Volume 20 - Issue 11 - November, 2008

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...

Do Things that Make Sense to Further Improve STEMI Treatment

Guest Editor: Samin K. Sharma, MD

Director, Cath Lab and Intervention
Cardiovascular Institute
Mount Sinai Medical Center, New York, New York
E-mail: Samin.Sharma@mountsinai.org

Primary percutaneous coronary intervention (PCI) using stents (bare-metal or drug-eluting) has become the gold standard of treatment of ST-segment elevation myocardial infarction (STEMI). Numerous studies have established the importance of shortening the door-to-balloon time to ...

Intractable Prinzmetal’s Angina Three Months after Implantation of Sirolimus-Eluting Stent

Mitsuru Abe, MD, Akemi Yoshida, MD, Yoritaka Otsuka, MD

Author Affiliations:

From the Division of Cardiology, National Cardiovascular Center, Osaka, Japan.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted May 14, 2008, provisional acceptance given June 19, 2008, and final version accepted June 30, 2008.
Address for correspondence: Mitsuru Abe, MD, Division of Cardiology, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan. E-mail: mitsuru@ hsp.ncvc.go.jp

ABSTRACT: Sirolimus-eluting stents (SES) prevent neointimal proliferation and have been widely used to treat stenotic lesions in coronary arteries because of a significant reduction of restenosis in comparison with bare-metal stents. Sirolimus, however, may cause endothelial dysfunction by damage to vascular endothelium or impairing vascular repair. Recent studies report the occurrence of exercise- or acetylcholine-induced coronary vasoconstriction in the vessel segments adjacent to the SES. We report here a clinical case of intractable Prinzmetal’s angina 3 months after SES implantation and...

A Variant of Takotsubo Cardiomyopathy: A Rare Complication in the Electrophysiology Lab

*Jacob Collen, MD, §William Bimson, DO, §Patrick Devine, MD

Author Affiliations:
From the *Department of Internal Medicine, and the §Department of
Cardiology, Walter Reed Army Medical Center, Washington, D.C.
Presented at: ACC, Military Chapter Conference, April 2007, Washington,
D.C., Combined Army-Airforce ACP, November 2007, San Antonio, Texas,
National ACP, May 2008, Washington, D.C.
The authors have no conflicts of interest to disclose.
The views expressed in this paper are those of the authors and do not
reflect the official policy of the Department of the Army, Department of
Defense, or the U.S. Government.
Address for correspondence: Jacob F. Collen, MD, 1672 North 21st Street,
Apt. #7, Arlington, VA 22209. E-mail: jacob.collen@amedd.army.mil

ABSTRACT: Catecholamine-induced cardiomyopathy has been recognized for decades. We present the case of a 21-year-old female referred for an electrophysiologic (EP) study who underwent an infusion of isoproterenol and epinephrine in an attempt to unmask an ectopic atrial tachycardia. Prior to leaving the study suite, the patient started complaining of chest pain and shortness of breath. Bedside echocardiography revealed a severely depressed left ventricular ejection fraction (EF) of 25–30% with basal-mid left ventricular cavity hypokinesis, but normal apical wall motion. Her coronary angiogra...

Suitability of Saphenous Vein Graft Lesions for the Use of Distal Embolic Protection Devices

Sameer K. Mehta, MD, Joshua M. Stolker, MD, Andrew D. Frutkin, MD, Steven P. Marso, MD

Author Affiliations:

From the Mid-America Heart Institute, St. Luke’s Hospital, Kansas City, Missouri.
Disclosure: Dr. Marso is a consultant for Volcano Corp., and is a research grant recipient from Volcano Corp., Boston Scientific Corp., and Amylia Corp.
Manuscript submitted May 13, 2008, provisional acceptance given July 7, 2008, manuscript accepted September 5, 2008.
Address for correspondence: Joshua M. Stolker, MD, Mid-America Heart Institute, St. Luke’s Hospital, 4401 Wornall Road, Suite 5601, Kansas City, MO 64111. E-mail: jstolker@saint-lukes.org

ABSTRACT: The use of distal embolic protection devices (EPD) in saphenous vein graft percutaneous interventions (SVG-PCI) has been associated with a decrease in adverse events. Currently, there are limited data regarding the percentage of SVG lesions that are suitable for EPD deployment. We retrospectively reviewed 131 SVG-PCI procedures occurring over 18 months for suitability for EPD deployment, utilizing previously published suitability criteria. We found that 49% of cases were suitable for EPD use, which is similar to results from other studies. Given the data supporting the use of EPD use...

When Catastrophe Strikes — A Case of Atrial Myxoma with Distal Embolization

Manreet Kanwar, MD, Yassar Almanaseer, MD, Abdulwahhab Alroaini, MD

Author Affiliations:

From the Division of Cardiology, Department of Medicine, St. John Hospital and Medical Center, Detroit, Michigan.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted April 14, 2008, provisional acceptance given June 12, 2008, final version accepted June 13, 2008.
Address for correspondence: Manreet Kanwar, MD, St. John Hospital and Medical Center, 22101 Moross Rd., 2nd Floor VEP, Cardiac Cath Lab, Detroit, MI 48236. E-mail: manreet.kanwar@stjohn.org

ABSTRACT: Primary tumors of the heart are rare, with an incidence between 0.0017 and 0.19 percent in unselected patients at autopsy.1 About three-quarters of these tumors are benign, and nearly half of these benign tumors are myxomas. First described in 1845, myxomas were diagnosed posthumously until the 1950s. The clinical features are determined by their size, locations and mobility. Embolism occurs in one-third of patients, but it is rare for patients to initially present with multiple, simultaneous widespread emboli.1–3

J INVASIVE CARDIOL 2008;20:E314–E315

Case Presentation. A 56...

