PubMed Health⌕ Search

Biomedical subjects

J Heibig

Publications and source records attributed to J Heibig.

At least 19 recordsLinked to original sources
PubMed1995

Rotational ablation of discrete lesions in the coronary arteries is safe. A nonrandomized comparison with percutaneous transluminal coronary angioplasty.

Rotational ablation is receiving increasing attention as a new therapeutic intervention for coronary artery disease. In a nonrandomized study, we compared echocardiographic regional wall-motion scores of patients treated with rotational ablation with those of patients treated with percutaneous transluminal coronary angioplasty. We found that rotational ablation achieved angiographic results comparable to those of percutaneous transluminal coronary angioplasty, and was in fact associated with less myocardial ischemia. The reduction in ischemia observed in the ablation group might arise from shorter treatment times in those patients, from the use of nitroglycerin infusion in the ablation group, or from both factors.

Angioplasty, Balloon, Coronary↗
PubMed1994

Transvalvular left ventricular assistance in cardiogenic shock secondary to acute myocardial infarction. Evidence for recovery from near fatal myocardial stunning.

OBJECTIVES: The purpose of this study was to test the hypothesis that transvalvular left ventricular assistance would support the circulation in patients with cardiogenic shock secondary to acute myocardial infarction and allow recovery of function in patients with a reversibly damaged (stunned) left ventricle. BACKGROUND: Cardiogenic shock occurs in 7.5% of patients presenting with acute myocardial infarction, resulting in survival of only 20%. Despite the use of aggressive interventional therapy in patients with shock secondary to anterior myocardial infarction, survival remains as low as 33%. METHODS: We studied 11 patients with acute myocardial infarction and cardiogenic shock, as defined by a cardiac index < 2 liters/min per m2, pulmonary capillary wedge pressure > 18 mm Hg and systolic blood pressure < 90 mm Hg during positive inotropic therapy. Patients were 57 +/- 13 years old (mean +/- SD) and had a mean left ventricular ejection fraction of 25 +/- 11%, mean arterial pressure of 69 +/- 13 mm Hg and mean cardiac index of 1.6 +/- 0.4 liters/min per m2 on admission to the study. RESULTS: During the 1st 24 h of left ventricular assistance, pulmonary capillary wedge pressure decreased from 26 +/- 4 to 16 +/- 4 mm Hg (p = 0.01), cardiac index increased from 1.6 +/- 0.4 to 2.4 +/- 0.4 liters/min per m2, and the dopamine hydrochloride dose decreased from 51 +/- 92 to 18 +/- 12 micrograms/kg body weight per min. In survivors, cardiac index improved to 3.2 +/- 0.5 liters/min per m2 (p = 0.01), and left ventricular ejection fraction improved to 34 +/- 5% (p < 0.05). The overall survival in the study group was 4 (36%) of 11 patients (95% confidence interval [CI] 8% to 65%), and 4 (66%) of 6 patients (95% CI 29% to 100%) with a Q wave anterior myocardial infarction survived. CONCLUSIONS: Transvalvular left ventricular support during cardiogenic shock complicating acute myocardial infarction is feasible and results in significant hemodynamic and functional improvement.

Female↗
PubMed1993

Coronary artery flow monitoring following coronary interventions.

Technologic innovations have made it possible to measure coronary artery blood flow in awake patients. Both flow velocity as well as flow reserve can be assessed. In particular, the period of time immediately following coronary interventions offers a unique opportunity to study important features of coronary flow behavior. In 22 patients, coronary flow reserve was measured before and after an intervention, either angioplasty or atherectomy, using a 0.018-in Doppler guidewire (Flowire). The minimum lumen diameter (MLD) was increased from 1.0 +/- 0.4 to 1.7 +/- 0.4 mm, while coronary flow velocity increased significantly, rising from 29 +/- 13 to 39 +/- 14 cm/sec (p < 0.025). The maximum hyperemic velocity also increased, from 44 +/- 16 to 69 +/- 21 cm/sec. Using only the preintervention or postintervention values, the flow reserve ratio was 1.53 +/- 0.4 prior to intervention and 1.84 +/- 0.5 after intervention (p = nonsignificant). However, the post-intervention value may have been artifactually reduced by the fact that both resting as well as hyperemic velocities increased. When the post-intervention flow reserve ratio was recalculated, using the preintervention resting value, flow reserve ratio was seen in increase from 1.53 +/- 0.4 to 2.73 +/- 1.2 (p < 0.001). Measurements of coronary flow in the postintervention period also revealed several interesting phenomena. Spasm of a coronary artery was documented, and its resolution in response to intracoronary nitroglycerin was observed. Elastic recoil following angioplasty was documented by gradual decline in coronary flow over 30 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1993

Percutaneous transluminal balloon aortic and mitral valvuloplasty in 27 patients treated at Hermann Hospital.

