Volume 19 - Issue 11 - November, 2007

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...

Isolated Disease of the Ostium Left Anterior Descending or Circumflex Artery: Management Using a Left Main Stenting Technique.

Roberto J. Cubeddu, MD, Frances O. Wood, MD, Elizabeth K. Saylors, MS, Tift Mann, MD

Treatment of isolated coronary stenoses involving the ostium of the left anterior descending (LAD) or circumflex (LCX) artery is challenging for the interventionalist. Although focal stenting is often attempted, it may result in incomplete lesion coverage or protrusion of the proximal stent margin into the ostium of the adjacent vessel. Furthermore, plaque shift with compromise of the adjacent vessel is a potential complication.1,2 Because of these concerns, many patients with this type of disease are referred for coronary artery bypass graft surgery (CABG).
Since compromise...

Distal Side Branch Entry Technique to Accomplish Recanalizationof a Complex and Heavily Calcified Chronic Total Occlusion

Farrukh Hussain, MD, FRCPC

Percutaneous intervention of chronic total occlusions (CTOs) can improve exercise capacity, symptoms and left ventricular function.1 The parallel wire technique is a useful technique in recanalizing CTOs.2 This technique utilizes a second wire to cross into the true lumen, while leaving the initial wire in a dissection plane or false lumen.2 The initial wire is used as a guide for where not to cross, and also may act to occlude the entry point to the false lumen, thereby improving chances of true luminal wiring. The bilateral/contralateral injection techniqu...

Extended Stenting of Distal Left Main Coronary Artery for the Treatment of Branch Ostial Disease — Belling the Cat or Bearding

Deepak Jain, MD

Besides the inherent risk involved in an angioplasty of a major vessel supplying a large myocardial area, percutaneous coronary intervention (PCI) of left main coronary artery (LMCA) branch ostial disease is fraught with some unique problems, namely, high elastic recoil, excessive plaque burden, plaque shift or plaque redistribution, melon-seeding effect, calcification, retrograde dissection of the left main or the other major branch artery, and the technical challenge of a very precise stent placement when attempting the conventional focal stenting of the affected branch ostium. The stent,...

Myocardial Infarction during Pregnancy: Whose Responsibility?

Jesus G. Mirelis, MD, Jose Antonio Fernandez-Diaz, MD, Javier Goicolea, MD

Case Report. A 37-year-old female in her seventh week of pregnancy presented to the emergency department after the onset of oppressive chest pain which had started 1 hour before. Her 8 previous pregnancies had terminated in abortion. She had no cardiovascular risk except for smoking, nor a history of alcohol or drug abuse. Her father had died of Leriche’s syndrome. A history of untreated peripheral obstructive arteriopathy was reported.
Clinical examination showed obesity. The patient was afebrile. Her blood pressure was 140/100 mmHg with a pu

Treatment of Restenotic Drug-Eluting Stents: An Intravascular Ultrasound Analysis

Koichi Sano, MD, PhD, Gary S. Mintz, MD, Stephane G. Carlier, MD, PhD, Emilia Solinas, MD,
Jose de Ribamar Costa Jr., MD, Jie Qian, MD, Eduardo Missel, MD, Shoujie Shan, MD,
*Theresa Franklin-Bond, MS, PA, *Paul Boland, BS, Giora Weisz, MD, Issam Moussa, MD,
George Dangas, MD, PhD, Roxana Mehran, MD, Alexandra J. Lansky, MD, Edward Kreps, MD,
Michael Collins, MD, Gregg W. Stone, MD, Jeffrey W. Moses, MD, Martin B. Leon, MD

Sirolimus-eluting and paclitaxel-eluting stents decrease neointimal hyperplasia leading to a reduction, but not elimination, of in-stent restenosis.1–4 Because sirolimus and paclitaxel decrease neointimal hyperplasia, restenosis is dependent on final drug-eluting stent (DES) dimensions; an optimally expanded stent area assessed by intravascular ultrasound (IVUS) is a strong predictor of freedom from clinical, angiographic and IVUS restenosis after DES implantation.5–9 However, it is not possible to obtain an optimum stent area in all lesions, and it is not ...

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