Onal Ozsaruhan

Predominant Tricuspid Stenosis Secondary to Bacterial Endocarditis in a Patient With Permanent Pacemaker and Balloon Dilatation of the Stenosis

In a 49‐year‐old woman with sick sinus syndrome and a pemanent VVI pacemaker, severe tricuspid stenosis and its clinical consequences developed 4 years after the attack of endocarditis. Besides the quite unusual occurrence of lead related tricuspid stenosis, successful treatment with balloon dilatation is the unique feature of this case.

Cardiac surgery in Belgium. State of the art in 2003.

Preinfarction angina pectoris has been suggested in some studies to have a beneficial effect on left ventricular function after acute myocardial infarction (AMI).The precise mechanisms of this protection have not been fully elucidated.The effect of preinfarction angina on myocardial tissue perfusion also needs to be clarified. In this study, we investigated the influence of preinfarction angina on microvasculatory damage by using ST-segment resolution and pressure-derived collateral flow index (CFIp) as a marker of microcirculatory perfusion. Methods — We studied 41 patients with a first AMI in whom thrombolysis in myocardial infarction (TIMI) grade 3 flow in the infarct-related artery was established by thrombolytic therapy.The percent resolution of ST-segment deviation (DS ST) after thrombolysis was determined. All of the patients had TIMI grade 3 flow in IRA at the coronary angiography, which was done a mean of 4 days after AMI. Intracoronary pressure measurements and stent implantation to the IRA were performed. After angiography, CFIp was calculated as the ratio of simultaneously measured coronary wedge pressure – central venous pressure (Pv) to mean aortic pressure – Pv. Results — Patients with preinfarction angina pectoris had greater percent DS ST than those without PA (67 ± 18% vs. 44 ± 24%, p = 0.03).The mean of the coronary wedge pressure (16.4 ± 7.4 compared with 23.2 ± 9.4, P < 0.03) and the pressure-derived collateral flow index (0.15 ± 0.10 compared with 0.22 ± 0.08, P < 0.03) were significantly lower in patients with preinfarction angina compared to those without. Conclusion — Preinfarction angina is associated with a greater degree of ST-segment resolution and lower CFI-p in patients with TIMI-3 reflow after thrombolysis.These findings suggest that a protective effect of preinfarction angina against reperfusion injury may result in greater ST resolution and lower CFIp after AMI.

Can thrombolytic therapy provide beneficial effects additional to epicardial coronary artery recanalization? A study based on coronary pressure measurement.

BackgroundCollaterals provide significant blood supply to the myocardium at risk and the presence of a preserved and adequate collateral network may limit microvascular damage during the occlusion of an epicardial coronary artery. The aim of this study was to evaluate whether thrombolytic therapy (TT) may produce beneficial effects at the level of microvascular circulation in addition to epicardial coronary artery recanalization by using quantitative intracoronary pressure measurement techniques in patients with recent acute myocardial infarction (AMI). Materials and methodsThirty-six patients who presented with AMI and had preinfarction angina pectoris, more than 60% stenosis and thrombolysis in myocardial infarction (TIMI) grade II flow in the infarct-related artery and who underwent a stent implantation procedure within 10 days of AMI were included in this study. Seventeen of 36 patients had received TT (group 1) and 19 had not received TT due to presence of contraindications or late admission (group 2). Quantitative coronary angiography, TIMI frame count (TFC) assessment and intracoronary pressure measurements were performed before and after stent implantation for all patients. Myocardial fractional flow reserve (FFRmyo) was calculated as the ratio of mean distal coronary pressure to mean aortic pressure. During total occlusion with balloon inflation, distal pressure was recorded as coronary wedge pressure (CWP). Collateral flow index (CFI) was determined by the ratio of simultaneously measured CWP to mean aortic pressure. ResultsThere were no differences between the two groups with respect to mean per cent stenosis and mean FFRmyo both before and after stent implantation. The mean CWP (25.1 ± 8.6 mmHg compared with 17.2 ± 6.2 mmHg, P  < 0.01) and CFI (0.24 ± 0.10 compared with 0.16 ± 0.11, P  < 0.01) were significantly higher and mean post-stent corrected TFC (18.8 ± 3.7 compared with 22.4 ± 3.1, P  < 0.01) was significantly faster in the group of patients who had received TT compared to those who had not. ConclusionsWe concluded that destruction degree of collateral circulation and distal microvasculature is lower in patients who had received TT, compared to patients who could not be treated with TT. Besides protective effect on collateral vessels, TT provides even more reperfusion and less destruction of the microvasculature.