Volume 19 - Issue 11 - November, 2007

Consensus Update on the Appropriate Usage of Cardiac Computed Tomographic Angiography

Moderators: a,§Michael Poon, MD and b,*Geoffrey D. Rubin, MD
Panelists: cStephan Achenbach, MD, dTim W. Attebery, MD, eDaniel S. Berman, MD,
fThomas J. Brady, MD, gJill E. Jacobs, MD, hHarvey S. Hecht, MD, iJoão A.C. Lima, MD,
jWm. Guy Weigold, MD

Introduction and Purpose

The consensus statement outlined here was formulated following a roundtable meeting among clinical experts in the fields of radiology and cardiology held in Miami, Florida, in June 2007. This group was gathered under the auspices of two key specialty societies supporting the field of computed tomographic angiography (CTA): the Society of Cardiovascular Computed Tomography (SCCT) and the North American Society for Cardiac Imaging (NASCI).
The purpose of the roundtable meeting was to produce an updated consensus on CTA’s utility and ...

Percutaneous Closure of Postoperative and Post-Traumatic Ventricular Septal Defects

Carlos A.C. Pedra, MD, Sérgio C. Pontes, Jr, MD, Simone R.F. Pedra, MD, *Lucia Salerno, MD,
*J. Breno Sousa, MD, Marly A. Miaira, MD, Ana Luisa Guerra, MD, M. Virginia T. Santana, MD,
M. Aparecida Silva, MD, Valmir F. Fontes, MD

Surgery has been regarded as the gold standard method of treatment for all kinds of ventricular septal defects (VSDs).1 The incidence of postoperative residual shunts varies according to the type of defect being repaired, with malalignment (tetralogy of Fallot), muscular and postinfarction types probably producing the higher rates.1 Although some of these leaks are restrictive and well tolerated, especially after perimembranous VSD repair,2 they may result in significant left-to-right shunting with persistent left ventricular volume overload, which requires ...

Unintended Stent Extraction from a Coronary Artery during Bifurcation Coronary Angioplasty

Ivo Varvarovsky, MD, PhD and Jan Matejka, MD

Provisional stenting is the most widely used method for the treatment of bifurcation coronary artery lesions. It consists of the placement of the first stent in the main branch, followed by provisional stenting of the side branch through the main branch stent. The advantage of this approach is its simplicity and predictable results. Generally, a stent is placed in the main branch and the use of a second stent (in the side branch) is based on the angiographic appearance.
The “jailed” wire technique maintains side branch patency and facilitates side branch access through the ...

Stent Implantation for Diffuse and Multiple Coronary Spasm in a Patient with Variant Angina Refractory to Optimal Medical Ther

Atsuhiko Sugimoto, MD, Yoshihiro Morino, MD, Yuji Ikari, MD, PhD

Variant angina is more frequently seen in East Asia than in the West. It may be associated with acute myocardial infarction, severe cardiac arrhythmia and sudden death. Most patients obtain sufficient relief by vasodilator drug management such as calcium antagonists and/or nitrates. However, it is well known that some patients experience angina refractory to such treatments.1,2 Reportedly, about 5–30% of patients with variant angina do not get relief from anginal attacks with medical management. Previous studies showed that stent placement in spastic segments might be help...

The Undilatable Lesion: A Striking Example of Plaque Modification for Severe Calcification with Rotational Atherectomy – Impet

Farrukh Hussain, MD, FRCPC and Steven Hodge, MD, FRCPC

The undilatable lesion requiring rotational atherectomy is an uncommon occurrence with the current availability of noncompliant balloons and other methods of “focused-force” angioplasty. The use of noncompliant balloons, or a “buddy” cutting wire, and finally, the use of nonablation devices such as the Cutting Balloon Ultra (Boston Scientific Corp., Natick, Massachusetts) or the FX miniRAIL catheter (Abbott Laboratories Inc., Abbott Park, Illinois) have all been described in previous reports.2,3 Each of these plaque modi...

Negative Remodeling at the Ostium of the Left Anterior Descending Artery Induced Myocardial Ischemia

Kenji Sadamatsu, MD, PhD, Naoya Maehira, MD, Hideki Tashiro, MD, PhD

Negative remodeling is a condition in which the vessel area decreases in size, often as a result of a structural change in the coronary vessel wall. It is a major factor in restenosis following balloon angioplasty, but its contribution to myocardial ischemia in a de novo lesion has not been clearly shown. We report on a patient with exertional angina that was caused by negative remodeling at the ostium of left anterior descending artery (LAD).

 

Case Report. A 48-year-old female with exertional angina was admitted to our hospital. Electrocardiography reveal...

Saphenous Vein Graft-to-Left Atrium Fistula Treated with Percutaneous Transcatheter Embolization with Coils

Gilbert J. Zoghbi, MD, *Souheil Saddekni, MD, Vijay K. Misra, MD

Coronary artery fistulae (CAF) are direct precapillary communications which bypass the myocardial capillary network and connect a coronary artery to another vessel or cardiac chamber (cameral).1 CAF are reported in 0.1–0.7% of patients undergoing coronary angiography and account for 13% of congenital coronary artery anomalies.1,2 Acquired CAF occur as complications of myocardial infarction, traumatic accidents, invasive cardiac procedures or cardiac surgery.1 Acquired CAF were present in 30% of 96 fistulae reported between 1985 and 1995.1 Fi...

Percutaneous Occlusion of Patent Ductus Arteriosus with the Nit-Occlud® Device in an Adult Patient

*Jorge Gomez, MD and §Jorge Blüguermann, MD

Percutaneous occlusion of a patent ductus arteriosus (PDA) is actually a standard procedure for the treatment of this congenital heart defect. Different devices have been used for the last 20 years with high rates of success.1,2,4,8,11,13,14 A few exceptions include low-weight premature newborns and ductus endarteritis. Anatomic features of the ductus, the presence of an aortic ampulla and its minimal diameter are to be considered when the closing device is selected.6 We report the case of an adult patient with a PDA, a large aortic ampulla and mild-to-moderate pulmona...

Dissociation of the Inflammatory Reaction following PCI for Acute Myocardial Infarction

*Karin Åström-Olsson, MD, §Erik Hedström, PhD, £Lillemor Mattsson Hultén, PhD,
*,£Olov Wiklund, MD, PhD, §Håkan Arheden, MD, PhD, ¶Ann-Kristin Öhlin, MD, PhD,
†Anders Gottsäter, MD, PhD, ¥Hans Öhlin, MD, PhD

Early reperfusion after coronary occlusion reduces the extent of acute myocardial infarction (AMI) as well as mortality.1 However, reperfusion itself may cause damage to surviving myocardium, the so-called “reperfusion injury”.2 Neutrophils are activated and infiltrate the myocardium following ischemia and reperfusion.3 A vast number of experimental studies suggest that neutrophils are important players in the development of irreversible reperfusion injury.4 Activated neutrophils are capable of releasing substances injurious to the myo...

Delayed Complete Heart Block Secondary to Jailed First Septal Perforator

Lisa M. Nee, MD, Brian Guttormsen, MD, Giorgio Gimelli, MD

Complete heart block (CHB) due to the loss of a first septal perforator (FSP) following left anterior descending artery (LAD) stenting is uncommon, with few reported cases in the literature.1,2 It usually occurs at the time of the procedure and is transient, typically resolving within 72 hours. This report describes the case of an elderly female who developed unheralded syncope secondary to CHB 2 days after uneventful percutaneous coronary angioplasty and stenting of the LAD.

Case Report. A 76-year-old female with hypertension and dyslipidemia presente...

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