Volume 19 - Issue 10 - October, 2007

Reduction in Myocardial Infarct Size by Postconditioning in Patients after Percutaneous Coronary Intervention

§Xin-Chun Yang, MD, §Yu Liu, MD, Le-Feng Wang, MD, Liang Cui, MD, Tie Wang, MD,
Yong-Gui Ge, MD, Hong-Shi Wang, MD, Wei-Ming Li, MD, Li Xu, MD, Zhu-Hua Ni, MD,
Sheng-Hui Liu, MD, Lin Zhang, MD, Hui-Min Jia, MD, *Jakob Vinten-Johansen, PhD,
*Zhi-Qing Zhao, MD, PhD

Timely reperfusion is the most effective intervention to protect the heart from myocardial infarction resulting from coronary occlusion. However, experimental studies and clinical observations have provided strong evidence in support of the existence of reperfusion-induced myocardial injury. Reperfusion injury initiates a series of adverse events that offset the benefits intended by implementing early reperfusion.1–4 Protection elicited by pharmacological treatment applied briefly at the onset of reperfusion may be observed acutely, but may not be evident when the duration ...

Spontaneous Coronary Artery Perforation Secondary to a Sirolimus-Eluting Stent Infection

Ravi K. Garg, MD, James E. Sear, MD, Eric S. Hockstad, MD

From the Section of Cardiology, Research Medical Center, Kansas City Cardiology, Kansas City, Missouri.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted February 28, 2007, provisional acceptance given May 2, 2007, manuscript accepted June 6, 2007.

Address for correspondence: Ravi K. Garg, MD, Section of Cardiology, Research Medical Center, Kansas City Cardiology, 6420 Prospect Avenue, T-509, Kansas City, MO 64132. E-mail: ravi.garg@kchf.org

ABSTRACT: Coronary stent infection is exceedingly rare despite the widespread use of percutaneous coronary intervention (PCI). The utilization of drug-eluting stents (DES) may have a higher theoretical risk of infection due to their local immunosuppressant effect. Vigilance in suspecting stent infection is important, as the associated mortality rate is approximately 50%. We discuss the case of a patient who presented with an infected DES 2 weeks after implantation which led to spontaneous Type II coronary perforation. The perforation was sealed with prolonged balloon inflation,...

Clopidogrel Loading Doses and Outcomes of Patients undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes

*Cheng Wang, MD, PhD, §Dean J. Kereiakes, MD, £Jay P. Bae, PhD, £Patrick McCollam, PharmD,
*Jianming He, MS, *Brian Griffin, MBA

Current American College of Cardiology/American Heart Association guidelines for the treatment of unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) recommend initiation of clopidogrel treatment in patients for whom percutaneous coronary intervention (PCI) is planned and who are not at high risk for bleeding.1,2 Although the guidelines indicate that a loading dose of 300 mg to 600 mg can be used when rapid onset-of-action is required, followed by a maintenance dose of 75 mg/day, the evidence supporting the efficacy of clopidogrel in preventing cardio...

Of Swiss Alchemists and Road Hazards

James J. Ferguson, MD and Cindy W. Tom, MD

“Alle Ding’ sind Gift und nichts ohn’ Gift; allein die Dosis macht, dass ein Ding kein Gift ist”

[ All things are poison and nothing is without poison; only the dose permits something not to be poison ] – Paracelsus

Although he was born Phillip von Hohenheim, he later changed his name to Philippus Theophrastus Aureolus Bombasticus von Hohenheim, and called himself Paracelsus (literally: equal to or greater than Celsus — a Roman encyclopedist known for medical writings). No, he was not a 15th century version ...

Preserving Left Ventricular Function during Percutaneous Coronary Intervention

Prithwish Banerjee, MD and Dip Card, MRCP

Perhaps we interventionists should be more aware than we currently are of our patients’ left ventricular (LV) function or what angioplasty might do to that LV function. I am not suggesting that we don’t attach importance to this vital detail. But let’s face it, most of us don't consciously plan to preserve myocardium at all costs when we are confronted with a difficult bifurcation lesion. To the battle-ravaged ventricle that has endured the torment of hypertension, diabetes, a few previous non-ST-elevation myocardial infarctions (NSTEMIs), along with the regular pulses of ...

Stents in the Successful Management of Protein-Losing Enteropathy after Fontan

*Safi Shahda, MD, Michael Zahra, MD, Andrew Fiore, MD, Saadeh Jureidini, MD

Protein-losing enteropathy (PLE) is a serious, and if not treated, fatal complication of the Fontan-cavopulmonary anastomosis procedure.1 It has been suggested that creation of a fenestration may prevent2 and treat3,4 PLE in this setup. Other therapeutic modalities have included the use of heparin,5 spironolactone,6 steroids and angiotensin-converting enzyme inhibitors with variable success.6 Transcatheter interventional procedures have been thought to be beneficial in the treatment of PLE, but experience in this modality is ...

Protein-Losing Enteropathy following the Fontan Operation

P. Syamasundar Rao, MD

Protein-losing enteropathy (PLE) may be defined as excessive loss of proteins across the intestinal mucosa and is due to either a primary gastrointestinal abnormality or secondary to cardiac disease. Initial reports of PLE secondary to cardiac disease, namely, congestive heart failure,1 constrictive pericarditis2,3 and myocarditis4 were published in the early 1960s. The association of PLE with high superior vena caval pressure secondary to an obstructed Mustard baffle5 and superior vena cava-toright pulmonary artery anastamosis (Classical Glenn Op...

Late Incomplete Apposition and Coronary Artery Aneurysm Formation following Paclitaxel-Eluting Stent Deployment: Does Size Mat

*Eric Yamen, FRACP, *,§David Brieger, FRACP, PhD, *Leonard Kritharides, FRACP, PhD,
§Wilfred Saw, FRACP, *,§Harry C. Lowe, FRACP, PhD


Case Presentation. A 43-year-old female with stable angina pectoris underwent stenting of a 99% stenosis in a small left anterior descending coronary artery (Figure A). In an uneventful procedure, a 2.25 x 8 mm Taxus® Express paclitaxel-eluting stent (Boston Scientific Corp., Natick, Massachusetts) was deployed at 12 atm, achieving an optimal angiographic result, with slight oversizing of the stented segment in relation to the reference vessel (Figure B). Two months later, angiography revealed localized CAA formation within t...

Treatment of Severe Functional Mitral Regurgitation: Is Cardiac Surgery Always Indicated?

Albert W. Chan, MD

Severe symptomatic functional mitral regurgitation (MR), or ischemic MR, is traditionally an indication for cardiac surgery, as recommended by the current practice guidelines.1 It is hoped that coronary bypass surgery, combined with either mitral annuloplasty or mitral valve replacement, will improve the patient’s overall cardiac function and symptoms. Debate has surrounded the question whether patients with severe ischemic MR could do just as well with bypass surgery alone without mitral valve repair.

With the superior patency rates of drug-eluting stents (DES), mul...

Dual-Guidewire Percutaneous Intervention of Anomalous Coronary Artery Facilitated by Steerable Guidewire

Jack P. Chen, MD

Case Report. A 56-year-old male without previous cardiovascular history was admitted with chest pain suggestive of acute coronary syndrome. He reported experiencing exertional angina over the previous several days. His past medical and social histories were significant for hypertension and hyperlipidemia, as well as a 40-pack per year history of tobacco abuse. Home medications included 25 mg/day of atenolol, 10 mg/day of lisinopril and 20 mg/day of simvastatin. His family history was significant for coronary disease, but no history of unexplained sudden death. ...

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