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Biomedical subjects

K Kisslo

Publications and source records attributed to K Kisslo.

14 recordsLinked to original sources
PubMed1999

Predictors and significance of atrial rhythm before and six months after percutaneous balloon mitral commissurotomy.

Clinical, echocardiographic, and cardiac catheterization data were evaluated in 263 patients with mitral stenosis who were undergoing balloon commissurotomy to determine the predictors of atrial rhythm and its effect on functional status. Conversion from atrial fibrillation to sinus rhythm at 6 months after the procedure occurred in 16 of 86 patients (19%) and was predicted by the duration of atrial fibrillation, baseline functional class, and antiarrhythmic therapy; patients who remained in atrial fibrillation had a poorer functional status compared with those in sinus rhythm despite similar procedural results.

Adult↗
PubMed1993

Technique of intraluminal biliary ultrasonography during laparoscopic cholecystectomy.

Intraluminal ultrasonography of the common duct was performed in nine patients undergoing laparoscopic cholecystectomy, using a system comprising a 20-MHz crystal in a 95-cm, blunt-tipped 6F sheath, mechanically rotated at 1,800 rpm. The probe was introduced through an incision in the cystic duct and passed into the duodenum. When the catheter was withdrawn, excellent visualization of the common and cystic ducts and lower end of the common hepatic duct was achieved. In seven patients, the biliary tree was normal. A small calculus was discovered in the common duct in one patient. This stone was not seen on a subsequent cholangiogram and was subsequently retrieved. An additional patient had mucus or sludge noted in the duct, which cast no acoustic shadow and thus was distinguished from calculi. The technique was fast, efficient, and easy to perform in this small group of patients and holds promise for screening the common duct pathology during laparoscopic cholecystectomy.

Adult↗
PubMed1993

Ultrasound guide wire-directed stent deployment.

A new mechanically rotated 20 MHz intravascular ultrasound guide wire (0.032 inch) with a transducer core was placed through the central lumen of a peripheral arterial balloon-expandable stent. Using an anesthetized canine model, 11 stents were then deployed into the iliac or femoral arteries. Eight stents were successfully deployed with proper position and full stent expansion documented by ultrasound imaging. Four of the stents were overlapping and the double row of stent struts at the region of overlap was easily seen. Three stents were unsuccessfully deployed because of undersizing, as clearly documented by ultrasound imaging showing stent strut recoil. As a result, the procedure was modified by performing ultrasound measurements of arterial dimensions before stent selection. There were no complications attributed to the ultrasound guide wire. This study demonstrates an effective combination of diagnostic and therapeutic devices that may allow more precise placement of intravascular stents.

Animals↗
PubMed1992

Real-time assessment of experimental arterial angioplasty with transvenous intravascular ultrasound.

Optimal evaluation of experimental angioplasty procedures would allow real-time simultaneous assessment during the procedure without direct manipulation of treated arterial segments. To assess the feasibility and utility of transvenous real-time intravascular ultrasound imaging during experimental angioplasty, 11 consecutive atherosclerotic iliac artery segments in rabbits were imaged before, during and after thermal or conventional perfusion balloon angioplasty. A 20-MHz intravascular ultrasound catheter was positioned in the adjacent vein, and images were correlated with data from quantitative angiography and histologic studies. Images suitable for analysis were obtained at all 11 sites. Arterial distension and recoil were observed during balloon inflation and deflation. Measurements of lumen diameter and cross-sectional area by intravascular ultrasound and angiography were closely correlated (r2 = 0.90, SEE = 0.2 mm, and r2 = 0.90, SEE = 0.8 mm2, respectively). Intimal dissections were identified in six segments by intravascular ultrasound and all were concordant with histologic findings. Thus, real-time transvenous ultrasound avoids manipulation of the treated artery, and is a feasible modality for dynamic quantitative and qualitative assessment of arterial interventions.

Angiography, Digital Subtraction↗
PubMed1991

Determinants of one-year outcome from balloon aortic valvuloplasty.

