Volume 20 - Issue 11 - November, 2008

Patching Up the Differences: Vascular Closure with Topical Hemostasis versus Manual Compression

Zoltan G. Turi, MD

Author Affiliations:

From the Division of Cardiology, Cooper University Hospital, Camden, New Jersey.
Disclosure: Dr. Turi reports receiving research grant support from Abbott Vascular and St. Jude Medical, and consultation/lecturing honoraria from Abbott Vascular, Arstasis, Johnson and Johnson and St. Jude Medical.
Address for correspondence: Zoltan G. Turi, MD, Professor of Medicine, Robert Wood Johnson Medical School, One Cooper Plaza, D-427, Camden, NJ 08103. E-mail: [email protected]

The very nice study by Narins et al described in this edition of the Journal of Invasive Cardiology compares 75 patients randomized to vascular closure using a topical patch containing a polysaccharide-based procoagulant with 75 patients randomized to manual compression.1 Although the study found that those randomized to the patch had lower time to hemostasis and ambulation, several potentially confounding factors need to be kept in consideration.

First, the vascular closure literature is replete with studies that depend on two of the softer endpoints in interventional cardiology: time to h...

A New Method to Quantify Coronary Calcification by Intravascular Ultrasound

Xiaofei Wang, MD, Chengzhi Lu, PhD, Xin Chen, MD, Xiangdong Zhao, PhD, Dasheng Xia, MD

Author Affiliations:

From the Department of Cardiology, Tianjin First Central Hospital, Tianjin Medical University, Tianjin, China.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted June 30, 2008, provisional acceptance given August 8, 2008, manuscript accepted August 29, 2008.
Address for correspondence: Xiaofei Wang, MD, Department of Cardiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, 300192, China. E-mail: [email protected]

The Different Patterns of Calcification of Acute Myocardial Infarction, Unstable Angina Pectoris and Stable Angina Pectoris

ABSTRACT: Background. Intravascular ultrasound (IVUS) enables the identification of calcification with more details and quantification of calcification, but there is not a proper method to quantify the calcification with IVUS. Previous IVUS studies used arc or length of calcium, respectively, to quantify calcification, but calcium is determined by a combination of arc and length. We devised a new method to quantify calcium as arc area (AA) in the present study...

Intravascular Quantification of Coronary Calcification — Current and Future Utility

*Daniel H. Steinberg, MD and §Neil J. Weissman, MD

Author Affiliations:

From the *Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, and §MedStar Research Institute, Washington Hospital Center, Washington, D.C.
Disclosures: Dr. Weissman has received research grants from Boston Scientific Corp.; Dr. Steinberg has received speaker honoraria from the same.
Address for Correspondence: Neil J. Weissman, MD, Washington Hospital Center, 100 Irving Street N.W., Suite EB 5123, Washington, D.C. 20010. E-mail: [email protected]

Coronary calcification has long been known to reflect underlying atherosclerotic coronary artery disease. In fact, the presence of coronary calcification has become an important component of screening for coronary artery disease and the extent of calcification on electron beam computed tomography has been shown to correlate with prediction of future cardiovascular events.1,2

Intravascular ultrasound (IVUS), by virtue of its ability to image at high resolution, allows not only assessment of the location of coronary calcification, but also the number, depth, arc and length of calcified plaque...

“Hybrid” Stent Delivery in the Pulmonary Circulation

*,§Ralf J. Holzer, MD MSc, *,§Joanne L. Chisolm, RN, *,§Sharon L. Hill, MSN ACNP,
*Vincent Olshove, CCP CCT, *,£Alistair Phillips, MD, *,§John P. Cheatham, MD, *,£Mark Galantowicz, MD

Author Affiliations:

From the *Heart Center, Nationwide Children’s Hospital, Columbus, Ohio, the §Department of Pediatrics, Ohio State University School of Medicine, Columbus, Ohio, and the £Department of Cardiothoracic Surgery, Ohio State University School of Medicine, Columbus, Ohio.
Disclosure: John Cheatham is a consultant for Toshiba Medical. None of the other authors report any conflicts of interest related to the content herein.
Manuscript submitted May 27, 2008, provisional acceptance given August 8, 2008, manuscript accepted September 5, 2008.
Address for correspondence: Ralf J. Holzer, MD, MSc, FSCAI, Assistant Director, Cardiac Catheterization & Interventional Therapy, Assistant Professor of Pediatrics, Cardiology Division, The Ohio State University, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205. E-mail: [email protected]

ABSTRACT: Objective. To describe our institutional experience providing “hybrid” intraoperative stent therapy for pulmonary artery (PA) stenoses. Background. Surgical patch angioplasty, transcatheter stent therapy and intraoperative stent delivery are valuable treatment options for PA stenoses. The experience with intraoperative hybrid therapy has increased and new techniques and equipment have become available. Methods. This study involves a retrospective review of 20 patients with a median age of 5.1 years who underwent hybrid PA stent therapy between March 2003 and April 2008. Thirteen ...

“Apical Ballooning” — What Is the Cause?

*Sunil Wani, MD, DM, §Kathrin Glatz, MD, *Yves Suter, MD, *Peiman Jamshidi, MD, FESC, *Paul Erne, MD, FESC

Author Affiliations:
From the *Department of Cardiology, Luzerner Kantonsspital, Luzern, and the §Department of Pathology, University Hospital, Basel, Switzerland.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted July 11, 2008, provisional acceptance given September 15, 2008, and final version accepted September 16, 2008.
Address for correspondence: Prof. Paul Erne, Department of Cardiology, Luzerner Kantonsspital, CH- 60000 Luzern 16, Switzerland. E-mail: [email protected]

ABSTRACT: The pathophysiology of takotsubo cardiomyopathy remains enigmatic. Here we attempted to define the link between the coronary arteries and the histopathological involvement of the left ven- tricle. We observed similarities and discrepancies between patients. All patients experienced stress prior to the event. We found a reduced coronary flow reserve in all patients and signs of hibernating my- ocardium on biopsy specimen. This raises a strong suspicion of stress- induced endothelial dysfunction with hibernating myocardium in the pathogenesis of this cardiomyopathy.


Microvascular Dysfunction following Primary Percutaneous Coronary Intervention

*Radhakrishnan Ramaraj, MD and *,§,£Mohammad Reza Movahed, MD, PhD

Author Affiliations:

From the *University of Arizona College of Medicine, the §University of Arizona Sarver Heart Center and the £Southern Arizona VA Health Care System, Tucson, Arizona.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted March 13, 2008, provisional acceptance given May 29, 2008, and accepted June 3, 2008.
Address for correspondence: Radhakrishnan Ramaraj, MD, University of Arizona Medical Center, 1501, N. Campbell Avenue, Tucson, AZ 85724. E-mail: [email protected]

In the Setting of ST-Elevation Myocardial Infarction

ABSTRACT: Primary percutaneous coronary intervention (PCI) is an established reperfusion strategy in the treatment of acute myocardial infarction with ST-segment elevation (STEMI). Nevertheless, myocardial damage is not terminated immediately, even with successful primary PCI, which eliminates the epicardial occlusion. Despite the success of contemporary reperfusion therapy and effective restoration of epicardial coronary flow, many patients have suboptimal flow at the tissue level within the myocardium. Studies indicate that the...

Use of Anticoagulants in ST-Elevation Myocardial Infarction Patients undergoing Percutaneous Coronary Intervention

George W. Christy, MD

Author Affiliations:

From the Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois.
Disclosure: Dr. Christy is a consultant and on the speakers bureau for Sanofi-Aventis. He received editorial writing support in the preparation of this manuscript, funded by Sanofi-Aventis, New Jersey. The author is fully responsible for the content and editorial decisions for this manuscript.
Manuscript submitted June 10, 2008, provisional acceptance given July 29, 2008, and final version accepted August 29, 2008.
Address for correspondence: George W. Christy, MD FACC, Advocate Christ Hospital, 4440 W. 95th Street, Oak Lawn, IL 60453.

