Cathet Cardiovasc Diagn Research Articles

IMPROVED ACUTE ST-SEGMENT ELEVATION DUE TO AIR EMBOLISM AFTER CORONARY ARTERY BYPASS GRAFT PROCEDURE

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Air embolism is often an iatrogenic complication during coronary artery bypass grafting (CABG) surgery.1 Although infrequent as a complication of CABG surgery it is generally attributed to air introduced into the coronary arteries during the procedure.2 We report a case of ST-segment elevation after triple CABG surgery secondary to the introduction of air into the coronary arteries. CASE PRESENTATION: A 62-year-old male presents to the emergency department with mid-sternal chest pain, radiating to the left arm, his symptoms were associated with diaphoresis and palpitations. Initial Electrocardiogram (ECG) showed lateral ST-segment depressions, the initial troponin was elevated at 0.32 ng/ml (0.015-0.045 ng/ml). Patient underwent a left heart catheterization, which showed severe multi-vessel coronary artery disease. The decision was made to proceed with CABG. CT surgery was consulted and he underwent triple CABG with left internal mammary artery grafting to the anterior descending coronary artery, saphenous venous grafting to obtuse marginal 1 branch and saphenous venous grafting to the posterolateral branch of the right coronary artery. The anastomosis was completed with successful filling of the grafts. The aortic cross-clamp was removed, and the patient was allowed adequately to reperfuse and rewarm. Shortly after that, the patient developed ST-segment elevation in lead II, III, and aVF, along with ST depressions in lead I, aVL, V1, V2. Flow in the grafts were checked and they remained patent. Air embolization of the coronary arteries was suspected. Transthoracic echocardiogram (ECHO) demonstrated ventricular function impairment. Extended reperfusion was performed to force air from the coronaries out. The ECG showed resolution of ST-segment elevations and repeat ECHO showed improved ventricular function. The patient was monitored in the cardiovascular intensive care unit and was discharged home after four days of routine Post-CABG care. DISCUSSION: Air embolization of the coronary arteries may result as a complication of CABG as well as cardiac catheterization, leading to disruption of coronary perfusion.1 There may also be elevations of cardiac enzymes and hemodynamic instability. An extended reperfusion period with increased perfusion pressures usually causes the passing of bubbles through the coronary artery system, during the surgery.3,4 Late embolizations require urgent re-catheterization. 4 CONCLUSIONS: In conclusion, this case illustrates ST-segment elevation on ECG from an air embolism during CABG surgery. Early diagnosis and prompt treatment of this rare iatrogenic complication are crucial to prevent life-threatening cardiac complications. Reference #1: 1. Engelmann U, Minden H, Stock UA, Kühnel R, Albes JM. Late air embolism with interventional removal after isolated coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2006;131(6):1403-1404.doi:10.1016/j.jtcvs.2006.01.046 2. Khan M, Schmidt DH, Bajwa T, Shalev Y. Coronary air embolism: Incidence, severity, and suggested approaches to treatment. Cathet Cardiovasc Diagn. 1995;36(4):313-318. doi:10.1002/ccd.1810360406 3. Solodky A, Birnbaum Y, Assali A, Gal T Ben. Coronary Air Embolism Treated by Bubble Aspiration. 2000;454(October 1999):452-454. 4. Patterson MS, Kiemeneij F. Coronary air embolism treated with aspiration catheter. Heart. 2005;91(5):1-2. doi:10.1136/hrt.2005.060129 Reference #2: Figure 1. Initial Electrocardiogram. Figure 2. Post CABG Electrocardiogram. Figure 3. Electrocardiogram at discharge. DISCLOSURES: No relevant relationships by Ahmad ababneh, source=Web Response No relevant relationships by Shubham Adroja, source=Web Response No relevant relationships by HANAD BASHIR, source=Web Response No relevant relationships by Ahmad JABRI, source=Web Response

Counterpoint: Sickle cell trait should not be considered asymptomatic and as a benign condition during physical activity

Counterpoint: Sickle cell trait should not be considered asymptomatic and as a benign condition during physical activity

Left main coronary artery stenosis associated with extremely long fusiform aneurysm

