Volume 15 - Issue 1 - January, 2004

Utility of Intracardiac Echocardiography to Facilitate Transvenous Coronary Sinus Lead Placement for Biventricular Cardioverter-

Todd J. Cohen, MD and George Juang, MD

Recently, with the results of the MIRACLE and COMPANION trials, there has been an increase in the demand for implanting cardiac resynchronization devices. One of the initial hurdles that the implanter must overcome is to access the coronary sinus through its ostium. However, in approximately 1–5% of cases, the coronary ostia may be difficult to identify. Muscle bands, bridges, and valves may prevent the operator from entering the coronary sinus and thereby finding an appropriate left ventricular lateral branch. A number of tools have been utilized to facilitate these difficult implants. We d...

In-Hospital Initiation of Cardiovascular Protective Medications for Patients Undergoing Percutaneous Coronary Intervention: Taki

Gregg C. Fonarow, MD

Percutaneous coronary interventional (PCI) procedures have changed the face of cardiovascular care, providing significant improvements in quality of life and survival for patients with debilitating cardiac disease. In 2000, there were over 500,000 patients who underwent PCI procedures in the United States.1 Although these coronary procedures have become routine, they do not modify the underlying disease process of atherosclerosis; they only reduce ischemia by mechanically increasing blood flow. Even when completely revascularized and in the absence of stress-induced ischemia, cardiovascular di...

Multi-Lesion “Culotte” and “Crush” Bifurcation Stenting with Sirolimus-Eluting Stents: Long-Term Angiographic Outcome

Joost Daemen, Pedro A. Lemos, MD, Patrick W. Serruys, MD, PhD

Case Report. A 63-year-old man, an ex-smoker with a history of hypertension and previous myocardial infarction, was admitted with stable angina (Canadian Cardiovascular Society Class 1) for elective percutaneous coronary intervention. Pre-procedure coronary angiogram revealed diffuse disease in the proximal and mid segments of the left circumflex artery (LCx) that was totally occluded in its distal portion (Fig. 1A). The first obtuse marginal branch (OM) presented a severe ostial stenosis (Fig. 1A). Also, the left anterior descending artery (LAD) presented a long stenosis in its mid por...

Anomalous Origin of Left Internal Mammary Artery

Shahid Aziz, MBChB, MRCP, and David R. Ramsdale, MD, FRCP

Origin of the internal mammary artery from sites other than the inferior surface of the first part of the subclavian artery is not uncommon. We describe the case of a left internal mammary artery (LIMA) originating from the third part of the left subclavian artery and its clinical relevance.

Case Report. A 65-year-old man gave a two-week history of unstable angina seven years after successful coronary artery bypass (CABG) surgery. He had required two admissions to the hospital with typical angina at rest associated with ST segment depression in leads V4-V6, I and AVL and raised Tr...

Successful Treatment in a Case of Acute Aortic Dissection Complicated with Acute Myocardial Infarction Due to Occlusion of the L

Yoshikazu Ohara, MD, Yoshikazu Hiasa, MD, Shinobu Hosokawa, MD

Recently, the surgical results of acute aortic dissection (Stanford type A) have improved. However, the treatment of cases complicated with severe organ ischemia, especially myocardial ischemia, is very difficult. When the aortic dissection extends to the coronary artery, catastrophic changes in the hemodynamic state occur; as a result, it is often difficult to save the patient’s life in such cases.1 Most of the cases in which a fatal outcome is avoided are successful emergency operation cases or right coronary myocardial infarction cases.2–6 We reported a case successfully treated by perc...

Considerations on Radiation Source Selection and Utilization in Vascular Brachytherapy

Ian Crocker, MD

The initial evaluation of radiotherapy in animal models of restenosis focused on the used of 192Iridium ribbons, a commercially available source. After initial animal studies revealed that therapy with this isotope reliably inhibited vascular renarrowing following balloon angioplasty, investigation into alternative, more “user-friendly” radiation delivery sources and systems was undertaken. Permanently implanted radioactive stents were very successful in animal models and clinical trials at inhibiting neointimal proliferation within the stent but created problems of narrowing at the ends o...

The Anticoagulant Therapy with Bivalirudin to Assist in the Performance of Percutaneous Coronary Intervention in Patients with

Kenneth W. Mahaffey, MD,* Bruce E. Lewis, MD,† Nancy M. Wildermann, BA,* Scott D. Berkowitz, MD,*‡ Renee M. Oliverio, RN,* Mark A. Turco, MD,§ Yoseph Shalev, MD,§§ Peter Ver Lee, MD,*** Jay H. Traverse, MD,‡‡ A. Ralph Rodriguez, MD,** E. Magnus Ohman, MD,†† Robert A. Harrington, MD,* Robert M. Califf, MD,* for the ATBAT Investigators

Heparin-induced thrombocytopenia (HIT) is infrequent and often goes unrecognized. It occurs in ~1% to 5% of the patients given unfractionated heparin,1 about 25–50% of whom will develop HIT with thrombotic syndrome (HITTS).2 Morbidity and mortality are high, and more than 50% of patients suffering thrombotic complications will die.3 Patients with recognized HIT may require anticoagulation for acute coronary syndromes (ACS) or percutaneous coronary intervention (PCI), thus presenting a clinical challenge given the limited alternatives for anticoagulation treat...

Hemostasis in the Era of the Chronic Anticoagulated Patient

Bonnie Weiner, MD, *Thomas Fischer, PhD, †Sergio Waxman, MD

Mechanisms for Hemostasis and Comparative Efficacy

The technology to produce poly-N-acetylglucosamine (pGlcNAc) polymer is based on a biomaterial that is derived in a fiber form from aseptic cultures of a marine microalgae diatom. Once isolated and purified, the high quality, pure material is subject to rigorous quality control and quality assurance. The end product can be formulated as patches, lyophilized patches, gels, microspheres, and foams. The isolation of pGlcNAc fibers provides the source of the material for the manufacture of the Syvek Patch® (Marine Polymer Technologies, Danvers...

Use of Lepirudin During Percutaneous Vascular Interventions in Patients with Heparin-Induced Thrombocytopenia

Kevin Cochran, MD, Tony J. DeMartini, MD, Bruce E. Lewis, MD, James O’Brien, RN, Lowell H. Steen, MD, Eric D. Grassman, MD, PhD, Ferdinand Leya, MD

Percutaneous coronary intervention is a common procedure, with over 750,000 interventions performed in the United States per year. Balloon inflation and stent deployment cause endothelial injury and plaque disruption, leading to platelet activation, thrombin generation and an inflammatory response. Aspirin, clopidogrel, platelet glycoprotein (GP) IIb/IIIa receptor inhibitors and unfractionated or low-molecular weight heparin are routinely used to counteract the effects of thrombin and the stimulated platelet population. The GP IIb/IIIa inhibitors block the final common pathway of platelet acti...

Thrombolytic Therapy for Right Atrial and Pulmonary Embolus

David G. Rizik, MD, Bernard J. Villegas, MD, Andre P. Bouhasin, MD, Richard Levinson, MD

A 68-year-old male with a history of hypertension presented to the emergency department with acute onset pain and severe swelling of the left lower extremity. Pleuritic chest discomfort was also noted. He had been traveling by automobile from Canada to the Desert Southwest for 3 days and admitted to very little activity during this period. Physical exam was notable for a swollen, painful left calf with an easily reproducible Homan’s sign. He was noted to have a murmur of tricuspid regurgitation. Shortly after initial evaluation, he became visibly dyspneic with oxygen saturations of 89–90% ...

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