Primary stent implantation compared with primary balloon angioplasty for acute myocardial infarction: a meta-analysis of randomized clinical trials.
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
A Feit
Publications and source records attributed to A Feit.
Successful percutaneous stenting of a right gastroepiploic coronary bypass graft using monorail delivery system: a case report.
The right gastroepiploic artery (RGEA) is being successfully used as an arterial conduit in a selected group of patients undergoing coronary artery bypass graft surgery. However, myocardial ischemia may result due to spasm, occlusion, and stenosis of this graft. The anastamosis site at distal right coronary artery (RCA) or posterior descending artery (PDA) is the most common location for stenosis of an in situ gastroepiploic coronary bypass graft. Balloon angioplasty of such stenoses has been reported with optimal short-term results. Stent deployment would decrease the restenosis rate, so that repeat procedures could be minimized for these technically challenging lesions. We describe a case of successful deployment of a stent with monorail delivery system at the anastamotic site stenosis of an in situ gastroepiploic right coronary artery bypass graft. This percutaneous coronary intervention could prevent redo coronary artery bypass graft surgery. Cathet. Cardiovasc. Intervent. 49:197-199, 2000.
Angioplasty, Balloon, Coronary↗
Fatal left main coronary artery embolism from aortic valve endocarditis following cardiac catheterization.
Coronary artery embolization has been associated with sudden cardiac death. It is more commonly seen with aortic valve endocarditis. It manifests as acute myocardial ischemia or infarction, causing instability of the cardiac rhythm, which may be fatal. We report a patient with aortic valve endocarditis who had sudden cardiac death following coronary angiography. Autopsy revealed embolic occlusion of the left main coronary artery.
Aortic Valve↗
Rescue PTCA complicated by pulmonary artery rupture after tPA and abciximab.
Since the introduction of pulmonary artery catheterization for hemodynamic monitoring, several complications associated with its use have been described. Pulmonary artery rupture is an infrequent complication of flow-directed pulmonary artery catheters. We report a case of pulmonary artery rupture complicating rescue PTCA in the presence of systemic platelet inhibition with abciximab (Reopro), anticoagulation, and thrombolytic therapy. With the increasing use of these medications in patients undergoing acute coronary interventions, particularly those patients requiring hemodynamic monitoring, this uncommon but potentially fatal complication may be seen more frequently.
Abciximab↗
New hemoglobin substitutes.
Blood transfusion is an essential and ubiquitous component of medical therapy. Despite careful screening and processing, allogeneic blood still carries a small but definable risk of the transmission of severe viral disease and the induction of immunological reactions. The logistics of its storage and transport continue to present a challenge, and its dependence on human donors will always keep it a scarce resource. It is not surprising that in the latter half of the 20th century efforts to develop blood substitutes have gained increasing momentum.
Journal Article↗
ST-T alternans and myocardial ischemia.
Previous studies using intracoronary electrocardiography have demonstrated that ST-T alternans can develop during standard balloon coronary angioplasty. Total occlusion with a large amount of myocardium in jeopardy is the postulated prerequisite. In this study, the authors used perfusion balloons instead of standard balloons, so coronary perfusion was maintained and ischemia was minimized. Fourteen patients with standard balloon technique and 11 patients with perfusion balloon technique were studied. The ST segment was less elevated during perfusion angioplasty (0.15 +/- 0.05 mV vs 1.04 +/- 0.19 mV, p<0.001). There were six (43%) patients with ST-T alternans with standard balloon technique compared with none in the perfusion balloon group (p<0.001). In this study, the authors found that there was less ischemia, less ST segment elevation, and lack of ST-T alternans on the intracoronary electrocardiogram during perfusion balloon angioplasty. These findings support the postulate that a large amount of ischemic myocardium is a prerequisite for ST-T alternans.
Adult↗
Successful percutaneous balloon mitral valvuloplasty in a patient with left atrial thrombus--a case report.
Percutaneous balloon mitral valvuloplasty (PBMV) described by Inoue et al, is a safe FDA (Food and Drug Administration) approved procedure in patients with severe mitral stenosis. One of the contraindications of the procedure is presence of a left atrial thrombus; however, it has been reported that intense warfarin therapy may led to dissolution of the thrombus. The authors report a patient who was referred for PBMV and was found to have a left atrial thrombus. After intense warfarin therapy, successful PBMV was undertaken without complications.
Anticoagulants↗
Takayasu's arteritis: an unusual manifestation--a case report.
Takayasu's arteritis is a rare entity. The authors describe a case of a middle-aged woman with an atypical form of Takayasu's arteritis. This manifestation has not been described previously.
Aorta, Abdominal↗
DNA studies of limb-girdle muscular dystrophy type 2A in the Amish exclude a modifying mitochondrial gene and show no evidence for a modifying nuclear gene.
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Child↗
Pulsus alternans in diastolic left ventricular dysfunction--a case report.