Coronary artery aneurysm is defined as coronary dilatation, which exceeds the diameter of normal adjacent segment or the diameter of the patient's largest coronary vessel by 1.5 times [Syed M, Lesch M: Coronary artery aneurysms: a review. Prog Cardiovasc Dis 1997; 40:77–10 84 [1]]. Most studies show an incidence of 1% to 2% [Barettella MB, Bott-Silverman C. Coronary artery aneurysm: an unusual case report and a review of the literature. Cathet Cardiovasc Diagn 1993; 29:57–61 [2]]. Left main coronary aneurysms (LMCA) are even more rare; in a study by involving 22,000 coronary angiograms an occurrence rate of 0.1% has been found [Topaz O, DiSciascio G, Cowley MJ, Goudreau E, Soffer A, Nath A et al. Angiographic features of left main coronary artery aneurysms. Am J Cardiol 1991; 67:1139–1142 [3]]. The majority of patients present with ischemic symptoms secondary to the coexisting atherosclerotic lesions and most of the coronary aneurysms are incidentally diagnosed by coronary angiography. This report details the exceptional case of a 62-year-old patient with “unusually long fusiform” aneurysm of the left main coronary artery associated with critical left main coronary artery distal stenosis involving the ostia of left anterior descending and left circumflex coronary artery. With this case the possible anatomic determinants of the type, location, and mechanism of aneurysm formation were also discussed.

Guide wire fracture with retained filament in the LAD and aorta

Complete fracture of coronary guide wires during PCI is a very rare event usually associated with debulking devices [ 1 Cafri C. Rosenstein G. Ilia R. Fracture of a coronary guidewire during graft thrombectomy with the X-sizer device. J Invasive Cardiol. 2004; 16: 263-265 PubMed Google Scholar , 2 Woodfield S.L. Lopez A. Heuser R.R. Fracture of coronary guidewire during rotational atherectomy with coronary perforation and tamponade. Cathet Cardiovasc Diagn. 1998; 44: 220-223 Crossref PubMed Scopus (34) Google Scholar , 3 Vrolix M. Vanhaecke J. Piessens J. De Geest H. An unusual case of guide wire fracture during percutaneous transluminal coronary angioplasty. Cathet Cardiovasc Diagn. 1988; 15: 99-102 Crossref PubMed Scopus (30) Google Scholar , 4 Stellin G. Ramondo A. Bortolotti U. Guidewire fracture: an unusual complication of percutaneous transluminal coronary angioplasty. Int J Cardiol. 1987; 17: 339-342 Abstract Full Text PDF PubMed Scopus (23) Google Scholar , 5 Khonsari S. Livermore J. Mahrer P. Magnusson P. Fracture and dislodgment of floppy guidewire during percutaneous transluminal coronary angioplasty. Am J Cardiol. 1986; 58: 855-856 Abstract Full Text PDF PubMed Scopus (37) Google Scholar , 6 Foster-Smith K. Garratt K.N. Holmes Jr., D.R. Guidewire transection during rotational coronary atherectomy due to guide catheter dislodgement and wire kinking. Cathet Cardiovasc Diagn. 1995; 35: 224-227 Crossref PubMed Scopus (22) Google Scholar ]. Theoretically, guide wire remnants could lead to complications such as thrombosis, embolic phenomena and vessel occlusion. Whilst most authors recommend surgical extraction if percutaneous retrieval fails, there have been rare reports of wire fragments being left in situ without any adverse outcomes [ 1 Cafri C. Rosenstein G. Ilia R. Fracture of a coronary guidewire during graft thrombectomy with the X-sizer device. J Invasive Cardiol. 2004; 16: 263-265 PubMed Google Scholar , 7 Doorey A.J. Stillabower M. Fractured and retained guide-wire fragment during coronary angioplasty–unforeseen late sequelae. Cathet Cardiovasc Diagn. 1990; 20: 238-240 Crossref PubMed Scopus (27) Google Scholar , 8 Lotan C. Hasin Y. Stone D. et al. Guide wire entrapment during PTCA: a potentially dangerous complication. Cathet Cardiovasc Diagn. 1987; 13: 309-312 Crossref PubMed Scopus (28) Google Scholar , 9 Hartzler G.O. Rutherford B.D. McConahay D.R. Retained percutaneous transluminal coronary angioplasty equipment components and their management. Am J Cardiol. 1987; 60: 1260-1264 Abstract Full Text PDF PubMed Scopus (121) Google Scholar , 10 Chang TM, Pellegrini D, Ostrovsky A, Marrangoni AG. Surgical management of entrapped percutaneous transluminal coronary angioplasty hardware. 2002;29(4):329–32. Google Scholar ].

