摘要:

AbstractWe report the immediate results and 6 month follow‐up data of 494 consecutive patients who underwent coronary angioplasty in two or more major epicardial arteries. Clinical success was achieved in 95% of the 494 patients. The technical success rate for the 1,117 vessels dilated was 89%, defined as at least a 35% reduction (mean = 53%) of the initial percent diameter stenosis and a decrease in the transstenotic gradient to ≤15 mmHg (mean = 9 mmHg). Complications of the procedure included emergency bypass surgery (2.8%), myocardial infarction (3.0%), and hospital death (0.4%) inclusive. At least one of these complications (major cardiac event) occurred in 3.8% of patients. Prior to angioplasty, 46% of patients were in Canadian Cardiovascular Society Class II, 42% in Class III, and 12% in Class IV. Follow‐up clinical evaluation (mean follow‐up period of 16.9 months) showed 83% of patients in Class I, 14% in Class II, and 3% in Class III. Of the 286 successful patients who have reached 6 month follow‐up plateau (mean follow‐up period of 20.5 months), 164 (57%) have so far had repeat coronary angiography and exhibited three different patterns: all lesions patent (N = 54), some lesions restenosed (N = 60), and all lesions restenosed (N = 32). There were 18 patients with new vessel lesions (not previously dilated). Logistic regression analyses demonstrated that clinical factors including diabetes (P<.05), hypercholesterolemia, (P<.01), new onset angina (P<.05), current smoking (P95% (P<.05) and higher balloon inflation pressure (P<.05) were predictive of increased risk of recurrence. Patients were classified into two groups based on the anatomy of the target lesions. In Group A (N = 217), patients had a single lesion in each of the vessels to be dilated; Group B (N = 277) patients had a complex lesion in at least one of the vessels dilated. Group B patients were more likely to develop recurrence (P<.05). Of the original 494 patients, 488 (99%) are alive. Coronary angioplasty (either initially or with repeat PTCA) has been the definitive treatment in 453 of the 494 patients for an overall success of 92%. Thus multiple vessel coronary agioplasty can be performed effectively with a high angioplasty success rate and relatively low complication rate and excellent clinical prognosis. Patterns of restenosis appear to be related to clinical, morphologic, and techni

ISSN:0098-6569    

DOI:10.1002/ccd.1810130102

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

年代:1987

数据来源: WILEY

摘要:

AbstractThe duration of effective anticoagulation with heparin during cardiac catheterization and angiography was determined in 201 patients. Effective anticoagulation was defined as prolongation of the activated partial thromboplastin time (APTT) by 2 or more times the upper limit of normal. When the procedure was completed within 40 min of heparin administration, all patients were anticoagulated adequately. The incidence of inadequate anticoagulation ranged from 9% to 25% as the time from heparin administration increased to 89 min. Procedures completed more than 90 min after heparin administration had a 58% incidence of inadequate anticoagulation. A protocol to estimate the appropriate protamine dose was developed based on experience accumulated in the first 78 patients and tested subsequently in 101 consecutive patients. Clotting studies returned to the normal range in 92% of the patients. The mean APTT decreased from 84.1 ± 19.4 to 27.4 ± 2.5 sec (p<.001) after protamine. Patients who did not correct to normal after protamine remained only 2.8 ± 1.4 sec (range 0.7–;–;5.5 sec) above normal. These data provide an estimate of the duration of anticoagulation during cardiac catheterization and angiography and demonstrate the feasibility of a simple and reliable method to reverse the effects of h

ISSN:0098-6569    

DOI:10.1002/ccd.1810130103

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

年代:1987

数据来源: WILEY

摘要:

AbstractAbnormal vascularity in the region of the left atrial appendage was demonstrated by coronary arteriography in 5 patients with mitral stenosis. Subsequently, three of these patients proceeded to operation, and left atrial thrombi were confirmed in all three cases. Neovascularity must be differentiated from congenital fistulae, tumours, and coronary artery disease. Thrombus in the left atrial appendage is difficult to diagnose even with the use of cross‐sectional echocardiography and may occasionally be demonstrated by coronary arteriograph

ISSN:0098-6569    

DOI:10.1002/ccd.1810130104

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

年代:1987

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810130105

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

年代:1987

数据来源: WILEY

摘要:

AbstractA new technique was used to dilate sequentially a bifurcation lesion involving the left anterior descending artery and the origin of a large septal branch. Two steerable long guide wires (300 cm) were advanced through a single guiding catheter and placed across each lesion. The balloon catheters were introduced into the target arteries for angioplasty one at a time over the pre‐positioned guide wires. After the septal branch had been successfully dilated, the balloon catheter was completely withdrawn from the manifold and a second balloon catheter positioned in the left anterior descending artery over the guide wire already placed across the stenosis. Such a technique is feasible and safe, and overcomes the potential risks of the conventional kissing balloon techniqu

ISSN:0098-6569    

DOI:10.1002/ccd.1810130106

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

年代:1987

数据来源: WILEY

摘要:

AbstractCoronary air embolism may go unnoticed or cause chest pain, electrocardiogram changes, and myocardial damage; it may mimic coronary spasm [1,2]. We report a patient who sustained subendocardial myocardial infarction following intracoronary injection of air.

ISSN:0098-6569    

DOI:10.1002/ccd.1810130107

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

年代:1987

数据来源: WILEY

摘要:

AbstractA patient is described in whom a left atrial catheter was inadvertently wedged in a pulmonary vein following mitral valve replacement. The pulmonary vein wedge pressure obtained approximated the pulmonary artery pressure and was suggestive of paraprosthetic mitral valve regurgitation.

ISSN:0098-6569    

DOI:10.1002/ccd.1810130108

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

年代:1987

数据来源: WILEY

摘要:

AbstractTwo cases are described of percutaneous removel of trapped, broken steerable PTCA guidewire. One case described breakage of a guidewire inside the ascending aorta leaving a free end, which is retrieved using the snare loop technique. The second case described retrieval of an intact yet unwound wire through the guiding catheter using a snare loop wire.

ISSN:0098-6569    

DOI:10.1002/ccd.1810130109

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

年代:1987

数据来源: WILEY

摘要:

AbstractPercutaneous transluminal coronary angioplasty (PTCA) is recognized as an effective therapeutic procedure for nonsurgical relief of critical coronary stenosis. However, this procedure has the inherent traumatic risk of thromboembolic phenomenon in treated patients. This paper describes a hiterto unreported complication. In two patients a thrombus appeared in the ascending aorta during PTCA performed in the left anterior descending artery (LAD). Mechanisms involved are postulated. It is emphasized that particular attention should be paid to the lateral view in dilatation to treat LAD lesion, especially if the procedure is prolonged.

ISSN:0098-6569    

DOI:10.1002/ccd.1810130110

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

年代:1987

数据来源: WILEY

摘要:

AbstractIn a 52‐year‐old man with severe chest pain of 3 hours duration and ST‐segment elevation in leads V1 and V2, a nondominant right coronary artery was recanalized by an intracoronary infusion of urokinase. Coronary cineangiography revealed a total occlusion of the nondominant right coronary artery and no significant narrowing of the left coronary artery. Hemodynamic studies during the acute phase of myocardial infarction demonstrated an increase of right atrial mean pressure in association with normal pulmonary capillary wedge pressure. Following the recanalization, chest pain disappeared and hemodynamic alterations were corrected. The purpose of this report is to document a case of isolated right ventricular infarction due to a nondominant right coronary artery occl

ISSN:0098-6569    

DOI:10.1002/ccd.1810130111

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

年代:1987

数据来源: WILEY