ISSN:0098-6569    

DOI:10.1002/ccd.1810250102

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

年代:1992

数据来源: WILEY

摘要:

AbstractBalloon aortic valvuloplasty (BAV) was performed in 219 elderly patients with aortic stenosis between December 1985 and April 1990. Forty‐three patients underwent repeat BAV for symptomatic restenosis of the aortic valve 13±8 mo following initial BAV. To evaluate the outcome following initial and repeat BAV, hemodynamic results were analyzed according to the following subgroups: BAV 1‐initial BAV for all patients (n = 219); BAV 1/1‐initial BAV in those who had only one BAV (n = 176); BAV 1/2‐the initial BAV in those who had repeat BAV (n = 43); and BAV 2‐repeat BAV (n = 43).The mean age of patients undergoing BAV 2 was 82±6 yr compared to 78±10 yr for all patients undergoing BAV 1 (p = .01). At the time of BAV 1 there was no difference in baseline or post‐valvuloplasty aortic valve area (AVA) or peak aortic valve gradient (AVG) for patients having BAV 1/1 compared to those having BAV 1/2. However, for patients having repeat BAV, although the magnitude of the hemodynamic improvement of BAV 1/2 (AVA increased from 0.6 to 0.9 cm2, AVG decreased from 65 to 34 mm Hg, p<.001) was similar to the magnitude of the hemodynamic improvement of BAV 2 (AVA increased from 0.5 to 0.8 cm2, AVG decreased from 65 to 34 mm Hg, p<.001), the baseline AVA (0.5 cm2at BAV 2 vs. 0.6 at BAV 1/2) and the post‐valvuloplasty AVA (0.8 cm2at BAV 2 vs. 0.9 at BAV 1/2) were significantly smaller (p<.004). There were no major complications in patients undergoing repeat BAV. Median event‐free survival was 12 mo after initial BAV and 8 mo after repeat BAV (p = .09).In conclusion, repeat BAV results in similar immediate hemodynamic improvement and event‐free survival compared to initial BAV. However, baseline aortic valve area and gradient prior to repeat BAV are significantly worse than those prior to initial BAV, suggesting that balloon‐induced injury to the aortic valve may offer only a temporary hiatus from the natural hist

ISSN:0098-6569    

DOI:10.1002/ccd.1810250103

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

年代:1992

数据来源: WILEY

摘要:

AbstractCoronary angioplasty of chronic total occlusions is known to have a lower success rate and higher frequency of restenosis than angioplasty of subtotal stenoses, but there are no data describing the additional time, resources, and radiation exposure associated with this procedure. The purpose of this study was to compare these features in 90 consecutive patients who underwent angioplasty of a total occlusion (group 1) to those of 100 consecutive patients who underwent angioplasty of a subtotal stenosis (group 2). Angioplasty was successful in 60% of group 1 and in 94% of group 2 patients. Procedures were longer in group 1 and significantly more guide catheters, angioplasty balloon catheters, and guide wires were required per patient compared to group 2. The volume of contrast media used in each group was similar. Estimates of radiation entry exposure, calculated from fluoroscopy exposure times and using data from phantom studies, were 53 R (roentgen) per patient in group 1 vs. 34 R in group 2. These procedures were performed using pulsed progressive fluoroscopy; radiation exposure would be considerably higher using conventional fluoroscopic systems. Cineangiographic radiation exposures were similar for each group and accounted for an average additional exposure of 14–22 R for each procedure. Total radiation exposure was reduced in both groups when the angioplasty procedure was combined with the diagnostic angiogram. These observations should be considered when dilation of a total occlusion is planned. Efforts to reduce the amount of radiation exposure should remain a priority in interventional catheterization laboratorie

ISSN:0098-6569    

DOI:10.1002/ccd.1810250104

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

年代:1992

数据来源: WILEY

摘要:

AbstractTwenty‐three children with cyanotic congenital heart defects, aged 3 days to 11.5 years, weighing 2.9 to 30 kg, underwent percutaneous balloon pulmonary valvuloplasty to improve pulmonary oligemia. The patients were divided into two groups: group I with intact ventricular septum and group II with ventricular septal defect. In 12 group I patients, there was an increase of systemic arterial oxygen saturation [83 ± 8% (mean ± SD) vs. 94 ± 5%, P<0.001] and pulmonary‐to‐systemic flow ratio (0.7 ± 0.1 vs. 1.0 ± 0.2, P0.001) from 105 ± 48 to 25 ± 18 mm Hg. In 11 group II patients, arterial oxygen saturation (67 ± 13 vs. 83 ± 13%, P<0.01) and pulmonary‐to‐systemic flow ratio (0.7 ± 0.4 vs. 1.2 ± 0.5, P<0.02) increased following valvuloplasty. Peak systolic pressure gradient across the pul‐monic valve (52 ± 16 vs. 32 ± 22 mm Hg, P0.1). Immediate surgical intervention was avoided in all cases in both groups. On follow‐up, 1 to 36 months after valvuloplasty, arterial oxygen saturation, pulmonary‐to‐systemic flow ratio, and pulmonary valve gradients remain improved in both groups. However, in group I, repeat balloon valvuloplasty was required in two children. In group II, six children with tetralogy of Fallot (TOF) underwent successful total surgical correction 4 months to 2 years after valvuloplasty. Two children with transposition of the great arteries required Blalock‐Taussig shunts 6 and 18 months after valvuloplasty for further improvement of hypoxemia. Demonstrable increase in pulmonary artery diameter occurred in several children. These data suggest that pulmonary valvuloplasty offers an excellent relief of pulmonary valve obstruction in the intact ventricular septum group and palliation of pulmonary oligemia in the ventricular septal defect group. In the latter group, avoiding immediate surgical shunts in all patients and achieving growth in pulmonary arterial size in many patients, thus making them suitable for further surgical palliation or corre