Intra-Arterial Thrombolysis for Left Middle Cerebral Artery Embolic Stroke During Coronary Angiography

Cerebral thromboembolism is an uncommon but serious complication of cardiac catheterization. Early diagnosis and rapid treatment by reperfusion techniques have been shown to prevent long-term neurological morbidity. We report 2 consecutive cases of successful local intra-arterial thrombolysis (LIT) for embolic stroke of the middle cerebral artery (MCA) during diagnostic coronary angiography that resulted in complete neurological recovery. A 77-year-old woman with severe valvular aortic stenosis was admitted to our catheterization laboratory for a preoperative coronary angiography. Performed from the femoral approach, it showed a normal angiographic pattern. Immediately after the procedure, the patient became stuporous with right hemiplegia and global aphasia. She was hemodynamically stable. The left carotid digital subtraction angiography that was performed immediately revealed total occlusion of the M2 part of the left MCA. There was no extravasation of contrast (Figure 1). We decided to administer selective intra-arterial urokinase infusion. After systemic heparinization (bolus of 5000 UI), a 6F Amplatz Right Guide catheter was placed in the left internal …

Intraventricular Pressure Differences

Like all fluids, blood tends to flow from areas of high pressure to low pressure. This seemingly trite observation hides a great deal of sophisticated pathophysiology that we are only beginning to exploit diagnostically and potentially therapeutically. In this issue of Circulation , Yotti and colleagues have exploited a new noninvasive technique to measure the small pressure differences generated within the normal left ventricular outflow tract in systole, demonstrating the utility of such measurements in quantifying ventricular systolic function.1 Because the fluid dynamics concepts behind these methods remain obscure to many cardiologists, it is worth reviewing the theoretical underpinnings in the hope that they will be more widely applied on the basis of articles like those of Yotti et al and others. See p 1771 Cardiologists have become comfortable with the use of the Gorlin equation in the cardiac catheterization laboratory and the simplified Bernoulli equation in the echocardiography laboratory to characterize the severity of valvular stenosis. Both equations are based on the principle of conservation of energy, relating the pressure drop (potential energy) across the valve to the rise in velocity (kinetic energy) as blood rushes through it. Several special circumstances combine to make these simple equations particularly applicable to flow through a restrictive orifice, including lack of a significant friction factor (viscosity) and a lack of pressure recovery as the blood rushes out of the abrupt obstruction. One of the most important simplifications is the absence of a significant “inertial” component to flow through a restrictive orifice. That is, the amount of blood actually moving at high velocity is tiny compared with the volume of the overall column of blood in the left ventricular outflow tract. Thus, very little pressure is expended in getting that small mass moving, and all of the potential energy lost across the …

Letter Regarding Article by Wang et al, “Coronary Artery Spatial Distribution of Acute Myocardial Infarction Occlusions”

To the Editor: I read with interest the recent article by Wang et al1 investigating the geographical distribution of coronary thromboses causing ST-segment elevation myocardial infarctions (STEMI). The authors demonstrated that these thromboses are clustered within the proximal portions of the major epicardial coronaries. They claimed that diagnostic and therapeutic approaches designed to diagnose unstable plaques or to prevent subsequent thrombosis should focus on these high-risk locations. The authors proposed theoretical explanations for the proximal location of coronary thromboses, such as high shear stress. Gibson et al2 also studied culprit lesion location in patients with STEMI, and reported similar findings—that the majority of culprit lesions in STEMI are located within the proximal third of the major coronary arteries. These 2 articles give the impression that the proximal coronary plaques are …

Carotid Stent Placement, Stroke Prevention, and Training

Carotid Stent Placement, Stroke Prevention, and Training

Relation of pulmonary venous wedge pressures to pulmonary artery pressures in patients with single ventricle physiology