Percutaneous aortic and mitral valvuloplasty are recognized as alternative interventions in cases of severe symptomatic aortic and mitral stenosis. We described the acute hemodynamic results, immediate clinical outcomes, and complications in 27 patients treated consecutively at Hermann Hospital with either percutaneous balloon aortic or mitral valvuloplasty. We review the possible mechanisms of action of balloon valvulotomy and the current indications for either procedure. Balloon aortic valvuloplasty is indicated in elderly patients with severe aortic stenosis in whom open-heart surgery is contraindicated or carries excessive mortality. All patients with symptomatic mitral stenosis are potential candidates for balloon mitral valvulotomy. In centers with an experienced interventional team in transseptal catheterization and an active surgical program, balloon valvulotomy is the initial procedure of choice for significant mitral stenosis with mobile leaflets and minimal chordal thickening.

Adolescent↗
PubMed1992

Rotational ablation of coronary artery lesions using single, large burrs.

Previous clinical use of the Rotablator in coronary artery disease has involved a sequential increase in burr sizes up to 2 mm in diameter and has often utilized balloon adjunct to achieve an optimal result. We report our experience and describe our technique using a single, large burr (2.25, 2.5, or 2.75 mm diameter) without balloon assistance. The burr size was selected to approximate 70-90 percent of the apparent normal lumen diameter. Thirty-one patients with 36 lesions of complex morphology (eccentric, irregular, calcified, ulcerated, at bends, at bifurcations, completely occluded, as well as balloon failures) were successfully treated with the Rotablator. Results were assessed by computerized quantitative angiography. The percent diameter stenosis (mean +/- SD) for the group was reduced from 69.8 +/- 11.3% to 30.9 +/- 10% (p less than 0.001). The mean absolute diameter stenosis increased from 0.9 +/- 0.3 mm to 2.2 +/- 0.3 mm (p less than 0.001). Angiographically visible dissections were seen in 4 patients and were uncomplicated in 2. One patient had a non-Q-wave myocardial infarction. A fourth patient had a presumed acute occlusion 36 hr after the procedure, necessitating emergency bypass surgery, but without Q waves on the electrocardiogram or wall-motion abnormalities on the echocardiogram. Nitroglycerin was infused through the Rotablator catheter and has considerably lowered the degree and frequency of spasm. No other acute complications occurred. The mean procedure time using a single burr was shorter than when multiple burrs were used: 56.5 vs. 97.3 min, respectively (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Percutaneous transluminal coronary angioplasty utilizing prolonged balloon inflations: initial results and six-month follow-up.

Coronary angioplasty (PTCA) using prolonged balloon inflation has obviated emergency coronary bypass surgery in some patients with acute occlusions at the time of PTCA. However, the use of prolonged balloon inflations has not been shown to improve long-term restenosis rates. As an alternative to the passive autoperfusion catheter, we evaluated a hemoperfusion system in which blood was obtained from the side arm of an arterial sheath and infused through the central lumen of standard balloon catheters via a modified Medrad IV pump during balloon inflation. PTCA was performed in 71 male patients (median age 57 yr). The median balloon inflation time was 4.8 minutes and the median rate of blood perfusion was 30 ml/min. PTCA was successful (lumen increase by 20 percentage points) in 83% of patients (59/71) with diameter stenosis decreasing from a median 82% to 30%. Emergency coronary bypass was required in four patients (5%). Angiographic data for six-month followup was available on 37 patients. The restenosis rate (loss of 50% of gain) was 46% (17/37). The conclusion is that prolonged balloon inflation angioplasty has a role in complicated PTCA but offers no advantage in improving long-term restenosis rates in elective PTCA.

Adult↗
PubMed1991

Influence of coronary collateral vessels on myocardial infarct size in humans. Results of phase I thrombolysis in myocardial infarction (TIMI) trial. The TIMI Investigators.

