摘要:

Prothrombin time and partial thromboplastin time tests are commonly obtained prior to cardiac catheterization but the usefulness of the tests in these patients has not been examined. The records of 1,462 consecutive patients undergoing diagnostic catheterization were reviewed. All patients had received prothrombin time and partial thromboplastin time tests. The prevalence of abnormal test values was determined. The coagulation test values were correlated with history and physical evidence of bleeding risk, and also with bleeding complications. Abnormal coagulation values were found in 72/1,462, a prevalence of 4.9%. The history and physical exam predicted 63/72 (87.5%) of abnormal values, yielding a sensitivity of 87.5%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 99.3%. The nine unpredicted abnormal values (0.6%, 9/1,462) were minimally abnormal and clinical decision making was not affected by the test result in any of the nine patients. There was no correlation between abnormal values and bleeding complications. Abnormal test values have a low prevalence in catheterization patients, 4.9% in this series, are highly predictable from history and physical exams, and in the absence of history or physical findings do not predict procedural bleeding complications. The tests should, therefore, be obtained only in a small percentage of patients, 4.3% in this series, who have an increased bleeding risk indicated by history or physical findings of anticoagulant use, excessive bleeding, liver disease, or malabsorption.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00989.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Three patients with ischemic heart disease in whom ventricular arrhythmia was thought to be the consequence of acute myocardial ischemia underwent percutaneous transluminal coronary angioplasty. This approach was not consistently successful. The mechanisms of ventricular tachyarrhythmia in ischemic heart disease and the rationale for the treatment of ventricular arrhythmia by revascularization remain unclear. The role of percutaneous transluminal coronary angioplasty needs to be defined in this context.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00990.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

During percutaneous transluminal coronary angioplasty the correct intravascular placement of an angioplasty guidewire and balloon is important especially when crossing a site of previous intimal dissection. This may be hazardous when total occlusion prevents anterograde opacification of the artery. This case illustrates the technique of retrograde opacification of the distal vessel by cross‐filling from the contralateral coronary arter

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00991.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

From 1980 to 1985, 1,179 patients underwent percutaneous transluminal coronary angioplasty (PTCA) for the first time. Of these, 92 (7.8%) underwent a second PTCA, 25 (2.1%) a third, and 5 (0.4%) a fourth PTCA of the same vessel and site of the initial stenosis. Success rates for these groups were 78%, 87%, 88%, and 100%, respectively. The left anterior descending coronary artery (LAD) was involved in 14 (56%), the right coronary artery (RCA) in 9 (36%), and the circumflex coronary artery (CX) in 2 (8%). There were no deaths or emergency surgery due to the third and fourth PTCA. Follow‐up after the last PTCA indicated symptomatic relief and an improvement in Canadian Cardiovascular Society functional class (CAHA) along with an increase in the exercise time on a standard Bruce stress test. We conclude that a third or fourth PTCA provides a safe and effective therapy for recurrent stenosi

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00992.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Percutaneous coronary laser thermal angioplasty was successfully performed on a 57‐year‐old white male with a total occlusion of the left anterior descending coronary artery. The patient was the recipient of an orthotopic heart transplant 3 years previously secondary to end‐stage heart disease due to idiopathic dilated cardiomyopathy. The lesion was reduced from 100% to 33% residual stenosis following a single 4‐second pulse of 12 W of continuous wave Nd:YAG (neodymium:yttrium‐aluminum‐garnet) laser energy delivered to a distal thermal probe. Conventional balloon angioplasty reduced the remaining stenosis to 22%, without evidence of vessel perforation, spasm, dissection, or embolization of debris. This case represents the first known use of thermal laser energy as an adjunct to conventional angioplasty for the treatment of coronary artery disease in a heart transplant recipient. Additional studies are indicated to determine the clinical role of this procedure in relation to established methods of revascularization for the treatment of accelerated transplant athe

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00993.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

With the advent of widespread use of the internal mammary artery for coronary revascularization, high quality delineation of this conduit during angiography is necessary. We describe herein a safe, easy method to selectively cannulate the internal mammary artery based on a steerable angioplasty guidewire technique.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00994.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Two patients presented with features typical of Prinzmetal's variant angina: recurrent episodes of chest discomfort at rest associated with transient ST segment elevation. Episodes of recurrent ischemia persisted despite treatment with intravenous nitroglycerin. Coronary arteriography disclosed a high grade stenotic lesion and intracoronary thrombus in both patients. Coronary spasm was not demonstrated. These observations suggest that “dynamic thrombosis” may have a more important role than heretofore recognized in some patients with Prinzmetal's variant ang

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00995.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

A world survey of 34 patients with persistent left superior vena cava who required permanent pacing is reviewed and one case of ours with dominant left superior vena cava is reported. Based on these cases, we conclude that the transvenous, rather than epicardial placement of a permanent pacemaker lead is the procedure of choice in patients with persistent left superior vena cava, with or without coexisting right superior vena cava.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00996.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00997.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00998.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY