摘要:

AbstractA discrete fall in the ACT (activated coagulation time) has been observed in patients with known activation of the coagulation cascade. Injury to the coronary artery resulting in thrombin activation, whether spontaneous as in the case of acute myocardial infarction or planned as with percutaneous transluminal coronary angioplasty (PTCA), may there‐fore be reflected in a change in ACT values. We reviewed the records of patients under‐going PTCA at St. Luke's Episcopal Hospital/Texas Heart Institute from January 1990 through December 1992 for information regarding ACT values and clinical events. A total of 469 patients, whose record contained adequate information for study inclusion, were divided into four separate groups: acute myocardial infarction (group I, n = 62), unstable angina with heparin therapy that was withdrawn at least 4 hr prior to PTCA (group II, n = 102), unstable angina with heparin therapy continued until the time of PTCA (group III, n = 154), and stable angina undergoing elective PTCA (group IV, n = 151). Heparin was discontinued 12–15 hr after the procedure in all but group I where anticoagulation was often maintained up to 72 hr. ACT values were measured prior to the PTCA procedure (baseline), after the initial heparin bolus of 10,000 U (postheparin) and ∼ 12–18 hr after the procedure (heparin withdrawal). The “baseline” ACT was significantly lower in patients with unstable angina (93 ± 13 sec) or acute myocardial infarction (78 ± 9 sec) who had their baseline value obtained off of heparin therapy than in patients with stable angina (136 ± 21 sec) or those receiving heparin at the time of baseline measurement (135 ± 14 sec,P<0.001). All patients with unstable coronary syndromes had a blunted response to heparin (group 1–189 sec, group II‐221 sec, group III‐248 sec). Although groups I‐III were not significantly different compared to one another, each was significantly lower than group IV whose past heparin ACT was 279 sec. Heparin withdrawal ACT values fell within the ranges seen in patients with unstable coronary syndromes untreated with heparin in all but group I (whose heparin therapy was continued through the time of the 12–18‐hr postprocedure measurement time). Recurrent ischemic events were seen with increased frequency (16.6%) only in patients with unstable angina whose heparin therapy was interrupted prior to PTCA.In conclusion, low baseline ACT values and a blunted ACT response to heparin are associated with clinical syndromes known to result from thrombus formation. The possibility that the ACT may be of value in reflecting thrombus activity re

ISSN:0098-6569    

DOI:10.1002/ccd.1810340302

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

年代:1995

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810340303

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

年代:1995

数据来源: WILEY

摘要:

AbstractThis report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids.

ISSN:0098-6569    

DOI:10.1002/ccd.1810340304

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

年代:1995

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810340305

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

年代:1995

数据来源: WILEY

摘要:

AbstractDespite expectations that excimer laser ablation would result in a low incidence of coronary dissection, studies have documented a 15–20% incidence of dissection (including a 4–6% incidence of clinically significant dissection) during excimer interventions. This investigation sought to determine if pressure pulses produced by the exposure offluid phasemedia (blood and contrast) to 308‐nm excimer radiation might contribute to unto‐ward outcomes. Pressure pulses generated in these media were quantitated to be>100 atm. In vitro ablation of porcine aorta in the presence of blood or contrast resulted in tissue dissection, while ablation in pure crystalloid did not. Next, a “flush and bathe” technique designed to replace all blood and contrast with crystalloid was applied to a pilot population of 57 consecutive patients. There were no rhythm disturbances or laserrelated clinically significant dissections in this group, and the clinical success rate was 95%. In summary, this report quantitates a potential etiology for excimer dissection and suggests that replacement of blood and contrast with crystalloid might improve procedural and clinical su

ISSN:0098-6569    

DOI:10.1002/ccd.1810340306

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

年代:1995

数据来源: WILEY

摘要:

AbstractBetween 1985 and 1992, 36 consecutive neonates, aged 1–29 days, weight 2.4–5.0 kg, with critical valvar pulmonary stenosis underwent attempted balloon dilation (BD). At catheterization, 30 were on prostaglandin (PGE1) therapy and 20 were intubated. The valve was successfully crossed and dilated in 34/36 (94%), including three with an echocardiographic diagnosis of valvar pulmonary atresia and a right ventricle of adequate size. The valve was first dilated with a 2‐ to 5‐mm balloon and then with serially larger ones (up to 12 mm) to a final balloon/annulus value of 126%. The RV/systemic pressure value fell from 150 ± 32 to 83 ± 30%, O2saturation rose from 91 ± 6% to 96 ± 4%, and PGE1was discontinued at the end of the procedure. There were 11 complications (31%) including one early death from sepsis and necrotizing enterocolitis, endocarditis in another, two myocardial perforations, one femoral‐iliac vein tear, and one transient pulse loss.A repeat BD was carried out in five patients, two of whom subsequently had surgery. At follow‐up (33 ± 23 months), the 31 patients managed by BD alone were well and had echocardiographic gradients of<30 mm Hg in 90% and pulmonary regurgitation, considered mild in most, in 52%.In neonates with critical valvar pulmonary stenosis, we believe BD mortality is less than with surgery and is the tre

ISSN:0098-6569    

DOI:10.1002/ccd.1810340307

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

年代:1995

数据来源: WILEY

摘要:

AbstractWe reviewed pre‐closure echocardiograms on all patients undergoing transcatheter atrial septal defect (ASD) closure with the Bard double‐umbrella occluder device aided by simultaneous transesophageal echocardiography to determine precatheterization predictors of outcome. Transesophageal echocardiograms were performed on 28 of 132 patients (22%) undergoing device closure (age = 3–72 years, mean = 14 years; weight = 15–68 kg, mean = 35 kg). Three devices were removed because of unstable position. Of the remaining 25 patients, 21 had effective closure (residual flow diameter ≤ 3 mm) and 18 had favorable arm position (device arm on proper side of the septum and not in contact with an atrioventricular valve leaflet).Only ASD size predicted effective closure. All patients with a maximum defect size of<13 mm had effective closure. Among the 17 patients with defects ≥ 13 mm, 10 had effective closure, 4 had significant residual flow, and 3 had devices removed for unstable position. Atrial dimensions and rim size did not predict effective closure. There were no pre‐closure predictors of favorable arm position which was associated only with the size of the dev

ISSN:0098-6569    

DOI:10.1002/ccd.1810340308

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

年代:1995

数据来源: WILEY

摘要:

AbstractSeven patients underwent attempted low pressure balloon dilation of stenotic conduits or homografts from right ventricle to pulmonary artery (n=5), in the aortic valve position (n=1), or from right atrium to left pulmonary artery (n=1). In the right ventricle to pulmonary artery group, mean gradient reduction was only 17%. At follow‐up, two patients underwent surgical conduit replacement, one had a stent implanted at cardiac catheterization, the other two are awaiting surgical intervention. The patient with a homograft in the aortic valve position had a good initial result but restenosed within 1 year and underwent a pulmonary autograft operation. The patient with the Fontan homograft stenosis had transient obstruction relief but subsequently required stent implantation. Low‐pressure balloon dilation of conduits or homografts is only partially and transiently successful. Whether stent implantation will offer better long‐term results remains to be deter

ISSN:0098-6569    

DOI:10.1002/ccd.1810340309

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

年代:1995

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810340310

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

年代:1995

数据来源: WILEY

摘要:

AbstractIn a 3060‐g infant with fibromuscular pulmonary atresia an open right ventricular outflow tract was created by means of interventional cardiological methods. Following two inadvertent perforations without sequelae or clinical symptoms, radiofrequency perforation and subsequent balloon dilatation were successfully performed. The implantation of a Palmaz iliac stent led to a predictable communication between the right ventricle and pulmonary arter

ISSN:0098-6569    

DOI:10.1002/ccd.1810340311

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

年代:1995

数据来源: WILEY