[Use of the rotablator in the therapy of diabetic macroangiopathies of the lower leg--initial experiences].
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Angiography↗
Biomedical subjects
O Pachinger
Publications and source records attributed to O Pachinger.
[Long-term results of percutaneous atherectomy in peripheral arterial occlusive disease].
In a retrospective study the indications and the long-term results of percutaneous atherectomy of a nonselected group of patients were analysed. From March 1988 to November 1989, 94 patients suffering from peripheral vascular disease were treated using Simpson's atherectomy technique. There were 132 lesions, 101 stenoses and 31 occlusions in a total of 94 patients. The primary success rate was 95%. After 12 months of follow-up the cumulative patency rate was 69% and after 24 months, 42%. After a follow-up period of 15 months patent arteries and recurrences were recorded and the results used to analyse the factors that influence patency after Simpson atherectomy. The patency rate is 71% in diabetics and 62% in non-diabetics. It is 51% in occlusions and 73% in stenoses. The patency rate in patients with fair runoff is 69%, in patients with poor runoff 60%. Comparing these results with historical studies concerning balloon dilation the results are poor. Residual stenoses after balloon dilation seem to be the optimal indication for percutaneous atherectomy.
Adult↗
Myocardial infarction after chronic ergotamine abuse.
As a result of chronic ergotamine abuse, reversible arterial narrowing has been documented angiographically in peripheral, but not in coronary arteries. We report on a patient with no cardiovascular risk factors, but because of chronic ergotamine abuse suffered on acute myocardial infarction, complicated by ventricular fibrillation. Coronary angiography performed 3 days after resuscitation revealed a distal occlusion of the left anterior descending artery. Three months later, spontaneous recanalization had occurred, and no residual narrowing was seen angiographically. Thus, surveillance of patients with migraine headache to avoid chronic ergotamine abuse is recommended to prevent cardiovascular complications.
Coronary Disease↗
[Percutaneous aspiration embolectomy of the popliteal artery].
Twenty-eight patients (17 women, 11 men, average age 67 years, range 40-85 years) with embolic occlusions of the popliteal arteries were treated by aspiration embolectomy. 6 patients were in clinical stage IIb and 22 in stage III. In 25 of the 28 patients the occlusion was treated successfully. Complications could be treated non-surgically at the same time. 2 of the patients died within the first week of cerebral emboli, 2 further patients suffered recurrent emboli in the treated extremity during the first month. 17 patients who were followed up for six months were free of recurrences.
Adult↗
Ventricular late potentials in haemodialysis patients and the risk of sudden death.
Cardiovascular diseases account for approximately 50% of deaths in patients on chronic haemodialysis. Therefore we prospectively studied 54 consecutive patients on dialysis for the presence or absence of ventricular late potentials (LP). LP, i.e. low-amplitude potentials in the terminal part of the QRS complex, have been shown to be highly indicative of life-threatening arrhythmias and sudden death. The results were correlated with echocardiographic studies and the clinical outcome during a follow-up period of 18 months. Fifty patients were suitable for evaluation (29 males, 21 females; mean age 55 years; mean time on dialysis 32 months; coronary artery disease present in 5) Our analysis revealed LP in seven of 50 patients only. Left ventricular hypertrophy, i.e. mean wall diameter > 12 mm, was present in 78%, a compromised left ventricular function, i.e. shortening fraction < 28%, was found in 28% of the patients. With respect to echocardiographic parameters, patients with and without LP were similar. During follow-up, sudden cardiac death was observed in three of 11 patients deceased. LP were detectable in one of the three only. From the remaining six patients with LP, four are still alive, and two patients died due to atherosclerosis and pulmonary embolism. Our data underline the crucial role of sudden cardiac death in dialysis patients. Ventricular late potentials, however, are of no prognostic relevance with respect to identification of dialysis patients at risk of sudden death.
Adolescent↗
Transient myocardial perfusion abnormalities during cold provocation test in patients with arterial hyperreactivity.
The effect of peripheral cold provocation on myocardial perfusion was evaluated utilizing thallium-201 perfusion imaging in 13 selected patients with arterial hyperreactivity (Raynaud's phenomenon: n = 8; migraine: n = 6) and angiographically documented coronary artery spasm. Eleven out of 13 subjects with coronary arterial spasm--but none of a group of patients with obstructive coronary artery disease--had transient myocardial perfusion defects during cold provocation. The localization of transient perfusion abnormalities during myocardial scintigraphy correlated with the myocardial areas distal to the spontaneous or ergonovine-induced coronary arterial spasm detected by angiography. Transient reduction of tracer uptake during cold provocation and normalization of myocardial perfusion by redistribution imaging was paralleled by areas of hypokinesia observed during the test by contrast ventriculography (n = 8). The described findings in the coronary system during peripheral cold pressor test occurred independently of the presence of Raynaud's phenomenon, and without achieving the ischemic threshold.
