Volume 16 - Issue 3 - March, 2004

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...

Use of PercuSurge GuardWire in Native Coronary Arteries During Acute Myocardial Infarction

Cameron Haery, MD, Jose E. Exaire, MD, Deepak L. Bhatt, MD, Jay S. Yadav, MD, Irving Franco, MD, Stephen G. Ellis, MD

One of the most challenging scenarios encountered during the percutaneous treatment of acute coronary syndromes (ACS) is the presence of thrombus, and the subsequent distal embolization due to mechanical disruption of the culprit lesion.1 Resultant epicardial vessel and microvascular impedance to flow contributes to long-term left ventricular dysfunction, congestive heart failure and death.2–5 Preventing distal embolization during percutaneous coronary intervention (PCI) in ACS is therefore of the utmost importance. The PercuSurge GuardWire (Medtronic, Minneapolis, Minn...

Percutaneous Coronary Interventions in Diabetic Patients: Is Complete Revascularization Important?

Eugenia Nikolsky, MD, PhD, Luis Gruberg, MD, Chandrashekhar V. Patil, MD, Ariel Roguin, MD,
Michael Kapeliovich, MD, Sirouch Petcherski, MD, Monther Boulos, MD, Ehud Grenadier, MD, Shlomo Amikam, MD, Shai Linn, MD, Walter Markiewicz, MD, Rafael Beyar, MD, DSc

ABSTRACT: Background. The long-term prognosis of diabetic patients with multivessel coronary artery disease (CAD) treated by surgical or percutaneous coronary revascularization is significantly worse as compared to non-diabetics. Lower rates of complete revascularization may be one factor that influences the poor long-term outcome in the diabetic population. Our study assessed the impact of complete revascularization on the long-term prognosis in diabetic patients with CAD treated by percutaneous coronary intervention (PCI). The study included 658 consecutive diabetic patients (m...

Intracoronary Brachytherapy for In-Stent Restenosis of the Left Anterior Descending Artery Via the Left Internal Mammary Artery

Joseph Aragon, MD and Frank Litvak, MD

Intravascular radiation is currently the only Food and Drug Administration-approved modality to treat in-stent restenosis (ISR).1,2 Multiple clinical trials have shown efficacy of beta-radiation in reducing intimal growth associated with ISR.3,4 The Galileo centering catheter (Guidant Corporation, Santa Clara, California) uses a balloon centering catheter to deliver a Phosphorus-32 (32P) radiation source to the area of restenosis. The catheter design includes a rapid-exchange lumen and a central lumen with a closed end to isolate the radiation source from the patient. The...

Percutaneous Coronary Revascularization in Diabetic Patients with Multivessel Coronary Artery Disease: Importance and Feasibilit

Rajendra H. Mehta, MD, MS and Michael H. Sketch, Jr., MD

Percutaneous coronary interventions (PCI) have been increasingly adopted for the treatment of coronary artery disease in patients with diabetes mellitus. This form of coronary revascularization is attractive because of its ability to avoid coronary artery bypass surgery (CABG), leading to shorter hospital stays and lower initial costs.1 Nonetheless, the inability to completely revascularize patients remains the ‘Achilles Heel’ of percutaneous coronary interventions.1 This limitation is much more apparent among patients with diabetes, who often have diffuse, severe, an...

Primary Stenting of an Anomalous Left Main Trunk Originating from the Right Coronary Artery During Acute Myocardial Infarction

Raúl Moreno, MD, Carlos Barrera-Ramírez, MD, José Garcia, MD, Carlos Macaya, MD

ABSTRACT: In 1.5–2.0% of patients with acute myocardial infarction referred for primary percutaneous coronary intervention, the left main trunk is identified as the culprit vessel. Among the congenital coronary anomalies, an anomalous origin of the left main trunk from the right sinus of Valsalva is very rare. A 73-year-old patient with lateral acute myocardial infarction was referred to primary angioplasty. The initial angiogram showed an anomalous origin of the left main from the right coronary artery, apparently with a septal course, with an angiographic image of intraluminal throm...

Interaction Between a Perfluorocarbon Emulsion and Radiographic Contrast Media

Ralf-Peter Franke, PhD, MD, Peter Reuter, PhD, Wolfgang Röhlke, PhD, *Klaus Matschke, MD, *Steffi Keller, MD, †Bernd Klosterhalfen, MD, †Christian Mittermayer, MD, §Christoph Mrowietz, PhD, §Friedrich Jung, PhD

ABSTRACT: This study evaluated specially designed perfluorocarbon (PFC) emulsions as blood substitutes in case of induced ischemia of the left heart ventricle in healthy farm pigs. Two hundred milliliters of perfluorocarbon emulsion were infused while 200 ml of blood were simultaneously drawn. Radiographic contrast media were given to aid placement of balloon catheters in the left coronary artery. Histopathological analysis showed that right heart failure caused the deaths of both pigs. Particles (up to > 3 µm) of foreign body materials obstructed capillaries of all organs analyzed (he...

One Stent Lost in Two Arteries

Alexander Goldberg, MD, Arthur Kemer, MD, Ganeshkumar Anne, MD, Luis Gruberg, MD

The use of stents during percutaneous coronary intervention is now increasingly common. Stent embolization into the systemic or coronary circulation before deployment is a rare but recognized complication of coronary stenting, with hazardous risk for the patient.1–4 Potentially fatal consequences of intracoronary embolization of balloon-mounted stents include coronary thrombosis and subsequent myocardial infarction.5,6 In the past, manual crimping of stents was associated with a significantly increased risk of stent disengagement and embolization. Although manually crim...

Validation of 4 French Catheters for Quantitative Coronary Analysis: In Vivo Variability Assessment Using 6 French Guiding Cathe

Marcelo Sanmartin, PhD, Javier Goicolea, MD, Raul Castellanos, MD, Marisol Bravo, MD, Raymundo Ocaranza, MD, Diogenes Cuevas, MD, Ramon Mantilla, MD, Rafael Ruiz-Salmeron, PhD

ABSTRACT: Although numerous studies have established the utility of 4 French (Fr) catheters for routine coronary angiography, its adequacy for automatic quantitative coronary analysis has not been previously assessed. Methods. In 32 consecutive patients, coronary angiography was performed sequentially with 4 Fr diagnostic catheters and 6 Fr guiding catheters after intracoronary nitroglycerin. A total of 43 lesions were evaluated for quantitative analysis using both types of catheter as scaling devices. Possible differences in the reference diameter, minimal luminal diameter and p...

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