Accurate assessment of pulmonary artery pressures (PAP) is important in determining the indication for Fontan procedure in patients with single ventricle physiology. However, it is sometimes difficult to measure PAP directly. Pulmonary vein wedge pressure (PVWP) may be used as an alternative to PAP in such cases. Several studies have demonstrated that PVWP correlates with PAP 1 Rao S. Sissman N.J. The relationship of pulmonary venous wedge to pulmonary arterial pressures. Circulation. 1971; 44: 565-574 Crossref PubMed Scopus (13) Google Scholar , 2 Hawker R.E. Celermajor J.M. Comparison of pulmonary artery and pulmonary venous pressures in congenital heart disease. Br Heart J. 1973; 35: 386-391 Crossref PubMed Google Scholar , 3 Waldman J.D. LaCorte M. Dick M. John S.A. Miettinen O.S. LaFarge C.G. The pulmonary venous wedge pressure in pulmonary artery hypertension. Cathet Cardiovasc Diagn. 1977; 3: 231-239 Crossref PubMed Scopus (8) Google Scholar , 4 Chern M.S. Yeh S.J. Lin F.C. Wu D. Hung J.S. Estimation of pulmonary artery pressure from pulmonary vein wedge pressure. Cathet Cardiovasc Diagn. 1994; 31: 277-282 Crossref PubMed Scopus (6) Google Scholar since a technique of catheterization for obtaining PVWP was introduced by Hellems et al. 5 Hellems H.K. Haynes F.W. Dexter L. Kinney T.D. Pulmonary capillary pressure in animals estimated by venous and arterial catheterization. Am J Physiol. 1948; 155: 98-105 PubMed Google Scholar However, these studies were based on patients with simple heart disease, and little is known about patients with complex heart disease. Accurate measurements of PAP and pulmonary vascular resistance (Rp) are critical in the selection of patients with complex heart disease for the Fontan procedure. If PVWP is used as an alternative to PAP, a small difference between PAP and PVWP could produce a big difference in the Rp, resulting in misinterpretation in determining the indication for the Fontan procedure. Thus, it is necessary to know not only the correlation between PVWP and PAP, but also to know how closely PVWP estimates PAP in patients with single ventricle physiology. The purpose of this report was to evaluate how accurately PVWP estimates PAP and to assess the relation focusing on the clinical use of PVWP as an alternative to PAP in patients who are being evaluated as Fontan candidates.

Usefulness of percutaneous left ventricular assistance to support high-risk percutaneous coronary interventions

