Coronary angioplasty in high risk patients with percutaneous cardiopulmonary support.

Cardiopulmonary Support (CPS) was employed electively in 13 patients during high risk percutaneous transluminal coronary angioplasty (PTCA) in accordance with a selection criteria, which included at least two of the following; (i) left ventricular ejection fraction of less than 35%, (ii) target vessel(s) supplying more than 50% of the viable myocardium, and (iii) patients refused coronary bypass surgery. The mean age of the patients was 56.8 +/- 10.7 years (range 39-77). PTCA was attempted in a total of 35 lesions in 12 patients; 29 lesions were successfully dilated (technical success rate of 82.9%). On average, 2.7 lesions were attempted in each patient, and 2.2 lesions were successfully dilated per patient. In one patient the procedure was abandoned due to dissection of the iliac artery during cannulation. One patient died of a large pulmonary embolism 72 h after the procedure. All the surviving 11 patients who had successful PTCA on CPS showed symptomatic improvement during a mean follow-up period of 18.5 +/- 4.3 months (range 11 to 24 months). The commonest complication encountered following the CPS-assisted PTCA was local haematoma (nine of 13 patients), but all patients required transfusion due to significant periprocedural blood loss. Our early experience suggests that CPS enhances the safety of undertaking PTCA in high risk patients.

Oesophageal motility, luminal pH, and electrocardiographic-ST segment analysis during spontaneous episodes of angina like chest pain.

The relation between oesophageal motility, luminal pH, and spontaneous pain events in 47 patients with recurrent angina like pain and normal coronary arteries was investigated. Preliminary investigation by conventional station pull through manometry (SPTM), was followed by a 24 hour period of ambulatory oesophageal motility and luminal pH monitoring. Computerised analysis of motility and pH data recorded during chest pain was then compared with pre-elected control samples taken before and after symptoms. Concurrent real time electrocardiographic (ECG)-ST segment analysis was performed to catalogue any ECG-STT wave changes indicative of myocardial ischaemia. SPTM showed a high group percentage incidence of simultaneous contractions (mean (SD) 11.1 (2.3)%) and a raised lower oesophageal sphincter tone (57.4 (15.2) mm Hg). During ambulatory monitoring, 35 patients experienced one or more episode of angina, providing a total of 59 pain events, although no significant change in group motility and reflux parameters peculiar to episodes of chest pain were found. Ischaemic ECG changes were detected in 10 (21%) patients, but were accompanied by pain in only two. Independent analysis of the ECG traces corresponding to these purported ischaemic ECG events determined them unequivocal in three patients and probable in a further two. No apparent correlation was noted, however, between these ECG events and corresponding patterns of motility or reflux.

A system for ambulatory monitoring and computerised analysis of oesophageal motility and luminal pH.

It is often desirable to monitor physiological events from subjects free to participate in their normal daily activities. This is especially so where clinical symptoms are elusive or precipitated by specific activities. Through ambulatory monitoring, evidence of a causal relationship between recorded parameters and the spontaneous onset of symptoms may be revealed. We describe an ambulatory monitoring system which permits continuous 24-hour recording of oesophageal motility from three levels within the oesophagus together with luminal pH. Computerised analysis of the recorded data addresses many of the problems associated with processing the information accrued through long-term monitoring by providing an automatic comparison of patient data against either preselected values or those of the program's algorithm. Motility is quantified in terms of wave frequency, amplitude, duration and temporal relationship together with an integration of the wave area and mean pressure baseline. The corresponding pH data is quantified as frequency, duration and integrated area of pH excursions throughout a range of pH1-8. This system provides access to the entire patient record which may either be viewed on screen, analysed or output to a printer. Analysis yields a tabulated breakdown of motility and pH events from any section of the patient's record. Selective analysis readily permits statistical comparison of discrete time-matched samples corresponding to different patient circumstances.