Volume 19 - Issue 9 - September, 2007

Percutaneous Closure of Patent Foramen Ovale for Refractory Hypoxemia after HeartMate II Left Ventricular Assist Device Placemen

*Navin K. Kapur, MD, §John V. Conte, MD, *Jon R. Resar, MD

During the fourth week of gestation, the primitive atrium divides into right and left atria by forming two septa, the septum primum and secundum. As the septum primum grows from the dorsocranial wall, two openings develop, the foramen primum at the level of the endocardial cushions, and the foramen secundum at the mid-septal level. As the septum primum fuses with the endocardial cushions, the foramen primum is obliterated. During the fifth and sixth weeks of gestation, the septum secundum develops from the ventrocranial wall of the primitive atrium and overlaps the foramen secundum, leaving...

Towards an Understanding of the Role of Rescue Angioplasty for Failed Fibrinolysis: Comparison of the MERLIN, RESCUE and REACT T

Babu Kunadian, MBBS, MRCP, Kunadian Vijayalakshmi, MBBS, MRCP, Joel Dunning, MRCS, PhD,
Andrew Sutton, MA, MD, MRCP, Mark A. de Belder, MA, MD, FRCP

Early restoration of infarct-related artery (IRA) blood flow and myocardial perfusion in patients with acute ST-segment elevation myocardial infarction (MI) is linked with preservation of left ventricular function, myocardial salvage and a reduction in mortality.1 Although primary percutaneous coronary artery intervention (PPCI) is superior to hospitaldelivered thrombolytic treatment, the latter remains the firstline therapy in 30–70% of cases worldwide.1–3 However, thrombolytic therapy fails to restore full patency of the IRA (TIMI grade 3 flow) in up to 5...

Primary Percutaneous Coronary Intervention in Saphenous Vein Grafts: A Visualization Strategy to Improve Outcome with New Uses f

Mark S. Patterson, MRCP, MSc, Azad Ghuran, MD, Gert Jan Laarman, MD, PhD

Percutaneous revascularization of diseased saphenous vein bypass grafts (SVGs) remains a difficult challenge for the interventional cardiologist despite major advances in catheter-based reperfusion therapies, adjunctive pharmacology and stent technology. Primary percutaneous coronary intervention (PCI) to SVGs has lower rates of TIMI 3 flow after PCI in the range of 70.2–80.7% as compared to 92–97.4% in native vessels.1,2 This reduced short-term success rate is consistently associated with sustained poor long-term results with increased 1-month,3 6-month...

Vascular Complications in Women after Catheterization and Percutaneous Coronary Intervention 1998–2005

Robert J. Applegate, MD, Matthew T. Sacrinty, MPH, Michael A. Kutcher, MD, Talal T. Baki, MD,
Sanjay K. Gandhi, MD, Frederic R. Kahl, MD, Renato M. Santos, MD, William C. Little, MD

Women have been shown historically to have a greater risk of complications than men following invasive procedures.1–5 The increased incidence of complications in women appears to occur independently of other factors known to influence the incidence of complications after invasive procedures.6–8 Moreover, in the past several years, multiple reports have indicated that women also experience a higher incidence of vascular complications after cardiac catheterization (CATH) and percutaneous coronary interventional (PCI) procedures.9–14 Whether h...

Stent Undersizing Can Result in Procedure-Related Very Late Stent Thrombosis

Steve Ramcharitar, MRCP, DPhil, Jurgen Ligthart, BSc, Willem J. Van der Giessen, MD, PhD

Stent thrombosis is rare, but very serious, with potentially fatal consequences following percutaneous coronary intervention (PCI). Traditionally, it has been classified as acute, within 48 hours, subacute up to 30 days, and late, corresponding to all cases after day 30. Acute or subacute stent thrombosis is often thought to be procedure- or lesion-related, as suggested by data from randomized studies and large registries having fairly similar rates (1–2%) between both bare-metal stents (BMS) and drug-eluting stents (DES).1–3 Late stent thrombosis (LST) with DES remai...

