Volume 21 - Issue 6 - June, 2009
Patent Foramen Ovale and Atrial Septal Aneurysm: Achieving Closure
- Tue, 6/9/09 - 3:48pm
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The debate continues in the cardiology community over indications of percutaneous closure of patent foramen ovale (PFO) with or without an associated atrial septal aneurysm (ASA). Observational studies with control cohorts have shown an association between unexplained ischemic stroke and PFO. Hazard ratios for a stroke in the setting of a PFO range from 1.46–1.64.1,2 with an increase in the odds ratio of 3.9 for experiencing a cryptogenic stroke.3 An ASA alone or in combination with a PFO appears to increase the odds ratio of a paradoxical embolic stroke by 4.3 and 33.3, respectively.3 The
Cutting Balloon Angioplasty for Aortic Coarctation
- Tue, 6/9/09 - 3:57pm
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ABSTRACT: Background. Cutting balloon angioplasty (CBA) has improved outcomes for resistant stenotic vascular lesions in adult coronary artery disease. Application of this technique in coarctation of the aorta (CoA) in children has not been reported. Objective. We sought to review the safety, efficacy and outcomes of CBA in the setting of CoA. Methods and Results. Between February 2004 and October 2007, 8 children (4 males) underwent 10 procedures. The median age was 5.5 months (range: 2.5 months to 5 years) and median weight 7.5 kg (range: 4.1–13.3 kg). Two children had native CoA. CBA was
Successful Use of a Novel PCI Guiding Catheter with an Extra Lumen in an Animal Model
- Tue, 6/9/09 - 4:01pm
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ABSTRACT: This report describes a novel percutaneous coronary intervention (PCI) guiding catheter equipped with an additional lumen running along the full length of the main lumen. This lumen allows continuous infusion of medications (e.g., thrombolytic agents, nitroglycerin, glycoprotein IIb/IIIa inhibitors, etc.) during the procedure without interrupting the procedure being carried out using the main lumen. Intracoronary infusion of medication at the time of PCI should allow for more effective treatment with lower dosages and fewer side effects.
J INVASIVE CARDIOL 2009;21:300–302
Con
Coronary Rupture during Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction
- Tue, 6/9/09 - 4:04pm
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Case description. A 60-year-old female patient was admitted to our institution for acute inferior myocardial infarction 4 hours after symptom onset. She had no previous history of coronary artery disease and her risk factors included diabetes mellitus and dyslipidemia. Her history included chronic glucocorticoid therapy for 25 years to treat inflammatory arthritis. After antithrombotic therapy (aspirin, clopidogrel, heparin and abciximab), coronary angiography was urgently performed and showed mild disease of the left coronary system and occlusion of the right coronary artery (RCA) (Figure 1A)
The Army of Medicine without Any Soldiers
- Tue, 6/9/09 - 4:14pm
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The United States is in a recession, and shifting priorities have relegated medicine, health care and health insurance to secondary issues. Thus, the real issue of health care will not come to the forefront and receive significant attention. It is likely that physicians’ concerns and needs will be ignored. I believe that the primary resolution of our health-care crisis will not come from the implementation of universal health insurance, but rather through the existence and quality of physicians practicing the best medicine possible for patients. Without adequate numbers of highly trained phy
Back from Irreversibility: Use of Percutaneous Cardiopulmonary Bypass for Treatment of Shock (full title below)
- Tue, 6/9/09 - 4:30pm
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Back from Irreversibility: Use of Percutaneous Cardiopulmonary
Bypass for Treatment of Shock from Refractory Anaphylaxis
during Coronary Intervention
ABSTRACT: Anaphylaxis during diagnostic catheterization and coronary intervention is a rare and potentially life-threatening complication. Fortunately, with standard intervention, fatality is rare. We report a case of medically refractory anaphylaxis during a coronary intervention that ultimately responded to percutaneous cardiopulmonary bypass (CPB). T he proposed mechanics and use of CPB for shock are discussed.
Angiographic Segmental Narrowing of a Saphenous Vein Bypass Graft During Diastole
- Tue, 6/9/09 - 4:35pm
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ABSTRACT: Dynamic narrowing of native coronary vessels is widely known to occur during the systolic phase of the cardiac cycle. This phenomenon has also been reported to occur in coronary artery bypass grafts. However, to the best of our knowledge, only one case report exists of this event taking place in bypass grafts during diastole. We discuss the angiographic findings of a 73-year-old male who had undergone coronary artery bypass grafting surgery twice and experienced diastolic compression of his saphenous vein graft to the right posterior descending artery.
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Frequency and Outcomes of Provisional Glycoprotein IIb/IIIa Blockade in Patients Receiving Bivalirudin (full title below)
- Tue, 6/9/09 - 2:43pm
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Frequency and Outcomes of Provisional Glycoprotein IIb/IIIa Blockade in Patients Receiving Bivalirudin during Percutaneous Coronary Intervention
ABSTRACT: Objectives. This study sought to evaluate the frequency and efficacy of combination of bivalirudin and provisional glycoprotein (GP) IIb/IIIa blockade compared with bivalirudin monotherapy in current clinical practice of percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Background. Previous randomized trials have demonstrated that a strategy of bivalirudin with provisional (bailout) GP IIb/IIIa inhibition
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