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Biomedical subjects

M Been

Publications and source records attributed to M Been.

At least 19 recordsLinked to original sources
PubMed2002

Early experience with a helical coronary thrombectomy device in patients with acute coronary thrombosis.

OBJECTIVE: To report our experience with a new thrombectomy device (X-SIZER(TM)) in patients with angiographically visible thrombus or total coronary occlusion in the setting of acute coronary syndromes. DESIGN: A safety and feasibility study in the use of the X-SIZER during intervention in patients with acute coronary syndromes. PATIENTS: 35 patients, age range 31 to 83 years (mean 60). SETTING: University Hospitals of Coventry and Warwickshire NHS Trust (tertiary referral centre). INTERVENTIONS: The indication for intervention was primary or salvage percutaneous coronary intervention for acute myocardial infarction in 17 of the 35 patients; unstable angina or non-ST-elevation myocardial infarction in 10; and unstable postinfarct angina in eight. Abciximab was given in 11 patients. MAIN OUTCOME MEASURES: Device success (successful deployment of the device at the site of the lesion with resultant improvement in TIMI flow); clinical success (no residual stenosis at the end of the procedure with no in-hospital major adverse coronary events). RESULTS: Successful use of the device was achieved in 26 of the 35 cases. It failed to cross the lesion in five and failed to improve TIMI flow despite crossing the lesion in four. Clinical success was achieved in 30 of the 35 cases. Device related complications occurred in two cases (vessel perforation) and there was one intraprocedural death (acute myocardial infarction with cardiogenic shock). CONCLUSIONS: Thrombectomy with the X-SIZER catheter system appears promising in percutaneous coronary intervention where thrombus extraction is considered necessary before stent implantation.

Adult↗
PubMed2001

Evaluation of patient characteristics and utilisation of invasive cardiac procedures in a UK ethnic population with unstable angina pectoris.

OBJECTIVES: To evaluate patient characteristics and utilisation of invasive cardiac procedures in a UK ethnic population with unstable angina pectoris (UAP). DESIGN: Retrospective, observational study. SETTING: Tertiary referral cardiology centre in the United Kingdom serving a large Asian ethnic population. SUBJECTS: White and Asian patients undergoing PTCA for UAP over a 2.5-year period at a UK referral cardiology centre from a comprehensive PTCA database. Data were also collated for all emergency admissions with unstable angina, or angina (type unspecified), to our institute. MAIN OUTCOME MEASURES: Demographic and angiographic characteristics of patients undergoing PTCA. Frequency of usage of invasive cardiac procedures was determined in emergency angina admissions. RESULTS: From January 1997 to July 1999, 435 White and 36 Asian patients underwent PTCA for UAP at our institute. Asian patients were on average 4.4 years younger (P=0.015), had 19.3% more diabetes (P=0.003) and 19.7% less smoking (P=0.007). Trends to more single vessel disease in Whites and more double vessel disease in Asians were observed, with similar rates of triple vessel disease. Interestingly, Asians also had trends towards more left-sided coronary artery disease and revascularisation, smaller vessels and less bail-out stenting. Asian patients were significantly less likely to undergo coronary angiography, OR 0.64 (CI 0.45-0.91, P=0.012), during the index admission, and showed a trend to less PTCA. CONCLUSIONS: Asian patients with unstable angina pectoris appear to have clinical and angiographic differences from their White counterparts, and are less likely to have invasive cardiac procedures deployed. The reasons for these observations require elucidation and the prognostic significance of these findings is uncertain.

Aged↗
PubMed2001

Multiple coronary aneurysms in a patient with neurofibromatosis type 1: case report and intravascular ultrasound of aneurysm.

A 54 year old woman with neurofibromatosis type 1 (NF-1) was found to have multiple coronary aneurysms. Intraoperative intravascular ultrasound (IVUS) revealed severe coronary disease proximal to the aneurysm that had not been apparent angiographically. An IVUS picture of one of the giant coronary aneurysms is also shown. The vascular manifestations of neurofibromatosis and the causes of coronary aneurysms are reviewed.

Coronary Aneurysm↗
PubMed1999

Coronary artery stenting in unstable angina pectoris: a comparison with stable angina pectoris.

