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Biomedical subjects

G W Vetrovec

Publications and source records attributed to G W Vetrovec.

At least 55 records · Page 3Linked to original sources
PubMed1992

Intracoronary urokinase as an adjunct to percutaneous transluminal coronary angioplasty in patients with complex coronary narrowings or angioplasty-induced complications.

The effectiveness of intracoronary urokinase infusion as an adjunct to percutaneous transluminal coronary angioplasty (PTCA) was studied in 50 patients who underwent angioplasty for complex coronary narrowings or had thromboembolic complications during PTCA (29 [58%] men, 3 [6%] stable and 37 [74%] unstable angina, and 16 [32%] prior coronary bypass surgery). The primary indications for intracoronary urokinase infusion were intracoronary thrombus in 27 patients (54%), distal coronary embolization in 9 (18%), and abrupt reclosure in 14 (28%). Urokinase was infused in a mean (+/- standard deviation) dosage of 399,000 +/- 194,000 IU (range 150,000 to 1,000,000) at an average rate of 5,000 to 20,000 IU/min. Angiographic success was achieved in 43 patients (86%). Complications included the need for urgent bypass surgery in 3 patients, Q-wave myocardial infarction in 2, and non-Q-wave myocardial infarction in 12 (8 of whom had peak creatine kinase less than twice the upper normal limit). The incidence of myocardial infarction was significantly higher in patients with vein grafts (69%) than in those with PTCA of native vessels (14%). Two patients died (1 massive gastrointestinal necrosis 24 hours after angioplasty, and 1 after urgent bypass surgery). Mean (+/- standard deviation) fibrinogen levels were 355 +/- 73 mg/dl before urokinase infusion, and 361 +/- 70, twelve hours afterward. Three patients had local bleeding, but no transfusions were needed. It is concluded that intracoronary urokinase is a safe and effective adjunct to PTCA in patients with associated thrombi and may improve the success rate in angioplasty complicated by thrombus formation.

Aged↗
PubMed1992

Angioplasty of a totally occluded right coronary artery.

We have presented a case of angioplasty of a chronically occluded right coronary artery. The occlusion had been present for 6 wks by clinical estimates. The length of the occluded segment (approximately 55 cm) did not preclude a successful outcome. Proper selection and manipulation of angioplasty equipment are, as in every case, critical for procedural success. Subintimal guidewire passage, though a frequent event, is occasionally associated with ischemic manifestations, and mandates detection and proper management. New approaches to PTCA of total coronary occlusions continue to be developed.

Angina Pectoris↗
PubMed1992

Subclavian balloon angioplasty in the management of the coronary-subclavian steal syndrome.

The syndrome of coronary-subclavian steal presenting with angina pectoris after coronary revascularization with the mammary arteries is not common. This disorder should be suspected in post LIMA patients with blood pressure differences between the arms and confirmed by angiography. PTA of the subclavian artery via the brachial approach, in appropriately selected patients, offers potential advantages over carotid subclavian bypass including an apparent lower complication rate with equally good results. Recurrences, which are apt to be more common after PTA versus carotid subclavian bypass, are easily managed with repeat dilatation. This course of management in our patient resulted in an excellent clinical outcome without complication. This report emphasizes the importance of considering subclavian stenosis in patients with prior LIMA bypass grafting, particularly when the ipsilateral arm blood pressure is reduced. In such cases, subclavian PTA offers a reasonable nonsurgical approach for correction.

Aged↗
PubMed1992

A technique to access severely diseased arteries.

Cardiac catheterization performed in patients with severe peripheral vascular disease may represent a difficult technical challenge and is associated with a higher incidence of vascular complications. We describe a technique that uses angioplasty equipment to access severely diseased arteries. This technique allows a percutaneous transluminal coronary angioplasty (PTCA) guide wire to be steered across vascular lesions under direct visualization of the lumen and continuous pressure monitoring, potentially reducing the risk of vascular complications.

Aged↗
PubMed1992

Guidelines for the performance of outpatient catheterization and angiographic procedures.

Cardiac catheterization and angiography is a safe procedure performed on patients with suspected or potentially serious cardiovascular disorders. Complications of the procedure are related both to heart disease itself and to elements of the procedure. For a variety of social and financial reasons, the performance of cardiac catheterization and coronary angiography on an outpatient basis has increased recently. The purpose of this paper is to state the guidelines of The Society for Cardiac Angiography and Interventions regarding the performance of outpatient catheterization in a hospital setting.

Ambulatory Care↗
PubMed1992

Coronary aneurysms: a case report and review.

This case report describes a large coronary aneurysm and poses questions regarding management. The discussion that follows addresses what is known about the natural history of and options for management of coronary aneurysms.

Aged↗
PubMed1992

Coronary perforation during angioplasty: angiographic detection and demonstration of complete healing.

A patient is presented with localized perforation of the left anterior descending artery secondary to angioplasty balloon rupture. Despite a remarkable angiographic picture of coronary tear and dye extravasation into the surrounding pericardial tissue, the patient remained hemodynamically stable, and was medically treated. Five years later she redeveloped angina, and repeated coronary arteriography revealed complete healing of the perforation site. This case attests to the remarkable ability of the coronary artery to completely heal from a major wall trauma. Although a rare complication of coronary angioplasty, perforation can occur, and various management aspects should be considered.

Aged↗
PubMed1992

Radiation-induced coronary artery disease.