Percutaneous coronary intervention (PCI) has been proposed as a measure to alleviate symptoms and improve prognosis in patients with atherosclerotic heart disease and depressed heart function. Nonetheless, the risk of ischemic complications during or after the procedure is potentially increased in these patients. A number of supportive techniques have been described for high-risk angioplasty 1 Shawl F.A. Quyyumi A.A. Bajaj S. Hoff S.B. Dougherty K.G. Percutaneous cardiopulmonary bypass-supported coronary angioplasty in patients with unstable angina pectoris or myocardial infarction and a left ventricular ejection fraction ≤25%. Am J Cardiol. 1996; 77: 14-19 Abstract Full Text PDF PubMed Scopus (25) Google Scholar , 2 Scholz K.H. Dubois-Rande J.L. Urban P. Morice M.C. Loisance D. Smalling R.W. Figulla H.R. Clinical experience with the percutaneous hemopump during high-risk coronary angioplasty. Am J Cardiol. 1998; 82: 1107-1110 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar , 3 Dubois-Rande J.L. Teiger E. Garot J. Aptecar E. Pernes J.M. Tixier D. Gueret P. Loisance D. Dupouy P. Effects of the 14F hemopump on coronary hemodynamics in patients undergoing high-risk coronary angioplasty. Am Heart J. 1998; 135: 844-849 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 4 Schreiber T.L. Kodali U.R. O’Neill W.W. Gangadharan V. Puchrowicz-Ochocki S.B. Grines C.L. Comparison of acute results of prophylactic intraaortic balloon pumping with cardiopulmonary support for percutaneous transluminal coronary angioplasty (PCTA). Cathet Cardiovasc Diagn. 1998; 45: 115-119 Crossref PubMed Scopus (22) Google Scholar , 5 Kaul U. Sahay S. Bahl V.K. Sharma S. Wasir H.S. Venugopal P. Coronary angioplasty in high risk patients comparison of elective intraaortic balloon pump and percutaneous cardiopulmonary bypass support—a randomized study. J Interv Cardiol. 1995; 8: 199-205 Crossref PubMed Scopus (18) Google Scholar ; however, no single approach has achieved wide acceptance. Limited effectiveness in the actual support 6 Taguchi I. Ogawa K. Oida A. Abe S. Kaneko N. Sakio H. Comparison of hemodynamic effects of enhanced external counterpulsation and intra-aortic balloon pumping in patients with acute myocardial infarction. Am J Cardiol. 2000; 86: 1139-1141 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar and device-related complications 2 Scholz K.H. Dubois-Rande J.L. Urban P. Morice M.C. Loisance D. Smalling R.W. Figulla H.R. Clinical experience with the percutaneous hemopump during high-risk coronary angioplasty. Am J Cardiol. 1998; 82: 1107-1110 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar , 4 Schreiber T.L. Kodali U.R. O’Neill W.W. Gangadharan V. Puchrowicz-Ochocki S.B. Grines C.L. Comparison of acute results of prophylactic intraaortic balloon pumping with cardiopulmonary support for percutaneous transluminal coronary angioplasty (PCTA). Cathet Cardiovasc Diagn. 1998; 45: 115-119 Crossref PubMed Scopus (22) Google Scholar , 7 Alderman J.D. Gabliani G.I. McCabe C.H. Brewer C.C. Lorell B.H. Pasternak R.C. Skillman J.J. Steer M.L. Baim D.S. Incidence and management of limb ischemia with percutaneous wire-guided intraaortic balloon catheters. J Am Coll Cardiol. 1987; 9: 524-530 Abstract Full Text PDF PubMed Scopus (87) Google Scholar have hampered a more widespread use of these methods. Recently, a newly developed percutaneous left ventricular assist device (pVAD) has been demonstrated to effectively reverse cardiogenic shock after myocardial infarction (Tandem Heart pVAD; Cardiac Assist Technologies, Inc., Ithaca, New York). 8 Thiele H. Lauer B. Hambrecht R. Boudriot E. Cohen H.A. Schuler G. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation. 2001; 104: 2917-2922 Crossref PubMed Scopus (233) Google Scholar This system is readily deployed by percutaneous approach in the catheterization laboratory and is able to provide a systemic output of up to 4 L/min. An inflow cannula is inserted into the left atrium via transseptal puncture and the oxygenated blood is diverted to the femoral artery by a low-speed centrifugal continuous-flow pump. In this study, we report on a series of patients who underwent high-risk PCI supported by the Tandem Heart pVAD.

Left ventricular outflow tract pseudoaneurysms in congenital heart disease

complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg 1999;118:674–680. 3. Sievert H. Interventional versus surgical closure of atrial and ventricular septal defects: advantages and limitations of the catheter-based approach. J Intervent Cardiol 2000;87:116–118. 4. Cao QL, Du ZD, Joseph A, Koenig P, Heitschmidt M, Rhodes J, Hijazi ZM. Immediate and six-month results of the profile of the Amplatzer septal occluder as assessed by transesophageal echocariography. Am J Cardiol 2001;88:754–759. 5. Masura J, Gavora P, Formanek A, Hijazi ZM. Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder: initial human experience. Cathet Cardiovasc Diagn 1997;42:388–393. 6. Rhodes J, Hijazi ZM, Marx GR, Fulton DR. Aerobic exercise function of patients with persistent coronary artery aneurysms secondary to Kawasaki disease. Pediatr Cardiol 1996;17:226–230. 7. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 1986;60:2020–2027. 8. Jones NL. Clinical Exercise Testing. Philadelphia, PA: WB Saunders, 1988: 174. 9. Clark AL, Poole-Wilson PA, Coats AJS. Effects of motivation on indices of exercise capacity in chronic heart failure. Br Heart J 1994;71:162–165. 10. Wasserman K, Hansen JE, Sue DY, Whipp BJ, Casaburin R. Prinicples of Exercise Testing and Interpretation. 2nd Edition. Philadelphia, PA: Lea & Febiger, 1994:66–133. 11. Cumming GR. Maximal exercise capacity of children with heart defects. Am J Cardiol 1978;42:613–620. 12. Goldberg SJ, Mendes F, Hurwitz R. Maximal exercise capability of children as a function of specific cardiac defects. Am J Cardiol 1969;23:349–353. 13. Schofield PM, Barber PV, Kingston T. Preoperative and postoperative pulmonary function tests in patients with atrial septal defect. Br Heart J 1985;54: 577–582. 14. Porter CJ, Feldt RH, Edwards WD, Seward JB, Schaff HV. Atrial septal defects. In: Emmanouilides GC, Riemenschneider TA, Allen HD, Gutgessell HP, eds. Heart Disease in Infants, Children and Adolescents. 5th Edition. Baltimore, MD: Williams and Wilkins, 1995:687–703. 15. Wasserman K. New concepts in assessing cardiovascular function. Circulation 1988;78:1060–1071.

