Biomedical subjects
Publications and source records attributed to A Schob.
A patient with a large saphenous vein graft aneurysm is described. This case illustrates the role of magnetic resonance imaging and cardiac catheterization in patients with a mediastinal mass and history of coronary bypass surgery.
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Coronary angioplasty of tortuous anomalous coronary arteries can be technically challenging. We describe a successful percutaneous transluminal coronary angioplasty (PTCA) of an anomalous right coronary artery after a failed previous attempt. The anatomic limitations of anomalous right coronary arteries and technical considerations for PTCA are discussed.
A patient is reported who underwent cardiac catheterization 4 years following coronary artery bypass grafting. Cardiac catheterization revealed the presence of a fistulous tract in the wall of the ascending aorta, originating at the site of aortic anastomosis of a saphenous vein bypass graft and ending in the superior aspect of the right sinus of Valsalva. This complication was felt to have resulted from a inadvertent localized dissection of the aorta during bypass surgery. The fistula was also imaged by ultrafast cine computerized tomography which proved a useful non-invasive method for follow-up examination.
Iatrogenic aortocoronary vein fistula following coronary artery bypass surgery is a rare complication. We describe the first reported case of inadvertent anastomosis of the left internal mammary artery to cardiac vein. The clinical characteristics and consequences as well as the angiographic characteristics of this fistula are described. Precautions that may be taken to prevent this complication are also addressed.
New balloon-on-a-wire dilation systems allow crossing of severely stenosed coronary arteries owing to their ultra-low profile. However, these systems do not allow for over-the-wire exchange to a larger balloon catheter or insertion of perfusion catheters, should the vessel close abruptly during dilation. Therefore, if the need for such catheters arises, the vessel must be left unprotected during attempts to recross the lesion. We describe a new technique using a combined balloon-on-a-wire system and an exchangeable guidewire, which permits the crossing and dilation of severely stenosed coronary arteries, while at the same time offering vessel protection and balloon catheter exchange.
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