A severe acute myocardial infarction patient with cardiogenic shock was successfully treated with percutaneous coronary intervention, percutaneous cardiopulmonary support (PCPS), and percutaneous left atrium-artery bypass (LAAB). LAAB assisted the patient’s circulation sufficiently, with few complications. The patient recovered from shock after LAAB. High fever and elevation of CPK disappeared after removal of the intra-aortic balloon pump (IABP). Staphylococcus epidermidis was detected in the culture of the IABP tip later. A small left atrium-right atrium shunt remained for ten months after LAAB removal and disappeared naturally. The patient was discharged 7 months after his initial myocardial infarction. He has been well for over one year since discharge without the need for re-hospitalization.

Primary angioplasty has emerged as the treatment of choice in acute ST-elevation myocardial infarction. While the timely restoration of infarct artery patency is central, close attention needs to be paid to microvascular integrity for successful restoration of normal myocardial metabolism. Clearance of thrombus burden is central to restoring normal myocardial metabolism. Available therapies do not efficiently remove thrombus in a timely and simple fashion. Microthrombi can be treated with appropriate pharmacological therapy, whereas larger macrothrombi should be treated with commercially available thrombectomy devices. In these case reports, the use of the Pronto™ (Vascular Solutions, Inc., Minneapolis, Minnesota) catheter is described as a quick, simple, and timely tool for the management of thrombus in the setting of an acute right coronary artery myocardial infarction.

Complete left coronary system abolition due to thrombotic occlusion of the left main coronary ostium is an unusual presentation of myocardial infarction. Delays in reaching hospital and restoring coronary blood flow are major predictors of survival in cardiogenic shock. This rare case highlights the high mortality rate of cardiogenic shock due to thrombotic occlusion of the left main coronary ostium in spite of all efforts using innovative devices to remove thrombus and achieve adequate coronary and myocardial perfusion.

Minimizing the dose of contrast media is considered to reduce the risk of contrast-induced nephropathy (CIN), which is a serious complication occurring in patients with chronic renal insufficiency (CRI) after percutaneous coronary intervention (PCI). We describe the drastic method of PCI, which successfully completes the procedure with minimal dose of contrast media in order to prevent CIN. In two cases complicated by CRI, PCI was safely carried out using less than 20 ml of contrast media in conjunction with various techniques or devices for minimizing the wasteful use of contrast media.

We describe a case of a 50-year-old male with hypertrophic obstructive cardiomyopathy (HOCM) who presented with syncope, progressively limiting dyspnea and chest discomfort. Coronary angiography showed an unusually extreme angle (~130°) to the origin of the major septal artery. After conventional guidewire cannulation failed, use of magnetic navigation with the Stereotaxis Niobe® system permitted guidewire and balloon catheter cannulation of the septal artery to facilitate successful transcatheter alcohol septal ablation.

This is a case of a 58-year-old female with a history of mitral regurgitation who had undergone mitral valve repair and was readmitted in cardiogenic shock with pericardial effusion, and then developed an anterior ST-elevation myocardial infarction. Coronary angiography revealed an embolus in the left main artery which was treated with rheolytic thrombectomy. This represents an uncommon cause of acute myocardial infarction.

Background. No previous study has analyzed the possible responsibility of fellows-in-training in terms of the risk of complications during cardiac catheterization. Thus, we sought to identify possible risk factors for access site complications following cardiac catheterization procedures, with particular attention to the role of cardiology fellows. Methods. A total of 1,288 left heart catheterization procedures (both diagnostic and interventional), performed over a 1-year period at a university hospital, were retrospectively evaluated to determine the incidence of local complications (pseudoaneurysm, arterio-venous fistula, major hematoma or bleeding, vascular dissection). Several clinical (age, gender, previous coronary artery bypass surgery, indication to the exam) and procedural (procedure performed by the fellow, access site, type of procedure, urgent setting, use of glycoprotein IIb/IIIa inhibitors, simultaneous right heart catheterization, use of closure devices) covariables were

Platelet glycoprotein IIb/IIIa receptor inhibitors have been shown to improve outcomes in percutaneous coronary interventions. Their use with multiple anticoagulants has been associated with increased bleeding complications. Among these, alveolar hemorrhage is a rare and potentially fatal complication. Six patients with this complication were identified over a four-year period. Patient characteristics, possible risk factors, pathophysiology, prevention and potential treatment options are discussed.