Recanalization Strategy for Chronic Total Occlusions with Tapered and Stiff-Tip Guidewire

aKazuaki Mitsudo, MD, bTakehiro Yamashita, MD, cYasushi Asakura, MD, dToshiya Muramatsu, MD, eOsamu Doi, MD, fYoshisato Shibata, MD, gYoshihiro Morino, MD

Author Affiliations:

From the aDepartment of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan, bDepartment of Cardiology, Cardiovascular Center Hokkaido Ohno Hospital, Sapporo, Japan, cDepartment of Cardiology, Toyohashi Heart Center, Toyohashi, Japan, dDepartment of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan, eDepartment of Cardiology, Shizuoka Prefectural General Hospital, Shizuoka, Japan, fDepartment of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan, gDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Disclosure: This study was funded by a research grant from St. Jude Medical Company.
Manuscript submitted April 15, 2008, provisional acceptance given May 12, 2008, manuscript accepted June 30, 2008.
Address for correspondence: Kazuaki Mitsudo, M.D., Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan. E-mail: km2131@kchnet.or.jp

The Results of CTO New techniQUE for STandard Procedure (CONQUEST) Trial

ABSTRACT: Background. The success rate of percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO) lesions varies depending on the guidewire manipulation skills of the operator. The standardization of guidewire technique is very important. A new technique with a new tapered wire (Conquest, Confianza Pro™) was tested to verify effectiveness for higher initial success rates and standardization of PCI for CTO. Methods. A prospective, multicenter registry was conducted at 6 investigati...

“Bail–Out” Bivalirudin Use in Patients with Thrombotic Complications

Luigi La Vecchia, MD, FESC, Ester Cabianca, MD, Leonardo Varotto, MD, Paolo Vincenzi, MD, Alessandro Fontanelli, MD, FESC

Author Affiliations:

From the Catheterization Laboratory, S. Bortolo Hospital, Vicenza, Italy.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted April 18, 2008, provisional acceptance given May 22, 2008, and final version accepted May 28, 2008.
Address for correspondence: Ester Cabianca, MD, Catheterization Laboratory, Department of Cardiovascular Medicine, S. Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy. E-mail: cabi72@libero.it

Unresponsive to Conventional Treatment during Percutaneous Coronary Intervention

ABSTRACT: Percutaneous coronary intervention (PCI) is routinely performed in patients with non-ST elevation acute coronary syndromes after pretreatment with clopidogrel and periprocedural administration of unfractionated heparin on a weight-adjusted basis. Although activated clotting time (ACT) monitoring is encouraged to verify the adequacy of anticoagulation during the procedures, this is not a common practice in many laboratories. The Authors describe 4 cases of patients with bifurcation lesions inv...

A Prospective, Randomized Trial of Topical Hemostasis Patch Use following Percutaneous Coronary and Peripheral Intervention

*,§Craig R. Narins, MD, *Wojciech Zareba, MD, PhD, *Vicki Rocco, RN, *Scott McNitt, MS

Author Affiliations:

From the Divisions of *Cardiology and §Vascular Surgery, The University of Rochester School of Medicine and Dentistry, Rochester, New York.
Disclosure: This trial was supported by a grant from Possis Medical Inc., Minneapolis, Minnesota. The authors report no additional potential conflicts of interest.
Manuscript submitted June 30, 2008, provisional acceptance given August 8, 2007, manuscript accepted August 29, 2008.
Address for correspondence: Craig R. Narins, MD, University of Rochester Medical Center, 601 Elmwood Avenue, Box 679, Rochester, NY 14642. E-mail: craig_narins@urmc.rochester.edu

ABSTRACT: The use of topical hemostasis patches has grown rapidly despite a paucity of evidence supporting their clinical utility. We performed a randomized, controlled trial to assess the efficacy of a topical hemostasis patch as a means to accelerate vascular hemostasis following percutaneous intervention. One hundred fifty (150) patients undergoing coronary or peripheral intervention through a 6 Fr femoral arterial sheath were randomized to sheath removal with either: (1) manual pressure and adjunctive use of a patch incorporating a polysaccharide based procoagulant material (SafeSeal Patch...

Percutaneous Ventricular Assist Device To Rescue a Patient with Profound Shock From a Thrombosed Prosthetic Mitral Valve

Hemant Solomon, BSc (Hons) MRCP (UK), *D. Scott Lim, MD, Michael Ragosta, MD

Author Affiliations:

From the Department of Cardiology and the *Department of Pediatric Cardiology, University of Virginia Health System, Charlottesville, Virginia.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted March 28, 2008, provisional acceptance given May 1, 2008, and final version accepted May 2, 2008.
Address for correspondence: Michael Ragosta, MD, FSCAI, Department of Cardiology, University of Virginia Health System, Box 800158, 1215 Lee Street, Charlottesville, VA 22908.

ABSTRACT: The TandemHeart® is a percutaneous ventricular assist device that has been approved to provide hemodynamic support in high-risk patients undergoing cardiac procedures, including percutaneous coronary interventions and aortic balloon valvuloplasty. Limited data exists for its role in stabilizing cardiogenic shock secondary to prosthetic valve dysfunction. In conclusion, we report the first case, to our knowledge, of profound cardiogenic shock secondary to an acutely thrombosed mechanical mitral valve in which the use of the TandemHeart was instrumental in rescuing a critically ill yo...

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