Volume 18 - Issue 12 - December, 2006

COMMENTARY: Vasoconstriction and Coronary Artery Spasm after Drug-Eluting Stent Placement

§Mario Togni, MD and *Franz R. Eberli, MD

In this issue of the Journal, Brott et al1 report a series of 13 patients who developed severe, life-threatening coronary artery spasms after implantation of a drug-eluting stent. Symptoms occurred either during or immediately after the procedure or within the first 4 weeks after stent implantation. In 1 patient, vasoconstriction was present in a follow-up angiogram at 1 year. Spasms resolved in most patients after administration of vasodilators, however, 2 patients did not respond to treatment and died. Another 2 patients required placement of an intra-aortic balloon pump for cardi...

GENOMICS AND CELLULAR THERAPY: Successful Mobilization of Peripheral Blood Stem Cells by Use of Granulocyte-Colony Stimulating F

Clemens Steinwender, MD, Christian Gabriel, MD, Franz Leisch, MD

There is increasing evidence that the liberation of stem cells by use of granulocyte-colony stimulating factor (G-CSF) with or without their transcoronary transplantation is feasible and can improve cardiac function in humans after acute myocardial infarction (AMI).1–3 However, patients with severe hemodynamic deterioration due to extensive loss of contractile tissue after AMI have not been enrolled in stem cell programs up to now. We report on the case of a patient with acute anterior wall myocardial infarction who suffered from cardiogenic shock despite successful primary percut...

Troponin-Positive Chest Pain with Unobstructed Coronary Arteries: A Role for Delayed Enhanced Cardiovascular Magnetic Resonance

Nick G. Bellenger, MD, BSc, MRCP, Charles Peebles, MRCP, FRCR, Stephen Harden, RCS, FRCR, Keith Dawkins, MD, FRCP, Nick Curzen, PhD, FRCP, FESC

Acute coronary syndromes represent a significant health burden and convey a prognosis that is far from benign. Indeed, United Kingdom registry data reveal that 6 months following admission for a non-ST elevation myocardial infarction (NSTEMI), there is a 12.2% rate of death or non-fatal MI, and a 30% rate of death, MI, refractory angina or readmission for unstable angina.1 A number of trials have demonstrated that early revascularization has a significant beneficial impact on patients with NSTEMI,2,3,4 prompting international guidelines to recommend early angiography and ...

Strategies for Optimizing Outcomes in the NSTE-ACS Patient: The CATH (Cardiac Catheterization and Antithrombotic Therapy in th

*Marc Cohen, MD, Jose Diez, MD, Edward Fry, MD, Sunil V. Rao, MD, James J. Ferguson III, MD, James Zidar, MD, Glenn Levine, MD, Jacob Shani, MD

Target Audience: Clinical Cardiologists, Interventional Cardiologists and Nurses.
Release Date: 12-01-06 Expiration Date: 11-30-07
Learning Objectives: Upon completion of this educational activity, participants should be able to: Educate clinicians about the latest pharmacological treatment options for ACS patients; Review proper utilization of thrombolytic and antiplatelet drugs; Discuss the risks and benefits of device treatment versus pharmacologic treatment.
Method of Participation: Read the journal supplement and complete the Post-Test and Evaluation form...

Incidence and Prognosis of Pacemaker Lead-Associated Masses: A Study of 1,569 Transesophageal Echocardiograms

Ronald Lo, MD, Michael D’Anca, MD, Todd Cohen, MD, Todd Kerwin, MD

Cardiac permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) devices have significantly enhanced the treatment of patients with dysrhythmias, and their application in clinical practice has become increasingly common. As of 2002, there were an estimated 415,000 functioning ICD devices, and over 2.25 million PPM devices presently utilized worldwide.1
Pacemaker and ICD lead masses are rare, however, they are becoming more prevalent. Lead endocarditis is becoming a significant source of morbidity and mortality. Although rare, the incidence rates range from 1–7%...

Strategies for Optimizing Outcomes in the NSTE-ACS Patient: The CATH (Cardiac Catheterization and Antithrombotic Therapy in th

*Marc Cohen, MD, Jose Diez, MD, Edward Fry, MD, Sunil V. Rao, MD, James J. Ferguson III, MD, James Zidar, MD, Glenn Levine, MD, Jacob Shani, MD

(PART II)

A second group of patients who have received less attention were those who were switched at randomization; approximately three quarters of the patients were on some form of antithrombotic therapy prior to randomization — half of these would have stayed on their initial therapy and half would have switched to the other therapy. In patients who were switched at randomization under controlled, protocol-driven algorithms, there was no significant increase in bleeding complications (or reduction in clinical efficacy) in patients switching from enoxaparin to UFH. Blindly and un...

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...

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