ISSN:0098-6569    

DOI:10.1002/ccd.1810190102

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

年代:1990

数据来源: WILEY

摘要:

AbstractVentricular fibrillation during coronary angiography with Renografin‐76 has been attributed to the high osmolar ionic and calcium binding additive properties. Isovue‐370 is a new low osmolar nonionic contrast medium lacking calcium binding additives. The present investigation compared the incidence of contrast media‐induced ventricular fibrillation in patients undergoing coronary angiography with Renografin‐76 to that with Isovue‐370. Group I consisted of 2,000 consecutive patients undergoing coronary angiography with Renografin‐76, and group II consisted of 2,000 subsequent consecutive patients in whom lsovue‐370 was employed as the contrast medium. There was no significant difference between groups I and II with respect to volume of contrast media used per patient (125 ± 35 vs. 140 ± 45 ml), age (63.5 ± 15 vs. 60 ± 17 years), sex (74% male vs. 76% male), ejection fraction (55% vs. 55%), valvular heart disease (8% vs. 9%), prior coronary artery bypass graft surgery (5.8% vs. 5%), or extent of coronary artery disease. Contrast media‐induced ventricular fibrillation occurred in 20 patients in group I (incidence 1%), whereas eight episodes occurred in group II (incidence 0.4%) (P<0.03). Thus the present investigation suggests that the incidence of ventricular fibrillation during coronary angiography can be significantly decreased by using low osmolar nonionic contrast media lacking calciu

ISSN:0098-6569    

DOI:10.1002/ccd.1810190103

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

年代:1990

数据来源: WILEY

摘要:

AbstractCardiac arrest in the catheterization laboratory is fatal if unresponsive to advanced cardiac life support (ACLS). Seven patients not responding to ACLS following cardiac arrest in the catheterization laboratory underwent percutaneously instituted cardiopulmonary bypass support. Cardiac arrest occurred following abrupt closure postcoronary angioplasty in three patients, during cardiogenic shock in three patients, and during diagnostic angiography in one patient. Cardiopulmonary bypass was instituted 10–45 min (mean, 21 min) following the onset of cardiac arrest. Flows on bypass ranged from 4.0 to 5.2 liter/min. Mean blood pressure ranged from 70 to 110 mm Hg on bypass. Six of the seven patients regained consciousness after the institution of bypass. Acid‐base balance was normalized in all patients. Coronary bypass surgery was subsequently performed in three patients and coronary angioplasty in two. Four patients survived. One patient died following coronary bypass surgery. Two patients, who were not suitable candidates for revascularization, expired. Total bypass time was 1.5–8.5 hr (mean, 2.7 hr). At a mean follow‐up of 6 months, all four survivors are alive and asymptomatic or NYHA class 1. We conclude that cardiopulmonary bypass support 1) can stabilize patients following cardiac arrest in the catheterization laboratory, 2) can facilitate emergency coronary angioplasty or transfer to the operating room for coronary bypass surgery, and (3) can improve survival in patients unresponsive to ACLS when instituted early following cardiac arrest in the catheterization lab

ISSN:0098-6569    

DOI:10.1002/ccd.1810190104

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

年代:1990

数据来源: WILEY

摘要:

AbstractIn preparation for coronary bypass surgery, digital subtraction angiography (DSA) was used to assess the caliber of the left and right internal mammary arteries and to exclude stenoses of their feeding arteries. In 100 patients (86 males, mean age 56 ± 9 years) DSA was performed with a Siemens Digitron 2 device. A frontal projection was used in 18 patients, and a 10–20 degree right anterior oblique projection was used in 82 patients. The flow was 10 to 25 ml/sec; 20 ml was injected in 45 patients, 30 ml in 41, 40 ml in 5, 50ml in 8, and 60 ml in 1 patient, Judged on the proximal third, visualization of the left and the right internal mammary artery was good in 80 and 72, fair in 17 and 20, and bad in 3 and 8 arteries, respectively. The diameter (mm) was 2.7 ± 0.4 (range 1.8–3.4) and 2.7 ± 0.3 (range 2.0–3.5), and visible length (cm) was 8 ± 5 (range 1–24) and 9 ± 4 (range 2–22) for the two arteries, respectively. The 10–20 degree right anterior oblique view separated the left internal mammary artery better from the descending aorta than the frontal view. In more pronounced right anterior oblique views the ascending aorta interfered with the right internal mammary artery. The quality was not different with 20 ml or 30 ml injections. The feeding arteries could not be assessed in 4 patients. One left subclavian artery was found occluded at the orifice. Incidentally, 2 distal right subclavian stenoses and 2 carotid stenoses were detected. In conclusion, DSA with 20 ml (10 ml/sec) of contrast medium, injected into the ascending aorta in a 15 degree right anterior oblique view, sufficiently visualizes the internal mammary arteries and their feeding vessels before bypass surgery in most patients. Any catheter inserted for coronary or left ventricular angiogr