Balloon aortic valvuloplasty (BAV) has been a therapeutic alternative treatment for severe symptomatic aortic stenosis. Previous studies have been unable to predict 1-year outcome because of limited acute and follow-up clinical, invasive and echocardiographic data. The purpose of this study was to predict long-term outcome based on comprehensive data obtained at the time of valvuloplasty and at 3 and 6 months after the procedure. Of 170 consecutive patients undergoing BAV, 108 (mean age 78 years) were at least 1 year from their procedure. Prospective clinical, micromanometer hemodynamic, digital ventriculographic and echocardiographic/Doppler data were collected at baseline and immediately after the procedure. Echocardiographic data were also obtained at 3 and 6 months. With use of Cox model analysis, major events (defined as cardiac death [n = 30], aortic valve replacement [n = 21] or repeat BAV [n = 13]) were predicted by advanced age, baseline heart failure class, and baseline echocardiographic-determined diastolic left ventricular diameter. Only baseline left ventricular ejection fraction proved to be a significant predictor of cardiac death (p = 0.002) in a multivariate model. Absolute values after BAV (stroke work, first derivative of left ventricular pressure, valve area, end-systolic volume, Fick cardiac output, transvalvular gradient) and acute changes measured by catheterization or echocardiography did not provide additional predictive information over that of post procedure ejection fraction. Similarly, echocardiographic valve area and transvalvular gradient at 3 months added no further prognostic data. With an ejection fraction greater than or equal to 45% (n = 63), cardiac survival at 1 year was 80%, irrespective of age, sex, congestive heart failure class or severity of coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Mechanisms of angioplasty in hemodialysis fistula stenoses evaluated by intravascular ultrasound.

Quantification of luminal dimensions and the mechanisms by which angioplasty (PTA) corrects non-atheroma venous fistula stenoses have been poorly studied. In 38 consecutive percutaneous balloon angioplasties of hemodialysis fistula stenoses, catheter-based, mechanically-rotated intravascular ultrasound (IVUS) images were obtained along with cineangiography. Images from 24 brachial vein, 11 central vein, 2 graft anastomoses, and 1 brachial artery were quantitatively and qualitatively evaluated. Semiautomated quantitative angiographic stenosis was 64 +/- 13% pre-PTA and reduced to 36 +/- 19% post-PTA (P less than 0.001). Post-PTA IVUS minimal lesion diameter and cross sectional area were 5.7 +/- 1.5 mm and 2.9 +/- 1.5 mm2, respectively. With IVUS, mechanisms observed were: vessel dissection in 16 (42%), arterial stretch (defined as vessel diameter: balloon diameter ratio = 0.75 to 1.0) in 19 (50%), and elastic recoil (defined as vessel diameter: balloon diameter ratio less than 0.75) in 19 (50%). Compared to angiography, morphologic information provided by IVUS were plaque composition (hard 11%, soft 89%), plaque topography (eccentric 94%, concentric 6%), thrombus (IVUS: N = 6 vs. angio: N = 1), dissection (IVUS: N = 16 vs. angio: N = 1). Thus, IVUS can evaluate lesion morphology and define luminal dimensions after angioplasty. Mechanisms of successful angioplasty of hemodialysis fistula stenosis occur primarily by vessel stretching and dissection, and significant post-PTA narrowing is due to elastic recoil.

Adult↗
PubMed1990

Interventional applications of intravascular ultrasound imaging: initial experience and future perspectives.