Excessive unprotected radiation to the heart appears to lead to the development of CAD, even in the absence of significant cardiovascular risk factors. The coexistence of such factors may enhance the probability of CAD. The presence of hypercholesterolemia and concomitant or sequential use of chemotherapeutic agents (especially doxorubicin) could further increase this risk. Therapeutic decisions, as with any other manifestation of CAD, relate to the extent of myocardium at jeopardy and to the overall diffuseness of CAD. Management options possible are PTCA or coronary artery bypass surgery. The latter may be required in left main artery stenosis and complicated ostial lesions. Use of shielding should decrease the associated risk of radiation-induced CAD in future years. However, clinicians should continue to have a high degree of suspicion of CAD in patients treated with thoracic radiation without cardiac shielding.

Adult↗
PubMed1992

Long-term efficacy of triple-vessel angioplasty in patients with severe three-vessel coronary artery disease.

Between May 1982 and December 1988, a total of 103 patients underwent angioplasty of all three major coronary arteries at a single institution. Angiographic success was achieved in 334 of 352 vessels (95%) and in 441 of 460 lesions (96%). No patients required urgent bypass surgery, and none died during the procedure; six had non-Q wave infarctions. The mean length of follow-up time was 49 +/- 15 months (range 28 to 107 months). There have been 11 deaths, and one patient has undergone cardiac transplantation. Thirty-six patients had a clinical recurrence; 30 had repeat angioplasty and five had bypass surgery. Another nine patients eventually had bypass surgery after the clinical recurrence. At 48 months actuarial event-free rates are myocardial infarction, 98%; bypass surgery, 88%; and death, 89%. Of 86 current survivors, 58 are in functional class O to I, 21 are in class II, and seven are in class III.

Adult↗
PubMed1991

Comparison of angiographic findings and demographic variables in patients with coronary artery disease presenting with acute pulmonary edema versus those presenting with chest pain.

One hundred nineteen patients admitted to the coronary care unit with pulmonary edema were retrospectively reviewed to identify the demographic characteristics and underlying cardiac disorders of this population. The patients with pulmonary edema were compared with 119 patients admitted to the coronary care unit with chest pain. Cardiac catheterization in 71 patients with pulmonary edema and 93 with chest pain showed left main and 3-vessel coronary artery diseases to be equally common in both groups, although anginal pain was infrequent in patients with pulmonary edema (n = 28, 24%). Left ventricular function was reduced in the patients with pulmonary edema compared with those with chest pain (mean ejection fraction 42 vs 59%; p less than 0.001). More patients with pulmonary edema were black, and had diabetes and preexisting hypertension than those with chest pain. The results of cardiac catheterization were the same for black and white patients with pulmonary edema. In conclusion, patients with pulmonary edema have a high incidence of cardiac disease, and pulmonary edema may be 1 manifestation of silent myocardial ischemia. Important demographic differences exist between patients admitted with pulmonary edema and those who present with chest pain.

Adult↗
PubMed1991

Application of coronary angioplasty to the septal perforator arteries.

Significant coronary artery disease affecting the septal perforator arteries can cause anginal pain, rhythm disturbances, or septal infarction. However, since these vessels are usually inaccessible to coronary bypass surgery, there is a tendency among angiographers and angioplasters to overlook lesions of the septal perforator arteries. Our experience suggests that if medical treatment is not sufficient to treat clinical manifestations resulting from septal perforator disease, then coronary angioplasty can be considered a therapeutic alternative for revascularization. We herein present 11 patients who underwent coronary angioplasty of a major septal artery and discuss angiographic and technical aspects of the procedure.

Angina, Unstable↗
PubMed1991

Cardiac catheterization 1990: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I).

This report presents the first year's experience of a totally computerized cardiac catheterization laboratory reporting system, including the results and complications of invasive and interventional procedures. Sixty-three laboratories reported a total of 71,916 patients studied between January 1 through December 31, 1990. Two previous registry reports have been published. Compared with data acquired by previous methods, in spite of an older and sicker population, the mortality for diagnostic procedures has remained remarkably constant (0.11%). The computerized format facilitates data collection and analysis, helps resolve new issues as they arise and serves as a method of monitoring quality of laboratories and individuals.

Adult↗
PubMed1991

Late complications involving the ascending aorta after cardiac surgery: recognition and management.

Pseudoaneurysms and dissecting aneurysms of the ascending aorta after cardiac surgery are uncommon but important complications. Pseudoaneurysms, which result from extravasation of blood into the mediastinum, most commonly occur at the site of aortotomy or aortic cannulation. Infection may play an important role. Dissecting aneurysms after cardiac surgery usually occur at the site of aortic incision or cross clamping, especially in atherosclerotic aortas. Both conditions may be clinically silent but more frequently are seen with significant symptoms. Noninvasive techniques including CT scan, MRI, and echocardiography are very useful in the diagnosis of both complications, with contrast aortography remaining the definitive method. Surgical repair is necessary for dissecting aneurysms and for enlarging and symptomatic pseudoaneurysms, with improving morbidity and mortality.

Aged↗
PubMed1991

Coronary collateral recruitment: functional significance and relation to rate of vessel closure.

Studies in animals and humans have demonstrated the anatomic presence and functional significance of coronary collaterals. The extent of collateralization varies among species and among individuals. Collateral vessels are usually adequate for preserving resting regional and global ventricular function in the face of coronary obstruction. During stress, however, collateral supply may be inadequate. Collateral development is a time-dependent process during both the initial occlusion and following transient reflow and reclosure. Therefore when a previously collateralized coronary occlusion is recanalized and then recloses, the extent of the resulting collateral recruitment will depend, at least in part, upon the period of reflow between the two occlusions. The longer the reflow period, the less enhanced will be the collateralization. This is illustrated in the cases presented and has also been demonstrated in animal studies. The exact mechanisms for this recurrent collateral recruitment need further study.

Adult↗