PubMed Health⌕ Search

Biomedical subjects

J C Missri

Publications and source records attributed to J C Missri.

17 recordsLinked to original sources
PubMed1999

Inadvertent stenting of left main coronary artery complicated by later in-stent restenosis.

Stenting of both the protected and unprotected left main coronary artery has been described. This case presents a patient who had inadvertent left main stent deployment. A 47-year-old female presented with a non-Q-wave infarction and subsequent angina leading to angiography and angioplasty of her proximal ramus intermedius artery. Recurrent angina and ECG changes necessitated repeat coronary angiography and angioplasty on the same day with Wiktor stent deployment to treat a resultant dissection. Poststent deployment pictures revealed that the stent had been partially deployed in the left main coronary artery. Additional balloon dilatations were performed at the ostia of the left anterior descending and circumflex arteries through the stent. Three months later the patient presented with progressive angina and was discovered to have severe distal left main stenosis. In a case such as this, stent removal may be preferable to leaving an unnecessary stent within the left main coronary artery. Cathet. Cardiovasc. Intervent. 48:194-197, 1999.

Aortic Dissection↗
PubMed1999

Cardiocutaneous fistula.

Infection of the Teflon pledgets on the heart suture line after left ventricular aneurysm repair, presenting late with a fistulous tract connecting the heart with the skin (cardiocutaneous fistula) is an uncommon but potentially serious condition. The case is reported of a 73 year old man who developed a cardiocutaneous fistula extending through the left hemidiaphragm and draining at the abdominal wall, which developed six years after left ventricular aneurysmectomy. Following radiographic evaluation, which established the diagnosis, the Teflon pledgets and fistulous tract were successfully surgically removed. Prompt diagnosis depends on a high index of suspicion. Eradication of infection requires excision of infected material, which must be planned on an individual basis.

Aged↗
PubMed1997

Successful coronary stenting without warfarin or intravascular ultrasound.

Although warfarin is typically recommended in the management of patients following coronary stent implantation, several studies have suggested a reduced incidence of subacute thrombosis if the antiplatelet drug ticlopidine is employed instead. Postdilatation with a high pressure balloon catheter is now commonly performed following stent deployment. However, there is uncertainty whether intravascular ultrasound is important in assessing adequacy of stent expansion. Some investigators have proposed a set of ultrasound criteria that need to be met in order to achieve optimal stent deployment. Others have reported low rates of subacute stent thrombosis using empiric high pressure postdilatation rather than an ultrasound-guided strategy. We retrospectively studied 100 consecutive patients in a single institution who received coronary stents for a variety of indications. No patient received warfarin or intravascular ultrasound, and all were followed for a minimum of six weeks. Subacute stent thrombosis did not occur in any patient. We conclude that an excellent result can be routinely obtained in stented patients without the use of intravascular ultrasound.

Angioplasty, Balloon, Coronary↗
PubMed1996

Pseudoaneurysm causing partial obliteration of the left atrium: case report and review.

We describe a case of left ventricular pseudoaneurysm with subepicardial dissection onto the left atrial wall, mimicking a smooth left atrial mass, causing partial obliteration of the left atrial cavity. This patient presented with a transient ischemic attack, most likely resulting from a thromboembolic episode to the brain. Emergent surgery was successfully performed and the patient is doing well at 1-year follow-up, with no signs of left atrial compression by transthoracic echocardiography.

Aged↗
PubMed1996

Coronary stenting for aortocoronary dissection following balloon angioplasty.

We report a case of coronary dissection following percutaneous transluminal coronary angioplasty (PTCA) in which the dissection extended antegrade as well as retrograde into the aortic root. Emergent stenting was able to seal the dissection entry point, resulting in restoration of normal coronary flow and diminution in the degree of aortic dissection.

Aortic Dissection↗
PubMed1994

Activated clotting-time variability in patients undergoing coronary angioplasty.

Although the activated clotting time (ACT) is commonly used to assess adequacy of anticoagulation during percutaneous transluminal coronary angioplasty (PTCA), there is uncertainty whether measurements on samples from the arterial and venous circulations are directly comparable. We performed ACT determinations on 115 patients undergoing PTCA at our institution. Blood samples were drawn in a sequential fashion from the arterial and femoral venous sheaths at the conclusion of each case, and ACT determination were performed in the catheterization laboratory immediately thereafter. The venous ACT exceeded the arterial value in 63 patients (55%), and was identical in only 2 instances. The arterial and venous ACT differed by more than 100 s in 10 patients. In 23 patients (20%) one ACT determination was > or = 300 s, while the value from the other circulation was < 300 s. We conclude that there is substantial variability between arterial and venous ACT determinations in heparinized patients undergoing PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1984

Non-invasive predictors of short and long-term survival in dilated cardiomyopathy.

Dilated cardiomyopathy (DCM) carries a poor prognosis. This study examined the non-invasive parameters that may be predictive of survival in two groups of patients, short-term survivors who died within one year of onset of symptoms (Group I, 6 patients) and long-term survivors who survived greater than one year of presentation (Group II, 16 patients). The M-mode echocardiogram (E), resting radionuclide ventricular function study (RNA) and electrocardiogram (ECG) were reviewed for factors that would differentiate between Group I and II. The E mean ventricular wall thickness in Group I was 0.6 cm and Group II 0.9 cm (p less than 0.05), a hypertrophy-dilation index (mean thickness/LVDd) was 0.09 for Group I and 0.12 for Group II (p less than 0.05). There was no significant difference between Groups I and II in LVDd by E, RNA, LV ejection fraction, ECG (LVH, ventricular ectopy, conduction abnormalities). Thus, the finding of a mean ventricular wall thickness of 0.9 cm and a hypertrophy-dilation index of greater than 0.10 by E was predictive of survival longer than one year. The ECG and RNA LV ejection fraction did not predict outcome.

Adult↗
PubMed1984

A new therapeutic approach in fibrinolytic therapy: intracoronary streptokinase.

Although it is certain that thrombolytic therapy is effective in achieving reperfusion in an acutely thrombosed coronary artery, the ability of such restoration of flow to preserve myocardial function must be demonstrated. It must also be determined if the gains in contractile function are of sufficient magnitude to reduce morbidity and deaths after infarction. The patient population that can potentially benefit from this procedure is largely unknown. However, it is certain that the institution of thrombolytic therapy must begin in the early hours of acute infarction. The vast majority of patients with MI are cared for in hospitals that do not perform cardiac catheterizations. Thus the question of efficacy of intravenous fibrinolytic therapy is very important. Randomized clinical trials are already in progress and answers to important questions are forthcoming.

Coronary Angiography↗
PubMedDate not supplied

Doppler echocardiography in the evaluation of valvular heart disease.

Doppler echocardiography is a relatively new non-invasive technique which provides direct hemodynamic data that is complementary to M-Mode and 2-Dimensional echocardiography. This technique allows measurement of peak flow velocity through a stenotic valve and allows accurate prediction of the pressure gradient across the valve. It is a promising technique for screening patients with suspected pulmonic and aortic stenosis. It allows quantitation of gradient and valve area in patients with mitral stenosis. Doppler techniques are also valuable in detecting and semi-quantitating valvular regurgitation. Pulsed Doppler echocardiography is accurate in evaluating patients with multi-valvular disease. Finally, Doppler techniques are finding an important role in the evaluation of suspected prosthetic valve malfunction. In summary, Doppler echocardiography offers a complementary approach for direct evaluation of intracardiac hemodynamics in patients with valvular heart disease.

Aortic Valve Insufficiency↗