Volume 15 - Issue 12 - December, 2003

How Should Diuretic-Refractory, Volume-Overloaded Heart Failure Patients Be Managed?

Clinical problem. Heart failure patients are frequently hospitalized with decompensated heart failure,1 usually with volume overload. Treatment guidelines recommend diuretics to optimize volume status,2 and are most effective administered intravenously. However, the management of patients refractory to diuretic therapy is not addressed in the guidelines of the American Heart Association/American College of Cardiology,3 the European Society of Cardiology4 or the Heart Failure Society of America.5
One problem with defining a treatment strategy in these patients is the lack of a consisten



Pilot Study of Oral Rapamycin to Prevent Restenosis in Patients Undergoing Coronary Stent Therapy: Argentina Single-Center Study

Observational and randomized studies recently showed that sirolimus-coated stents were associated with a lower rate of restenosis than bare stents.1–3 Although the restenosis rate was lower, coated stents have a significantly higher cost than conventional stents and their future use in multivessel disease or in patients with multiple lesions is questionable due to the prohibitive costs of such therapy.
Sirolimus (rapamune), a natural macrocyclic lactone, is a potent immunosuppressive agent that was developed by Wyeth-Ayerst Laboratories and is given orally to renal transplant patients to av



PCI for Totally Occluded Site Consisting of Huge Thrombus

Case Report. A 53-year-old male was admitted to our hospital complaining of persistent chest pain. He was diagnosed as having acute posterior myocardial infarction based on the clinical findings of ST segment elevation in posterior ECG leads and echocardiographic posterior-lateral wall motion abnormality. Emergency coronary angiography (CAG) revealed total occlusion of the distal left circumflex coronary artery. The culprit lesion was successfully treated with primary implantation of a 4.0 X 13 mm ACS Multi-Link RX Tristar stent (Guidant Corporation, Santa Clara, California). CAG als



Left Atrial Thrombus Formation on a CardioSeal Septal Occlusion Device in a Patient with Elevated Factor VIII: Resolution with

Transcatheter closure of patent foramen ovale (PFO) has increasingly become accepted therapy for patients with a history of multiple cryptogenic strokes.1–3 As more patients undergo transcatheter closure of PFO, and septal defects (atrial and ventricular septal defects), complications associated with these procedures will continue to be reported in the literature.4–6 One of the more worrisome complications that has previously been reported is thrombus formation on the septal occlusion device.7-10 This particular complication though rare, if present on the left atrial disc of the device, ca



Diabetes Mellitus and Preferred Method of Coronary Revascularization — The Debate Continues

Diabetes mellitus is a public health problem of increasing importance in both the developed and developing worlds.1 The prevalence of obesity, the metabolic syndrome, and in particular diabetes, continues to increase; the impact on present and future healthcare resources is substantial. Since more than 75% of all diabetic patients die of atherosclerotic coronary heart disease, cardiologists are at the forefront of efforts, along with endocrinologists, to treat patients with established diabetes and coronary heart disease. Efforts to reduce the risk of dying from cardiovascular disease must inc



Passive Coating: The Dream Does not Come True

Stainless steel and small amounts of nickel, chromium molybdenum and other contaminants tends to produce a foreign body reaction when implanted in human coronary arteries. The goal of “passive coatings” is to make the stent as neutral as possible to this recognition. The two most common approaches utilized in the clinical setting are to coat the stent with phosphorylcholine or with carbon ions. Carbon-coated stents are widely used in different clinical settings and several companies have designed and developed stents with different technology to coat the stainless steel. The initial enthus



Milking-Like Effect Secondary to Systolic Expansion of a Post-Infarction Left Ventricular Aneurysm

Systolic compression (milking) of the coronary arteries is almost always due to the existence of myocardial bridging. The prevalence of myocardial bridging ranges from 0.5% to 16% of patients submitted to coronary angiography, and is usually located at the proximal or mid segment of the left anterior descending coronary artery (LAD).1–3
Ocassionally, systolic compression may be caused by a systolic expansion of a left ventricular aneurysm.4 We present a patient with a post-infarction left ventricular aneurysm in whom coronary angiography showed a milking-like effect with systolic compressio



Editor's Message - October 2003

Dear Readers,

This issue of the Journal of Invasive Cardiology includes original research articles, a special medical informatics update, interesting case reports, and articles from the Journal special sections “Clinical Decision Making” and “Clinical Images”.

In the first original research paper, Dr. Christian Hamm and collaborators from the Department of Cardiology at the Kerckhoff Heart Center in Bad Nauheim, the University Hospital in Frankfurt and the University Hospital Eppendorf in Hamburg, Germany present their study of short-term and 6-month follow-up of a peptide-coat



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