Catheterization and cardiovascular diagnosis最新文献

Extraction atherectomy utilizes suction aspiration as an attempt to limit distal emboli during atherectomy. We sought to test the hypothesis that extraction atherectomy produces less distal embolization than balloon angioplasty when treating saphenous vein grafts. Among 163 consecutive, nonrandomized patients, 103 patients underwent transluminal extraction catheter (TEC) atherectomy with or without adjunctive balloon angioplasty, and 60 patients had conventional balloon angioplasty. Both groups showed comparably high procedural success rates (TEC 90.3%, angioplasty 83.3%, P = NS). TEC cases had a significantly lower incidence of angiographic distal embolization, compared with angioplasty (3.9% vs. 16.7%, P = 0.005). In cases with angiographic evidence of thrombus in the grafts, TEC maintained a significantly lower incidence of distal embolization than angioplasty (5.6% vs. 31.8%, P = 0.004). There were no statistical differences between the two groups regarding the incidence of other procedure-related complications, including death, myocardial infarction, or emergency coronary artery bypass grafting. TEC atherectomy appears to have a significantly lower incidence of distal embolization than balloon angioplasty when treating saphenous vein grafts, particularly in the presence of angiographically apparent thrombus.

We describe the development of hemolysis from moderate residual shunting across a patent ductus arteriosus following coil embolization. The fall in hemoglobin levels from 11.6 to 6.0 gm/dl necessitated a second coil procedure which resulted in complete closure of the residual shunting and resolution of hemolysis. Therefore, appearance of anemia following coil embolization of patent ductus arteriosus should be monitored closely; however, repeat coil embolization with elimination of residual shunt will lead to prompt recovery of normal hemoglobin levels.

Thrombosis of a tilting-disk prosthetic heart valve can be an acute and potentially life-threatening problem. Surgical thrombectomy, valve replacement, or systemic thrombolytic agents have been successfully employed in the management of such cases. Some patients, however, may not survive the acute episode long enough to receive definitive surgical therapy. For such patients, temporary hemodynamic stabilization might be achieved by re-establishing partial valve disk mobility. This report describes a technique for re-establishing valve disk mobility in an acutely compromised patient by using a percutaneously introduced "rigid" catheter to manipulate an entrapped tilting-disk valve in the aortic position.

Pseudo-aneurysm following diagnostic or interventional procedures is a well-recognized complication. Ultrasound guided compression repair is routinely used to close an uncomplicated pseudo-aneurysm. We describe a patient with a femoral artery pseudo-aneurysm following iliac angioplasty and stenting in which ultrasound guided compression repair failed. Pseudoaneurysm was successfully closed by transcutaneous coil embolization technique.

Chronic total left main coronary artery occlusion at angiography is very rare, and there are only four cases reported with concomitant total right coronary artery occlusion. We describe a case of total left main and proximal right coronary artery occlusion and review the clinical and angiographic characteristics of this condition which represents the most severe from of coronary artery disease compatible with life.

A young girl in whom a Palmaz stent embolized from the pulmonary artery to the right ventricle during a prior cardiac catheterization underwent successful retrieval and repositioning by a transcatheter technique 8 d later. This technique provides an alternative to surgery when intracardiac embolization of a stent occurs.

Guidewires can distort a tortuous vessel, creating the illusion of an intraluminal defect that does not exist. This case report demonstrates the changing severity of defects in the same vessel seen with two different types of guidewires varying in stiffness.

A patient with rheumatic mitral stenosis associated with cor triatriatum is described. The anomalies were detected by two-dimensional echocardiography and confirmed by transesophageal echocardiography. Percutaneous mitral valvuloplasty was successfully performed with the inoue technique. The clinical and technical implications during the procedure of this previously unreported association are discussed.

Extending a guidewire (ACS) with a "Doc" device not infrequently results in kinking of the proximal end of the guidewire, due to the fragile nature of the tapered proximal tip. Straightening the bent guidewire is accomplished easily with the use of two guidewire torque devices attached to both ends of the kinked connection.

Endoluminal stenting has often become the percutaneous treatment of choice for older vein grafts. We report a case of successful stenting of a degenerated vein graft that was complicated by prolapse of atheroma through the stents leading to ischemia that was successfully reversed by catheter aspiration of the prolapsed atheroma.