ABSTRACT
We report a case of coronary embolism in a 63-year-old woman with St. Jude aortic and mitral valve replacements who presented with acute myocardial infarction. Urgent catheterization revealed a saddle embolus in the proximal part of the circumflex and ramus arteries and another embolus in a diagonal branch. After employing angioplasty for the totally occluding diagonal embolus, a combined regimen of intracoronary urokinase and intravenous abciximab was successful in achieving complete resolution of the emboli.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Coronary Thrombosis/drug therapy , Heart Valve Prosthesis Implantation , Immunoglobulin Fab Fragments/therapeutic use , Plasminogen Activators/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Postoperative Complications , Urokinase-Type Plasminogen Activator/therapeutic use , Abciximab , Aortic Valve/surgery , Coronary Angiography , Coronary Thrombosis/diagnostic imaging , Female , Humans , Middle Aged , Mitral Valve/surgeryABSTRACT
A patient who developed a pseudo-, or false, aneurysm following mitral valve replacement is presented here with the unique angiographic finding of systolic compression of the right coronary artery by the pseudoaneurysm. Clinical and angiographic features of this case along with a discussion of pseudoaneurysms and the significance and causes of systolic compression of coronary arteries are presented.
Subject(s)
Coronary Aneurysm/diagnosis , Coronary Vessels/pathology , Heart Valve Prosthesis/adverse effects , Adult , Catheterization, Peripheral , Diagnosis, Differential , Humans , Male , Mitral Valve Insufficiency/surgery , Postoperative ComplicationsABSTRACT
Angioplasty is most commonly performed with catheters introduced percutaneously into the femoral artery. A brachial approach has previously been described that employs arteriotomy and cutdown. We describe here the technique and initial results of an alternative method of brachial entry, wherein the catheter is introduced percutaneously. Angioplasty has been performed in 26 patients in this manner, without complications.
Subject(s)
Angioplasty, Balloon/methods , Brachial Artery , Adult , Aged , Humans , Male , Middle AgedSubject(s)
Aortic Valve Stenosis/therapy , Catheterization , Aged , Aortic Valve Stenosis/physiopathology , Calcinosis/therapy , Female , Hemodynamics , HumansSubject(s)
Brachial Artery , Cardiac Catheterization/methods , Adolescent , Adult , Aged , Cardiac Catheterization/adverse effects , Coronary Angiography , Female , Humans , Male , Middle AgedABSTRACT
The trichothecene mycotoxin, T-2, is responsible for a wide range of human diseases and animal toxicoses and is known to cause hemolysis of erythrocytes, over time. In order to determine the initial, prehemolytic effect of T-2 toxin on the red cell, we analysed the osmotic deformability pattern using the ektacytometer. After a lag period of 10-60 minutes, hemolysis of T-2 treated red cells is associated with a loss of deformability. During this lag phase there is echinocytosis but no hemolysis. Concurrent with production of echinocytosis there is an initial left shift of the osmotic deformability profile so that the points of maximum and minimum deformability occur in solutions of lower osmolality than normal. The elongation index is also increased. This pattern, one of increased surface area and/or reduced volume (cellular dehydration), represents the initial effect of T-2 toxin on the red cell and is transient. Very quickly, the deformability profile returns to normal, then shifts to the right with a subsequent decrease in elongation index as hemolysis ensues. These changes are independent of the presence of Ca++ and Mg++ and reduced cellular levels of ATP. The findings are consistent with T-2 toxin interacting directly with the cell membrane.
Subject(s)
Erythrocyte Deformability/drug effects , Sesquiterpenes/pharmacology , T-2 Toxin/pharmacology , Adenosine Triphosphate/analysis , Calcium/pharmacology , Erythrocyte Indices/drug effects , Erythrocyte Indices/instrumentation , Erythrocyte Membrane/drug effects , Female , Hemolysis/drug effects , Humans , Magnesium/pharmacologyABSTRACT
Left heart catheterization via percutaneous entry of the brachial artery was attempted in 1,783 cases. A plain sheath without valve or side-port was employed and 7 and 8 French Sones catheters were used for females and males, respectively. Successful performance of the procedure was achieved in 96.5% of the cases. Brachial artery occlusion occurred in 1.3% of the cases and was readily correctable. There were no major complications attributable to the method of brachial artery entry. This technique has advantages over the standard Sones technique employing cutdown and arteriotomy, and may be the preferred method of left heart catheterization by way of the upper extremity.
Subject(s)
Brachial Artery , Cardiac Catheterization/methods , Adolescent , Adult , Aged , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Female , Humans , Male , Middle AgedABSTRACT
The occurrence of fever (daily maximal temperature greater than or equal to 38 degrees C) was analyzed in 123 patients after open-heart operation. A statistical difference was found in the incidence of fever after the third postoperative day between patients without infection and patients with bacteremia, wound infection, or pneumonia. Fever after the third day should prompt a diligent search for deep-seated infection.
Subject(s)
Bacterial Infections/complications , Cardiac Surgical Procedures , Fever/complications , Female , Humans , Male , Pneumonia/complications , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Sepsis/complications , Surgical Wound Infection/complications , Time Factors , Urinary Tract Infections/complicationsABSTRACT
Percutaneous entry of the brachial artery using a sheath system has been attempted in 223 patients undergoing left heart catheterization; successfully, in 212. After arterial puncture, a dilator and sheath are passed over a short guidewire. A number 7-80 cm Sones specially stiffened coronary catheter is passed through the sheath, and left heart catheterization is performed in the usual manner. The study can usually be completed with this single catheter. Initial entry, as well as any needed catheter change, is facilitated by the use of an inflatable sphygmomanometer cuff around the upper arm. Ease of manipulation and patient comfort have been satisfactory, and brachial artery spasm has not been encountered. There have been no major complications and a low incidence (approximately 15%) of brachial arterial occlusion.
