Bail-Out of Stent Jail: Stent Delivery Through Stent Struts.

Stent deployment in a lesion with a large side branch is an example of the potential limitation of intracoronary stents, especially the Palmaz-Schatzª stent with its tubular slotted design. This case study describes a patient in whom a Palmaz-Schatz stent of excessive length covered the origin of a side branch (Òstent jailÓ). Thrombus developed in the jailed branch as well as in the main vessel, causing abrupt vessel closure and impending acute myocardial infarction within one hour after the procedure.

[The immediate and midterm results of percutaneous mitral valvuloplasty in subjects over 60].

We have analyzed the immediate and mid-term (1 and 2 years) results of percutaneous mitral valvuloplasty (PMV) by Inoue's catheter in 97 patients < 60 years (Group A) compared with 34 patients > 60 years (Group B). In 61% Group A the patients were in NYHA functional class II, 36% in III, and 3% in I; in Group B, 56% of the patients were in NYHA functional class III, 38% in II, and 6% in IV. Mean mitral valve area was 1.

[Percutaneous mitral valvuloplasty in patients who have undergone surgical commissurotomy].

Percutaneous mitral valvuloplasty (PMV) was performed with Inoue's catheter, by anterograde approach, in 19 patients (2 males and 17 females, mean age of 56 +/- 13 years) with restenosis after surgical commissurotomy. Mean valvular area increased from 1.2 +/- 0.

[Value of intraoperative transesophageal echocardiography during repair of thoracic aorta dissection].

The study was designed to assess the diagnostic accuracy and usefulness of intraoperative transesophageal echocardiography (TEE) during repair of aortic dissection. To this end, 32 patients with ascending aortic dissection, undergoing replacement of the ascending aorta, were examined. The diagnosis was validated in each case by intraoperative and/or autopsy findings.

Predictors of short term clinical and angiographic outcome after coronary angioplasty for acute myocardial infarction.

Unlabelled: Coronary angioplasty is an effective method to achieve myocardial reperfusion in acute myocardial infarction (AMI). We reviewed our experience in 132 patients (pts) who underwent percutaneous transluminal coronary angioplasty (PTCA) of a totally occluded infarct-related artery (IRA) within 24 h after the onset of symptoms (mean delay 10 +/- 7 h), in order to identify the predictors of primary success and of major complications. PTCA was successfully performed in 113 patients (86%).

Cardiac iron overload in thalassemic patients: an endomyocardial biopsy study.

Secondary heart failure induced by organ siderosis is the main cause of death in patients affected by thalassemia major. At present it cannot be predicted whether heart siderosis is correlated with iron overload and little is known about the real cardiac histological pattern of post transfusional hemochromatosis in patients with thalassemia major and intermedia. The study aim was to evaluate cardiac iron overload by non invasive and invasive techniques.

[Diagnostic accuracy of transesophageal echocardiography in the diagnosis of aortic dissection: comparison with computerized axial tomography].

This study was designed to assess the sensibility, specificity and diagnostic accuracy of transesophageal echocardiography (TEE) and X-ray contrast enhanced computed tomography (CT) in the diagnosis of aortic dissection and its complications. Fifty patients with clinically suspected aortic dissection were examined. Imaging results were validated in each case by intraoperative and/or autopsy findings and/or the results of cineangiography.

[Coronary angioplasty during acute myocardial infarction].

Background: Percutaneous coronary angioplasty (PTCA) is an effective method to achieve myocardial reperfusion in acute myocardial infarction. In order to identify the predictors of primary success and major complications, we reviewed our experience in 107 patients (pts) who underwent PTCA of a totally occluded infarct-related coronary artery (IRA) within 24 hours (h) after the onset of symptoms.

Methods And Results: PTCA was successful in 92 pts (86%); PTCA failed without complications in 9 pts (8.

Right coronary artery subselective angiography with a 5-French catheter mimicking a coronary arteriovenous fistula.

We report the case of a 58-year-old woman who underwent outpatient coronary angiography with 5F catheters for atypical chest pain. Superselective angiography of a right superior septal artery mimicked a coronary arteriovenous fistula. Appropriate placement of the catheter in the ostium of the right coronary artery excluded the suspected anomaly.

[Coronary recanalization in acute myocardial infarction: early coronary angiography].

In acute myocardial infarction the early patency of the infarct-related artery is positively correlated with improved left ventricular function and survival. Coronary artery reperfusion is commonly achieved by intravenous administration of thrombolytic agents. Methods of mechanical recanalization, mainly percutaneous transluminal coronary angioplasty (PTCA), have been proposed and tested as alternative or adjunctive ways to thrombolysis.

[Echocardiography in the early diagnosis of acute rejection in patients with heart transplant].

The aim of our study was to assess the sensibility and specificity of Doppler echocardiographic evaluation of left ventricular diastolic function during acute cardiac rejection. We studied 34 patients who had undergone a recent heart transplant and compared the echocardiographic results with the histologic findings. We considered the following parameters of left ventricular filling: early peak of mitral flow velocity; pressure half-time (PHT); isovolumic relaxation time (IVRT).

Initial experience with the Europass: a new ultra-low profile monorail balloon catheter.

