Paul Van den Heuvel

Rotational vs. standard coronary angiography: An image content analysis

Objective: To evaluate the clinical utility of images acquired from rotational coronary angiographic (RA) acquisitions compared to standard “fixed” coronary angiography (SA). Background: RA is a novel angiographic modality that has been enabled by new gantry systems that allow calibrated automatic angiographic rotations and has been shown to reduce radiation and contrast exposure compared to SA. RA provides a dynamic multiple‐angle perspective of the coronaries during a single contrast injection. Methods: The screening adequacy, lesion assessment, and a quantitative coronary analysis (QCA) of both SA and RA were compared by independent blinded review in 100 patients with coronary artery disease (CAD). Results: SA and RA recognize a similar total number of lesions (P = 0.61). The qualitative assessment of lesion characteristics and severity between modalities was comparable and lead to similar clinical decisions. Visualization of several vessel segments (diagonal, distal RCA, postero‐lateral branches and posterior‐descending) was superior with RA when compared to SA (P < 0.05). A QCA comparison (MLD, MLA, LL, % DS) revealed no difference between SA and RA. The volume of contrast (23.5 ± 3.1 mL vs. 39.4 ± 4.1; P = 0.0001), total radiation exposure (27.1 ± 4 vs. 32.1 ± 3.8 Gycm2; P = 0.002) and image acquisition time (54.3 ± 36.8 vs. 77.67 ± 49.64 sec; P = 0.003) all favored RA. Conclusion: Coronary lesion assessment, coronary screening adequacy, and QCA evaluations are comparable in SA and RA acquisition modalities in the diagnosis of CAD however RA decreases contrast volume, image acquisition time, and radiation exposure.

Myocardial involvement in acromegaly

We recently encountered a case of an acromegalic patient with congestive heart failure and secondary cardiomyopathy. Cardiac biopsies were available in addition to autopsy material. This enabled us to perform electron microscopical studies which have hitherto not been reported. This may help to clarify the relationship between these two conditions and reveal specific characteristics.

Intravenous streptokinase-mediated thrombolysis of acute occlusion of the left main coronary artery

Abstract In the absence of collaterals, acute occlusion of the left main (LM) coronary artery causes extensive myocardial necrosis and cardiogenic shock. 1 We report on 2 patients in whom thrombolysis, with administration of intravenous streptokinase, of an occluded LM coronary artery resulted in reversal of clinically diagnosed shock. Both patients survived with excellent preservation of the left ventricular function.

Stenosis in a coronary collateral artery--a case report.

The coronary cineangiography of a man with an inferoposterior myocardial infarction is reported. An occlusion of the proximal right coronary artery and an occlusion at the origin passing around the left atrial wall of the circumflex artery was observed. A large collateral artery connected the right coronary artery and the distal circumflex artery. This vessel showed a significant stenosis of 70%. This case suggests that collateral arteries are not protected from atherosclerotic degeneration. Alternatively, since the exact caliber of the anastomosis before the occlusion of the recipient artery is not known, an extrinsic compression or kinking may have generated the stenosis at the time of the flow-related dilatation of the vessel.