Successful use of transvenous atrial and bifocal left ventricular pacing in Ebstein's anomaly after tricuspid prosthetic valve surgery.

A 62-year-old woman with Ebstein's anomaly and a tricuspid valve prosthesis underwent placement of a permanent atrioventricular pacemaker to treat highly symptomatic sinus node dysfunction and atrioventricular block. Transvenous bipolar leads were placed in the anterior cardiac and lateral coronary veins and were set to optimal ventricular pacing parameters to preserve prosthetic valve function, back-up ventricular pacing, and maintain atrioventricular and interventricular synchrony. An atrial septal lead was placed to control atrial pacing.

Severe rhabdomyolysis associated with the cerivastin-gemfibrozil combination therapy: report of a case.

Cerivastatin is the new 3rd-generation of the synthetic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, the 1st drugs of choice for treating hypercholesterolemia. A potent inhibitor of HMG-CoA reductase, it possesses a high affinity for liver tissue and decreases plasma low-density lipoprotein cholesterol at microgram doses. Cerivastatin produces reductions in low-density lipoprotein cholesterol of 31.

Percutaneous treatment of life-threatening congenital arteriovenous malformations with the Wallgraft endoprosthesis.

Purpose: To report the percutaneous endovascular repair of massive congenital arteriovenous malformations (AVMs) of the right arm complicated by tissue ischemia, severe edema, and life-threatening recurrent hemorrhagic episodes.

Methods And Results: A 25-year-old man with a 3-year history of symptomatic upper right arm AVMs had been treated unsuccessfully with surgical ligation and coil embolization. The arm had become massively enlarged, disfigured, severely painful, and unusable, with extension of swelling to the upper chest.

Endoluminal exclusion of an iliac artery aneurysm by Wallstent endoprosthesis and PTFE vascular graft.

Aneurysms isolated in the iliac artery and measuring more than 3 cm in diameter are associated with an increased rate of rupture and a high mortality rate. The current therapy recommended for such aneurysms is surgical exclusion. Percutaneous exclusion of isolated iliac aneurysms with covered or uncovered stents, however, reduces the morbidity and mortality rates associated with surgery by obviating the need for general anesthesia, avoiding significant blood loss, and reducing in-hospital recuperation time.

Gianturco-Roubin stent placement for variant angina refractory to medical treatment.

A 43-yr-old man with mild, fixed obstruction of the left anterior descending (LAD) coronary artery and severe, uncontrolled variant angina underwent placement of an endovascular stent to preserve patency of the artery. The decision for stent placement was based on several factors, including refractoriness to medical treatment and standard balloon angioplasty, documented spasm localized to the proximal LAD lesion, and the morbidity, mortality, and costs associated with the surgical approach in this type of patient. At follow-up, there was moderate restenosis of the stented coronary segment; the vasospastic angina syndrome had totally resolved.

Relation between procedural activated coagulation time and outcome after percutaneous transluminal coronary angioplasty.

Objectives: The purpose of this study was to determine whether a low procedural activated coagulation time is associated with a high rate of in-hospital complications and to identify whether there is an activated coagulation time range that may be associated with a low rate of complications.

Background: In recent years the activated coagulation time has come into widespread use for monitoring anticoagulation in the catheterization laboratory. However, considerable controversy exists as to the standards by which to judge "adequate" anticoagulation for interventional procedures.

Activated clotting times and activated partial thromboplastin times in patients undergoing coronary angioplasty who receive bolus doses of heparin.

The accurate assessment of coagulation status is an important part of interventional procedures performed in the cardiac catheterization laboratory. While the traditional clinical means of assessing heparin anticoagulation has been with the activated partial thromboplastin time (APTT), the activated coagulation time (ACT) has come into widespread use in the catheterization laboratory as an assay of whole blood clotting time which can be performed rapidly at the bedside. The purpose of the present study was to (1) assess the anticoagulant effect of a 10,000 U bolus of heparin in PTCA patients and (2) document the relationship between ACTs and APTTs in a subset of these patients.