OBJECTIVE: To compare early complication rates in unselected cases of coronary artery stenting in patients with stable v unstable angina. SETTING: Tertiary referral centre. PATIENTS: 390 patients with stable angina pectoris (SAP) and 306 with unstable angina (UAP). Patients treated for acute myocardial infarction (primary angioplasty) or cardiogenic shock were excluded. INTERVENTIONS: 268 coronary stents were attempted in 211 patients (30.3%). Stents used included AVE (63%), Freedom (14%), NIR (7%), Palmaz-Schatz (5%), JO (5%), and Multilink (4%). Intravascular ultrasound was not used in any of the cases. All stented patients were treated with ticlopidine and aspirin together with periprocedural unfractionated heparin. RESULTS: 123 stents were successfully deployed in 99 SAP patients v 132 stents in 103 UAP patients. Failed deployment occurred with nine stents in SAP patients, v four in UAP patients (NS). Stent thrombosis occurred in four SAP patients and 11 UAP patients. Multivariate analysis showed no relation between stent thrombosis and clinical presentation (SAP v UAP), age, sex, target vessel, stent length, or make of stent. Stent thrombosis was associated with small vessel size (p < 0.001) and bailout stenting (p = 0.01) compared with elective stenting and stenting for suboptimal PTCA, with strong trends toward smaller stent diameter (p = 0.052) and number of stents deployed (p = 0.06). Most stent thromboses occurred in vessels < 3 mm diameter. CONCLUSIONS: Coronary artery stenting in unstable angina is safe in vessels >/= 3 mm diameter, with comparable initial success and stent thrombosis rates to stenting in stable angina.

Angina Pectoris↗
PubMed1995

Coronary ventricular fistula as a complication of PTCA: a case report and literature review.

A 58-year-old man with previous myocardial infarction and coronary bypass surgery underwent angioplasty to a totally occluded venous graft to the left anterior descending artery (LAD). The procedure resulted in a coronary-ventricular fistula. Prolonged inflation of the balloon in the proximal part of the graft resulted in obliteration of the fistula with little haemodynamic compromise.

Anastomosis, Surgical↗
PubMed1992

The occurrence of early sudden coronary artery occlusion following angioplasty may be predicted from the clinical characteristics of the patients and their coronary lesion morphology.

The aim of this study was to assess whether the incidence of early occlusion following angioplasty was greater among patients with unstable angina and whether the coronary lesions prone to early occlusion could be predicted from their angiographic appearance. Seventy-seven patients who had had a first angioplasty of a native vessel for stable or unstable angina in one twelve month period were included. The angiographic appearances of the angioplastied lesions were classified as either Type 1, which were smooth and unlikely to have thrombus or intimal rupture, or Type 2, which were irregular due to thrombus or intimal rupture. The lesion classification was compared to the patients' clinical features, i.e. stable or unstable angina, and the outcome of the angioplasty. Type 2 lesions occurred in 25% of patients with stable angina but 49% of patients with unstable angina (p less than 0.05). Early sudden occlusion of the angioplastied vessel occurred in 24% of patients with unstable angina but in only 3% of patients with stable angina (p less than 0.05) and in 6% of Type 1 lesions compared with 24% of Type 2 lesions (p less than 0.05). Thus it is possible to identify the clinical characteristics and angiographic appearances of those patients undergoing angioplasty who are most likely to experience early vessel occlusion.

Angina Pectoris↗
PubMed1990

Valvar stenosis: a comparison of clinical assessment, echocardiography, Doppler ultrasound and catheterisation.