XX and Risky Business

Jacob Green, MD and Peter Block, MD

There is extensive literature demonstrating a disturbingly higher mortality rate, intraprocedural coronary artery injury rate and periprocedural vascular complication rate in women versus men. The disparity has been partially explained by more comorbid disease, older age, smaller size and higher prevalence of hypertension, diabetes, peripheral vascular disease and more severe angina at presentation. Furthermore, it has been suggested that smaller vessel diameters associated with smaller body size have been a driving force for the observed higher rates of both coronary and entry-site vascula...

Multivessel Acute Coronary Thrombosis and Occlusion — An Unusual Cause of Cardiogenic Shock

Yoav Turgeman, MD, Khaled Suleiman, MD, Shaul Atar, MD

Coronary angiography in the early phase of ST-elevation acute myocardial infarction (STEMI) usually identifies total thrombotic occlusion of a single infarct-related artery.1 However, simultaneous acute occlusion of all major epicardial coronary arteries is extremely unusual.2 We present a case of STEMI and cardiogenic shock associated with multiple large thrombi treated successfully by thrombus aspiration and balloon inflations.

Case Report. A 44-year old physician was transferred urgently to our catheterization unit 3 hours after a ...

Outlook of Drug-Eluting Stent Implantation for Unprotected Left Main Disease: Insights on Long-Term Clinical Predictors

Sabine Vecchio, MD, §Tania Chechi, MD, *Guido Vittori, MD, £Giuseppe G.L. Biondi Zoccai, MD,
*Alessio Lilli, MD, *Gaia Spaziani, MD, *Gabriele Giuliani, MD, §Elena Falchetti, MD,
§Massimo Margheri, MD

Unprotected left main coronary artery (LMCA) is one of the most challenging lesion subsets for interventional cardiologists, and is still considered a strict surgical indication as long-term results of recent randomized trials are awaited.

Although no adequately powered randomized comparisons have yet been completed, many registries have assessed the feasibility and safety of LMCA revascularization with bare-metal stents (BMS),1–4 particularly in good surgical candidates with a low EuroSCORE (an established means to predict early mortality in patients undergoing card...

Successful Coronary Intervention for Chronic Total Occlusion Using a Retrograde Approach with Biradial Arteries

Yoshio Taketani, MD, Hideaki Kaneda, MD, PhD, Shigeru Saito, MD

Treating chronic total occlusions (CTOs) remains one of the major challenges in interventional cardiology. In the last 20 years, as the procedural outcomes of intervention for CTOs have significantly increased as a function of improved guidewires and devices, as well as operator technique and experience, successful recanalization of CTOs may now be achieved in approximately 80% of lesions. Various new techniques to cross CTOs have been introduced over the years, including the use of dedicated CTO wires, blunt dissection and other technologies.1,2

One of the new techniques ...

Comparative Intravascular Ultrasound Analysis of Ostial Disease in the Left Main versus the Right Coronary Artery

Sang-Wook Kim, MD, *Gary S. Mintz, MD, Patrick Ohlmann, MD, Salah-Eddine Hassani, MD,
Aleksandra Michalek, MD, Esteban Escolar, MD, Anh B.Bui, MD, Augusto D. Pichard, MD,
Lowell F. Satler, MD, Kenneth M. Kent, MD, PhD, William O. Suddath, MD, Ron Waksman, MD,
Neil J. Weissman, MD

The aorto-ostial junction has high elastic fiber content with significant elastic recoil.1-7 Ostial left main coronary artery (LMCA) stenoses have larger lumen areas with less plaque burden and more negative remodeling than non-ostial LMCA stenoses. Most ostial LMCA stenoses have been categorized as eccentric and less calcified.8 The RCA ostium shows a lack of arterial distensibility and excessive rigidity, presumably because it contains highly elastic rigid tissue.1,7 Both the LMCA and RCA ostia may have similar morphologic characteristics. However, there i...

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