Volume 18 - Issue 12 - December, 2006

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


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...

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...

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Editorial Correspondence
  • Laurie Gustafson, Executive Editor, JIC
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