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Biomedical subjects

DR Holmes

Publications and source records attributed to DR Holmes.

10 recordsLinked to original sources
PubMed2000

Bypass Without the Surgeon: The Coronary Veins as Arterial Conduits.

More than a century ago, Pratt demonstrated that perfusion of arterial blood through the coronary veins could sustain myocardial viability during acute ischemia. Recognition that atherosclerosis spared the coronary veins and that these vessels frequently followed a parallel course to the corresponding artery provided the necessary stimulus for the development and evaluation of several methods of venous retroperfusion. Although most of these procedures have now been superseded, the coronary veins remain a tempting therapeutic target when direct arterial revascularization is not feasible. Novel percutaneous strategies using these vessels to provide definitive myocardial revascularization have been proposed and extensively tested in animals.

Journal Article↗
PubMed2000

The Coronary Venous System: An Alternate Portal to the Myocardium for Diagnostic and Therapeutic Procedures in Invasive Cardiology.

Retrograde coronary venous perfusion can preserve myocardium during experimental coronary artery occlusion and has been used clinically to deliver oxygenated blood to ischemic myocardium during unstable angina or high-risk percutaneous transluminal coronary angioplasty (PTCA). Retrograde delivery of drugs accelerates coronary thrombolysis, preserves regional myocardial function, and limits infarct size in animal models. Modifications of the coronary venous retroperfusion technique have allowed access to smaller coronary venous branches and minimization of systemic effects of local drug delivery. Retrograde coronary sinus perfusion as an adjunct in high-risk coronary PTCA is limited by its inability to provide systemic hemodynamic support during circulatory collapse. Targeted and specific gene delivery to myocardium with transfection rates superior to intraarterial or systemic injection may be a promising new application for this technique. The coronary venous system can also be used for the noninvasive creation of coronary artery bypasses or the insertion of leads for left ventricular pacing. Contrast-enhanced electron beam computed tomography (EBCT) can noninvasively provide high-resolution imaging of the coronary vessels with qualitative and quantitative information on coronary venous anatomy and coronary arteriovenous relationships and may help in selecting appropriate candidates, anticipating the degree of difficulty of the procedure, and guiding the approach. Therefore, EBCT may become the imaging modality of choice for the assessment of patients considered for such strategies.

Journal Article↗
PubMed1997

Prevention of Groin Vascular Complications Associated with Percutaneous Procedures.

Groin vascular complications are frequent problems associated with percutaneous interventions. The potential for these problems may increase as more potent antiplatelet and anticoagulant regimens are tested and become more widely used. Prevention of these complications involves consideration of several factors including 1) technical factors of arterial entry; 2) early sheath removal; 3) careful monitoring of the patient after sheath removal; and 4) measurement of activated clotting time and 5) consideration of weight adjustment of heparin in selected patients in whom adjunctive medications are given. If local bleeding occurs, prompt evaluation is required to assess the site of bleeding, the reason for bleeding, and magnitude of hemodynamic compromise. Often local vascular complications can be treated without need for other invasiveive procedures. Prevention of vascular complications is essential to optimize the outcome of interventional cardiology care.

Journal Article↗