Objectives. To evaluate the accuracy of a new long sheath single-puncture technique in obtaining accurate transvalvular gradients in aortic stenosis. Background. Despite advances in echo Doppler, the evaluation of aortic stenosis continues to be a common procedure in the cardiac catheterization laboratory. Experts agree that simultaneous evaluation of the proximal aortic and left ventricular pressures yields the most accurate data; however, this is difficult to achieve unless two arterial punctures are performed. Methods. We postulated that using a 4 Fr pigtail catheter inside a 55-cm long 6 Fr sheath would provide accurate simultaneous pressure data, yet avoid the complications of two arterial punctures. We performed this technique in 13 male patients, and placed a second arterial catheter in the aortic root as a control aortic pressure. We then performed this technique in 55 other male patients without placing an additional control arterial catheter. Results. In the test population,

Background. Patients with cardiac arrest have been excluded from most randomized trials on percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Objective. The aim of the study was to evaluate the outcome of patients undergoing primary PCI for acute myocardial infarction who suffered from cardiac arrest prior to the procedure, focusing the study on the influence of immediate paramedical/medical assistance on the outcome. Methods and Results. Sixty-three patients with ST-elevation AMI and previous cardiac arrest underwent primary PCI within 12 hours after symptom onset. Three groups of patients were defined: Group 1: Cardiac arrest before hospital admission, without immediate (< 1 minute) initiation of resuscitation maneuvers (n = 13); Group 2: Pre-hospital cardiac arrest with immediate initiation of resuscitation maneuvers (n = 14); Group 3: Cardiac arrest after hospital admission. The proportion of patients with ventricular tachycardia or fibrillation as docu

Objectives. We aimed to compare the clinical outcomes of dialysis versus nondialysis patients after coronary drug-eluting stent (DES) implantation. Background. The revascularization of ischemic heart disease in dialysis patients has remained controversial due to consistent exclusion of this population from major trials, especially in the context of percutaneous coronary interventions (PCI) with DES. Methods. We analyzed the data on 3,442 consecutive patients who underwent PCI and DES implantation since March 2003. Periprocedural events, 1- and 6-month clinical outcomes were then compared between dialysis (n = 72) and nondialysis patients (n = 3,370). Results. Baseline characteristics revealed a higher prevalence of female gender (p = 0.03), African Americans (p < 0.001), hypertension (p < 0.001), diabetes mellitus (p < 0.001), number of diseased vessels (p = 0.04), lower ejection fraction (p < 0.001), and a higher prevalence of acute myocardial infarction (MI) (p = 0.04) in dialysis pa

Background. Although coronary artery bypass graft surgery (CABG) is known to reduce angina, previous studies have suggested that anti-anginal medication use is not significantly reduced after CABG. However, it is unclear how functional testing results have an impact on anti-anginal medication prescription patterns. Objectives. To determine whether post-CABG functional testing results impact prescription patterns of anti-anginal medication during the 12 months after CABG. Methods. The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter study. We examined anti-anginal medication use (beta blockers, calcium channel blockers and nitrates) at discharge and at 12 months post-CABG with respect to functional testing results among 392 patients. Results. Among the 392 patients, 146 had at least one functional test over the 12-month follow up period. Among the 146 patients, 17% had positive functional

Thirty percent of diagnostic angiograms have at least 1 chronic total occlusion (CTO). The 10-year survival of patients with a CTO is improved if they have the CTO successfully recanalized. The success of recanalization with conventional wires is 50% and the impact of new technology on recanalization is unknown. This abstract reports a single center experience with one such new device, the Lumend Frontrunner™ catheter in revascularization of this difficult lesion subset. A consecutive series of 18 patients with CTO’s of native coronary arteries were enrolled in this single center, single operator series. The mean age of the CTO was 5.3 years. The indication for attempt at recanalization was ischemia in the territory of the CTO on SPECT imaging. Success was defined as TIMI flow restoration and < 40% residual stenosis. Primary success (defined as TIMI 3 Flow restoration and < 40% residual stenosis) was achieved in 77% of patients. At 30 days and out to 6 months, clinical TVR was 11% (2/1