Adult↗
[Simpson atherectomy--long-term results and indications].
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Adolescent↗
[Treatment of thrombotic occlusion with the Starck rotation-aspiration thromboembolectomy catheter].
A thrombotic occlusion of the femoral artery with a history of 16 days is recanalized using the Rotational-Aspiration-Thromboembolectomy catheter according to Starck. The underlying stenosis is treated by balloon dilatation.
Angiography, Digital Subtraction↗
[Care of patients following coronary bypass surgery from the internist's viewpoint].
Follow-up of bypass patients in the early postoperative phase involves the management of complications such as perioperative myocardial infarction, postoperative arrhythmias, pericarditis, postcardiotomy-syndrome, fever, infection and chest pain. The longterm management has to focus on changes in lifestyle with particular regard to risk factors for coronary atherosclerosis. Diagnostic tools for work-up of postoperative chest pain include stress testing and radionuclide techniques; ultrafast computerized tomography is superior in the evaluation of bypass function to cine-NMR. Conventional angiography is still the only method to reliably visualize graft patency and anastomotic sites. Indications for reoperations can be well defined.
Arrhythmias, Cardiac↗
[Percutaneous atherectomy of the pelvic and leg arteries].
Percutaneous atherectomy, using a Simpson atherectomy catheter, was performed in 70 patients (43 men, 27 women) whose average age was 72 years (range 42 to 87 years). Between June 1988 and July 1989 all patients with disease in suitable localisations were treated in this way. The Doppler sonographic index before treatment was 0.6 (SD = 0.15), after treatment 0.89 (SD = 0.13). Recurrence was 21% after six months and 29% after twelve months. Atherectomy is superior to balloon dilation in the treatment of solitary eccentric stenoses of the superficial femoral artery and of the popliteal artery.
Adult↗
[The value of Doppler echocardiography findings in selecting patients with aortic stenosis for surgical intervention].
Doppler echocardiographic and catheter measurements of pressure gradients were compared in 29 patients (61 +/- 11 a) with isolated aortic stenosis. In addition we retrospectively evaluated which easily obtained Doppler echocardiographic parameters might indicate severe aortic stenosis requiring surgery. Catheter-derived peak to peak and mean gradients correlated well with maximum systolic Doppler gradient (r = 0.78, p less than 0.01) and mean Doppler gradient (r = 0.73, p less than 0.01). Using the continuity equation, the aortic valve area was assessed in 14 patients by Doppler echocardiography. A good correlation was found with catheter-determined aortic valve area (r = 0.83, p less than 0.01). Surgical intervention was recommended in 19 patients after left heart catheterisation. Doppler determined maximum transvalvular flow velocity (Vmax.) was greater than 4.5 m/s in 10 patients, all ultimately considered to be surgical candidates. None of the 7 patients with Vmax. less than 3.8 m/s proved to have critical aortic stenosis. In 12 patients Vmax. was between 3.8 and 4.5 m/s. In this group aortic valve replacement was advised in 9 patients after catheterisation. In 5 surgical candidates echocardiography showed reduced left ventricular function (systolic shortening fraction less than 0.27). Hence, the Doppler derived peak flow velocity greater than 4.5 m/s or peak flow greater than 3.8 m/s in the presence of reduced left ventricular function indicate severe aortic stenosis requiring surgery.
Aortic Valve Stenosis↗
[Value of myocardial scintigraphy of coronary anomaly in the differential diagnosis of pediatric cardiomegaly].
The differentiation between anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and other causes of cardiomegaly and thereby the decision to operate, as opposed to undertaking conservative therapy is often extremely difficult in clinical practice. Electrocardiographically, signs of myocardial infarction can be missed in ALCAPA, other forms of dilative cardiomyopathy (DCMP) often showing similar clinical features. Up to now aortography alone can make a clear-cut distinction between these two entities. In order to determine the diagnostic value of thallium-201 myocardial scintigraphy in ALCAPA, we investigated 18 children, 7 of them with angiographically or autoptically established ALCAPA and 11 patients with DCMP. The coronary artery anomaly was diagnosed on the basis of the typical myocardial perfusion defects in only 3 of the relevant 7 patients. In 9 of the 11 patients with DCMP ALCAPA was excluded by the homogeneous perfusion pattern or small focal reduction in thallium-201 activity in the left ventricular muscle mass. In view of the overall disappointing results of this method in achieving a specific diagnosis in ALCAPA, all patients with DCMP with or without suspected fibroelastosis should undergo invasive diagnosis with aortography.
Adolescent↗
[Thrombolytic therapy of acute myocardial infarct: which drugs? Which patients?].
