Volume 18 - Issue 12 - December, 2006

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

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

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



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

(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



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

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%



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

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



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

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



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

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



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

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