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G W Vetrovec

Publications and source records attributed to G W Vetrovec.

123 records · Page 7Linked to original sources
PubMed1984

Aneurysms of the left main coronary artery: a report of three cases and review of the literature.

Coronary artery aneurysms have been reported to occur in 1-2% of most large angiographic series. However, aneurysms of the left main coronary artery (LMCA) are extremely rare. Only eight previous cases of LMCA aneurysms have been reported, and only one of these cases was felt to be atherosclerotic in etiology. The clinical findings in three hypertensive females with LMCA aneurysm diagnosed at angiography are presented, along with a review of the literature.

Aged↗
PubMed1984

Modification of cradle angiographic tables to more easily obtain axial coronary views.

With greater utilization of angled coronary views for better elucidation of coronary anatomy, many laboratories are still limited by the rotating cradle systems which make angulation for these views somewhat difficult. The following report describes a simple, inexpensive way to modify existing cradle structures to accommodate easy cranial angulation.

Angiography↗
PubMed1984

Effect of cimetidine on quinidine clearance.

Cimetidine has been reported to inhibit the hepatic metabolism of numerous drugs. Theoretically cimetidine could inhibit the metabolism of quinidine. This study was undertaken to determine the effect of cimetidine on quinidine plasma concentrations. Nine healthy volunteers were entered into the matched-pairs study. Baseline quinidine pharmacokinetic parameters were determined after a single oral 400-mg dose. Study parameters were determined after 3 days of cimetidine 300 mg p.o. q.i.d., when 400 mg quinidine was again administered. Cimetidine increased the area under the time-concentration curve (14.5%, p less than 0.01), decreased the total body clearance (24.9%, p less than 0.05), and prolonged the half-life (22.6%, p less than 0.05) of quinidine in this study. There was no change in peak quinidine concentrations or time to peak. These data document an interaction between cimetidine and quinidine. The clinical importance of this interaction should be greatest in patients with impaired liver function, patients with preexisting near-toxic plasma concentrations of quinidine, and the elderly. Patients placed on cimetidine and quinidine should be monitored closely for signs and symptoms of quinidine toxicity.

Adult↗
PubMed1983

Fibrinolytic effects of intracoronary streptokinase administration in patients with acute myocardial infarction and coronary insufficiency.

Serial coagulation studies were obtained in 25 patients treated with intracoronary streptokinase infusion for myocardial infarction (23 patients) or coronary insufficiency (two patients) to determine the frequency of systemic fibrinolytic activity. Clotting studies were obtained before and after infusion and at 4-hour intervals until normalization. Intracoronary thrombolysis was successful in 20 of 23 patients (87%) with myocardial infarction. Streptokinase dosage in this study was 201,000 +/- 74,000 IU (+/- SD). Systemic fibrinolytic activity, defined as greater than 70% reduction of fibrinogen using a functional assay (Claus method), occurred in 22 of 25 patients (88%) and was present at a mean streptokinase dosage of 119,000 +/- 52,000 IU. Fibrinogen in the total population decreased from 342 +/- 80 to 87 +/- 94 mg% (p less than 0.0001). In patients with systemic effect, the mean fibrinogen level after infusion was 17% of baseline, increased to 43% at 24 hours, and returned to normal at 30 hours. Plasminogen decreased to 7% of baseline activity after infusion (p less than 0.0001), was 44% of baseline at 24 hours, and returned to normal at 48 hours. Intraprocedural sampling during infusion showed reduction of fibrinogen by 25% after 30,000 IU (p less than 0.0005) and by 71% at 120,000 IU (p less than 0.0001); plasminogen decreased by 50% after 30,000 IU (p less than 0.0001) and by 84% at 120,000 IU (p less than 0.0001). Prothrombin time increased from 11.5 +/- 0.8 seconds to 22.0 +/- 7.8 seconds after infusion (p less than 0.0001) and returned to normal at a mean of 18 +/- 11 hours after infusion. Partial thromboplastin time was markedly prolonged (greater than 100 seconds) after infusion, returned to less than or equal to 2 times control at 5 +/- 2 hours, and returned to normal at 9 +/- 4 hours after infusion. Fibrinogen degradation products were less than 10 micrograms/ml before infusion, increased to greater than 40 micrograms/ml after infusion, and remained greater than 40 micrograms/ml in 40% of patients at 24 hours after infusion. These data indicate that systemic fibrinolytic activity occurs in a high percentage of patients with "low-dose" intracoronary streptokinase infusion and that coagulation variables may be altered for 24-48 hours after infusion.

