Catheterization and cardiovascular diagnosis最新文献

This study describes an alternative method of exchanging over-the-wire (OTW) angioplasty catheters over standard length coronary guide wires. Exchange was facilitated with a specially designed catheter stripper, Jaws (Microvena, White Bear Lake, MN). Jaws is a disposable instrument similar to an electrician's wire stripper whose cutting blades automatically center the wire before cutting the catheter shaft. One hundred seventy catheter exchanges were performed in 93 patients. Catheter extraction success was 99% and reinsertion success was 98%. Catheters were extracted by withdrawing the catheter to the proximal end of the wire and transecting the catheter shaft near the hemostatic valve. All catheters were extracted with two to three cuts. After catheters removal, another OTW, sliding rail, directional atherectomy, Cook, or J&J stent could be introduced over the standard 175 cm wire. In those situations where catheter reuse is unanticipated, Jaws exchange affords the operator a full range of catheter choices with the convenience and economy of using a standard length angioplasty guide wire.

Serial sampling from the coronary sinus is an attractive technique for drawing blood samples to be used in the characterization of procoagulant activity during coronary interventions. We have developed a modified Simmons catheter for rapid cannulation of the coronary sinus from the femoral approach. The catheter design incorporates heparin bonding and distal side-holes to minimize blood sampling artifacts. Coronary sinus cannulation was performed via the femoral approach in 186 patients by use of a multipurpose catheter (n = 8), an unmodified Simmons I or II catheter (n = 64), or the modified Simmons catheter (n = 114). The coronary sinus was cannulated successfully with the modified Simmons catheter in 97% of patients; the success rate with the unmodified Simmons II catheter was 87% (P = 0.02). The modified Simmons catheter represents an improved technique for cannulation of the coronary sinus from the femoral vein.

Allergic reactions, including anaphylactoid shock due to contrast material, are not uncommon. However, persistent anaphylactoid shock refractory to conventional therapy is rare. We present a case of refractory anaphylactoid shock during coronary angiography unresponsive to aggressive standard therapy in a patient on beta-blockers. Significant clinical improvement was noted upon administration of glucagon. Since beta-blockers are commonly used in patients with coronary artery disease, this potentially life-threatening complication has to be kept in mind with any procedure involving contrast media in patients on beta-blockers. Immediate access to glucagon by keeping it in the procedure room may be lifesaving in these situations.

Ten patients (median age 36 yr, 5 male) with idiopathic IVC obstruction underwent balloon angioplasty followed by placement of a self-expanding stent due to unfavourable lesion characteristics. Six had total occlusion, 5 had restenosis (including 2 with total occlusion), and 1 had a suboptimal result after initial dilatation. Median minimum IVC diameter increased from 0 to 14.5 mm, and the median gradient across the lesion decreased from 16.5 to 1 mmHg. Follow-up venography (median interval 69 d) in six patients revealed no restenosis with further enlargement at the lesion site (median 4.5 mm) and abolition of gradients. Follow-up ultrasound in nine patients revealed no restenosis in the IVC. One patient died 6 mo after the procedure with acute Budd-Chiari syndrome due to hepatic vein occlusion. Autopsy revealed a widely patent stent with hepatic vein thrombus. Stent implantation is useful in the management of IVC obstruction with prior restenosis, total occlusion, or suboptimal result of balloon angioplasty.

We describe a case of balloon angioplasty of a totally occluded left anterior descending coronary artery through a tortuous left internal mammary artery graft. Because of early recurrence of the lesion, we implanted a short Palmaz-Schatz stent with good angiographic and clinical results.

Intracoronary stenting as a transcatheter treatment for bifurcation stenoses remains controversial. A novel technique of coronary bifurcation stenting is reported. A 15 mm Palmaz-Schatz stent is bent 180 degrees at its bridge articulation into a V- configuration and mounted on two balloon-catheters linked together by adhesive tape. This unified stent delivery system was used successfully in five cases of porcine coronary bifurcation stenting.

We report a case of an anomalous right coronary artery arising from the morphological left sinus of Valsalva in a patient with Kartagener's syndrome. Literature review has revealed only a small number of cases of anomalous coronary arteries in patients with dextrocardia and none previously reported in Kartagener's syndrome.