The relative merits of noninvasive techniques in the assessment of valve stenosis were examined by comparing the results of clinical assessment by two independent clinicians, the cross-sectional echocardiogram and Doppler ultrasound using the results of cardiac catheterisation as reference in 58 patients with a total of 60 stenotic valve lesions. Doppler ultrasound was the most reliable technique; it was correct in 57 (95%) of the 60 lesions. Clinical assessment and cross sectional echocardiography were correct in 48 (80%), and 46 (77%) of the 60 lesions, respectively. In 7 instances 2 noninvasive assessments were wrong in the same patient but on no occasion were all 3 techniques misleading in the same patient. In 17 patients with severe mitral stenosis, clinical assessment Doppler ultrasound and cross-sectional echocardiography were correct in 14 (82%), 16 (94%) and 17 (100%) patients, respectively, whilst in the 4 patients with moderate mitral stenosis the corresponding figures were 3 (75%), 4 (100%) and 2 (50%). In mild mitral stenosis (3 patients), the clinical assessment was correct in 2 (67%) patients, Doppler ultrasound in 3 (100%) patients and cross-sectional echocardiography in 2 (67%) patients. In 22 patients with severe aortic stenosis, the clinical assessment and Doppler ultrasound were correct in every patient (100%), whilst the cross-sectional echocardiogram was correct in 18 (82%) patients. In 11 patients with moderate aortic stenosis, the clinical assessment was correct in only 5 (45%) patients, the cross-sectional echocardiogram in 5 (45%) patients and Doppler assessment in 9 (82%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Reduction in ST segment elevation after thrombolysis predicts either coronary reperfusion or preservation of left ventricular function.

The usefulness of a reduction in ST segment elevation to predict coronary reperfusion in myocardial infarction remains uncertain. ST segment changes and angiographic findings were compared in 45 patients soon after thrombolysis. The percentage ST segment change 3 hours after treatment (in the lead showing the greatest initial ST elevation) was compared with the TIMI perfusion grade (thrombolysis in myocardial infarction trial) obtained between 90 minutes and 3 hours after treatment. Global ejection fraction and regional wall motion were assessed by cineventriculography (11 (5) days (mean (SD))) and by gated blood pool imaging (44 (11) days). Prediction of coronary patency by a reduction of greater than 25% in ST segment elevation 3 hours after thrombolytic treatment had a sensitivity of 97% but a specificity of only 43%. Where the ST segment elevation was reduced by greater than 25% the global ejection fraction was well maintained whether or not the infarct vessel was patent. In patients with a reduction of less than 25% in ST elevation, the ejection fraction was significantly lower and regional wall motion abnormality more severe. Reduction in ST elevation of greater than 25% within 3 hours of thrombolysis indicates either a patent infarct artery or preservation of left ventricular function. When the ST segment elevation does not fall by greater than 25% persistent coronary occlusion is likely (predictive accuracy 86%) and is associated with a lower ejection fraction. These patients may benefit from further treatment or additional interventions.

Adult↗
PubMed1989

Serial angiographic findings during the development of a saccular aneurysm of the coronary artery in association with unstable angina.

A 60 year old man presented with unstable angina and electrocardiographic features suggestive of disease of the left anterior descending coronary artery. Angiography showed slight proximal narrowing in this artery with reduced density of contrast that suggested an associated thrombus. Repeat angiography after 24 hours of heparin administration showed the development of a small saccular aneurysm. Three weeks later, after a further episode of unstable angina, angiography showed enlargement of the aneurysm. Although there were no further episodes of angina, repeat angiography three months after the initial event showed further slight enlargement of the aneurysm. It is suggested that the episodes of angina at rest were secondary to embolisation of thrombotic or atheromatous material or both.

Angina Pectoris↗
PubMed1988

Myocardial involvement in systemic lupus erythematosus detected by magnetic resonance imaging.

Myocardial involvement in systemic lupus erythematosus is commonly found at autopsy but seldom recognized clinically or by routine cardiological investigations. As the magnetic resonance relaxation parameter, T1, is altered by changes in tissue cellularity, we carried out magnetic resonance imaging in 10 patients with systemic lupus erythematosus. Five had active systemic lupus erythematosus when assessed using the lupus activity criteria count. The mean (+/- SD) T1 was 319 +/- 12 in normal volunteers and 321 +/- 10 in a second control group with hypertrophic cardiomyopathy. In the group with systemic lupus erythematosus, there was a higher mean value of 336 ms with a wider scatter of individual results (SD +/- 22 ms). In the subgroup of patients with active disease, T1 was significantly higher (349 +/- 24) than in either of the two control groups. In addition, there was an inverse correlation between serum complement and myocardial T1 in patients with systemic lupus erythematosus. Myocardial abnormalities in systemic lupus erythematosus were demonstrated by magnetic resonance imaging even where other non-invasive cardiac investigations were negative. We conclude that T1 calculated from magnetic resonance imaging is often abnormal in systemic lupus erythematosus and probably indicates myocardial involvement.

Adult↗