Forward slide maneuver: a new method of advancing the Rotablator system.

In performing coronary rotational ablation, advancing the Rotablator (Heart Technology, Redmond, WA) out of the guiding catheter and through a tortuous, non-compliant vessel to reach the target lesion may be difficult and sometimes impossible without activation of the drive proximal to the target lesion. We report a technique not previously described for advancing the Rotablator to the target lesion before activating the drive by simultaneously advancing the burr control knob (slide) and the Teflon catheter sheath. Ten of 14 burrs (71%) ranging in size from 1.5 to 2.15 mm were successfully advanced in nine of ten (90%) cases in which the burr could not be advanced in the usual fashion (traction on the guidewire while advancing the sheath).

Primary amyloid heart disease presenting as hypertrophic obstructive cardiomyopathy.

This report describes the unusual presentation of a patient with primary cardiac amyloidosis. Initial clinical symptoms and hemodynamic studies, including Technetium-99m-pyrophosphate scintigraphy, suggested hypertrophic obstructive cardiomyopathy, but endomyocardial biopsy revealed diffuse amyloid infiltration. Only two other cases of left ventricular outflow tract obstruction due to cardiac amyloidosis have been reported. The false-negative technetium-99m-pyrophosphate scintigram in this patient argues for the use of endomyocardial biopsy to aid in the diagnosis of left ventricular hypertrophy.