Sarah A. Johnson

Acute procedural results in the treatment of 30 coronary artery bifurcation lesions with a double-wire atherectomy technique for side-branch protection

Percutaneous treatment of bifurcation lesions has been consistently shown to be associated with lower acute success rates, higher initial complication rates, and an increased rate of restenosis when compared with findings in nonbifurcation lesions. Recent analysis of data from a CAVEAT subgroup suggests that directional atherectomy of bifurcation lesions can improve initial success rates and lower restenosis rates but at the cost of high complication rates. Reports from several angioplasty series document improved success rates and lower complication rates with the use of a two-wire technique to protect side branches when treating bifurcation lesions. Our experience with a two-wire atherectomy technique that uses a nitinol wire to protect important side branches is presented.

Diagnosis and management of right atrial thrombus in heparin-induced thrombocytopenia and thrombosis syndrome with transesophageal echocardiography and thrombolytic therapy

2. Berdusis K, Fisher JB, Webb CL, Gidding SS, Alboliras ET. Successful preparation of community hospital sonogTaphers for transtelephonic transmission of infant echocardiographic studies. J Am Soc Echocardiography 1995;8:16E. 3. Fisher JB, Alboliras ET, Berdusis K, Gidding SS, Webb CL. Feasibility of transtelephonic echocardiology for evaluation of neonates in a community hospital setting. Ped Res 1995;37:205A. 4. Sobczyk, WL, Solinger RE, Rees AH, Elbl F. Transtelephonic echocardiography: successful use in a tertiary pediatric referral center. J Pediatr 1993;122:

Coronary Embolism: Surgical Management

84-8. 5. Finley JP, Human DG, Nanton MA, Roy DL, MacDonald RG, Marr DR, Chiasson H. Echocardiography by telephone evaluation of pediatric heart disease at a distance. Am J Cardiol 1989;63:1475-7. 6. Sahn DJ, Williams J, Rice MJ, MacDonald RW, Gross B. A real-time satellite-based telecommunications system providing live video conferencing and instantaneous transmission of echo Doppler images. J Am Coll Cardiol Feb 1994;Feb:409A.

Percutaneous transluminal coronary angioplasty for unstable angina: Predictors of outcome in a multicenter study

The successful use of Fogarty catheter embolectomy combined with aortocoronary vein bypass graft in 4 patients with an acute myocardial infarction is presented. Three patients sustained acute occlusion of the coronary artery secondary to an embolus during cardiac catheterization. In the fourth patient, the left anterior descending coronary artery was occluded with a fragment of calcium debris during aortic valve replacement. All patients survived the operation. Acute occlusion of the coronary artery secondary to an embolus is uncommon, but its early recognition and appropriate surgical management may be lifesaving.

Effect of cardiopulmonary support on regional and global left ventricular function during transient coronary occlusion.

Background: Angiographic and clinical studies have demonstrated that coronary artery plaque rupture with thrombus formation, spasm, or both are frequently responsible for the syndrome of unstable angina. Percutaneous transluminal coronary angioplasty (PTCA) is commonly used in the treatment of patients with coronary artery disease and unstable angina. A number of studies have shown, however, that intracoronary thrombus increases the risk of abrupt vessel closure. The purpose of this study was to define preprocedural variables predictive of the outcome of PTCA performed on patients with unstable angina in a prospective multicenter study using a core angiographic laboratory.Methods and Results: A total of 386 patients with unstable angina underwent coronary angioplasty of 487 lesions treated with balloon PTCA at 9 medical centers. Multivessel or left main coronary artery disease was present in 55% and recent myocardial infarction in 22%. Clinical success was achieved in 317 of 386 patients (82.1%), as defined by <50% residual stenosis at every target lesion evaluated in the core angiographic laboratory and no major complication during hospitalization. Major complications (death, Q-wave or non-Q-wave myocardial infarction, or emergency coronary artery bypass surgery) occurred in 36 patients (9.3%), and abrupt vessel closure occurred in 50 (13.0%). Logistic regression analysis identified preprocedural variables that were predictive of outcome of angioplasty. Strong predictors of any complication (major complication or abrupt vessel closure) included age [odds ratio (OR)=1.04; 95% confidence interval [CI] 1.02, 1.07]) for each additional year of age; p < 0.001), number of diseased vessels (OR=1.58; 95% CI=1.16, 2.15 per additional vessel; p=0.012), the number of lesions treated at angioplasty (OR =1.72; 95% CI=1.11, 2.66; p=0.014), and angiographic evidence of filling defect preceding angioplasty (OR=3.30; 95% CI=1.11, 9.75; p < 0.001).Conclusions: The outcome of PTCA performed for unstable angina is influenced by a combination of clinical, angiographic, and procedural variables. This study suggests that PTCA performed on lesions associated with filling defects or on more than one lesion at the time of the procedure carries an increased risk of complication. The outcome of PTCA for unstable angina may be improved by identifying new strategies for the treatment of lesions associated with filling defects and by using more accurate methods to identify and treat the culprit lesion responsible for unstable angina.

Ventricular fibrillation during coronary angiography: Reduced incidence in man with contrast media lacking calcium binding additives

The ability of extracorporeal cardiopulmonary support (CPS) to unload the left ventricle and reduce ischemic dysfunction during transient coronary occlusion was studied in 10 anesthetized dogs. Three serial 60-second circumflex coronary artery occlusions were performed with CPS initiated only during the second occlusion. CPS significantly reduced preocclusion systolic blood pressure, blood pressure x heart rate double-product, circumflex blood flow, left ventricular end-diastolic pressure (LVEDP), peak negative dP/dt, and left ventricular systolic thickening. Circumflex occlusion caused changes in LVEDP and left ventricular wall thickening that were similar regardless of the presence or absence of CPS. These data suggest that CPS unloads the left ventricle during myocardial ischemia but does not prevent regional or global myocardial dysfunction.