Extracorporeal cardiac shock wave therapy: first experience in the everyday practice for treatment of chronic refractory angina pectoris.
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Angina Pectoris↗
Biomedical subjects
Ahmed A Khattab
Publications and source records attributed to Ahmed A Khattab.
[Coronary embolism with apical ballooning complicating electrical cardioversion--is it part of the apical ballooning syndrome? Case report and review of the literature].
CASE STUDY: A case of thromboembolic left anterior descending artery occlusion following electrical cardioversion for atrial fibrillation is described. A 66-year-old female patient presenting with exertional angina pectoris and atrial fibrillation was subjected to coronary angiography, ventriculography and transesophageal echocardiography. No significant coronary stenoses were found, left ventricular systolic function and regional wall motion were normal, and she had no intracardiac thrombi. Direct-current cardioversion was complicated by asystole which was managed by cardiac massage and 1 mg atropine and 1 mg adrenaline intravenously. Shortly afterwards, the patient regained a normal sinus rhythm. She remained hypotensive and developed ST segment elevation over the chest leads. Angiography was repeated and showed apical ballooning and thromboembolic subtotal occlusion of the proximal LAD, which migrated to the periphery and subsequently disappeared with regain of TIMI 3 flow by the end of angiography. 4 months later, a normal left ventricular global and regional function was seen in echocardiography. HYPOTHESIS: At least part of the apical ballooning syndrome patients are a sequel of transient thromboembolic occlusions. METHODS: Therefore, all patients with the diagnosis of coronary embolism in the period from September 2004 to September 2005 were analyzed retrospectively. RESULTS: Further three patients had coronary artery embolism (two females, one male; age 69-76 years). Two patients had apical ballooning, and one showed global hypokinesia (known dilated cardiomyopathy). Cardiac markers were slightly elevated. ST segment elevation was seen in two patients and T-wave inversion in one. All had risk factors for embolization and two had an additional triggering factor. Both cases with apical ballooning had regained a normal ejection fraction at follow-up. CONCLUSION: This case series probably bridges the gap between two as yet separate disease entities, namely the apical ballooning syndrome and coronary emboli. The time factor probably plays the pivotal role in determining whether the apical ballooning alone or also an embolus is seen. It seems possible that some patients presenting with apical ballooning are unrecognized coronary thromboembolic cases.
Abciximab↗
Microemboli in aortic valve replacement.
Microembolic signals (MES) can be detected in many recipients of mechanical aortic valve prostheses by transcranial Doppler ultrasound. The nature and etiology of these MES have remained unclear for a long time. The solid and gaseous nature of MES are discussed, as well as whether or not MES may reflect artifacts. Recently, the gaseous nature of these MES has been widely established. To understand the physics of bubble formation related to mechanical heart valve prostheses, it is necessary to discuss the different types of cavitation occurring at the prostheses and the conditions leading to the degassing of blood. We describe the history of transcranial Doppler ultrasound-techniques and the current techniques in the measurement of these signals. Furthermore, the possible clinical impact of MES, as well as strategies for the design of new prostheses and surgical alternatives to diminish their load are discussed.
Aortic Valve↗
Effect of adjunctive treatment with tirofiban on troponin T elevation during stenting of critically stenosed aortocoronary saphenous vein grafts.
In this pilot study, we show that periprocedural administration of tirofiban during stenting of critically stenosed saphenous vein grafts, significantly reduces the occurrence of postprocedural minor myocardial necroses.
Aged↗
Sirolimus-eluting stent treatment for complex proximal left anterior descending artery stenoses: 7-month clinical and angiographic results.
BACKGROUND: High-grade involvement of the proximal left anterior descending artery (LAD), either in isolation or as part of multivessel coronary artery disease, remains a frequent indication for surgical revascularization. This is particularly true in complex proximal LAD lesions among high-risk patients, since stenting is usually ineffective in the long term as regards freedom from angina and target vessel revascularization (TVR) in such patient subsets. The sirolimus-eluting stent (SES) has been reported to significantly reduce clinical and angiographic restenosis rates. We therefore analyzed the clinical and angiographic long-term results of a group of complex patients treated with SES for proximal LAD stenoses. METHODS: A total of 80 consecutive patients treated with sirolimus-eluting stents (SES) for complex proximal LAD stenoses were analyzed. This high-risk cohort included diabetic patients, long, bifurcated, ostial and heavily calcified lesions, chronic total occlusions and in-stent restenoses. Late lumen loss and clinically-driven target lesion revascularization (TLR) were analyzed at 7 months. RESULTS: Late lumen loss was 0.19 +/- 0.06 mm in the analysis segment (stent with 5 mm proximal and distal to it) at 7 months. TLR was performed in 6.3% of cases, and the combined rate of death from any cause, nonfatal MI and TLR was also 6.3% at 7 months. CONCLUSION: SES, once successfully implanted into complex proximal LAD stenoses, appear effective, with rather acceptable rates of adverse events at 7-month follow-up. Accordingly, treating the proximal LAD using SES in complex patients may narrow the gap between PCI and surgery for this indication.
Angioplasty, Balloon, Coronary↗
The AngioGuard: a simplified snare?
We describe a case of successful retrieval of a lost intracoronary stent using the ANGIOGUARD XP emboli retraction guidewire system (Cordis Corporation) as a safe and innovative method for management of this critical issue in an 80-year old male patient.
Aged↗