Lower extremity pain after sexual intercourse: a case report of embolization due to femorofemoral bypass graft occlusion.

We describe a case of recurrent thromboembolism to the femoral-popliteal circulation in a patient with prior femorofemoral bypass graft placement. Two separate embolic events occurred, each within a short time after sexual intercourse. Normal circulation to the lower extremity was restored via percutaneous laser-assisted balloon angioplasty, but the source of emboli was corrected surgically via removal of the occluded femorofemoral graft.

Peripheral laser-assisted balloon angioplasty. Initial multicenter experience in 219 peripheral arteries.

In this multicenter clinical series of peripheral laser-assisted balloon angioplasty with an argon laser-heated, metallic-capped fiberoptic, angiographic and clinical success was achieved in a total of 155 (71%) of 219 attempted lesions. When the anatomy of the lesion was subjectively categorized by the angiographer into those considered possible or impossible to treat by conventional balloon angioplasty, clinical success was achieved in 116 (78%) of 149 lesions considered possible to treat with balloon angioplasty (39 [95%] of 41 stenoses and 77 [71%] of 108 occlusions). More importantly, clinical success was achieved in 39 (56%) of 70 lesions considered impossible to treat by conventional means.

Percutaneous transluminal coronary angioplasty after cardiac transplantation.

This report describes the 1st use of percutaneous transluminal coronary angioplasty in a posttransplant patient at the Texas Heart Institute. The patient, a 44-year-old man, experienced 3 episodes of moderate allograft rejection, hypercholesterolemia, transient severe hyperglycemia, and transient severe renal insufficiency in the posttransplant period. His cholesterol levels became elevated immediately and remained between 200 and 250 mg/dL, despite treatment with gemfibrozil.

Hot-tip laser angioplasty: a review of the Texas Heart Institute experience.

At the Texas Heart Institute, from October 1986 to October 1988, laser thermal angioplasty was used in conjunction with balloon angioplasty for treatment of 201 atherosclerotic vascular lesions in 162 patients. All patients had significant symptoms or impending limb loss. Most of the occlusions (148) were located in the superficial femoral artery; the clinical success rate in those cases was 80%.

Use of mechanical devices for distal hemoperfusion during balloon catheter coronary angioplasty.

Previous attempts to protect the dependent myocardium during balloon catheter coronary angioplasty in animals and humans have had generally unsatisfactory results. This paper summarizes the authors' experience in investigating commercially available mechanical pumps for distal coronary hemoperfusion during balloon angioplasty. Both roller and piston pumps can attain adequate distal perfusion without significant side effects in the majority of patients.

Distal hemoperfusion during percutaneous transluminal coronary angioplasty.

During percutaneous transluminal coronary angioplasty (PTCA), the ability to maintain balloon inflations for 3 to 5 minutes, as opposed to the usual 30 to 60 seconds, may lead to improved early and late results. To determine the feasibility and clarify the advantages of distal hemoperfusion during PTCA, blood from the renal vein was manually sampled and then reinjected through the pressure port of the coronary balloon catheter during sustained balloon inflations in 3 patients. By supplying the periphery of the left anterior descending coronary artery with flows of 30 to 50 ml/min, ischemic manifestations were suppressed in all 3 cases.

Evaluation of postextrasystolic T wave alterations in identification of patients with coronary artery disease or left ventricular dysfunction.

This study was performed (1) to assess the value of postextrasystolic T wave alterations in identification of patients with cardiac disease and (2) to determine if their frequency depends on length of compensatory pause. In 52 patients a pacing catheter was placed in the right ventricular (RV) apex, and premature beats were programmed to occur 30 msec beyond RV refractory period. Postextrasystolic T wave alterations occurred in 32 patients, 13 with an 19 without coronary artery disease (CAD) (NS).