Volume 15 - Issue 3 - March, 2003

Early and Late Reactions Following the Use of Iopamidol 340, Iomeprol 350 and Iodixanol 320 in Cardiac Catheterization

A.G.C. Sutton, *P. Finn,  P.G. Campbell, D.J.A. Price, J.A. Hall,  M.J. Stewart,  A. Davies, N.J. Linker, A.A. Harcombe, M.A. de Belder

ABSTRACT: Goal. To investigate the incidence of early (< 24 hours) and late (> 24 hours to 7 days) reactions to 3 contrast agents commonly used in cardiac catheterization. Methods and Results. A total of 2,108 patients undergoing cardiac catheterization in a Regional Cardiothoracic Unit were randomly assigned to receive 1 of 3 commonly used contrast agents in a prospective, double-blind study.


Post-Cardiac Catheterization Access Site Complications and Low-Molecular-Weight Heparin Following Cardiac Catheterization

Lee A. MacDonald, MD, Sheridan Meyers, MD, Charles L. Bennett, MD, PhD, Dan Fintel, MD, Neal Grosshans, MS, RPh, Raffy Syegco, RN, Charles J. Davidson, MD

No consensus has emerged on the periprocedural anticoagulation regimen of patients receiving long-term oral anticoagulation.1 Enoxaparin, a low molecular weight heparin (LMWH), is often used following percutaneous invasive procedures in patients on long-term anticoagulation who undergo temporary periprocedural discontinuation of warfarin. From 1993 through 1998, the Food and Drug Administration (FDA) received reports of 43 patients who developed spinal or epidural hematomas following the use of enoxaparin in the setting of neuraxial blockade.2 Many of these patients developed severe neurologic...

Long-Term Warfarin and Percutaneous Intervention

Sanjeev Vaderah, MD and John Webb, MD

Despite improvements in interventional procedural techniques and equipment, vascular and bleeding complications remain a too frequent complication of percutaneous coronary intervention (PCI). In the National Cardiovascular Network database of over 100,000 patients undergoing cardiac catheterization the transfusion rate was 4% and the vascular complication rate was 3.5%.1 Contemporary PCI trials report rates of major bleeding of 1 to 2% and minor bleeding rates of 3–6%.2,3
The optimal peri-procedural strategy for patients requiring ongoing anticoagulation with warfarin is unclear. In the cu...

Successful Aspiration of Occlusive Coronary Thrombus with Intracoronary Aspiration Using the Export™ Catheter

Srinivas Koneru, MD, Anthony Pucillo, MD, Melvin B. Weiss, MD, Craig Monsen, MD

Percutaneous transluminal coronary angioplasty (PTCA) for unstable angina relieves symptoms and reduces the likelihood of subsequent acute myocardial infarction. However, initial procedural success rates in patients with unstable angina are lower than in those with stable angina. This is postulated to mainly be due to the higher complication rates associated with PTCA procedures in this setting.1 Procedure-related mortality has been reported to range from 0–5.4%, periprocedural myocardial infarction rates range from 0–12% and the need for emergency surgery ranges from 3–13%.2–8 Complic...

A Comparison of Arterial Closure Devices to Manual Compression in Liver Transplantation Candidates Undergoing Coronary Angiograp

Lee A. MacDonald, MD, Nirat Beohar, MD, Norman C. Wang, MD, Lisa Nee, MD, Raj Chandwaney, MD, Mark J. Ricciardi, MD, Keith H. Benzuly, MD, Sheridan N. Meyers, MD, Mihai Gheorghiada, MD, Charles J. Davidson, MD

Coronary artery disease is common in adult patients with end-stage liver disease who are candidates for orthotopic liver transplantation.1 Patients with end-stage liver disease are predisposed to spontaneous bleeding complications due to thrombocytopenia, reduced synthesis of coagulation factors and increased fibrinolytic activity.2–4 The impaired immunity has been shown to lead to a higher frequency of bacteremia and subsequent increased mortality.5,6 Vascular access site hematomas and infections are well known complications of cardiac catheterization.7 Several trials have reported similar ...

Contemporary View of the Acute Coronary Syndromes (Part I of II)

Ali Moustapha, MD and *H. Vernon Anderson, MD

Acute coronary syndromes (ACS) represent a clinical spectrum that extends all the way from unstable angina presenting with worsening episodes of chest pain, to non-ST segment elevation myocardial infarction (NSTEMI) with more prolonged chest pain and biochemical evidence of myocardial injury, to ST-segment elevation myocardial infarction (STEMI) with more extensive myocardial damage and usually the formation of Q-waves on the surface electrocardiogram, and finally to sudden cardiac death. Pathophysiologic correlations in ACS include minor plaque ulceration and transient thrombus formation in u...

Contemporary View of the Acute Coronary Syndromes (Part II of II)

Ali Moustapha, MD and *H. Vernon Anderson, MD

The dilemma of invasive versus conservative strategies. After patients with unstable angina and NSTEMI have been stabilized with medical therapy, a decision must be made regarding risk stratification. Several randomized trials have compared outcomes with early conservative versus early invasive management in ACS. Results of these trials were conflicting and most antedated the use of platelet GP IIb/IIIa receptor inhibitors and coronary stenting (Table 3). These include TIMI-IIIB,60 VANQWISH,61,62 MATE,63 FRISC II,64,65 and TACTICS-TIMI 18.66
The TIMI-IIIB trial60 used a 2 x 2 factorial...

Obliteration of a Competitive Forward Flow from the Ventricle After a Bidirectional Cavopulmonary Shunt with an Amplatzer Duct O

Carlo B. Pilla, MD, Valmir F. Fontes, MD, Carlos A.C. Pedra, MD

The early and mid-term results of the Amplatzer Duct Occluder (ADO) (AGA Medical Corporation, Golden Valley, Minnesota) for obliterating flow through a patent arterial duct are highly encouraging.1,2 High occlusion rates, low complication rates and application even in small children have made the percutaneous occlusion of arterial ducts with this device an attractive alternative to surgery.
The ADO has also been used in other clinical situations, such as closure of coronary artery fistula,3 surgical conduit,4 left ventricle to aorta tunnel5 and muscular apical ventricular septal defect.6 All ...

IAGS 2002: The Intractable Angina Patient

Panel Members: Howard Cohen, MD, Philip Walker, MD, Gary Roubin, MD

Some Patients Can’t Be Revascularized with PCI or CABG

Despite the advances that have occurred in coronary revascularization, there is a growing population of patients who are not candidates for either coronary artery bypass grafting (CABG) or conventional percutaneous coronary intervention (PCI). This population is heterogeneous and includes patients with diffuse coronary disease, comorbid conditions or multiple previous bypass operations resulting in no remaining suitable conduits.
The majority of such patients present with anginal symptoms that are unresponsive to both conventi...

Selective Coronary Artery Fistula Embolization with Hystoacryl During Percutaneous Coronary Angioplasty

Ramón Villavicencio, MD, Raúl Marenco, MD, *Marco A. Zenteno, MD, Jorge Gaspar, MD

Coronary artery fistulae (CAF) are anomalous communications between coronary arteries and a cardiac chamber, great vessel or other vascular structure bypassing the myocardial capillary bed.1,2 The frequency has been reported to be approximately 0.2% of the adult population that has been subject to coronary angiography.3 CAF are usually congenital in origin, although they can rarely be acquired, either after coronary artery bypass grafting, mitral valve replacement4,5 or endomyocardial biopsy procedures.6
The clinical importance of CAF varies depending on the magnitude of the arteriovenous shu...

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