2271/2819. Left ventricular free wall rupture after coronary artery surgery. A patient who had undergone urgent coronary artery bypass grafting for unstable angina developed a fatal left ventricular free wall rupture in the early postoperative period. heart rupture following surgical revascularisation has not been reported before. ( info) |
2272/2819. Management of delirium associated with use of the intra-aortic balloon pump. Five patients who developed an agitated delirium in association with use of an intra-aortic balloon pump are presented. The differential diagnosis of delirium in critically ill cardiac patients is reviewed and effective pharmacologic treatment strategies (involving rapid and aggressive management with intravenous haloperidol) are discussed. ( info) |
2273/2819. pulmonary artery hemodynamic response to proximal balloon dilatation of a large dominant right coronary artery. The human right ventricle has a relatively low tolerance to even short periods of ischemia. During angioplasty of the right coronary artery, pulmonary artery pressure typically rises due to an increase in right ventricular afterload caused by left ventricular dysfunction during ischemia. We have presented two cases of angioplasty in the early proximal portion of a large, highly dominant right coronary artery. pulmonary artery and systemic pressure fell during balloon inflation probably secondary to acute severe right ventricular failure, though an interaction with left ventricular dysfunction cannot be excluded. These observations do emphasize the hemodynamic and combined ventricular consequences of proximal angioplasty in a large, dominant right coronary artery, particularly in the setting of preexisting left ventricular dysfunction. ( info) |
2274/2819. Transluminal extraction atherectomy and adjunctive balloon angioplasty for restenosis after Palmaz-Schatz coronary stent implantation. Two patients who developed restenosis after implantation of Palmaz-Schatz coronary stents were successfully treated by transluminal extraction atherectomy and there has been no recurrence on follow-up angiograms. The optimum strategy for managing restenosis after coronary stenting remains unclear, but transluminal extraction atherectomy appears to be a safe and effective option. ( info) |
2275/2819. Ventricular free wall and septal rupture (double rupture): a "pseudocomplication" during post-infarction laser angioplasty. We report the rare occurrence of double rupture of the myocardium occurring immediately following successful laser recanalization of an occluded right coronary artery in a 72-year-old woman 5 days following infero-posterior myocardial infarction. ( info) |
2276/2819. Closure of a coronary cameral fistula following endomyocardial biopsies in a cardiac transplant patient with a detachable balloon. Endomyocardial biopsy is the reference standard for the diagnosis of cardiac allograft rejection and is performed frequently in cardiac transplant patients. Biopsies are taken percutaneously via the right internal jugular or femoral vein. Fistulas from coronary arteries into the right ventricle following endomyocardial biopsies are a relatively frequent finding. Most of these fistulas are small angiographically, haemodynamically insignificant, and tend to disappear. We report a case of a haemodynamic significant coronary fistula, closed by a percutaneously introduced detachable balloon. ( info) |
2277/2819. Percutaneous transradial artery approach for coronary stent implantation. A new approach for implantation of Palmaz Schatz coronary stents is reported. We describe the technique and rationale of coronary stenting with miniaturized angioplasty equipment via the radial artery. This technique is illustrated in three patients. One patient underwent Palmaz Schatz stent implantation for a saphenous vene coronary bypass graft stenosis, the second patient for a restenosis in the anterior descending coronary artery after atherectomy, and the third patient for a second restenosis after balloon angioplasty in the circumflex coronary artery. ( info) |
2278/2819. coronary stenosis and steal phenomenon in coronary-pulmonary fistula--assessment with stress thallium tomography after coronary angioplasty and fistulectomy. We present a 46-year-old male with unstable angina and bilateral coronary-to-pulmonary artery fistulae in whom reversible myocardial ischemia was detected by exercise-stress thallium-201 single-photon emission computed tomography (SPECT). coronary angiography revealed a 99% stenosis at the proximal site of the left descending coronary artery and bilateral coronary-to-pulmonary artery fistulae with a saccular aneurysm. Percutaneous transluminal coronary angioplasty abolished chest pain and electrocardiographic changes. However, definitely improved, but still present, stress-induced perfusion abnormalities were demonstrated by an exercise-stress thallium-201 SPECT study. myocardial ischemia was the only serious complication related to the coronary fistulae, and after they were surgically resected, the reversible perfusion abnormality was no longer observed. These findings suggest that coronary-to-pulmonary artery fistulae potentiated the myocardial ischemia in patient with coronary stenosis leading to unstable angina and prolonged the presence of coronary perfusion abnormality on stress thallium scans probably through a coronary steal phenomenon. ( info) |
2279/2819. angioscopy: a valuable tool in the deployment and evaluation of intracoronary stents. Intracoronary stents were designed to improve balloon dilation results; however, to accomplish this, various criteria of optimal stent deployment must be met. Standard imaging techniques are neither sensitive nor specific enough for intraprocedural use in the verification of these implantation parameters. To assess the usefulness of angioscopy in the procedural and follow-up evaluations of Palmaz-Schatz and Strecker coronary stent deployment, 17 patients underwent angioscopy, 15 during stent placement and 2 during follow-up for stent restenosis. In the latter cases, thrombus formation was suspected; however, angioscopy showed tissue subtotally occluding the lumen without thrombus, so thrombolytic therapy was avoided. Similarly, among the 15 intraprocedural assessments, angioscopy disclosed intravascular thrombus unappreciated on angiography in two cases; another patient at high risk for intravascular thrombus was found not to have clot. In four patients, angioscopy disclosed residual narrowing in need of redilation at the Palmaz-Schatz stent articulation site. Thus in 9 (53%) of 17 stent patients, angioscopic findings either guided therapeutic selection or significantly modified the anticipated procedure. angioscopy offers important information critical to the accurate placement and evaluation of intracoronary stents. ( info) |
2280/2819. Case report: a case of multiple coronary artery to left ventricular communications. A 39-year-old man with anginal pain had multiple coronary artery to left ventricular communications. His electrocardiogram showed evidence of left ventricular hypertrophy, and an echocardiogram revealed a dilated left ventricle. A coronary angiogram revealed multiple coronary artery to left ventricular fistulae involving three major coronary arteries with no evidence of atherosclerotic lesions. Only 17 cases of such fistulous communications involving three major coronary arteries have been reported in the literature. It is suggested that the fistulous communications to the left ventricle was a cause of his angina pectoris, probably because of the coronary steal phenomenon. ( info) |