ABSTRACT
Recanalization of totally occluded aortocoronary saphenous vein grafts with extraction atherectomy was successful in 80% of patients. Whereas all patients with unsuccessful procedures were dead at 1 year, 75% of those with successful procedures are alive and free of events.
Subject(s)
Atherectomy, Coronary/methods , Coronary Artery Bypass/methods , Graft Occlusion, Vascular/surgery , Saphenous Vein/transplantation , Aged , Coronary Disease/surgery , Follow-Up Studies , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Report of a case of a mycotic pseudoaneurysm of the ascending thoracic aorta occurring in the absence of surgical or blunt trauma in a patient who presented with purulent pericarditis. Surgical pericardial drainage was required, which revealed Staphlococcal aureus. Subsequent transesophageal echocardiogram demonstrated a 4 cm x 4 cm pseudoaneurysm of the posterior wall of the aorta above the sinotubular junction. The patient refused surgical correction of the aortic pseudoaneurysm and was successfully managed with antibiotic therapy.
Subject(s)
Aneurysm, False/complications , Aneurysm, Infected/therapy , Aortic Aneurysm, Thoracic/complications , Pericardial Effusion/etiology , Pericarditis/etiology , Staphylococcal Infections/complications , Aneurysm, False/diagnostic imaging , Aneurysm, False/therapy , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/therapy , Echocardiography, Transesophageal , Humans , Male , Middle Aged , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapyABSTRACT
Preangioplasty intravascular ultrasound in 81 patients showed that adaptive remodeling occurred in 35% and constrictive remodeling in 34%. Multivariate analysis showed that smoking and fibrocalcific plaques were associated with constrictive remodeling, whereas small vessel size and hypercholesterolemia were associated with adaptive remodeling.
Subject(s)
Coronary Vessels/physiopathology , Myocardial Ischemia/physiopathology , Aged , Coronary Vessels/diagnostic imaging , Coronary Vessels/pathology , Female , Humans , Logistic Models , Male , Middle Aged , Myocardial Ischemia/diagnostic imaging , Myocardial Ischemia/pathology , Risk Factors , Ultrasonography, InterventionalABSTRACT
A 38-year-old male presented with an acute anterior myocardial infarction. Immediate cardiac catheterization revealed no evidence of angiographically significant atherosclerotic coronary artery disease, but there was a subtotal occlusion of the mid-left anterior descending coronary artery from myocardial muscle bridging. The patient did well with medical management. This review details myocardial bridging and its treatment.
Subject(s)
Coronary Vessel Anomalies/complications , Myocardial Infarction/etiology , Adult , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Disease/etiology , Coronary Disease/pathology , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/physiopathology , Humans , Male , Myocardial Infarction/diagnosis , Myocardial Infarction/physiopathologyABSTRACT
High technology interventions near the end of life exact a high cost both in human and economic terms. Breathtaking advances in cardiology have helped to prolong life and improve its quality for many. For some, it has transformed the process of dying into a medical nightmare. The "do everything possible" attitude that prevailed during the past few decades is both inhumane and wasteful. In contrast, in the new era of managed care with its focus on profit, a well meaning physician may become suspect whenever he recommends against a medical intervention that he deems to be futile. More than ever before, there is a pressing need to develop rational guidelines for end of life medical interventions to ensure primacy of patients' best interests, protect the integrity of the doctor-patient relationship and affirm the duty of the medical establishment toward society at large. This weighty issue must not be relinquished to medical ethicists, health care alliances or the courts. It is the domain of physicians and the public at large. Medical futility should be defined as a treatment unlikely to affect the course of illness or that which has failed to achieve its desired effects. Rational guidelines for cardiopulmonary resuscitation and do not resuscitate orders should be formulated for both inhospital and out of hospital victims of cardiac arrest. These guidelines need to be developed through a process similar to those for the treatment of unstable angina, with involvement from all relevant medical specialities. Proposed guidelines must be negotiated, reviewed and ratified by the lay public. Appropriate legislation is necessary to establish the framework and policies to carry out agreed on recommendations. The focus of the "living will" should change so that it covers the last chapter of life rather than its terminal phase. The document should serve to express the person's wishes regarding specific medical interventions when the quality of life is seriously diminished beyond what is uniquely desirable for the particular patient. Living wills must be comprehensive, clear and specific. They must be honored. The Uniform Health Decisions Act, now pending legislation, should enhance the utility of the living will.