Volume 18 - Issue 12 - December, 2006

Percutaneous Thrombectomy for Pulmonary Embolism

Ravi K. Garg, MD and Neeraj Jolly, MD

Case Presentation. A 65-year-old female with squamous cell carcinoma of the uterus was admitted with acute dyspnea and hypotension. A computed tomography (CT) angiogram using the pulmonaryembolism (PE) protocol revealed evidence of multiple pulmonary emboli, with the largest thrombus in the left lower pulmonary artery branch (Figure 1A). A transthoracic echocardiogram (TTE) demonstrated evidence of right ventricular (RV) dilatation and dysfunction (Figure 1B). Her hemodynamic instability necessitated inotropic support. She had recently undergone resection of the cervix complicated b...

Difficult Anatomies: Just Hold Your (Patient’s) Breath

Jack P. Chen, MD

To the Editor:

Today’s vast armamentarium of percutaneous coronary interventional devices has both simplified and complicated the procedure. While user-friendly catheters, wires and stents have allowed the seasoned interventionalist to conquer increasingly difficult anatomies, the complexity of these cases has likewise grown. Sometimes, however, a basic maneuver such as breath-holding can be of great assistance.
Deep inspiration causes caudal displacement of the diaphragm, resulting in increased distance between a stationary catheter in the aortic root and the heart. This techniqu...

Large Spontaneous Coronary Artery-to-Right Ventricular Fistula

Brian Cabarrus, MD, Nazim U. Khan, MD, Rony L. Shammas, MD

Coronary fistulae are congenital or acquired communications between a coronary artery and either a chamber of the heart (coronary-cameral fistula) or any segment of the systemic or pulmonary circulation bypassing the myocardial capillary network. Coronary artery fistulae are a rare occurrence seen in only 0.1–0.2% of angiograms, but comprise about 14% of all congenital coronary anomalies.1–3 Most fistulae are congenital in origin,3–5 but acquired fistulae have been rarely reported as a consequence of trauma,4,6 coronary artery bypass surgery,7...

To Close or Not To Close? PFO, Sex and Cerebrovascular Events

Toby Ferguson, MD, Lauren H. Sansing, MD, Howard Herrmann, MD, Brett Cucchiara, MD

The precise role of patent foramen ovale (PFO) in causing stroke remains controversial. Clinical factors felt to support a diagnosis of paradoxical embolization through a PFO include presence of concurrent deep vein thrombosis (DVT) and onset of symptoms with a Valsalva maneuver.1 Regarding the latter, sexual activity may be an often unrecognized Valsalva equivalent. The occurrence of stroke during sexual intercourse, therefore, may have important etiologic implications. We describe two cases of cerebrovascular events associated with sexual activity and strongly suggestive of parado...

Late Stent Thrombosis Mimicking Focal Restenosis after Sirolimus Stent Implantation: Angiographic and Intravascular Ultrasound A

Carlos Fernandez-Pereira, MD, Gaston Rodriguez-Granillo, MD, Alfredo E. Rodriguez, MD, PhD

Since the introduction of drug-eluting stents (DES) during interventional procedures, several randomized studies have demonstrated a significant reduction in coronary restenosis and target vessel revascularizations.1–4 However, despite the availability of long-term data, the safety of these devices remains an open question. Coronary stent thrombosis, not detected in the first series, has been recently reported in patients treated with DES.5 Furthermore, two controlled studies reported a higher incidence of subacute and late stent thrombosis with DES compared to bare-met...

Ostial RCA Intervention: Guiding Catheter Challenges and Use of a Buddy Wire to Perform Focused-Force Angioplasty on a Severely

Farrukh Hussain, MD, FRCPC, Tarek Kashour, MD, Mahadevan Rajaram, MD

Case Report. A 67-year-old female presented to our catheterization laboratory with a recent history of unstable angina for 3 weeks. Her cardiac markers were normal. Her past history was significant for diabetes, hyperlipidemia, hypertension and obesity. She subsequently underwent stress testing at another hospital, which was strongly positive. The paieint was therefore referred for angiography.
The left main coronary artery was unremarkable and the left anterior descending vessel had mild disease only. A small-caliber first obtuse marginal had a tight ostial lesion and the circumfle
...

Percutaneous Treatment of a Large Coronary Aneurysm with a Ball Thrombus: An Interventional Challenge

Babu Kunadian, MBBS, MRCP, Andrew R. Thornley, MB, MRCP, Mark A. de Belder, MA, MD, FRCP

A coronary artery aneurysm is defined as a coronary artery dilatation greater than 1.5 times the diameter of either the normal adjacent segments or the diameter of the patient’s largest coronary vessel.1,2 The prevalence varies from 0.3% to 4.9% among patients undergoing coronary angiography with a male preponderance.1 The true prevalence may be lower, as only one-third of angiographically diagnosed aneurysms have the intravascular ultrasound (IVUS) appearance of a true or false aneurysm.3 The most common site for a coronary aneurysm is the right coronary ar...

Fibrinolysis and Coronary Stenting for Treatment of an Acute Inferior Myocardial Infarction after Ascending Aortic Aneurysm Repa

Ali H. Shakir, MD, Jaime S. Gomez, MD, *H. Vernon Anderson, MD

Anastamotic complications of the coronary ostia after successful Bentall-type surgery for aortic root replacement have been reported, with an estimated incidence of 5–6%.1 These problems are usually minimized by coronary artery bypass graft surgery. We report a case of a patient with an acute inferior myocardial infarction that developed 18 months after Bentall repair surgery for a type-A aortic dissection, and which was treated with percutaneous coronary stenting.

Case Report. A 64-year-old male previously underwent repair of a type-A aortic dissection. Resection and...

Retrograde-Antegrade Left Main Coronary Artery Stenting

Ricardo I. Vicuna, MD, Paul Silverman, MD, Bruce Abramowitz, MD, FACC, FSCAI

Recurrent ischemic symptoms are the most frequent reason for repeat revascularization in post coronary artery bypass artery (CABG) patients. Of the reported 8% per year of patients who suffer from recurrent ischemia, 5% annually are attributable to the progression of atherosclerosis in the native coronary arteries.1–3
Repeat surgical intervention in this group of patients has been associated with a higher mortality rate than the initial CABG and a documented higher complication rate, lower angina relief4–7 and the risk of compromising a functioning left internal mamm...

December 2006

Richard E. Shaw, PhD, FACC, FACA
Editor-in-Chief

Dear Readers,

The December 2006 issue of the Journal of Invasive Cardiology includes original research articles, a continuing medical education offering, articles from the journal’s special sections Clinical Images and Genomics and Cellular Therapy, and seven online case reports which can be found on our website: www.invasivecardiology.com.
In the first research article, Dr. Amir Halkin and colleagues present a study assessing clinical outcomes following percutaneous coronary intervention (PCI) comparing drug-eluting stents (DES) and bare-metal stents (BMS) in dialysis patients u...

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