BACKGROUND: The influence of coronary collateral vessels on infarct size in humans remains controversial, partly because no previous study has examined the impact of collaterals present at the onset of acute myocardial infarction on infarct size. METHODS AND RESULTS: The present study used the data base of the Thrombolysis in Myocardial Infarction (TIMI) Phase I trial to correlate the presence or absence of angiographically documented collaterals in the initial hours of myocardial infarct evolution with the size of the infarct as assessed by serial measurements of serum creatine kinase (CK). To avoid the confounding effects of reperfusion on enzymatic estimates of infarct size, this report is limited to those 125 patients who failed to recanalize at 90 minutes after administration of tissue plasminogen activator or streptokinase. Patients with angiographically documented collaterals (group A, n = 51) had significantly lower values of peak serum CK than patients without collaterals (group B, n = 74) (1,877 +/- 216 versus 2,661 +/- 212 IU/l, respectively [mean +/- SEM], p = 0.004). Similarly, CK-derived infarct size estimates were significantly lower in group A than in group B (20.6 +/- 2.5 versus 31.4 +/- 2.8 CK gram equivalents, p = 0.001). The infarct size observed in patients with collaterals was less for anterior infarctions as well as for infarctions of other locations; thus, the beneficial effects of collaterals were independent of the site of the infarct. In 65 of the 125 patients who failed to reperfuse, left ventricular ejection fraction (LVEF) was assessed by contrast ventriculography both at initial cardiac catheterization (before thrombolytic therapy) and at hospital discharge. Among the patients who had both studies, global LVEF tended to increase from pretreatment to hospital discharge in group A (from 50.6 +/- 1.8% to 53.4 +/- 1.8%, p = 0.10) but decreased in group B patients (from 50.3 +/- 1.8% to 47.8 +/- 1.7%, p = 0.02). At hospital discharge, global LVEF was greater in patients with coronary collaterals (53.5 +/- 1.7% versus 49.6 +/- 1.7%, p = 0.01). CONCLUSIONS: The results demonstrate that, in patients in whom thrombolytic therapy fails to induce reperfusion, the presence of coronary collateral vessels at the onset of myocardial infarction is associated with limitation of infarct size as assessed enzymatically and with improved ventricular function on discharge as assessed by LVEF.

Collateral Circulation↗
PubMed1990

Phrenic nerve injury during coronary artery bypass.

After coronary artery bypass, some patients have diaphragmatic elevation, usually on the left side. To test our hypothesis that this phenomenon is due to phrenic nerve injury resulting from either 1) dissection of the proximal portion of the left internal mammary artery or 2) topical cooling of the heart with icy slush, we performed the following 2-part study. First, we reviewed our hospital records of 99 coronary artery bypass patients, 55 of whom had received left internal mammary artery grafts and 44 of whom had undergone saphenous vein grafting; the results showed no significant difference between the rates of left-sided diaphragmatic paralysis in the 2 groups (47% versus 41%, respectively). Next, we performed a prospective, randomized study in 100 consecutive patients, using a cardiac insulation pad to protect the left phrenic nerve in 58 patients and using no protective pad in 42 patients. At the time of hospital discharge, left-sided diaphragmatic elevation was seen in 6 (10.3%) of the 58 patients in whom insulation had been used and in 19 (45.2%) of the 42 patients whose phrenic nerve had been unprotected (p < 0.001). We conclude that cooling of the left phrenic nerve with icy slush in the pericardial cavity causes left-sided diaphragmatic paralysis and that the frequency of this injury can be reduced if a cardiac insulation pad is placed between the nerve and the icy slush.

Journal Article↗
PubMed1990

Distal coronary hemoperfusion and prolonged balloon inflation for acute occlusion: occurring during percutaneous transluminal coronary angioplasty.

We report 3 cases that demonstrate the use of distal coronary hemoperfusion with prolonged balloon inflation to treat acute coronary occlusion occurring during percutaneous transluminal coronary angioplasty. Despite acute occlusion, 2 of the patients had a good angioplasty result, and the 3rd underwent elective coronary bypass surgery. Thus, emergency coronary bypass was avoided in all 3 cases.

Journal Article↗
PubMed1989

Initial coronary occlusion improves tolerance to subsequent prolonged balloon inflations.

An acute coronary occlusion with severe ischemic signs during percutaneous transluminal coronary angioplasty was successfully treated with a long balloon inflation. Subsequent balloon inflations did not produce ischemic signs. Distal coronary occlusion pressure rose significantly during balloon inflations of more than 2 min. It is hypothesized that an initial ischemic occlusion may improve tolerance to prolonged coronary occlusions. The underlying mechanism may be that further coronary collateral circulation is recruited over time.

Angina Pectoris↗
PubMed1988

Use of mechanical devices for distal hemoperfusion during balloon catheter coronary angioplasty.

