On-Hing Kwok

Angiographic outcome after intracoronary X‐Sizer helical atherectomy and thrombectomy: First use in humans

The objective of this study was to evaluate the early angiographic outcome in the first human subjects who underwent intracoronary atherectomy and thrombectomy using the X‐Sizer helical cutting and aspiration system. Percutaneous coronary interventions in patients with thrombo‐occlusive disease or friable degenerative saphenous vein grafts are associated with considerable periprocedural morbidity and mortality, predominantly related to microscopic distal embolization. X‐Sizer catheter system is a novel atherectomy and thrombectomy device that consists of a helix cutter connected to a handheld motor drive unit and a vacuum collection chamber for aspiration of excised atheroma, thrombus, and debris. Quantitative coronary angiography was obtained in 14 patients before and after X‐Sizer extraction atherectomy with adjunctive balloon angioplasty and stenting. Thirteen native coronary arteries and one saphenous vein graft were treated. Mean preprocedural reference vessel diameter was 3.06 ± 0.66 mm. There were 71.4% AHA/ACC type B2 and C lesions. Preprocedural thrombus was present in nine patients and total occlusion in 64% of cases. Minimal luminal diameter was increased from 0.29 ± 0.47 mm to 1.32 ± 0.64 mm, a gain of 1.04 ± 0.69 mm after atherectomy. Final total gain was 1.47 ± 0.61 mm. Mean diameter stenosis was reduced from 89.3% to a final residual stenosis of 14.4%. Postatherectomy distal embolization occurred in one patient who had heavy preprocedural thrombus burden. No episodes of perforation, distal coronary spasm, abrupt closure, or slow/no‐reflow occurred. The angiographic analysis of the first cohort of human subjects suggests that X‐Sizer helical atherectomy is a feasible method of removing occlusive tissue or thrombus in coronary artery disease with a low angiographic complication rate. A large‐scale randomized phase II clinical trial is underway to determine the ultimate safety and efficacy of this device in thrombo‐occlusive native coronary arteries and saphenous vein grafts. Cathet Cardiovasc Intervent 2002;55:133–139.

First human experience with angiopeptin-eluting stent : A quantitative coronary angiography and three-dimensional intravascular ultrasound study

Angiopeptin has been shown to reduce in‐stent restenosis in various animal models. Meanwhile, BiodivYsio DD phosphorylcholine (PC)‐coated stent provides a platform for local delivery of antiproliferative agents to the coronary artery. We studied the feasibility, safety, and impact on tissue growth of angiopeptin‐eluting BiodivYsio DD PC‐coated stents in human native de novo coronary lesions. We enrolled 14 patients (16 lesions) who underwent intravascular ultrasound (IVUS)‐guided angiopeptin‐eluting stent implantation in native coronary arteries between 3.0 and 4.0 mm in diameter with lesion length ≤ 18 mm. We successfully implanted 13 stents loaded with 22 μg of angiopeptin and three stents with 126 μg of angiopeptin. No major adverse cardiac events or target vessel failure occurred at 1‐year clinical follow‐up. All patients underwent 6‐month angiographic and volumetric IVUS follow‐up. In‐stent late loss was 0.46 ± 0.32 mm in the low‐dose group and 0.26 ± 0.14 mm in the high‐dose group. Binary restenosis rate was 0%. Follow‐up percentage neointimal hyperplasia by IVUS was 18.4% ± 22.5% for the low‐dose group and 10.2% ± 5.8% for the high‐dose group, respectively. There were no edge effect and late stent malapposition. Angiopeptin‐eluting BiodivYsio DD PC stent appears feasible and safe in treating native de novo coronary lesions with modest degree of neointimal hyperplasia.

Pericardial effusion in adults undergoing surgical repair of atrial septal defect

The incidence of pericardial effusion and tamponade postatrial septal defect repair in adult patients are 16 and 1.5%, respectively. Small, medium, and large effusions progressed equally, and echocardiographic study on days 7, 14, and 28 best detects potentially significant effusion.

Long‐term Clinical Outcomes of Drug‐Eluting Stents Vs Bare‐Metal Stents in Chinese Patients

There is limited data on the magnitude of the problem of drug‐eluting stent (DES) thrombosis in the Asian population.

Coronary Artery Disease Obscuring Giant Cell Myocarditis A Case Report

A case in which the diagnosis of idiopathic giant cell myocarditis was obscured by the presence of severe coronary artery disease is described. A 47-year-old man presented with recurrent inferior myocardial infarction and complete heart block. Cardiac catheterization confirmed severe 2-vessel disease and left ventricular dysfunction. Incessant ventricular arrhythmia rapidly ensued, which did not respond to anti-arrhythmic therapy and overdrive pacing despite complete surgical revascularization. He eventually died. Autopsy revealed giant cell myocarditis superimposed on coronary artery disease. Acute myocarditis masquerading as myocardial infarction has been well known, but virtually all reported cases had normal coronary arteries. This case illustrated the fact that even in the presence of obvious coronary artery disease the remote possibility of myocarditis should not be entirely disregarded. Although giant cell myocarditis is a rare and frequently fatal disorder, recent studies suggest that combined immunosuppressive therapy may improve the prognosis.

An unusual late complication of infective endocarditis.

A 44 year-old man underwent emergent aortic valve replacement for decompensated heart failure. This was a result of a severe aortic regurgitation, a complication of Streptococcus agalactiae infective endocarditis 6 weeks prior. The patient presented with an acute coronary syndrome while receiving intravenous antibiotic treatment in a convalescence hospital. A coronary angiogram revealed a critical left main coronary artery stenosis (Panel B). A digital subtraction aortogram revealed extravasation of contrast from the left sinus of Valsalva into an abscess cavity, causing extrinsic compression of the left main coronary artery (Panel A). Emergent surgical exploration confirmed the diagnosis. The patient underwent surgical excision of the abscess with patch repair of the sinus of Valsalva and revascularization of the left coronary arteries using saphenous vein grafts. Recovery was uneventful. Aortic root abscess causing left main compression and acute coronary syndrome is a very unusual complication of infective endocarditis. Early cardiac catheterization and digital subtraction angiography could help to define the coronary anatomy and confirm the diagnosis in a safe and accurate manner. An Unusual Late Complication of Infective Endocarditis

Atrial septal defect with ascites and pleural effusion.

A case of a lady referred for repair of an atrial septal defect is described. She presented with an insidious onset of recurrent ascites and pleural effusion. Cardiac catheterization showed constrictive physiology. The patient subsequently underwent surgical closure of the atrial septal defect and pericardiectomy