Pulsus alternans is usually found in patients with reduced systolic ventricular function. We describe a patient with recurrent pulmonary edema, hypertension, bilateral renal artery stenosis, but with normal systolic function. Pulsus alternans was demonstrated in both pulmonary artery, right ventricle, and left ventricle pressures. After successful renal artery revascularization, the pulsus alternans disappeared. This case illustrates that pulsus alternans can be present with diastolic dysfunction of the left ventricle in the absence of systolic dysfunction.
Aged↗
Cardiac catheterization and selective coronary angiography with tortuous aorta and anomalous coronary artery.
The authors report a case of selective coronary angiography by use of a modified technique in a patient with tortuous iliac artery, distorted thoracic descending aorta, and anomalous left coronary artery. This approach to such anatomy can decrease the fluoroscopy time and reduce the likelihood of complications.
Aged↗
Coronary artery fistula coexisting with a ventricular septal defect due to a penetrating gunshot wound.
We describe a patient who survived a penetrating gunshot wound to the chest. Cardiac evaluation including echocardiography and cardiac catheterization revealed a coronary artery fistula and a ventricular septal defect. This combination has been rarely reported in patients with penetrating cardiac injury. Follow-up echocardiography performed 15 mo later showed persistent left-to-right shunt. This is the first case in the literature demonstrating the natural history of combined coronary artery fistula and ventricular septal defect without surgical correction.
Adult↗
Intracoronary ST-T alternans during coronary balloon angioplasty.
To evaluate the presence and clinical significance of electrical alternans during PTCA, intracoronary electrocardiography (ic-ECG) was performed in 65 consecutive lesions. ST-T alternans, defined as a beat-to-beat difference in the ST elevation > or = 1 mm, was present in five lesions (7.7%), all in the proximal left anterior descending (LAD) coronary artery. The phenomenon was seen only after 130 sec (mean 174 +/- 57) of balloon inflation. Only two of the five showed ST-T alternans simultaneously on both surface and ic-ECG. One of five patients had premature ventricular contractions following ST-T alternans. Three of these five lesions required a second balloon inflation with duration of > or = 300 sec; there was no ST-T alternans on the second inflation in any of these lesions. We conclude: (1) the detection of ST-T alternans during PTCA is enhanced by use of ic-ECG, (2) electrical alternans during PTCA was seen only in proximal LAD lesions, implicating a large amount of ischemic myocardium as a requisite for the phenomenon, (3) electrical alternans is not immediate, requiring a certain duration of balloon occlusion and hence ischemia to occur, and (4) the absence of ST-T alternans during second balloon inflations suggests ischemic preconditioning may abolish this phenomenon.
Adult↗
Combined dissection of the right coronary artery and right coronary cusp during coronary angiography.
Dissection of coronary arteries during diagnostic coronary angiography is infrequent; dissection of the coronary cusp is extremely rare. The combination of coronary artery and coronary cusp dissection has not been reported previously. A case of right coronary artery dissection and right coronary cusp dissection during diagnostic coronary angiography is described.
Coronary Angiography↗
Cardiac disease and nonorganic chest pain: factors leading to disability.
Research has shown that many chest pain patients, without coronary artery disease, may suffer from panic disorder, hypochondriasis, depression, and/or multiple phobias. Some patients with coronary artery disease may also suffer from these disorders and are often unable to return to previous activity. In spite of good prognosis for longevity and acceptable exercise test results, a large proportion of these patients continue to be disabled by chest pain and/or chronic cardiac fears and demand constant medical attention. This study examined the psychiatric and behavioral symptomatology that differentiated four groups of patients experiencing chest pain: the able (active/working patient) with and without coronary artery disease, as determined by exercise thallium-201 studies, and the disabled (inactive/nonworking patient) with and without coronary artery disease. The results of the study indicated that the inactive patients, both with and without heart disease, suffered from a host of debilitating psychiatric conditions.
Aged↗
Pseudo-alternans of left ventricular end diastolic pressure. A case report.
The authors report a case of left ventricular end diastolic pressure alternans without systolic alternans in a patient with bradycardia and tachypnea. This is an artifact due to the heart rate falling in a 2:1 ratio to the respiratory cycle. Alternation of left ventricular end diastolic pressure should be interpreted carefully in patients with bradycardia.
Artifacts↗
Multiple balloon rupture during coronary angioplasty. A case report.
The authors report a case of coronary angioplasty of the left anterior descending artery complicated by multiple balloon rupture. Various balloon types including polyethylene terephthalate and PE 600 (ACS) ruptured at low atmospheric pressure. During balloon rupture, a septal side branch was dissected with severe intimal staining. The authors postulate that a particular lesion morphology was responsible for balloon rupture. Approaches to such lesions using alternative coronary angioplasty techniques and newer technologies are discussed.
Aged↗
Anomalous origin of the right coronary artery above the left posterior sinus of Valsalva associated with a normal aortic valve. A case history.
This case report describes a right coronary artery arising from the ascending aorta, above the left posterior sinus. Unlike previously reported cases, this was associated with a normal aortic valve. The clinical significance and approach during angiography are discussed.
Adult↗