ISSN:0098-6569    

DOI:10.1002/ccd.1810190105

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

年代:1990

数据来源: WILEY

摘要:

AbstractIn order to determine the relationship of restenosis following percutaneous transluminal coronary angioplasty (PTCA) to risk factors such as hypercholesterolemia, hyperglycemia, smoking, and weight, we performed a univariate analysis to test the association of these variables with restenosis in 723 patients who had percutaneous transluminal coronary angioplasty and follow‐up catheterization.Cholesterol levels were higher in younger and female subjects (<0.0001). Initial cholesterol did not predict restenosis, and follow‐up cholesterol levels showed an inverse relationship with restenosis (P<.02). There was a trend (P<.09) toward decreased restenosis in those who were active smokers at the time of follow‐up catheterization. No differences were seen in diabetics with hyperglycemia, in both treated and untreated groups (P= NS). A stepwise multiple logistic regression was used to simultaneously test the association of the above risk factor variables to restenosis. None of the interactions were found to be significant, except cholesterol at follow‐up (P=.001).Therefore, the status of serum cholesterol, blood sugar, smoking, and weight during the time of PTCA and at follow‐up catheterization may be unimportant in predicting restenosis. Thus, we conclude 1) that to better determine the effect of these variables on restenosis, they should be estimated at times other than follow‐up and 2) that the pathophysiological mechanism of restenosis may have different risk factors than progression of atherosclerotic coronary art

ISSN:0098-6569    

DOI:10.1002/ccd.1810190106

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

年代:1990

数据来源: WILEY

摘要:

AbstractWe report a case of balloon catheter rupture with subsequent entrapment during percutaneous transluminal coronary angioplasty. The presence of a calcified, distal lesion is believed to have prevented withdrawal of the broken catheter. A nonsurgical retrieval technique, using a second dilation system, was used to free the catheter.

ISSN:0098-6569    

DOI:10.1002/ccd.1810190107

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

年代:1990

数据来源: WILEY

摘要:

AbstractThree cases of coronary angioplasty balloon rupture complicated by coronary artery dissection are described. Factors that may predispose to this previously undescribed and potentially devastating complication are discussed.

ISSN:0098-6569    

DOI:10.1002/ccd.1810190108

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

年代:1990

数据来源: WILEY

摘要:

AbstractDuring percutaneous transluminal coronary angioplasty, the appearance of persistent staining in the vessel by contrast media suggests coronary dissection. We report seven patients in whom a false image of severe coronary dissection was observed during angioplasty performed with the new Monorail balloon catheter. This image emerges at the moment of balloon inflation, is distally located to the balloon, and disappears with balloon catheter deflation. No complications were associated with the appearance of this image.

ISSN:0098-6569    

DOI:10.1002/ccd.1810190109

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

年代:1990

数据来源: WILEY

摘要:

AbstractRevascularization by angioplasty of total coronary artery occlusions is generally thought to be relatively safe in experienced hands. Although success rates are lower than with diseased but patent vessels, reasonable success can be expected. In this report, different events led to a sudden and fatal outcome in two patients with total coronary occlusions subtending recently infarcted, but still viable, areas of myocardium. The cases and procedural details are presented.

ISSN:0098-6569    

DOI:10.1002/ccd.1810190110

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

年代:1990

数据来源: WILEY

摘要:

AbstractA 62‐year‐old woman with disabling mitral prosthetic stenosis underwent percutaneous balloon valvuloplasty. The transvalvular gradient preoperatively was 22 mm Hg and was reduced to 6 mm Hg after the valvuloplasty. The valve area was increased from an initial value of 0.77 cm2to 1.53 cm2. No complications occurred related to the procedure. Further studies are necessary to ascertain the indications and long‐term results of percutaneous valvuloplasty on bioprosthesis in the mitral pos

ISSN:0098-6569    

DOI:10.1002/ccd.1810190111

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

年代:1990

数据来源: WILEY