Adult↗
PubMed1982

Intracoronary thrombolysis in syndromes of unstable ischemia: angiographic and clinical results.

For an assessment of association of intracoronary thrombus with prolonged unstable myocardial ischemia and of the possible efficacy of local thrombolysis, 12 patients with recent prolonged unstable angina underwent 13 intracoronary streptokinase infusions. All patients had prolonged rest angina within 5 days of coronary angiography. Abnormal resting ECGs were present in all patients, and 10 had ECG changes referable to the ischemic-related vessel. There were seven native coronary and six bypass graft infusions with a mean streptokinase dose of 187,00 +/- 22,000 IU (standard error of mean). Angiographic findings consistent with intracoronary thrombus were identified in 11 of 13 ischemia-related vessels. Evidence of partial or complete intracoronary thrombolysis was noted angiographically in 10 of 13 ischemia-related vessels (77%), although reestablishment of anterograde flow was seen in only two of six totally or subtotally occluded vessels. Nine patients experienced rest angina during the 48 hours prior to infusion, whereas only three experienced angina during the 48 hours following infusion. In conclusion, angiographic findings before and after thrombolysis in this preliminary study demonstrate a high frequency of intracoronary thrombus in preinfarction syndromes. Furthermore, these limited observations suggest a decrease in angina frequency following thrombolytic therapy.

Adult↗
PubMed1981

Efficacy of percutaneous transluminal coronary angioplasty: technique, patient selection, salutary results, limitations and complications.

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 25 patients and 29 vessels during a 12-month period. In six additional patients scheduled for PTCA, the procedure was cancelled when repeat angiography identified progression to occlusion, coronary spasm, or other adverse factors not previously apparent. PTCA was successful in 14 of 25 patients (56%) and in 18 or 29 vessels (62%); success was associated with clinical improvement in all patients by symptomatology, exercise testing and/or myocardial radionuclide imaging. Beneficial results were particularly achieved with left anterior descending artery lesions and with stenoses showing less than 90% narrowing. One peripheral arterial complication occurred and no patients required emergency surgery. While coronary dissection was detected angiographically in four patients and evidence of coronary spasm was present in three patients post-PTCA, neither was accompanied by untoward early clinical events. Multivessel dilatation in three patients was initially successful but symptoms returned in two during follow-up. Restenosis developed in 3 of 14 patients (21%) after 3 months. Our experience indicates (1) that the specific vessel attempted and lesion severity particularly influence the liklihood of success, (2) the not infrequently induced coronary dissection or spasm does not necessarily represent a serious complication, and (3) angiography repeated in preparation for PTCA identifies a significant minority of patients rwho are no longer candidates.

Adult↗
PubMed1981

Effects of intracoronary streptokinase in acute myocardial infarction.

Intracoronary streptokinase (SK) was administered to 11 patients with evolving acute transmural myocardial infarction 5.5 +/- 0.4 hours from the onset of symptoms. Ten patients (91%) had total coronary occlusion, and one had subocclusion of the vessel corresponding to the ECG site of infarction. Intracoronary nitroglycerin failed to restore patency of total occlusion in all patients. In 9 of 11 patients (82%), patency was restored or improved with intracoronary SK. Thrombolysis was successful in 8 of 11 patients (73%), and one patient with transient patency developed acute reocclusion. Average time from SK infusion to reperfusion was 24 +/- 7 minutes. Patients with successful thrombolysis had patency initially restored at a dosage of 61,000 +/- 15,000 IU of SK and received a total dosage of 136,000 +/- 17,000 IU. Patency persisted at late study in six of eight patients, and two patients developed late reocclusion. Successful thrombolysis was associated with significant improvement in left ventricular ejection fraction (LVEF) from early to late study, in contrast to deterioration of LVEF in patients with unsuccessful recanalization (p less than 0.001). Systemic fibrinolytic activity occurred in 8 of 11 patients at a mean dosage of 125,000 +/- 15,000 IU of SK and was unassociated with significant bleeding. Significant decrease in hemoglobin concentration in the early hospital phase occurred in patients receiving SK but did not differ from decreases occurring in a matched control population receiving conventional therapy for infarction. Thus intracoronary thrombolysis with SK was successful in the majority of patients during the early phase of evolving transmural infarction, and successful thrombolysis was associated with significant improvement in LVEF. Systemic fibrinolysis occurs in most patients despite small total doses of SK, and the significant decrease in hemoglobin in these patients may be unrelated to SK, since similar changes occurred in a control population receiving conventional therapy.