Bedside balloon atrial septostomy is safe, efficacious, and cost-effective compared with septostomy performed in the cardiac catheterization laboratory

Balloon atrial septostomy (BAS) is a life-saving palliative procedure for patients with d-transposition of the great arteries (d-TGA). 1 Rashkind W.J. Miller W.W. Creation of an atrial septal defect without thoracotomy a palliative approach to complete transposition of the great arteries. JAMA. 1966; 196: 991-992 Crossref PubMed Scopus (599) Google Scholar , 2 Hijazi Z.M. Abu A.ta I. Kuhn M.A. Cheatham J.P. Latson L. Geggel R.L. Balloon atrial septostomy using a new low-profile balloon catheter initial clinical results. Cathet Cardiovasc Diagn. 1997; 40: 187-190 Crossref PubMed Scopus (18) Google Scholar Typically performed in the cardiac catheterization laboratory under fluoroscopic guidance with hemodynamic monitoring, this procedure involves transport of a sick, cyanotic infant to the cardiac catheterization laboratory, often with some time delay from diagnosis to the start of BAS. The anatomy of the atrial septum, however, is well seen by 2-dimensional echocardiography, and the site of the restrictive atrial septal defect can be precisely located by imaging and the use of color flow Doppler. In addition, the balloon of the balloon septostomy catheter can be seen within the cardiac structures using echocardiography, making echocardiography an ideal imaging tool for this procedure. 3 Jamjureeruk V. Sangtawesin C. Layangool T. Balloon atrial septostomy under two-dimensional echocardiographic control a new outlook. Pediatr Cardiol. 1997; 18: 197-200 Crossref PubMed Scopus (15) Google Scholar , 4 Allan L.D. Leanage R. Wainwright R. Joseph M.C. Tynan M. Balloon atrial septostomy under two-dimensional echocardiographic control. Br Heart J. 1982; 47: 41-43 Crossref PubMed Scopus (52) Google Scholar Although the concept of bedside BAS was first discussed in 1984, 5 Baker E.J. Allan L.D. Tynan M.J. Jones O.D. Joseph M.C. Deverall P.B. Balloon atrial septostomy in the neonatal intensive care unit. Br Heart J. 1984; 51: 377-378 Crossref PubMed Scopus (28) Google Scholar cardiac catheterization remained an integral part of the evaluation of d-TGA in the early era of the arterial switch operation, and in patients who still have unanswered critical questions after full echocardiographic evaluation. We hypothesized that bedside BAS would significantly reduce the cost to the patient without a change in efficacy and might be safer by obviating the need for transport of a sick infant to the cardiac catheterization laboratory. In this report, we compare our results with BAS performed in the cardiac catheterization laboratory with those performed at the bedside over the past 4 years, with emphasis on the change in cost to the patient, efficacy, safety, and any change in morbidity or mortality.

