the 8‐week follow‐up. Conclusions:The self‐expanding stent implanted in normal pig coronary arteries reached a gradual relaxation state 8 weeks after implantation due to the persistent radial force. This radial force induces medial wall compression, which was only positively related to the thickness of the neointimal layer at 3 weeks after implant. (J Interv

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00594.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Balloon wrapping is a new phenomenon that has been described with the introduction of balloon‐on‐a‐wire devices. The ACETM balloon catheter is one such second‐generation device. There have been no reports of balloon wrapping or twisting with this fixed wire catheter. This article describes a patient who developed balloon wrapping in the course of percutaneous transluminal coronary angioplasty through a 5.2Fr Cordis diagnostic catheter, during multilesion dilatation in a small and tortuous left anterior descending coronary artery. The causative mechanisms, as well as alternative approaches for dealing with such a similar scenario in future are discussed. (J Interven Cardiol 1996;

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00595.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The literature is scarce regarding the management of ischemia due to disease of the nondominant right coronary artery (NDRCA). We describe two patients who suffered from myocardial ischemia due to significant disease of the NDRCA. Both were managed with balloon angioplasty. Disease of the NDRCA can be a source of ischemia and should be dealt with like other coronary vessels. (J Interven Cardiol 1996;9:59–6

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00596.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

An 84‐year‐old woman experienced an acute anterior wall myocardial infarction complicated by cardiogenic shock. Coronary angiography demonstrated a subtotal occlusion of the proximal left anterior descending artery. Conventional percutaneous transluminal coronary angioplasty, including a 15‐minute perfusion balloon dilatation resulted in a persistent intraluminal filling defect with high grade stenosis and ongoing ischemia and hypotension. Coronary splinting was performed, using an autoperfusion balloon to achieve a 6‐hour dilatation of the vessel in conjunction with balloon aortic counterpulsation. The patient remained hemodynamically stable during this lengthy dilatation without ECG evidence of ischemia. Angiography postdilatation demonstrated a minor residual stenosis with no evidence of intraluminal thrombus. The patient was discharged 8 days later without congestive heart failure. Follow‐up at 3 months demonstrated normal left ventricular function with no evidence of anterior wall infarction or ischemia by thallium imaging. (J Interven Cardiol 199

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1996.tb00597.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY