摘要:

AbstractIntracoronary papaverine is used as a means to induce a strong and short‐lasting hyperemia in several recently developed methods to measure coronary flow reserve. Changes in stenosis geometry from papaverine would influence the measured coronary flow reserve. Therefore, we investigated the influence of intracoronary papaverine on stenosis geometry with quantitative analysis of the coronary angiogram and assessed the influence of papaverine on pressure‐flow characteristics of the stenosis and coronary flow reserve. The cross‐sectional areas (mean ± SD) of the stenosis increased 18% ± 7% after papaverine. The normal proximal and distal parts of the coronary artery dilated 5% ± 2% after papaverine. This results in a decrease of the calculated pressure drop over the stenosis varying from 20% to 30%. Coronary flow reserve of a flowlimiting epicardial stenosis is overestimated by 16% when papaverine is used to induce hyperemia. These papaverine‐induced changes can nevertheless be circumvented by maximal vasodilation of the major epicardial coronary artery with 3 mg intracoronary isosorbidedinitrate prior to the investigation of the coronary flow reserve with

ISSN:0098-6569    

DOI:10.1002/ccd.1810140102

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

年代:1988

数据来源: WILEY

摘要:

AbstractIntracoronary nitroglycerin is frequently administered during invasive procedures such as coronary angioplasty or thrombolysis which may be associated with pain and sympathetic neural stimulation. Whether sympathetic‐mediated reflex vasoconstriction interferes with nitroglycerin‐induced augmentation of coronary blood flow is unknown. Therefore, coronary and systemic hemodynamics were measured in 19 patients during isometric handgrip exercise (3 min × 25% maximal effort), during intracoronary nitroglycerin, and during handgrip plus intracoronary nitroglycerin. Nine patients had no significant left anterior descending coronary artery stenosis (group 1) and ten patients had>70% left anterior descending coronary artery stenosis (group 2). Handgrip exercise increased heart rate, mean arterial pressure, and coronary sinus and great vein flow 15% while increasing coronary resistance 10%. Intracoronary nitroglycerin (200 μg) reduced mean arterial pressure ‐ 4 ± 6% and increased great cardiac vein flow 35–72%. Anterior left ventricular regional coronary flow responses to intracoronary nitroglycerin were unaffected by sympathetic stimulation for group 1. Group 2 had a greater increase in great vein flow with intracoronary nitroglycerin plus handgrip compared to nitroglycerin alone due to increased mean arterial pressure with no change in the great vein resistance. These data indicate that sympathetic stimulation does not alter the nitroglycerin‐induced augmentation of coronary sinus and great vein blood flow in patients with and without significant left anterior descending coronary artery stenosis. In patients undergoing invasive interventions who may have increased circulating catecholamines, mild sympathetic (isometric) stimulation does not appear to interfere with the coronary vasodilatory responses to intracoronary n

ISSN:0098-6569    

DOI:10.1002/ccd.1810140103

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

年代:1988

数据来源: WILEY

摘要:

AbstractThe purpose of this study was to assess the results of percutaneous transluminal coronary angioplasty (PTCA) in 469 consecutive patients with unstable angina pectoris refractory to medical therapy. The primary success rate was 88%, but, since the introduction of the steerable wire system, the success rate has increased to 90%. Mortality was 1%. There were no statistically significant differences in success rates per vessel. Actuarial total 5 year survival was 94%. After 5 years, actuarially, 79% of the patients were free of events (recurrence of angina, residual myocardial infarction, re‐PTCA, coronary artery bypass surgery or death). Aortocoronary bypass surgery was performed in 9% of the 469 patients. The angiographic recurrence rate was 28%, but, of the patients who were symptom‐free and who had a follow‐up angiogram, only 3% had an angiographic recurrence, whereas 98% of the patients who did not have a repeat angiogram were symptom‐free. It is concluded that, in a selected group of patients with the clinical syndrome of unstable angina pectoris refractory to medical therapy, the long‐term clinical results are good and survival is

ISSN:0098-6569    

DOI:10.1002/ccd.1810140104

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

年代:1988

数据来源: WILEY

摘要:

AbstractThe frequency of anaphylactoid reactions to protamine sulfate was examined by reviewing the records of diabetic patients undergoing cardiac catheterization over a 5‐year period, and by prospectively monitoring diabetic patients receiving NPH insulin during the infusion of protamine sulfate.No anaphylactoid reactions were noted after protamine administration (48 ± 5 mg) in the retrospective study in either patients with prior exposure to protamine (74 catheterizations) or in diabetics with no exposure to protamine (132 catheterizations). In the prospective study, no anaphylactoid reactions were seen in the 24 NPH insulin‐dependent diabetics during the infusion of protamine sulfate (45 ± 5 mg). Five of the 42 patients (12%) from the retrospective study who underwent vascular surgery developed severe reactions to much larger doses of protamine (380 ± 118 mg).Diabetics with prior exposure to protamine sulfate do not appear to be at increased risk of anaphylactoid reaction after the administration of protamine sulfate in the dose range of<50 mg at the time of cardiac catheteri

