Alessandro Giambartolomei

Successful treatment of a saphenous vein graft perforation with an autologous vein-covered stent

A 52‐year‐old man with a history of prior coronary bypass surgery suffered recurrent angina and underwent percutaneous placement of a stent within the midportion of the saphenous vein graft to the marginal branch of the left circumflex coronary artery, which was complicated by a significant perforation. The perforation was successfully closed using an NIR stent covered with a segment of autologous antecubital vein. Subsequent surgical exploration confirmed successful closure of the perforation. Cathet. Cardiovasc. Intervent. 48:382–386, 1999.

Transradial cardiac catheterization in elderly patients

The safety and efficacy of transradial cardiac catheterization in elderly patients is unknown. This study examines procedure success rates for transradial catheterization in appropriately selected patients < 70 (n = 195) and ≥ 70 (n = 83) years old. Elderly patients were less likely to be selected for the transradial approach (46% vs. 61%; P = 0.05). Although patients ≥ 70 years old were more often female (39.7% vs. 24.1%; P = 0.008) and had a smaller body surface area (1.89 ± 0.18 vs. 2.01 ± 0.24 m2; P = 0.001), procedure success rates did not differ (95.1% vs. 94.8%; P = NS). Procedure‐related variables including procedure time (15.4 ± 12.6 vs. 16.1 ± 11.6 min; P = NS), amount of radiographic contrast (90.1 ± 31.9 vs. 86.4 ± 29.8 cc; P = NS), and number of catheters used (1.5 ± 0.9 vs. 1.5 ± 0.7; P = NS) were similar between groups. We conclude that transradial catheterization can be safely and effectively performed in selected elderly patients. Cathet. Cardiovasc. Intervent. 51:287–290, 2000.

Overcoming vascular anatomic challenges to cardiac catheterization by the radial artery approach: Specific techniques to improve success

Anatomical variations in the peripheral vasculature can result in decreased procedural success rates for cardiac catheterization performed through the radial artery approach. We describe four categories of vascular challenges encountered in our catheterization laboratory: severe spasm, severe tortuosity, vascular stenosis, and congenital anatomical variations (e.g., accessory radial artery, radioulnar loop). For each situation, we provide a case report illustrating techniques that allowed for successful completion of the case. Cathet Cardiovasc Intervent 2002;56:207–211.

Myocardial ischemia resulting from spontaneous dissection in a patient with massive bilateral sinus of valsalva aneurysms.

We describe a patient with large sinus of Valsalva aneurysms involving both the left and right coronary sinuses. Spontaneous dissection of the left coronary artery occurred, causing unstable angina, a complication heretofore not associated with this disease. Successful surgical reconstruction of the aortic root, aortic valve replacement, and coronary bypass grafting were performed. Pathology revealed cystic medial necrosis. Cathet. Cardiovasc. Intervent. 47:194–198, 1999.

Transradial cardiac catheterization in patients with prior brachial artery cutdown.

The safety and efficacy of transradial cardiac catheterization in patients with prior ipsilateral brachial cutdown is not known. Using standard techniques we performed transradial catheterization in 278 consecutive patients, of which 63 had prior brachial cutdown. All patients had a strongly palpable radial pulse and a negative Allens test. Although patients with prior cutdown were older and had a higher incidence of hypertension and prior coronary artery bypass surgery, there was no significant difference in success rates for transradial catheterization (93.6% vs. 95.3%; P = NS). There were no periprocedural complications. Brachial artery occlusion was responsible for only two unsuccessful catheterization attempts. We conclude that, with careful preprocedural screening, ipsilateral transradial cardiac catheterization can be successfully performed in a majority of patients with prior brachial cutdown. Cathet. Cardiovasc. Intervent. 48:271–274, 1999.

The Use of Injectable Nitroglycerin in the Cardiac Catheterization Laboratory: Nitroglycerin in Cardiac Catheterization

At our institution, injectable nitroglycerin (TNG) has been employed dur ing cardiac catheterization since 1976. Initially, it was primarily used in pa tients undergoing a provocative test for coronary spasm with ergonovine maleate. After the initial favorable experience, the use of injectable TNG became routine. 1,2

An unusual complication during deployment of a Multi-Link stent.

The use of intracoronary stents has greatly impacted on the practice of interventional cardiology. Complications due to equipment failure during deployment of stents are rare but potentially serious. We report a case of a malfunctioning Multi‐Link delivery system and the successful treatment of the resulting complications. Cathet. Cardiovasc. Intervent. 47:58–60, 1999.

Neue Aspekte zur Beurteilung der linksventrikulären Funktion aus Pulmonalarterienverschlußdrucken und linksventrikulären Füllungsdrucken

Bei Rechtsherzkatheteruntersuchungen mit Ballonkathetern wird im allgemeinen der mittlere Pulmonalarterienverschlusdruck (Pulmonary Artery Occluded Pressure, PAOP [4]) zur Beurteilung des linksventrikularen Fullungsdruckes (LVEDP) gemessen. Aus den Untersuchungen von Braunwald et al. (1961) [2], von Mitchell et al. (1962) [5], Rahimtoola et al. (1972) [6], Fischer et al. (1975) [3] und Bonzel et al. (1976) [1] gehtjedoch hervor, das der PAOP wie auch der diastolische Pulmonalarteriendruck den LVEDP bei Patienten mit linksventrikularer Dysfunktion deutlich unterschatzt. Die exakte Analyse der Vorhofdruckkurve, insbesondere der A-Welle aus Pulmonalarterienverschlusdrukken erschien jedoch problematisch wegen Compliance-Anderungen der Pulmonalvenen in Abhangigkeit vom Fullungsdruck und von pharmakologischen Interventionen und dadurch bedingter Dapfung der Drucke.