ISSN:0098-6569    

DOI:10.1002/ccd.1810250105

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

年代:1992

数据来源: WILEY

摘要:

AbstractOne hundred consecutive patients had fasting lipids and percutaneous fat biopsy performed at the time of percutaneous transluminal coronary angioplasty to determine if there was an association between restenosis and lipids or fatty acids. Angiographic follow‐up and complete lipid and fatty acid results were available in 82 patients. Restenosis occurred in 37/82 (45%). Total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, and apolipoproteins A1 and B were not associated with restenosis. There was a significantly lower level of the monounsaturated fat palmitoleic acid (p<0.02), a trend towards a lower level of the monounsaturated fat oleic acid (p<0.09), and a trend towards a higher level of the saturated fat plamitic acid (p<0.08) in the restenosis group. The polyunsaturated fatty acids were not associated with restenosis.We conclude that lipids are not significantly associated with restenosis, and that lower levels of monounsaturated fatty acids may increase the risk of restenosi

ISSN:0098-6569    

DOI:10.1002/ccd.1810250106

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

年代:1992

数据来源: WILEY

摘要:

AbstractTo compare discomfort caused by ioxaglate and iopamidol, 25 patients scheduled for coronary angiography including internal mammary arteriography were studied. Each patient received both agents. Data were available on 22 randomly selected patients who completed the protocol. Two patients were withdrawn because of unsuccessful internal mammary artery cannulation and one because of idiosyncratic reaction to diazepam. After the internal mammary artery injections, the short‐ form McGill Pain Questionnaire (SF‐MPQ) was completed to evaluate the patient response. loxaglate caused significantly less discomfort than iopamidol. Word scale (WS) p<.05; visual analog scale (VAS) p<.05. We conclude that ioxaglate is much better tolerated than iopamidol in internal mammary arteriogra

ISSN:0098-6569    

DOI:10.1002/ccd.1810250107

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

年代:1992

数据来源: WILEY

摘要:

AbstractAtresia of the left main coronary artery is an extremely rare anomaly with very few cases presented in the literature. Even more uncommon are reports of successful surgical repair. This article concerns two cases of atresia of the left main coronary artery treated surgically with a favourable outcome.The two patients (a 16 year‐old boy and a 43 year‐old woman) had a different clinical presentation but identical angiographic and morphologic features. The authors examine the embryogenetic defect underlying this anomaly. The differential diagnosis involves two congenital malformations (single coronary artery and anomalous origin of the left coronary artery from the pulmonary trunk) and acquired atherosclerotic disease of the left main coronary artery; the distinguishing features of these conditions are reviewed.Surgical management by means of internal mammary artery revascularization is discussed in light of recent reports about adequacy of blood flow in internal mammary artery bypass gra

ISSN:0098-6569    

DOI:10.1002/ccd.1810250108

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

年代:1992

数据来源: WILEY

摘要:

AbstractAngioplasty of right internal mammary artery grafts may present problems because of the variable origin of the mammary artery and its angulation from the subclavian artery. We report a case of successful angioplasty using a custom designed guide catheter, after failed attempts using conventional guide catheters.

ISSN:0098-6569    

DOI:10.1002/ccd.1810250109

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

年代:1992

数据来源: WILEY

摘要:

AbstractAngled angiographic views demonstrated two areas of significant systolic narrowing in an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of Valsalva: (1) an ostial stenosis due to kinking as the anomalous artery turned sharply to the right after its origin from the aorta; (2) compression of the proximal segment as it coursed between the aorta and pulmonary artery. Appropriate angiographic studies to evaluate the presence of these changes may help to elucidate their significance.

ISSN:0098-6569    

DOI:10.1002/ccd.1810250110

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

年代:1992

数据来源: WILEY

摘要:

AbstractA 0.038 inch perfusion wire was used to selectively administer a 24‐hr infusion of urokinase into the occluded saphenous vein bypass graft of a 69‐yr‐old woman. Immediately following subsequent reperfusion by balloon angioplasty, she developed a hemorrhagic myocardial infar

ISSN:0098-6569    

DOI:10.1002/ccd.1810250111

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

年代:1992

数据来源: WILEY