Shih-Pu Wang

Mediastinal and neck hematoma after cardiac catheterization

Vascular complications after cardiac catheterization are rare and usually occur at the access sites. However, vessels along the tract of the catheter can also be injured, causing bleeding and hematoma formation. We present a 57‐year‐old male who underwent cardiac catheterization via the radial approach, later developing neck and mediastinal hematoma, which was managed conservatively. This complication has only been reported once in the English literature. Cathet Cardiovasc Intervent 2003;58:467–472.

Coronary computed tomography angiography---a promising imaging modality in diagnosing coronary artery disease.

Background: Traditionally, information on coronary artery lesions is obtained from invasive coronary angiography (CAG). The clinical applicability and diagnostic performance of the newly developed 64‐slice multislice computed tomography (MSCT) scanner in coronary angiographic evaluation is not well evaluated. Methods: Coronary computed tomography angiography (CCTA) was performed in 345 patients (119 women, 226 men; mean age, 59.64 ±11.67 years). Concomitant CAG was performed in 53 patients. The diagnostic performance of CCTA for detecting significant lesions was compared with that of CAG by 3 independent cardiologists. Results: All CCTA was performed without complication. Comparison between CCTA and CAG was made in the 53 patients who underwent both studies. Sensitivity, specificity and the positive and negative predictive values for the 53 patients were: 81%, 99%, 87% and 99%, respectively. Conclusion: The 64‐slice MSCT, developed in recent years, allows reliable noninvasive evaluation of coronary artery morphology, including plaque, stenosis and congenital anomaly. The diagnostic accuracy of MSCT scans for detecting lesions makes it a good imaging substitute for CAG in the evaluation of these coronary segments. [J Chin Med Assoc 2008;71(5):241–246]

Transient Left Ventricular Apical Ballooning Syndrome : The First Series in Taiwanese Patients

Previously thought as exclusive in Japanese patients, cases of transient left ventricular apical ballooning from other countries have also been reported. The cause remains unknown. From January 1997 to December 2005, 25 patients presenting with signs and symptoms of acute myocardial infarction with normal coronary arteries were analyzed. In all, 10 patients fulfilled all the criteria for transient left ventricular apical ballooning. In all, 6 patients had chest pain and diaphoresis, 5 patients had ST segment elevation, 7 had T wave inversions, and 5 had QT prolongation; 6 patients had normal coronary arteries and 4 had insignificant stenosis. In all, 2 patients died of sepsis, whereas the rest recovered. This is the first series in Taiwanese patients. Our series showed male preponderance, and most patients recovered with supportive treatment. Without any delineating preangiographic feature differentiating it from acute myocardial infarction, any patient should be treated as a case of myocardial infarction until proven otherwise.

Angiographic and Clinical Outcomes of Rosiglitazone in Patients With Type 2 Diabetes Mellitus After Percutaneous Coronary Interventions: A Single Center Experience

A beneficial effect of thiazolidinediones includes the reduction of intermediate markers, suggesting a potential for reducing atherosclerosis and restenosis. The objective of this study was to determine if rosiglitazone (RSG) reduced the odds of restenosis and if RSG improved the odds of clinical outcomes after percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) patients. A total of 609 patients with 734 lesions were selected from the period between January 1, 2001 and January 31, 2004. These patients were divided into 2 groups: a “control” group representing patients seen between January 1, 2001 and September 2002 when RSG was not available in our hospital and a “RSG treatment” group representing patients seen between September 2002 and January 31, 2004 when RSG was available in our hospital. Thus, 213 patients with 253 lesions (1.19 L/P) were placed in the RSG group and 396 patients with 481 lesions (1.21 L/P) were placed in the control group. Subgroup analysis based on the PCI received had 88 patients in the RSG arm receiving balloon angioplasty and 125 patients receiving coronary stenting; the control group had 187 and 209 patients, respectively, in the subgroups. Primary endpoint was angiographic restenosis at 6 months, and secondary endpoints were death, myocardial infarction, and target lesion revascularization. More patients in the control group were insulin-requiring, had poorer left ventricular function, but had a larger preprocedural minimal lumen diameter (pre-MLD). At 6 months, restenosis and reocclusion rates were lower in the RSG group (P = .014 and P = .006, respectively). Twenty-nine patients died in the control group versus 1 in the RSG group (P ≤ .001). RSG (P = .019), stenting (P = .005), preprocedural reference vessel diameter (P = .017), metformin (P = .022), pre-MLD (P < .001), hyperlipidemia (P = .016), and combined RSG and metformin (P = .020) were predictors of restenosis, while RSG (P = .016) and metformin (P = .029) were predictors of survival. In conclusion, RSG was found safe and well tolerated and was associated with reduced odds of restenosis, reocclusion, and mortality rates in type 2 DM patients independent of glycemic control and PCI performed.

