Volume 20 - Issue 2 - February, 2008

Clinical Application of Prophylactic Percutaneous Left Ventricular Assist Device (Tandem Heart™) in High-Risk Percutaneous Cor

Sanjay Rajdev, MD, Prakash Krishnan, MD, Adil Irani, MD, Michael C. Kim, MD,
Pedro R. Moreno, MD, Samin K. Sharma, MD, Annapoorna S. Kini, MD

Introduction of novel devices for cardiac support during complex percutaneous coronary intervention (PCI) has revolutionized the treatment of coronary artery disease (CAD) and has led to an increasing number of high-risk PCI procedures. Traditionally, the intra-aortic balloon pump (IABP) has been used to provide hemodynamic stability during coronary interventions in high-risk patients. However, the mortality rate continues to be high (30–75%) despite the use of IABPs in the setting of acute myocardial infarction complicated by cardiogenic shock; insertion of a percutaneous transseptal...

Bifurcation Coronary Artery Disease: Current Techniques and Future Directions (Part 1)

David G. Rizik, MD, Kevin J. Klassen, MD, James B. Hermiller, MD

Published randomized trials of drug-eluting stents (DES) have shown reduced rates of restenosis and target lesion revascularization (TLR) in noncomplex lesions compared to bare-metal stents (BMS).1 Given this documented success of the antiproliferative therapies in relatively simple lesions, interventional cardiologists have developed techniques and devices hoping to demonstrate similarly durable results in more complex lesion subsets.2–6 Bifurcation coronary artery disease (CAD) comprises an important subset of lesions inadequately studied and thus far unapproved f...

Double Inferior Vena Cava Filter Implantation in a Patient with a Duplicate Inferior Vena Cava

Rizwan A. Siddiqui, MD and Sachinder Hans, MD*

Case Presentation. A 79-year-old female presented with pain and swelling of the left lower extremity. Physical examination revealed a swollen left calf and 1+ pitting edema over both ankles. There was no evidence of calf tenderness and Homan’s sign was negative bilaterally. A venous duplex Doppler study revealed the presence of occluding thrombi in the left popliteal, as well as the right popliteal and posterior tibial veins. She was also found to have microcytic hypochromic anemia. Upper gastrointestinal endoscopy revealed the presence of erosive esophagitis and ant...

Double Right Coronary Artery with Acute Inferior Wall Myocardial Infarction

Manojkumar Rohit, MD, DM, Shivkumar Bagga, MD, DM, Kewal Krishan Talwar, MD, DM

The incidence of primary congenital coronary anomalies varies from 0.95–2% in the adult population undergoing coronary angiography (CAG).1–4 The majority of these are reported to be anomalies of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery being the most common. Coronary artery anomalies are divided into those that cause and those that do not cause myocardial ischemia.5,6 We describe a rare benign anomaly, a double right coronary artery (RCA) presenting as acute inferior wall myocardial infarctio...

Ductal Stent and Cavo-Atrial Sac Occlusion in an Adult with Profound Cyanosis after Palliated Cyanotic Congenital Heart Disease

§Daniel H. Gruenstein, MD, *Robert H. Beekman III, MD, *Robert L. Spicer, MD

Interventional catheterizations are an increasingly important component in the management of the growing population of adults with congenital heart disease (CHD). The experience of interventions on adults with CHD from some centers has been reported and the types of procedures resemble those that are common in the pediatric population.1,2
We report a unique case of a 35-year-old female with palliated complex who underwent two unusual interventions during the same catheterization procedure. The first, patent ductus arteriosus (PDA) stent placement, is an uncommon procedure t...

Retrieval of a Detached Partially Expanded Stent Using the SpideRX and EnSnare Devices — A First Report

Farrukh Hussain, MD, Barry Rusnak, MD, James Tam, MD

Case Report. A 66-year-old male with previous two-vessel coronary artery bypass graft surgery (CABG) presented with an acute coronary syndrome. Angiography demonstrated a critical 95% stenosis in the ostium of the saphenous vein graft (SVG) to the obtuse marginal (OM) of a dominant circumflex vessel, and another 70% thrombotic lesion in the mid portion of the same graft (Figure 1). The left internal thoracic artery (was widely patent, supplying a diffusely diseased distal left anterior descending artery not amenable to percutaneous intervention. Intervention was p...

Treatment of High-Burden Thrombus in a Large Right Coronary Artery

*Jaime Molden, MD, §John Kao, MD, *Atman P. Shah, MD

Case Report. A 30-year-old male with no previous medical history presented to an emergency department at a community hospital with left-sided, substernal chest pain. The pain was pressure-like and nonradiating. It began shortly after performing weight-lifting activity and lasted for more than 2 hours. In the emergency department, the patient was initially treated medically with aspirin and intravenous nitroglycerin, resulting in partial relief of the chest pain.
The patient was hemodynamically stable and physical examination, including cardiac auscultat...

Double Balloon Angioplasty for Unstentable Large-Caliber Right Coronary Stenosis

Scott B. Baron, MD, Clifford Nielson, CVT

Despite newer lower-profile stent technologies, placing coronary stents may still remain challenging when vessels are extremely tortuous. We describe a case of a very large-caliber right coronary artery (RCA) with a “shepherd’s crook” configuration, which could not be stented, and for which double balloon angioplasty was successfully performed.
Case Report. A 69-year-old Caucasian male was hospitalized for an acute coronary syndrome. Diagnostic heart catheterization revealed a 90% eccentric stenosis past the genu of the right coronary artery. The...

Prophylactic, Standby, or Rescue Support for High-Risk PCI: Who Knows?

*,§Fayaz Shawl, MD and *,£Robert J. Lederman, MD

This series from Mount Sinai Hospital extends the reported experience with prophylactic deployment of a percutaneous transseptal cardiopulmonary bypass system during high-risk elective coronary angioplasty. These highly experienced operators employed a dual-“preclose” technique in the majority of patients, implanting arterial sutures before pump deployment that permitted immediate postprocedure arterial closure. The short-term outcome was excellent, reported complications minimal, and intermediate-term outcomes reasonable for the high-risk patient cohort described.
How sh...

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