Volume 19 - Issue 11 - November, 2007

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 ...

Clinical Utility of TandemHeart® for High-Risk Tandem Procedures: Percutaneous Balloon Aortic Valvuloplasty followed by Comple

Sanjay Rajdev, MD, Adil Irani, MD, Samin Sharma, MD, Annapoorna Kini, MD

Percutaneous left ventricular (LV) assist devices are increasingly being used during high-risk percutaneous coronary interventional (PCI) procedures.1–4 These devices provide reliable short-term hemodynamic stability in complex cases during which the interventionist has the luxury of time to successfully carry out the procedure. The TandemHeart® (Cardiac Assist, Inc., Pittsburgh, Pennsylvania) is a relatively recent introduction to the available percutaneous nonpulsatile centrifugal LV assist devices that can be used to support poorly functioning ven...

Comparison of Multiple Drug-Eluting Stent Percutaneous Coronary Intervention and Surgical Revascularization in Patients with M

Elisabetta Varani, MD, Marco Balducelli, MD, Giuseppe Vecchi, MD, Matteo Aquilina, MD,
Aleardo Maresta, MD

Since the introduction of drug-eluting stents (DES) in clinical practice, it has become clear that percutaneous revascularization of multivessel coronary artery disease (CAD) could be more effective in terms of event reduction (major adverse cardiac events [MACE] and target vessel revascularization [TVR]) and become comparable to surgery. Results of randomized, controlled trials of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with progressively more complex lesions1–4 have confirmed the very good clinical and angiographic results of the first studies...

Editorial Staff
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    Laurie Gustafson
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    Elizabeth Vasil
  • National Account Manager
    Jeff Benson
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    Carson McGarrity
  • Special Projects Editor
    Amanda Wright
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