A Potential Role for Enoxaparin

ABSTRACT: Unfractionated heparin (UFH) is currently given as the standard anticoagulant therapy in ST-elevation myocardial infarction (STEMI) patients, including those undergoing percutaneous coronary intervention (PCI). Recent data, however, have shown lower rates of death or recurrent myocardial infarction (MI) with the low-molecular-weight heparin (LMWH) enoxaparin compared with UFH in STEMI patients treated with thrombolytics, offsetting an increase in major bleeding. This review compares the use of enoxaparin with UFH in STEMI patients undergoin...

ECG-Guided Immediate Intervention at the Time of Primary PCI

Philippe Lachance, Jean-Pierre Déry, MD, MSc, FRCP(C), Jonathan Beaudoin, MD, FRCP(C), Gérald Barbeau, MD, FRCP(C), Bernard Noël, MD, FRCP(C), Olivier F. Bertrand, MD, PhD, FRCP(C), Josep Rodés-Cabau, MD, FRCP(C), Can M. Nguyen, MD, FRCP(C), Guy Proulx, MD, FRCP(C), Onil Gleeton, MD, FRCP(C), Eric Larose, MD, DVM, FRCP(C), Louis Roy, MD, FRCP(C), Robert Delarochellière, MD, FRCP(C)

Author Affiliations:

From the Cardiology Department, Laval Hospital, Québec, Canada.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted April 9, 2008, provisional acceptance granted July 7, 2008, and final version accepted August 11, 2008.
Address for correspondence: Jean-Pierre Déry, MD, MSc, FRCP(C), Cardiology, Laval Hospital, 2725 ch Ste-Foy, Québec, Canada G1V 4G5. E-mail: [email protected]

To Reduce Door-to-Balloon Time in ST-Elevation Myocardial Infarction Patients

ABSTRACT: Background. In ST-segment elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), all efforts must be made to improve door-to-balloon (DTB) times. This study was designed to assess the impact of electrocardiographic-guided immediate intervention (EGII) without performing a complete coronary evaluation on DTB times and clinical outcomes of STEMI patients treated with primary PCI. Methods. Consecutive STEMI patients undergoing primary PCI...

Cardiac Mass Presenting as ST-Elevation Myocardial Infarction: Case Report and Review of the Literature

Guarav Aggarwala, MD, Nikhil Iyengar, MD, Phillip Horwitz, MD

Author Affiliations:

From the University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Manuscript submitted April 23, 2008, provisional acceptance given June 12, 2008, and final version accepted June 13, 2008.
The authors report no conflicts of interest regarding the content herein.
Address for correspondence: Guarav Aggarwala, MD, Fellow, Division of Cardiovascular Disease, University of Iowa Hospitals and Clinics, 200 Hawkins Dr E318-GH, Iowa City, IA 52242. E-mail: [email protected]

ABSTRACT: We discuss the case of a 71-year-old female patient who presented with findings suggestive of an acute myocardial infarction. Subsequent evaluation revealed an extrinsic cardiac mass encasing the left circumflex and right coronary arteries (RCA) which caused compression and spasticity of the RCA. Biopsy findings were consistent with a hematologic malignancy. Reports of extrinsic compression of epicardial coronary arteries are uncommon. Neoplasms, either primary cardiac tumors or metastatic disease, are a rare cause of extrinsic compression of coronary arteries.


Editor’s Message

Dear Readers,

This issue of the Journal of Invasive Cardiology continues our series of special focus sections to provide a more in-depth examination of important topics in cardiovascular medicine. The special section for this issue includes articles focusing on treatment of patients who present with ST-elevation myocardial infarction (STEMI). The guest editor for this section is Dr. Samin Sharma from Mount Sinai Medical Center in New York. Dr. Sharma has provided an introduction to the section and a short discussion about the articles that are featured this month. In addition to the foc...

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