One of the causes for percutaneous transluminal coronary angioplasty (PTCA) failure is the inability to cross the lesion with the balloon catheter after guidewire positioning. The Europass coronary angioplasty catheter is a monorail Duralyn balloon catheter developed to enhance lesion crossability and to overcome this limitation. This system was evaluated in 50 patients in which target lesions were chronic total coronary occlusions (12 cases) or stenoses that could not be reached or crossed by other new monorail balloon catheters.

Rotational coronary atherectomy with adjunctive balloon angioplasty for the treatment of ostial lesions.

Conventional balloon angioplasty (PTCA) of ostial lesions (OL) is associated with suboptimal results and a higher complication rate. Partial plaque ablation with rotational atherectomy (RA) before PTCA might improve results. This approach was used in 63 patients (pts) (mean age 64 +/- 10 yrs; 44 men, 19 women) with 69 OL.

[Preliminary experience in the treatment of complex stenosis in the aged (> or = 70 years) with high-speed rotational atherotomy followed by conventional PTCA].

Rotational coronary atherectomy with adjunctive balloon angioplasty was performed in 36 patients older than 70 years. Previous myocardial infarction, coronary angioplasty and coronary artery bypass were present in 44%, 11% and 14%, respectively. Thirty-six percent and 33% of patients presented stable and unstable angina pectoris, respectively.

[Short-term efficacy of high speed rotational atherectomy with and balloon angioplasty in the treatment of lesions located at the ostium of a coronary branch].

In the treatment of branch-ostial lesions (BOL) balloon angioplasty (PTCA) is associated with suboptimal results and a higher complication rate. Rotational atherectomy (RA) before PTCA might improve results. This approach was used in 37 patients (mean age 62 +/- 10 years; 27 men, 10 women) with 42 BOL.

Role of the different percutaneous revascularization techniques in single and multivessel coronary artery disease.

Over the past 16 years coronary angioplasty has become an established therapy for coronary artery disease. Advances in technology and growing operator experience have improved initial success rates, lowered the complications associated with coronary angioplasty and expanded the indications of percutaneous revascularization to include large numbers of patients with complex lesions. The mechanisms of coronary angioplasty include plaque fracture, intimal atherosclerotic flaps, localized medial dissection and stretching of plaque-free segments.

[Mitral valvuloplasty: immediate results and 2-year follow-up].

Since May 1991 to July 1993, 121 patients (mean age 50 +/- 13 years, 23 males and 98 females) underwent 122 percutaneous mitral valvuloplasty according to Inoue's technique. Following Wilkins criteria the indications for the procedure were given on the basis of the echo-score (ideal cases with score < or = 8). Echo-score was > 8 in 59 patients (49%), and < or = 8 in 62 (51%); 19 patients (16%) had previous surgical mitral commissurotomy and 36 (30%) had previous embolic events.

[Imaging in atherosclerosis: coronary arteriography].

Arteriography is still today the best imaging technique to evaluate coronary atherosclerosis. Some limitations have nonetheless been documented by pathologic studies (underestimated lesions), and by physiologic studies (poor correlation between stenosis and coronary flow reserve). Such limitations are due to the nature of the technique, as it provides the "silhouette" of the artery lumen, but does not provide any information on the artery wall, where the atherosclerotic plaque is located.

[Percutaneous valvuloplasty in mitral stenosis].

Since May 1991 to July 1992, 83 patients (mean age 49 +/- 13 years, 17 males and 66 females) underwent percutaneous mitral valvuloplasty according to Inoue's technique. Following Wilkins' criteria echo-score was < or = 8 in 46 patients and mono-commissural calcifications were present in 8 cases. Sixteen (19%) patients had previous surgical mitral commissurotomy and 15 (18%) had previous embolic events.

Differences in the time course of the effects of oophorectomy in women on parameters of bone metabolism and interleukin-1 levels in the circulation.

Interleukin-1 is a cytokine with bone-resorbing activity which is claimed to play a role in the pathogenesis of osteoporosis and of post-oophorectomy bone loss. We measured plasma levels of interleukin-1 (IL-1) in 16 women who underwent hysterectomy and bilateral oophorectomy and in 12 women with hysterectomy alone before surgery and 7, 15, 30, 45 and 60 days after surgery. Only oophorectomized patients showed a significant increase of circulating interleukin-1 levels.

Intracardiac extension of a calcified ovarian hemangioma--a case report.

The authors report a case of a fifty-five-year-old woman with clinical and echocardiographic diagnosis of right atrial myxoma. At fluoroscopy and phlebography a mobile calcified peduncle was appreciable originating from the left ovarian vein. This passed through the inferior cava to the right atrium where it wound round itself and extended into the right ventricle during diastole.

Transient myocardial ischemia stimulates atrial natriuretic factor release.

Atrial natriuretic factor release during transient myocardial ischemia was investigated in 29 patients with coronary artery disease and symptoms of angina (Canadian Cardiovascular Association classes II-III). Eleven patients (group I) underwent single-vessel percutaneous transluminal coronary angioplasty. Repeat determinations of mean pulmonary artery wedge pressure and blood sampling from pulmonary artery for atrial natriuretic factor measurements were performed at baseline, and at 2, 5, and 15 minutes after percutaneous transluminal coronary angioplasty was begun.