Previous attempts to protect the dependent myocardium during balloon catheter coronary angioplasty in animals and humans have had generally unsatisfactory results. This paper summarizes the authors' experience in investigating commercially available mechanical pumps for distal coronary hemoperfusion during balloon angioplasty. Both roller and piston pumps can attain adequate distal perfusion without significant side effects in the majority of patients. Our goal was to suppress angina for at least 5 min to prolong balloon inflation in awake patients. Minor T-wave changes without concomitant angina pectoris can be expected when the distal coronary bed is perfused with hypothermic blood. Side branch occlusion by the inflated balloon prevents effective protection of the corresponding part of the dependent myocardium during distal hemoperfusion, which may result in persistent angina and ST-T changes uncorrected by increasing the hemoperfusion rate. Distal coronary diffuse spasm, rare and transient, was the only immediate complication of this procedure. It is suggested that intense local wall stimulation could occur with a higher flow rate (jet effect). Improved balloon catheter pressure/flow characteristics and on-line continuous mechanical pumps should soon make distal coronary hemoperfusion through balloon catheters an accepted clinical technique.

Adult↗
PubMed1988

Arteriographic demonstration of coronary artery spasm during thrombolysis.

A 60-year-old man with an acute inferior-wall myocardial infarction was noted, on arteriography, to have an occluded distal right coronary artery. The vessel was reopened with intravenous tissue plasminogen activator; during resolution of the clot, spasm was observed arteriographically but was successfully treated with intracoronary nitroglycerin. Follow-up arteriography showed a normal right coronary artery. The significance of this case lies in the fact that we were able to document the occurrence of spasm during coronary thrombolysis; such documentation supports the hypothesis that spasm may be a factor in the initiation of coronary thrombosis.

Journal Article↗
PubMed1986

Distal hemoperfusion during percutaneous transluminal coronary angioplasty.

During percutaneous transluminal coronary angioplasty (PTCA), the ability to maintain balloon inflations for 3 to 5 minutes, as opposed to the usual 30 to 60 seconds, may lead to improved early and late results. To determine the feasibility and clarify the advantages of distal hemoperfusion during PTCA, blood from the renal vein was manually sampled and then reinjected through the pressure port of the coronary balloon catheter during sustained balloon inflations in 3 patients. By supplying the periphery of the left anterior descending coronary artery with flows of 30 to 50 ml/min, ischemic manifestations were suppressed in all 3 cases. Hemoperfusion was performed without complications for as long as 5 minutes, using a maximum of 225 ml of blood. This new technique represents a major step toward the long-sought goal of extracorporeal coronary circulation during PTCA.

Angioplasty, Balloon↗
PubMed1986

Flow characteristics of coronary balloon catheters.

The popularity recently achieved by balloon angioplasty of coronary arteries is limited by the risk of reocclusion of the stenotic segment addressed. Sudden reocclusion leads frequently to an acute coronary syndrome (acute myocardial infarction, hypotension, arrhythmias) that requires emergency surgery and also leads to permanent myocardial damage of various degrees. Preliminary data has recently become available to suggest that prolonged balloon inflations could be an important tool in attaining optimal early and late results of angioplasty. These considerations have resulted in renewed interest in peripheral coronary perfusion during balloon coronary angioplasty. The most critical limiting factor to the distal perfusion of blood is the inner lumen of the balloon catheters, which are relatively small. We present laboratory data regarding the pressure/flow ratios of different balloon catheters.

Journal Article↗
PubMed1984

Selective coronary arteriography by percutaneous transaxillary approach.

Coronary angiography by the percutaneous femoral approach is widely used. This technique is potentially dangerous or impossible in patients with advanced arterial disease of the lower limbs, whether or not surgically treated. In these cases, percutaneous left or right axillary approach is an alternative to brachial approach. In this article, we report our multicenter experience involving 120 patients. The left axillary artery was used in 94 cases (78%) and the right in 26 cases (22%). We used performed coronary catheters usually associated with the femoral approach. The left axillary artery was used preferentially since this avoids catheterization of the innominated trunk and allows easier catheterization of the coronary ostia and aortic ends of aorto-coronary bypass grafts. The routine use of a sheath (arterial introducer) avoided arterial compression during catheterization, prevented hemorrhagic suffusion when the catheters were exchanged, and reduced the risk of thrombosis or laceration of the axillary artery. There were no failures in the catheterization of the axillary artery and no complication was observed during or after the procedure. Axillary percutaneous technique appears to have the following advantages over the brachial arteriotomy: 1) Investigation time is equivalent to the time needed for the femoral percutaneous approach. 2) There is the possibility of lateral and simultaneous bi-plane angiograms. 3) Arterial puncture is preferable to arteriotomy. The axillary approach could also be used for percutaneous transluminal coronary angioplasty.

Adult↗