Volume 15 - Issue 12 - December, 2003

Coronary Fistula from Left Main Stem to Main Pulmonary Artery

C.K. Ekonomou, MD, D.P. Papadopoulos, MD, N.V. Dalianis, MD, N.G. Stratigis, MD,
J. Benos, CVT, V.E. Votteas

Congenital coronary arteriovenous fistula (CAF) is a rare anomaly. The incidence of congenital cardiac lesions is only 0.13%.1 Over 90% of these fistulas drain into the systemic venous side of the circulation.2 Drainage of the fistula into the pulmonary trunk has been reported in 17% of cases.2 To the best of our knowledge, a connection between the left main stem and main pulmonary artery has been reported in the literature only once, as a case in India in 1989.3

Case Report. A 51-year-old female with hypertension was admitted to the hospital with her first attack of acute myocard...

Comparison of Stainless-Steel Stents Coated with Turbostratic Carbon and Uncoated Stents for Percutaneous Coronary Interventions

Jürgen Haase, MD, PhD, Hans Störger, MD, Manfred Hofmann, MD, Claus-Eberhard Schwarz, MD, Harald Reinemer, MD, Franz Schwarz, MD, PhD

Implantation of stainless-steel stents has improved the results of percutaneous coronary revascularization.1,2 However, in various subsets of lesions, especially in the presence of complex lesion morphology, in-stent restenosis due to late neointimal hyperplasia occurs in up to 50% of cases3–5 requiring repeated coronary interventions including intravascular brachytherapy.6,7 Various passive stent coatings have been proposed to reduce thrombus formation and intimal hyperplasia following stent implantation.8–10 However, none of these stent coatings have proven to prevent in-stent restenosis...

Peptide-Treated Stent Graft for the Treatment of Saphenous Vein Graft Lesions: First Clinical Results

Christian W. Hamm, MD, FESC, *Volker Schächinger, MD, †Thomas Münzel, MD, Christian Maikowski, MD, **Tassilo Bonzel, MD, †Ralf Köster, MD, Matthias Rau, MD, *Andreas M. Zeiher, MD

Percutaneous interventions of degenerated saphenous vein grafts (SVGs) are associated with high rates of distal embolic events and in-stent restenosis.1 Recent experience with covered stents suggests that these types of devices may be a promising alternative to bare stents or repeat bypass surgery in the treatment of diseased saphenous vein grafts.2–4 A new, ePTFE stent graft (Figure 1) has been developed, which incorporates a synthetic, cell-adhesion peptide (P-15) surface treatment.5 Pre-clinical studies of this device in the porcine model have demonstrated a rapid and complete regeneratio...

Catheter-Based Revascularization of the Hepatic Artery to Treat Coronary Steal from a Gastroepiploic Artery Bypass Graft

David E. Kandzari, MD

For patients treated with coronary bypass surgery, atherosclerotic peripheral arterial disease may compromise blood flow to more distally located arterial bypass grafts. In most instances, proximal subclavian artery stenosis limits flow to the left internal mammary artery (LIMA) graft, resulting in myocardial ischemia. Although percutaneous revascularization of the subclavian artery to relieve ischemia related to the LIMA graft has been described,1–3 catheter-based revascularization of other peripheral arteries to treat steal phenomena from additional arterial conduits is not well characteri...

The Influence of Diabetes Mellitus on the Practice and Outcomes of Percutaneous Coronary Intervention in the Community: A Report

Aaron D. Kugelmass, MD, •David J. Cohen, MD, MSc, †Frank Houser, MD, ••Michael Mack, MD, ††April W. Simon, RN, MSN, †Salvatore L. Battaglia, BS, †Lynn G. Tarkington, RN, •••Edmund R. Becker, PhD, •••Steven D. Culler, PhD

Diabetic patients with coronary artery disease (CAD) have poorer long-term prognosis with more revascularization procedures than non-diabetic patients regardless of the initial treatment strategy.1,2 The role of percutaneous versus surgical revascularization as the initial treatment strategy for diabetic patients remains controversial. The Bypass Angioplasty Revascularization Investigation (BARI) trial found that diabetic patients with Multivessel coronary artery disease randomized to an initial strategy of PCTA versus CABG surgery had significantly higher mortality rates (34.7% versus 19.1%) ...

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

James L. Orford, MBChB, MPH and *Peter B. Berger, MD

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...

PCI for Totally Occluded Site Consisting of Huge Thrombus

Naotsugu Oyama, MD, Kazushi Urasawa, MD, Hidetsugu Sakai, MD, Akira Kitabatake, MD

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

Michael R. Recto, MD, Walter Sobczyk, MD, *Terence Hadley, MD, †Thomas Yeh Jr., MD, PhD

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...

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

Alfredo E. Rodríguez, MD, PhD, Máximo Rodríguez Alemparte, MD, Cesar F. Vigo, MD, Carlos Fernández Pereira, MD, Claudio Llauradó, BS, Miguel Russo, MD, *Renu Virmani, MD, PhD, †John A. Ambrose, MD

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...

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

Jonathan D. Sackner-Bernstein, MD and Rimvida Obeleniene, MD

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...

Editorial Staff
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    Laurie Gustafson
  • Production
    Elizabeth Vasil
  • National Account Manager
    Jeff Benson
  • Senior Account Director
    Carson McGarrity
  • Special Projects Editor
    Amanda Wright
Editorial Correspondence
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