Speed of normalization of right ventricular volume overload after transcatheter closure of atrial septal defect in children and adults

Right ventricular (RV) volume overload occurs in patients with significant atrial septal defect (ASD) shunt, which can impair left ventricular (LV) filling and ejection fraction. 1 Louie E.K Lin S.S Reynertson S.I Brundage B.H Levitsky S Rich S Pressure and volume loading of the right ventricle have opposite effects on left ventricular ejection fraction. Circulation. 1995; 92: 819-824 Crossref PubMed Scopus (149) Google Scholar RV dilation and abnormal ventricular septal motion are characteristic echocardiographic features of RV volume overload. Transcatheter closure of secundum ASD was first attempted >25 years ago, and it is being increasingly used in recent years with promising closure results. 2 Rome J.J Keane J.F Perry S.B Spevak P.J Lock J.E Double-umbrella closure of atrial septal defects initial clinical applications. Circulation. 1990; 82: 751-758 Crossref PubMed Scopus (278) Google Scholar , 3 Das G.S Voss G Jarvis G Wyche K Gunther R Wilson R.F Experimental atrial septal defect closure with a new, transcatheter, self-centering device. Circulation. 1993; 88: 1754-1764 Crossref PubMed Scopus (204) Google Scholar , 4 Prieto L.R Foreman C.K Cheatham J.P Latson L.A Intermediate-term outcome of transcatheter secundum atrial septal defect closure using the Bard Clamshell Septal Umbrella. Am J Cardiol. 1996; 78: 1310-1312 Abstract Full Text PDF PubMed Scopus (78) Google Scholar , 5 Rao P.S Berger F Rey C Haddad J Meier B Walsh K.P Chandar J.S Lloyd T.R de Lezo J.S Zamora R Sideris E.B Results of transvenous occlusion of secundum atrial septal defects with the fourth generation buttoned device comparison with first, second and third generation devices. International Buttoned Device Trial Group. J Am Coll Cardiol. 2000; 36: 583-592 Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar , 6 Masura J Gavora P Formanek A Hijazi Z.M Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder initial human experience. Cathet Cardiovasc Diagn. 1997; 42: 388-393 Crossref PubMed Scopus (406) Google Scholar , 7 Thanopoulos B.D Laskari C.V Tsaousis G.S Zarayelyan A Vekiou A Papadopoulos G.S Closure of atrial septal defects with the Amplatzer occlusion device preliminary results. J Am Coll Cardiol. 1998; 31: 1110-1116 Abstract Full Text Full Text PDF PubMed Scopus (258) Google Scholar This study evaluates the change in RV volume overload after transcatheter closure of ASD by echocardiography and assesses the possible influencing factors.

Cholesterol in Vascular and Valvular Calcification

In the early 1990s, the late Jeff Hoeg had the foresight to ask whether vascular calcification relates to the duration and severity of exposure to cholesterol. In a group of homozygous hyperlipidemic patients for whom detailed records of cholesterol levels were available over a long period of time, he and his colleagues found that coronary calcification scores by ultrafast computed tomographic scanning correlated significantly with the cholesterol year product.1 Studies that lack long-term cholesterol history may miss a correlation between lipids and calcification, because current treatments so dramatically change cholesterol levels as to make them unrepresentative of long-term exposure. See p 1927 In the present issue of Circulation , Pohle et al2 successfully overcame these difficulties by studying the rate of change in calcification as a function of change in lipid levels, excluding patients in whom treatment was altered during the study period. These investigators found that both coronary calcification and aortic valve calcification progress more rapidly in subjects with levels of LDL >130 mg/dL. This finding dovetails with those of Callister et al,3 who discovered that patients who successfully lowered their cholesterol levels with lipid-lowering agents significantly reduced the progression of coronary calcification. In a large population of young subjects, the risk factor that correlated most significantly with coronary calcification was LDL cholesterol.4 This relation was stronger than the correlation with age, smoking, fasting insulin, blood pressure, or male sex.4 In another study of asymptomatic outpatients, LDL cholesterol was the only risk factor correlating with progression of coronary calcification by electron-beam computed tomography over an 18-month period.5 The correlation of LDL cholesterol exposure to valvular and vascular calcification raises the possibility of a mechanistic role, which is also supported by in vitro studies. Two groups …

Pathways of Egr-1-Mediated Gene Transcription in Vascular Biology

Vascular endothelium forms a continuous cellular interface between the circulating blood elements and the surrounding tissues. Endothelium forms a nonthrombogenic surface and selective permeability barrier capable of modulating vascular reactivity and blood flow. The integrity of the endothelium is fundamental for the maintenance of normal homeostasis. Injury to this lining results in dramatic changes in the functional characteristics of the endothelium, rendering it adhesive and prothrombotic. These changes may result from molecules inducibly expressed or simply secreted by injured endothelium. These initial events are correlated with subsequent inflammatatory and proliferative cellular changes associated with the development of vascular pathology.