ISSN:0098-6569    

DOI:10.1002/ccd.1810140105

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

年代:1988

数据来源: WILEY

摘要:

AbstractTo assess the effect of rapid preload reduction on left ventricular performance in nonischemic cardiomyopathy, 11 patients were studied during inferior vena caval (IVC) balloon occlusion. Five developed sustained pulsus alternans.During pulsus alternans, the strong beats demonstrated systolic performance characteristics similar to baseline values, despite a drop in both left ventricular (LV) enddiastolic diameter (66 ± 13 to 61 ± 13 mm; p<0.05) and LV end‐diastolic pressure (21 ± 8 to 9 ± 6 mmHg; p<0.05). In contrast, the weak beats demonstrated a reduction in peak systolic pressure (130 ± 36 to 109 ± 33 mmHg; p<0.02), fractional shortening (20% ± 4% to 17% ± 9%; p<0.05) and peak positive dP/dt (1,006 ± 224 to 921 ± 287 mmHg; p<0.05).Measures of diastolic performance (peak negative dP/dt, the time constant of LV relaxation, the length of diastasis, and LV end‐diastolic stress) were not different between baseline beats and the strong beats; and only LV end‐diastolic stress differed when baseline beats were compared to the weak beats.When the strong beats were compared to the weak beats during induced pulsus alternans, significant differences were observed in peak systolic pressure, peak positive dP/dt, and fractional shortening, but no differences in any measured diastolic parameter was observed. A slight difference was noted in the left ventricular end‐diastolic diameters, with the weak beat consistently beginning at a slightly smaller diameter (61 ± 13 mm vs 59 ± 13; p<0.05).In summary, these data are consistent with an augmentation and deletion of intrinsic contractile forces in association with an alternation in preload on a beat‐to‐beat basis as best describing left ventricular performance

ISSN:0098-6569    

DOI:10.1002/ccd.1810140106

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

年代:1988

数据来源: WILEY

摘要:

AbstractA 31‐year‐old black man was admitted with an acute anterior myocardial infarction 20 minutes after IV cocaine abuse. Cardiac catheterization showed a totally occluded left anterior descending artery. Intracoronary and intravenous streptokinase resulted in thrombolysis: repeat angiography showed a normal anterior descend

ISSN:0098-6569    

DOI:10.1002/ccd.1810140107

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

年代:1988

数据来源: WILEY

摘要:

AbstractTwo cases of distal right coronary artery (RCA) bifurcational stenoses involving ostia of the posterolateral (PLA) and the posterior descending (PDA) branches in patients who underwent successful coronary angioplasty using a double‐wire technique are reported. A single guiding catheter and sequential balloon inflations were utilized in one, and two guiding catheters and simultaneous balloon inflations in the other. The indications, techniques, and outcomes are describe

ISSN:0098-6569    

DOI:10.1002/ccd.1810140108

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

年代:1988

数据来源: WILEY

摘要:

AbstractAfter 10 mg nicardipine IV a patient with stable angina developed chest pain and ST‐segment depression accompanied by excessive tachycardia, low arterial blood pressure, and initially decreased coronary sinus blood flow. Measurements of arterial concentrations and cardiac exchanges of lactate, glucose, free fatty acids, glutamate, and alanine showed alterations indicative of severe ischemi

ISSN:0098-6569    

DOI:10.1002/ccd.1810140109

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

年代:1988

数据来源: WILEY

摘要:

AbstractWe describe a patient in whom a brachial arterial cutdown done at the same site for percutaneous transluminal angioplasty immediately after uncomplicated percutaneous brachial coronary arteriography revealed the percutaneous sheath in a deeper, smaller, and more lateral artery than the brachial artery, complicating placement of the guiding catheter. This case illustrates the potential hidden hazard of normal brachial artery bifurcation variants, which may be responsible for some of the potential complications encountered in percutaneous brachial artery catheterization techniques.

ISSN:0098-6569    

DOI:10.1002/ccd.1810140110

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

年代:1988

数据来源: WILEY

摘要:

AbstractWe describe a case of an angioplasty of left internal mammary artery. This case had had a recent surgery and was found to have a stenosis at the site of a surgical clip. This was successfully dilated, and the patient became asymptomatic. Follow‐up at one year revealed continual improvemen

ISSN:0098-6569    

DOI:10.1002/ccd.1810140111

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

年代:1988

数据来源: WILEY