Cardiac Catheterization↗
PubMed1981

Intracoronary thrombus in syndromes of unstable myocardial ischemia.

The association of coronary thrombosis and transmural myocardial infarction is well documented. We have recently observed apparent intracoronary thrombi in patients with unstable myocardial ischemia without transmural infarction. To assess the frequency and angiographic characteristics of intracoronary defects consistent with thrombi, we reviewed the angiograms of all patients undergoing catheterization within 1 month of the onset of unstable angina or the intermediate coronary syndrome. Of 129 such patients, eight (6.2%) had nonoccluding, hazy, or nonopacified intracoronary filling defects consistent with thrombus in angiographically well-opacified vessels. All defects were just distal to a significant (80% to 99%) coronary stenosis. In each instance the thrombus-involved vessel supplied a myocardial segment referable to the electrocardiographically defined area of ischemia. Support for the theory that the intracoronary defects were thrombi includes three patients with enlargement of the filling defects, who underwent repeat angiography within 7 days, and two patients with embolization of defect fragments. Furthermore these defects were angiographically similar to poststenotic intraluminal defects seen transiently in some patients after partial intracoronary streptokinase recanalization. In conclusion, we have observed, angiographically, intracoronary filling defects consistent with thrombus in some patients with unstable myocardial ischemia.

Adult↗
PubMedDate not supplied

Diffuse coronary artery to left ventricular communications: an unusual cause of demonstrable ischemia.

Diffuse communications between both the left and right coronary arteries and the left ventricle were found in a 46-year-old man presenting with typical angina pectoris. Symptoms were reproducible on treadmill exercise and ST segment depression, and redistribution septal defects were documented on stress Thallium scintigraphy. Antianginal drugs were effective in treating the patient's symptoms. Only 13 patients with similar anatomy have been previously described. This report is the first to document reproducible objective evidence of ischemia in such patients. The literature is reviewed and possible mechanisms of ischemia and its treatment discussed.

Cardiac Catheterization↗
PubMedDate not supplied

The usefulness of the lateral projection in the assessment of the right coronary artery during percutaneous transluminal coronary angioplasty.

Optimum coronary angiographic definition of lesion morphology and side branch orientation is important during percutaneous transluminal coronary angioplasty (PTCA) to enhance the ease and safety of guidewire passage. This study was performed to compare the efficacy of the lateral (LAT) projection to conventional angiographic views for right coronary artery (RCA) evaluation pre- and post-PTCA. In 45 consecutive patients undergoing PTCA of 56 RCA lesions, the LAT was available to evaluate 40 lesions pre- and 44 lesions post-PTCA. Angiographic comparison of the LAT versus standard LAO, LAO cranial, and RAO views were performed by two experienced angiographers with consensus reading. The LAT was the best projection for assessing lesion morphology pre-PTCA in 19/40 (48%) and in 19/44 (43%) post-PTCA, while the LAT was significantly better (P less than or equal to 0.01) than standard views for assessing side branch orientation (48/56, 86%) and post-PTCA intimal disruption (18/33, 55%). In addition, LAT was the best view for assessing mid RCA lesions 13/21 (62%) pre-PTCA and 12/27 (44%) post-PTCA, while post-PTCA intimal disruption was best detected by LAT in 14/24 (58%). Lesions only recognized in the LAT view occurred in five instances, four involving right ventricular branch ostia and one involving the proximal posterior descending. Thus, the LAT projection appears helpful during PTCA to assess lesion morphology, eccentricity, side branch orientation, and intimal disruption pre- and post-PTCA as an adjunct to conventional views.

Angioplasty, Balloon↗
PubMedDate not supplied

Infected subfural hematoma: three case reports involving gram-negative organisms.

Three case reports of infected subdural hematoma are presented, two with Salmonellae and one with Escherichia. Infection of such hematomas most often occurs during bacteremia, and the area of infection is limited by the existing hematoma membrane. Clincally, fever, headache, nuchal rigidity, and focal neurological signs, especially in a patient with previous head trauma, suggest subdural infection. Treatment consists of drainage and systemic antibiotics. These case reports demonstrate the clinical features of this rarely reported entity, and especially illustrate the need for careful bacteriologic identification in suspected cases.

Adult↗