Volume 19 - Issue 10 - October, 2007

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. ...

High-Risk Left Main Coronary Stenting Supported by Percutaneous Impella Recover LP 2.5 Assist Device

Rémy Cohen, MD, Thierry Domniez, MD, Simon Elhadad, MD

Percutaneous coronary interventions (PCI) are increasingly performed in patients with severely depressed left ventricular (LV) function and complex coronary lesions, including left main (LM) disease. During these high-risk procedures, prolonged ischemia from balloon inflations, no-reflow or dissection may have major hemodynamic consequences.1 Various percutaneous supportive techniques have been described for high-risk angioplasty, but no single approach has achieved wide acceptance.1–99 Furthermore, device-related complications have hampered a more widespread use...

Coronary Stent Occlusion after Platelet Transfusion: A Case Series

*Alexander D. Cornet, MD, §Lucas J. Klein, MD, *A.B. Johan Groeneveld, MD

The introduction of coronary artery stents in the early 1990s reduced the early and late reocclusion rates of symptomatic coronary artery stenoses after balloon angioplasty. Nevertheless, coronary stent occlusion by thrombosis may occur, even in patients on (dual) antiplatelet treatment, thereby increasing morbidity and mortality.1-3 We report three cases of early coronary stent occlusion within 6–17 hours after transfusion of platelets for bleeding or anticipated bleeding, in order to draw attention to this important risk factor.

Case Reports


Early Occlusive Restenosis Due to Self-Expandable Stent Squeeze in the Popliteal Artery

Shinichi Furuichi, MD, Giuseppe M. Sangiorgi, MD, Antonio Colombo, MD

Self-expandable stent fracture may occur when the stent is implanted in peripheral arteries near or at flexion points.1 However, stent squeeze is quite rare, especially early after implantation. We report a case of a patient with an occlusive restenosis due to cross-sectional squeeze and deformation of a self-expandable stent in a popliteal artery 1 month after implantation.

Case Report

A 25-year-old male smoker, semiprofessional soccer player was referred to our hospital because of intermittent claudication of the right leg. He experienc...

Utility of Sirolimus-Eluting Cypher™ Stents to Reduce 12-Month Target Vessel Revascularization in Saphenous Vein Graft Stenoses

aStephen G. Ellis, MD, bDavid Kandzari, MD, cDean J. Kereiakes, MD, dAugusto Pichard, MD,
eKen Huber, MD, fFrederic Resnic, MD, gSteven Yakubov, MD, hKeith Callahan, MPH,
aMarilyn Borgman, RN, i,jSidney A. Cohen, MD, PhD

Approximately 1 million patients are now treated annually in the United States with drug-eluting stents (DES). Usage of these stents is substantiated in many patient and lesion subsets by their documented relative safety and reduction in clinical restenosis in large-scale randomized clinical trials.1,2 Such trials cannot be feasibly performed in all groups of patients. The pathology of atherosclerosis in saphenous vein grafts (SVGs) differs somewhat from that in native coronary arteries, and restenosis after bare-metal stenting (BMS) tends to occur more frequently in the former t...

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