Complex AV fistulas involving three coronary arteries, aorta, left internal mammary artery, vertebral artery and left pulmonary artery — Demonstration by MDCT

We describe a rare case of complex AV fistulas involving three coronary arteries, the aorta, the left internal mammary artery, the left vertebral artery, and left pulmonary artery. Multidetector row computed tomography well depicted the complex anatomy of the fistulas by multiplanar reconstruction and three-dimensional techniques.

Coronary Stenting or Balloon Angioplasty for Chronic Total Coronary Occlusions: The Taiwan Experience (A Single-Center Report):

The authors conducted this study to compare the restenosis and reocclusion rates of primary balloon angioplasty alone versus angioplasty followed by stenting in Taiwanese patients with chronic total occlusions. They also evaluated whether stenting reduced the incidence of restenosis and improved left ventricular function in these patients. From October 1998 to April 2000, a total of 294 patients with chronic total occlusion (Thrombolysis in Myocardial Infarction grade 0 flow) underwent recanalization using balloon angioplasty alone or followed by stent implantation. Of these, only 129 patients were included after procedural failure and patients lost to follow-up; 62 patients were placed in the stent group, while 67 patients were assigned to the percutaneous transluminal coronary angioplasty (PTCA) group. Coronary angiography was performed at baseline and at 6 months follow-up or earlier if angina or objective evidence of ischemia involving the target vessel or other vessels was present. Procedural success was 60%. Minimal lumen diameter increased significantly after stenting: 2.97 ±0.41 vs 2.24 ±0.41 (p<0.001); 60% of patients in the stent group were free of restenosis, whereas only 33% in the PTCA group were free of restenosis at follow-up. Only 1 patient in the stent group had reocclusion, as opposed to 17 (25%) patients in the PTCA group (p<0.001). The follow-up minimal lumen diameter (MLD) at 6 months was significantly larger in the stent group: 1.80 ±0.85 mm vs 1.08 ±0.82 mm (p<0.001). Left ventricular function improved in the stent group, but not in the PTCA group (58.44 ±16.58% to 63.60 ±14.59% [p<0.001] vs 54.13 ±15.66% to 54.31 ±15.60% [p=0.885]). More patients had angina in the PTCA group than in the stented group 43 vs 29 (p=0.053). The postprocedural MLD and reference vessel diameter (RVD) were the strong predictors of restenosis and follow-up MLD (p<0.001). Stenting of chronically occluded arteries significantly reduced the incidence of reocclusion and restenosis, at the same time improving left ventricular function in these patients. This should be the procedure of choice after successful angioplasty of chronically occluded vessels.

Intracoronary retrieval of the dehisced radiopaque ring of a guiding catheter: An unusual complication of coronary angioplasty

The guiding catheter used in coronary intervention may be damaged or some parts could be dehisced during the procedure, producing adverse effects in the vascular tree. So much so that immediate surgery is usually indicated. We report a case with a dehisced radiopaque ring of the catheter during the procedure. It was retrieved percutaneously without thoracotomy. Cathet Cardiovasc Intervent 2002;55:262–264.

Single coronary artery with septal course of left main coronary artery from right coronary sinus associated with coronary artery disease: Multislice computed tomography (MSCT) appearance

Congenital anomalies of the coronary arteries have an incidence of 1–2% in the general population [1]. The left coronary artery originating from the right sinus of Valsalva separately or as a single coronary artery is 0.09–0.11% of the population undergoing coronary angiography [2]. The current choice of diagnosis for coronary artery disease is coronary angiography; however, it cannot provide threedimensional images, and a congenital anomaly can be overlooked if the ostium is not properly engaged [3,4]. We present a case of a single coronary artery with the LMCA from the right coronary cusp following a septal course and associated with the LAD having significant stenosis (N50% stenosis) found by a 64-detector multislice computed tomography (MSCT) scan. To our knowledge, this is the first report of this anomaly with coronary artery disease imaged by MSCT in the literature.