Enhanced external counterpulsation in the management of patients with cardiovascular disease.

Studies over the past several decades support the hypothesis that enhanced external counterpulsation (EECP) can provide long-term benefits in patients with angina secondary to chronic coronary disease. Numerous non-sham controlled trials have recently been substantiated by a multicenter, randomized trial. Although the mechanism by which this mechanical treatment effects an alteration in cellular processes within the myocardium remains unclear, recent scientific investigations suggest that shear stress induced by chronic exposure to EECP might result in the release of a variety of growth factors and the subsequent stimulation of angiogenesis in the coronary beds. Ongoing clinical trials in patients with significant left ventricular dysfunction, an international registry, and additional clinical trials may help to elucidate further the role of this novel and unique therapy in our clinical armamentarium.

Massive Systemic Air Embolism Following a Blunt Chest Injury

Massive Systemic Air Embolism Following a Blunt Chest Injury

Coil occlusion of arteriovenous fistula of the vertebral artery in a child

A 5-year-old boy with congenital fistula between the right vertebral artery and concomitant veins underwent a successful transcatheter fistula occlusion with a Gianturco coil. Cathet Cardiovasc Diagn 43:434–437, 1998. © 1998 Wiley-Liss, Inc.

President's page: Investigational intervention: Revisit the paradigm or make a new one?

Catheterization and Cardiovascular DiagnosisVolume 41, Issue 4 p. 469-470 Society NewsFree Access President's page: Investigational intervention: Revisit the paradigm or make a new one? Warren K. Laskey, Warren K. LaskeySearch for more papers by this author Warren K. Laskey, Warren K. LaskeySearch for more papers by this author First published: 06 December 1998 https://doi.org/10.1002/(SICI)1097-0304(199708)41:4<469::AID-CCD32>3.0.CO;2-EAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Holmes DRJr., Bell MR, Holmes DRIII, Berger PB, Bresnahan JF, Hammes LN, Grill DE, Garratt KN: Interventional cardiology and intracoronary stents–A changing practice: Approved vs. nonapproved indications. Cathet Cardiovasc Diagn 40: 133–138, 1997. 2Serruys PW, Emanuelsson M, Van der Giessen W, Lunn AC, Kiemeney F, Macaya C, et al.: Heparin coated Palmaz Schatz stents in human coronary arteries. Early outcome of the Benestent II pilot study. Circulation 93: 412–422, 1996. Volume41, Issue4August 1997Pages 469-470 SCAI Member Sign in ReferencesRelatedInformation

Analysis of reproducibility of reference lumen quantitation with intravascular ultrasound in stented coronary arteries

Intravascular ultrasound is widely used to guide coronary stent implantation. The key quantitative criterion for successful implantation is the demonstration of adequate expansion of the stented lumen relative to that of the adjacent reference vessel segments. In this study we aimed to establish the reproducibility of intravascular ultrasound measurements of the reference segments in lesions undergoing coronary stenting. Measurements of the reference segment lumen dimensions were made in a blinded fashion by two experienced observers, and reproducibility was assessed by calculating the mean difference and standard deviation of the paired measurements. The unselected intraobserver random variability of the mean reference lumen area measured 0.8 mm2. The interobserver random variability was 0.94 mm2. The intraobserver and interobserver variability of minimum lumen area within the stent was smaller, measuring 0.30 mm2 and 0.52 mm2, respectively. There was 91% intraobserver agreement, and 75% interobserver agreement, in identifying adequate stent expansion as defined by a stent-to-mean reference lumen area ratio of >0.8. The potentially significant level of variability inherent in selecting and measuring the reference segments, and its impact on clinical decision-making, should be remembered when this method of assessing the acute quantitative outcome of stent implantation is applied. Cathet Cardiovasc Diagn 40:1–7, 1997. © 1997 Wiley-Liss, Inc.