Volume 18 - Issue 6 - June, 2006

Fatal Delayed Thrombocytopenia following Abciximab Therapy

Roger B. McCorry, MRCP and Paul Johnston, MRCP

Case Report. A 43-year-old Caucasian male was admitted with prolonged central chest pain. His initial ECG demonstrated ST depression in leads II, III, aVf and V2–V6. He received aspirin 300 mg, a loading dose of clopidogrel 300 mg (followed by 75 mg daily), and weight-adjusted enoxaparin (40 mg subcutaneously twice daily for 72 hours). Symptoms and ECG changes persisted and urgent coronary angiography was performed. This revealed a proximally occluded left anterior descending artery (LAD) and a severely stenosed, dominant right coronary artery (RCA), which completely collateralized...

Alveolar Hemorrhage Associated with Platelet Glycoprotein IIb/IIIa Receptor Inhibitors

aRasih Atilla Ener, MD, bNichole Bruno, MD, bDaniel Dadourian, MD, aNelson Wolf, MD, aWilliam Van Decker, MD, aJames Burke, MD, bMichael Styler, MD, bDavid Topolsky, MD

Bleeding into the alveoli from disruption of the pulmonary capillary lining may cause alveolar hemorrhage and can result from different mechanisms:1–4
1. Damage secondary to immunologic mechanisms, often associated with a pulmonary capillaritis (i.e., Goodpasture’s syndrome, systemic lupus erythematosus, vasculitides);
2. Direct mechanism or toxic injury (toxin or chemical inhalation, i.e., trimellitic anhydride, isocyanate, phenytoin, penicillamine, hydralazine, mitomycin-C, crack/cocaine use, propylthiouracil);
3. Physical trauma (i.e., pulmonary c...

Use of Magnetic Navigation to Facilitate Transcatheter Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Richard G. Bach, MD*, Christopher Leach, MD, Simon A. Milov, MD, Bruce D. Lindsay, MD*

Percutaneous transcatheter alcohol septal myocardial ablation (PTSMA) is an effective alternative to septal myectomy for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM).1–6 While alleviating symptoms for most patients, the procedure may not be technically feasible in 5–10% of cases,7 potentially due to septal artery anatomy. In some cases, success may be limited by operator difficulty in cannulating septal branches due to the typical 90° or greater angulation of their origin. The Stereotaxis Niobe® magnetic navigation system (Stereotaxis,...

Aortic Stenosis Catheterization Revisited: A Long Sheath Single-Puncture Technique

aJanet Hays, MD, bMichael Lujan, bRobert Chilton, MD

Aortic stenosis is one of the most common forms of valvular heart disease seen in adults. Despite advances in echocardiography, the evaluation of aortic stenosis continues to be a frequent procedure in the cardiac catheterization laboratory. In order to calculate the aortic valve area using the Gorlin formula,1 the mean transvalvular pressure gradient across the aortic valve must be measured. To obtain this transvalvular gradient, simultaneous evaluation of the proximal aortic and left ventricular pressures yields the most accurate data. Classically, this has required placing one ar...

Acute Left Main Coronary Artery Occlusion: A Catastrophic Problem with Poor Prognosis

Mouhammed A. Joumaa, MD, Thomas Davis, MD, Howard Rosman, MD

Left main coronary artery occlusion is a rare occurrence that is often fatal. It usually manifests as an acute myocardial infarction with cardiogenic shock and/or fatal arrhythmias. This circumstance is rarely observed, as most patients affected die before seeking medical attention.

Case Report. A 47-year-old male with no known coronary artery disease presented to our hospital one hour after sudden-onset chest pain and dyspnea. The pain occurred while the patient was working on a construction site. The patient’s past medical history included poorly-controlled hypertension, diabe...

Has THIS Target Stopped Moving?

Ronald J. Krone, MD

In this issue of the Journal, Hays, Lujan, and Chilton describe techniques to accurately measure aortic valve gradient during cardiac catheterization.1 While noninvasive cardiologists may consider this whole discussion a waste of time — “old cardiology” — there are times when an accurate gradient is important.
The gold standard of accuracy is measuring the pressure in the ascending aorta and simultaneously in the left ventricle using catheters with excellent frequency response.2 The most precise way of doing this is to place two catheters simultaneously i...

Cold Leg in Patient with High Coated Platelets: Possible Association with the Use of Rofecoxib

Abdul Rashid, MD, George Dale, MD, Thomas Hennebry, MD

Diagnostic coronary angiography in the current era is a remarkably safe procedure, yet major complications do occur. Many of these complications are related to vascular access. Although discomfort at the site of access is frequent and minor hematomas are common, one of the most potentially devastating complications is acute limb ischemia. This can relate to pre-existing atherosclerosis, prothrombotic state, catheter-induced dissection, local thrombus formation, or a combination of these factors. Prolonged use of external compression devices may also increase this risk. A new concern is whether...

Percutaneous Coronary Intervention for Cardiac Arrest Secondary to ST-Elevation Acute Myocardial Infarction. Influence of Immedi

Benigno Quintero-Moran, MD, Raul Moreno, MD, Sergio Villarreal, MD, Maria-José Perez-Vizcayno, MD, Rosana Hernandez, MD, César Conde, MD, Paul Vazquez, MD, Fernando Alfonso, MD,Camino Bañuelos, MD, Javier Escaned, MD, Antonio Fernandez-Ortiz, MD, Luis Azcona, MD, Carlos Macaya, MD

Primary percutaneous coronary intervention (PCI) is the best reperfusion strategy in patients with ST-elevation acute myocardial infarction (AMI).1 This is mainly because it achieves a very high rate of successful recanalization of the infarct-related artery in a wide variety of clinical and angiographic situations,2 but also because it virtually eliminates the risk of intracranial bleeding and reduces the incidence of mechanical complications.3
Half of the patients who die from AMI do so early, before reaching a hospital, and in most cases because of a fatal ...

Pronto™ Catheter Thrombectomy in Acute ST-Segment Myocardial Infarction: A Case Series

Ashish Pershad, MD, David Hoelzinger, MD, *Shirish Patel, MD

The aim in the treatment of patients with myocardial infarction is the early restoration of TIMI 3 blood flow in the infarct related artery.1 Primary angioplasty during an acute myocardial infarction achieves this objective but is associated with increased procedural risk because of the probability of dealing with a high thrombus burden.2 Although TIMI 3 flow is achieved in > 90% of patients with primary angioplasty/stenting in acute myocardial infarction, up to 15–20% of patients continue to have impaired myocardial perfusion. This is evident angiographically as the ...

Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Eluting Stents in Dialysis Patients

Salah-Eddine Hassani, MD, William W. Chu, MD, PhD, Roswitha M. Wolfram, MD,
Pramod K. Kuchulakanti, MD, Zhenyi Xue, MS, Natalie Gevorkian, MD, William O. Suddath, MD, Lowell F. Satler, MD, Kenneth M. Kent, MD, PhD, Augusto D. Pichard, MD, Neil J. Weissman, MD, Ron Waksman, MD

The major cause of mortality in dialysis patients is attributable to cardiovascular diseases.1,2 The higher prevalence of coronary artery disease in this population is thought to be related to a higher risk factor distribution, platelet thrombogenicity and premature coronary calcification, when compared with nondialysis subjects. Treatment of ischemic heart disease with percutaneous revascularization techniques has remained controversial because of consistent exclusion of dialysis patients from major clinical trials. To our knowledge, the literature has been composed of retrospectiv...

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