John D. Slack

Coronary balloon angioplasty dissections: “The good, the bad and the ugly”☆

Since the tntraduction of percutanewi coronary b&on lion simply means mvolvement or penetratton of the vessei angioplasty nearly IS years ago (I). there has been cow& media 117,. C’inically. however. it often conveys a sense of erable interest in the recognition of angiographic pa;.erns of failure. complication (“bad”) car impending doom P~ply”). successful dilation. angiogmphic predictors oi angopla<ty Angiographir evidence of dissection. Angiographically. complications and identification of angiographic factors usthe term dissection has been freelv used (and oerhaos sociated with restenosis. Similarly, there has been considerable morphologic interest in distinguishing mechanisms of wrongly so) for vartous luminographif appearker iIS-36.

Subacute Left Main Coronary Stenosis: An Unusual but Serious Complication of Percutaneous Transluminal Coronary Angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) is a proven non- operative method of direct myocardial revascularization. Acute complications occurring during PTCA center primarily around acute disruption at the site of dilatation, arrhythmias, or vascular problems at the site of guide catheter ac cess. Late complications include restenosis or aneurysm formation at the site of dilatation. Subacute stenosis of the left main coronary artery occurred in three of 440 patients who had PTCA performed between September 1980 and Decem ber 1983 and may be an infrequent but potentially critical complication of PTCA. The serious clinical course of patients with left main coronary stenosis requires prompt recognition and intervention.

Influence of Potassium Cardioplegia versus Ischemic Arrest on Regional Left Ventricular Diastolic Compliance in Humans

To compare the effects of hypothermic ischemic arrest versus hypothermic potassium cardioplegia, regional left ventricular performance was monitored in 20 adult male patients undergoing saphenous vein bypass operation. Twelve patients received ischemic arrest (Group 1), and 8 received potassium cardioplegia (Group 2). Groups 1 and 2 did not differ in left ventricular ejection fraction (0.62 versus 0.60), number of bypassed vessels (3.7 versus 3.4), mean cross-clamp time (75 versus 63 minutes), or mean cardiopulmonary bypass time (182 versus 170 minutes). Before cardiopulmonary bypass was begun, a pair of ultrasonic crystals was secured in the left ventricular anterior myocardium to measure segment motion and a micromanometer-tipped catheter was placed in the left ventricular chamber. All patients received a saphenous vein bypass graft to a vessel supplying the anterior left ventricular wall in the region of the ultrasonic crystals. Comparison of changes in systolic measurements revealed no significant differences between Groups 1 and 2. After saphenous vein bypass grafting, the left ventricular end-diastolic pressure (11.4 to 17.0 mm HG) and modulus of left ventricular segment stiffness (0.37 to 0.67, p less than 0.02) were elevated in Group 1 but no changes were observed in Group 2 (14.0 to 15.6 mm Hg, and 0.16 to 0.24, respectively). Compared with hypothermic ischemic arrest, hypothermic potassium cardioplegia is not associated with an increased left ventricular diastolic stiffness shortly after saphenous vein bypass grafting in humans.

Biplane regional wall motion analysis: Optimal method for identification of left ventricular akinesis/dyskinesis with quantitative cineangiography in man

Abstract Computer-assisted biplane regional wall motion analysis of left ventriculography has been shown to allow accurate, reproducible identification of normal vs abnormal patients. Recently, however, it has become evident that further quantitation of the degree of regional wall motion abnormality is necessary for optimal clinical evaluation, particularly in assessing the results of “Intervention Ventriculography”. Six commonly utilized methods adapted for ease in desk-top computer analysis were tested on 58 patients with healed myocardial infarctions undergoing biplane left ventriculography. A method utilizing radial chords constructed at 30° intervals from an origin at the centre of the end diastolic long axis proved most successful in both localizing regional wall motion abnormalities and quantifying the degree of abnormality.