Volume 16 - Issue 3 - March, 2004

Transcatheter Closure of Secundum Atrial Septal Defects with Complex Anatomy (Part II)

Carlos A.C. Pedra, MD, Simone R.F. Pedra, MD, César A. Esteves, MD, Renata Cassar, MD, Sérgio C. Pontes Jr., MD, Sérgio L.N. Braga, MD, Valmir F. Fontes, MD

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Transcatheter closure was successful in the remaining 35 patients (87.5%). The calculated Qp/Qs was 2.5 ± 0.8. All patients had normal to mildly elevated pulmonary artery pressures. The fluoroscopic and total procedure times ranged from 3–63 minutes (median time, 20 minutes) and 20–210 minutes (median time, 90 minutes), respectively. All patients with a single, large defect (n = 19) received an Amplatzer device, ranging in size from 26–38 mm (median, 32 mm; mean...

Percutaneous Occlusion of Complex Atrial Septal Defects

Ashraf M. Nagm, MD, and P. Syamasundar Rao, MD

Since the pioneering investigations by King, Rashkind and their colleagues1–6 in mid 1970s of percutaneous device occlusion of secundum atrial septal defects (ASDs), a number of other investigators have designed and tested other devices as reviewed elsewhere.7,8 The interventional cardiologist has therefore, lots of devices to choose from. But the selection of one device over the other is difficult because of lack of prospective randomized clinical trials.9,10 Such trials involving all the eligible devices is necessary to provide accurate information on usefu...

Simple Clinical Risk Stratification and the Safety of Ambulation Two Hours After 6 French Diagnostic Heart Catheterization

Gabriel Rosenstein, MD, *Carlos Cafri, MD, Jean Marc Weinstein, MRCP, Sergei Yeroslavtsev, MD,
Akram Abuful, MD, Reuben Ilia, MD, Shmuel Fuchs, MD

ABSTRACT: Heart catheterization is frequently applied in patients with coronary artery disease for diagnostic and therapeutic implications. Using the femoral approach, post-procedure bed rest of 4–6 hours is recommended to prevent groin complications. This extended strict bed rest is associated with patient discomfort and increased medical costs, and interferes with more efficient catheterization laboratory management of referred outpatients. Accordingly, we tested a simple clinical approach to identify low-risk patients who may benefit from ambulation within two hours after sheath re...

Comparison of the Radial and Femoral Approaches in Left Main PCI: A Retrospective Study

A. Ziakas, MD, P. Klinke, MD, R. Mildenberger, MD, E. Fretz, MD, M.B. Williams, MD, A. Della Siega, MD, R.D. Kinloch, MD, J.D. Hilton, MD

ABSTRACT: Transradial percutaneous coronary intervention (PCI) is a safe and effective method of percutaneous revascularization. However, there are no data on the efficacy of the transradial approach in left main (LM) PCI. We studied 80 patients (pts) who underwent LM PCI between February 1994 and January 2002, and compared the radial (27 pts) and femoral (53 pts) approaches. Patients were considered free of restenosis if they were free of angina and had a negative treadmill or nuclear imaging study 6 months post-PCI. Mean follow-up time was 27.4 ± 23.0 months. Reason for PCI (stable a...

Cutting Balloon Angioplasty to Treat Carotid In-Stent Restenosis

Michael R. Tamberella, MD, Jay S. Yadav, MD, Christopher T. Bajzer, MD, Deepak L. Bhatt, MD, Alex Abou-Chebl, MD

ABSTRACT: We describe a case of carotid artery restenosis following carotid artery stenting for treatment of post-endarterectomy stenosis. The goal is to highlight the risk of recurrent restenosis following endarterectomy. In this case report, we describe the use of cutting balloon therapy as a reasonable alternative to repeat surgical revascularization.

Key words: arteriosclerosis, cerebrovascular disorders, endarterectomy

With the recent presentation of the SAPPHIRE trial1 favoring carotid stenting with protection compared to carotid endarterectomy in ...

March 2004

Richard E. Shaw, PhD, FACC

Dear Readers,

This issue of the Journal of Invasive Cardiology coincides with the annual scientific sessions of the American College of Cardiology and includes original research articles, commentaries, review articles, case reports and offerings from our journal special sections Acute Coronary Syndromes, Interventions in Peripheral Vascular Disease, Clinical Decision Making and Clinical Images.

The research articles in this issue cover a broad range of topics that touch on important aspects of patient care. The first resear...

Low-Molecular-Weight Heparins and Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes (Part I)

James Ferguson, MD

ABSTRACT: Traditional antithrombotic regimens for the management of acute coronary syndromes are far from optimal. There is considerable opportunity for improvement of standard treatment with unfractionated heparin and aspirin. The introduction of new antithrombotic drugs, such as low-molecular-weight heparins (LMWH), and more potent antiplatelet drugs, such as glycoprotein (GP) IIb/IIIa antagonists, has the potential to significantly improve clinical outcomes. The complementary anticoagulant/antiplatelet modes of action of LMWHs and GP IIb/IIIa antagonists mean that combining these dru...

Low-Molecular-Weight Heparins and Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes (Part II)

James Ferguson, MD

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Several other recent studies have also examined the efficacy and safety of the combination of LMWHs and GP IIb/IIIa antagonists in the catheterization laboratory (Table 1). Kereiakes et al. reported the results of a pilot study comparing two doses of dalteparin (40 or 60 IU/kg) in combination with abciximab for anticoagulation during elective PCI in 107 patients.46 Randomized enrollment was halted because three acute thrombotic events occurred in the 40 IU/kg ...

Severe Intravascular Hemolysis Following Mitral Valve Repair

Truong Duong, MD,* Rahul N. Khurana, MD§, Richard A. Francoz, MD*

ABSTRACT: We report two cases of severe intravascular hemolysis (IVH) following mitral valve repair using a Cosgrove-Edwards ring. In both cases, the degree of mitral regurgitation (MR) seen postoperatively worsened significantly compared to intraoperative transesophageal echocardiogram. Both patients required reoperation with mitral valve replacement with immediate resolution of the hemolysis. We hypothesize that the mitral regurgitation in the setting of an inadequate mitral valve repair is responsible for the hemolysis and propose various mechanisms to explain this pathophysiology. A...

Stent Implantation for Coronary Aneurysm with Edge Stenosis: Angiographic and Intravascular Analysis

Benjamin M. Wu, MD, PhD, Mamoo Nakamura, MD, Mehrdad Rezaee, MD, PhD

ABSTRACT: The incidence of coronary artery aneurysms is about 1–2%, with clinical course dependent on the size of the aneurysm. A case of moderate-size aneurysm in the proximal left anterior descending coronary artery with stenosis at both edges is presented. This was interrogated with intravascular ultrasound (IVUS), and based on the patient’s presentation, a single stent, size-matched 1:1 to the proximal reference, was placed across the aneurysm and both lesions. Post-implantation IVUS demonstrated residual stenosis and minimal change in the “neck” size of the aneurysm. At 4 m...

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