Intravascular ultrasound imaging offers the potential to provide more detailed information about vessel and lesion morphology and physiology than is currently available from angiography. The greatest impact of intravascular ultrasound upon clinical decisions may be in the area of cardiac and vascular interventions. To evaluate the utility of intravascular ultrasound, we prospectively studied 45 patients, 11 of whom underwent interventional procedures. Intravascular ultrasound imaging was performed before and after interventions using a 20 MHz, mechanically rotating transducer on either 6.5 Fr or 8.0 Fr catheter systems. Interventions included seven peripheral vessel balloon angioplasties (Femoral artery-two, Renal artery-two, Arteriovenous fistula-two, Aortic coarctation-one), two Femoral artery rotational atherectomies, and two balloon valvuloplasties (Pulmonic valve-1, Mitral valve-1). Intravascular ultrasound and digital angiography provided similar information about vessel size. However, morphological information about the vessel wall, plaque composition, plaque topography, luminal thrombus, and vessel dissections was better appreciated by intravascular ultrasound. Intravascular ultrasound was determined to have provided unique and clinically useful information in 10/11 (91%) interventions. These preliminary data illustrate the potential value of intravascular ultrasound for the evaluation of the vascular system and in particular its value in interventional procedures.

Angioplasty, Balloon↗
PubMed1989

Quantification of aortic regurgitation after balloon aortic valvuloplasty using videodensitometric analysis of digital subtraction aortography.

The serial changes in aortic regurgitation (AR) after balloon aortic valvuloplasty have not been quantitatively evaluated. This study assessed the degree of AR by quantitative and qualitative techniques before and immediately after aortic valvuloplasty. Digital subtraction aortography was performed before and after valvuloplasty in 50 patients. The ratio of left ventricular to aortic contrast density during aortography was analyzed by videodensitometric techniques. A time-density curve was obtained by placing a 30 X 30 pixel region of interest over the aortogram and the left ventricular cavity. The ratio of left ventricular to aortic density at peak aortic density defined the videodensitometric ratio. Independent visual interpretation was also assessed and compared to videodensitometric methods. Quantitatively, no significant change in AR could be demonstrated in the mean videodensitometric ratio before or after balloon aortic valvuloplasty (0.33 +/- 0.21 vs 0.37 +/- 0.25, p = 0.07). Ten (20%) of the patients had a greater than or equal to 0.10 increase, and 4 (8%) patients a greater than or equal to 0.10 decrease in the AR ratio. Thus, serial quantitative and qualitative determinations of AR after balloon aortic valvuloplasty confirm that significant increases or decreases in AR severity are unusual after the procedure.

Absorptiometry, Photon↗
PubMed1989

Analysis of the early rise in aortic transvalvular gradient after aortic valvuloplasty.

The relationship between dynamic changes in aortic valve gradient and left ventricular ejection performance in the early period after successful percutaneous aortic valvuloplasty has not been described in detail. Accordingly 20 adult patients with severe symptomatic calcific aortic stenosis underwent first-pass radionuclide angiography and Doppler echocardiography before, immediately after, and 2 to 4 days after the valvuloplasty procedure. A significant (p less than 0.001) reduction in peak-to-peak (72 +/- 24 mm Hg to 36 +/- 11 mmHg) and mean (60 +/- 20 mm Hg to 34 +/- 9 mm Hg) transaortic gradient and an increase in aortic valve area (0.5 +/- 0.2 cm2 to 0.8 +/- 0.2 cm2) were measured by high-fidelity micromanometer catheters immediately after aortic valvuloplasty. Results of Doppler echocardiography showed a significant (p less than 0.001) immediate decrease in peak instantaneous (81 +/- 22 mm Hg to 53 +/- 15 mm Hg) and mean (48 +/- 14 mm Hg to 31 +/- 9 mm Hg) aortic gradients. However, 2 to 4 days later a significant (p less than 0.001) return of peak (56 +/- 15 mm Hg to 65 +/- 20 mm Hg) and mean (31 +/- 9 mm Hg to 39 +/- 12 mm Hg) transvalvular gradient occurred. Aortic valve area as determined by the continuity equation also increased from 0.4 +/- 0.2 cm2 to 0.6 +/- 0.2 cm2 immediately after the procedure (p less than 0.001), then partially returned to baseline (0.5 +/- 0.2 cm2; p less than 0.005) at 2 to 4 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