The efficiency of thrombolytic therapy in acute myocardial infarction has been documented in a large number of studies. The reduction of mortality has been shown for streptokinase (SK) and APSAC and various combinations (SK and aspirin). The recanalisation-rate is higher for rtPA as is the reocclusion-rate. Major bleeding complications are similar for all agents. However, the incidence of intracranial bleedings seems to be higher with rtPA; thus the cost-effectiveness for the tissue plasminogen activators is questionable. Attempts are made to focus on the implications of the major clinical trials for the therapeutic strategy in different patient-groups.
Fibrinolytic Agents↗
The inducibility of coronary artery spasm after successful PTCA.
An ergonovine test (0.2 mg ergonovine i.v.) was performed on 32 consecutive patients showing a good long-term result 3 to 6 months after successful PTCA. In seven patients (22%) a significant spasm could be induced. Six of the seven patients complained of atypical chest pain as compared to two of 25 patients with a negative test. This difference was statistically significant (P less than 0.01). These results implicate that a higher vasomotor tone at the site of previous stenosis is responsible for atypical chest pain in patients after successful PTCA and good angiographic long-term follow-up. The application of long-term nifedipine and nitroglycerin in this patient group seems to be indicated.
Adult↗
[Calcinosis of the mitral valve system and its effect on valve function. A Doppler echocardiography study].
Non-inflammatory calcific disease of the mitral valve apparatus is a common finding in elderly patients. This study describes the incidence, clinical findings and location of mitral calcium deposits detected by 2D-echocardiography in an unselected series of patients referred for echocardiography to a general hospital. In addition, valvular function was assessed by Doppler sonography. In 48 out of 217 consecutive patients, 2D-echocardiography showed mitral calcium deposits. The mean age of this patient group was 72 +/- 11 years. Clinical histories and findings in most patients indicated an association between calcium deposits and increased tension of valve structures by left ventricular pressure overload (i.e., hypertension, aortic stenosis), dilatative cardiomyopathy or valve prolapse. Calcific deposits were located predominantly at the posterior mitral ring, but in 48% of our patients calcification of mitral chordae was also seen. Mitral regurgitation was detected by Doppler sonography in 52% of the patient group, in 25% at least moderate mitral regurgitation could be demonstrated. The presence of valve incompetence was not dependent on the location of calcium deposits. Mitral valve area, as assessed by Doppler, ranged from 2.1 to 6.7 cm2.
Aged↗
[Atypical clinical course of thoracic aortic dissection with subacute pericardial hemorrhage].
A case of dissecting aortic aneurysm is reported which occurred without significant pain but was complicated by a subacute pericardial bleeding leading to a large pericardial effusion. The patient was hospitalized because of clinical signs of cardiac tamponade which could be alleviated by pericardiocentesis. Neither 2D-echocardiography nor a portable x-ray of the chest disclosed evidence of aortic dissection. After a symptom-free interval of several hours the patient died because of recurring intractable pericardial tamponade. The differential diagnosis of a large hemorrhagic pericardial effusion should include rupture of a dissecting aortic aneurysm even when typical symptoms are lacking.
Acute Disease↗
Non-invasive diagnosis of coronary artery disease: what must be available to the referring physician?
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Coronary Angiography↗
Relation of coronary arterial occlusion pressure during percutaneous transluminal coronary angioplasty to presence of collaterals.
To investigate the relation of the gradient across a coronary artery stenosis and the pressure distal to the stenosis after proximal occlusion during percutaneous transluminal coronary angioplasty to the amount of angiographically estimated collateral circulation, 63 patients (55 men, 8 women) were studied. All patients had 1-vessel disease (54 left anterior descending, 8 right coronary artery and 1 circumflex coronary artery). All patients had documented ischemia, and angioplasty was carried out within 4 weeks after the initial angiogram. The patients were separated into 4 groups: 0 = no collaterals (35 patients), +1 = just visible collaterals (8 patients), +2 = collaterals without reaching the contralateral vessel (10 patients), and +3 = filling of the contralateral vessel (10 patients). There was no difference in age among the 4 groups. There was a significant negative relation of the gradient vs the extent of collateral circulation, although the degree of stenosis increased significantly from group 0 to group +3. There was a significant positive relation of the occlusion pressure (in absolute terms and in percent of the proximal systolic pressure) vs the extent of collateral circulation. There was a significantly smaller change of the occlusion pressure vs the distal pressure before occlusion if good collaterals were present. The occlusion pressure remained constant during 1 occlusion up to 40 seconds and was reproducible in 3 successive occlusions. In conclusion, the pressure distal to a coronary artery stenosis is mainly dependent on the severity of the stenosis and on the collateral flow. If anterograde flow is eliminated by proximal occlusion the distal pressure is only dependent on the extent of collateral circulation.
Adult↗