Post-infarction ventricular septal defect: percutaneous transvenous temporary closure using a Swan-Ganz catheter.

We report on a case of temporary closure of a post-infarction ventricular septal defect (VSD) using a Swan-Ganz catheter through a femoral transvenous approach. This resulted in substantial improvement in the hemodynamic status of the patient. Six hr later, the patient underwent surgery for VSD closure. When immediate surgical intervention is not possible, it may be helpful to stabilize the patient until surgery can be performed. Thus, such a treatment has potential as a temporary measure for patients awaiting surgical repair of post-infarction VSD.

Delayed appearance of distal coronary perforation following stent implantation.

Coronary perforations are usually apparent immediately after the occurrence. We report a case of a 67-year-old woman where coronary perforation presented 16 hours after the procedure. This case illustrates the need for extra vigilance and careful evaluation of distal vasculature while using stiff coronary guidewires.

Lack of evidence for improvement in internal mammary graft flow by occlusion of side branch.

Coronary steal due to unligated side branches of an internal mammary artery graft has been reported previously. Embolization of these side branches has been shown to result in symptomatic improvement, but objective evidence of improved flow to the coronary artery has been lacking. We studied intracoronary Doppler flow in a patient presenting with symptoms thought to be due to a large unligated side branch of mammary graft. There was no significant change in the mammary flow after balloon occlusion of the side branch. More objective data may be required to routinely prescribe side branch embolization for symptomatic patients with unligated side branches of a mammary graft.

Spontaneous regression of post-percutaneous transluminal coronary angioplasty aneurysm.

We report a case of a 67-year-old male with spontaneous regression of post-percutaneous transluminal coronary angioplasty (PTCA) aneurysm. This case substantiates the benign prognosis of post-PTCA aneurysms.

Stent implantation in severely angulated lesions: safety, efficacy, and morphological remodelling.

Balloon angioplasty of severely angulated lesions is associated with a higher complication rate and lower success rate compared with non-angulated lesions. Whether this is true also of stenting such lesions is not know, nor has the alteration of vessel morphology produced by placing stents in these angulated segments been systematically investigated. We retrospectively analysed data from 60 patients who underwent stent implantation. Thirty patients formed a consecutive group whose stents were implanted in severely angulated lesions (> 45 degrees, group A). The other 30 were a a consecutive contemperaneous group whose stents were implanted in straight or less angulated lesions (group S). Change in morphology was assessed using a straightening index. In group A, 29 of the 30 patients had a successful angiographic and clinical outcome. In group S, 27 of the 30 patients had a successful outcome. Thus, unlike simple balloon angioplasty, stenting severely angulated lesions was not associated with a high-complication or low-success rate. Change in stented vessel morphology (straightening index) was greatest for right coronary (0.45 +/- 0.05), similar for left anterior descending (0.27 %/- 0.08) and circumflex (0.30 +/- 0.03), and least for vein grafts (0.14 +/- 0.10). The straightening index did not correlate with the preangioplasty lesion angulation, the maximum pressure used to inflate the stent, the size of the artery stented, or the type of stent used.

Multiple coronary-pulmonary fistulae involving all three coronary arteries: a case report.

Coronary pulmonary fistulae are rare cardiac anomalies. We present the case of a 46-year-old woman with multiple coronary-pulmonary fistulae involving all three coronary arteries. She presented with atypical chest pain and had no obstructive coronary lesion. SPECT thallium study demonstrated no perfusion defect. The fistulae were multiple but small with only a small left to right shunt (Qp:Qs = 1.2). The patient has remained well without intervention.

Rotational atherectomy of calcified ostial saphenous vein graft lesion with long term follow-up: a case report.

Rotational atherectomy, though widely used for calcified and difficult lesions, has not been used in vein graft lesions. We performed rotational atherectomy on a 75-year-old male with a calcified ostial lesion in an 11-year-old vein graft. No complications were encountered and good result was obtained. Angiogram at 10 months revealed no restenosis.

Recovery positive exercise stress test: an indication for coronary artery disease.

UNLABELLED: The significance of ST depression occurring during exercise treadmill stress test has been well established. However, at times there may be no ST segment changes during exercise with changes occurring during the recovery phase. Out of the 1234 patients who underwent exercise stress test, 17 patients had ST segment changes confined to recovery phase. Coronary angiography performed in these 17 patients showed 11 patients had significant coronary artery disease (CAD), with nine patients having triple vessel disease and 2 having double vessel disease. Analysis showed there was no significant difference in the two groups of CAD and no CAD with respect to sex ratio, mean duration of exercise, maximal heart rate and double product achieved. CONCLUSION: Although, patients with recovery positive stress test may have normal coronary angiography, a large number of patients (64.7%) in our study had significant CAD. Hence, such patients should be subjected to another noninvasive test such as thallium perfusion scan or coronary angiography.

Sion thrombolysis trial--randomised trial of intravenous thrombolysis & primary percutaneous transluminal coronary angioplasty for acute myocardial infarction [AMI]--feasibility phase data of angioplasty limb.

Reperfusion in acute myocardial Infarction [AMI] can be realised by thrombolytic therapy or percutaneous transluminal coronary angioplasty [PTCA] has theoretical advantage but hardly any randomised trials have been published till recently to compare the two modalities. We started the STAT trial with this objective. Patients of AMI were randomised to thrombolytic therapy or PTCA. In the present article we present the phase I data of the PTCA limb. The procedural success rate was 100% with no procedural mortality. In-hospital mortality was 10% [Anterior Infarction 0%, Inferior infarction 20%]. Recurrence of angina occurred in 10% patients. Direct PTCA to left anterior descending artery appeared to be more rewarding than PTCA to right coronary artery.

Percutaneous transluminal coronary angioplasty (PTCA) in unstable angina.

We performed percutaneous transluminal coronary angioplasty in 33 highly selected patients of unstable angina, a majority of whom were initially stabilized by medical therapy. All these patients had single vessel disease with type A lesion. The initial success rate was 91% with recurrence of 17% at the end of 1 year.

Acute accidental exposure to chlorine fumes--a study of 82 cases.

Eighty-two patients were hospitalized following an accidental exposure to chlorine. All patients presented with dyspnoea and cough. The other symptoms included irritation of throat (53.6%), irritation of eyes (42.3%), headache (29.2%), abdominal pain (26.8%), vomiting (24.3%) and giddiness (9.7%). All of them had bronchospasm and 5 (6%) had cyanosis at the onset. An x-ray of the chest revealed patchy infiltrates in 3 (3.85%) and hilar congestion in 2 (2.44%). Pulmonary function tests showed an obstructive pattern in 27.4%, restrictive in 3.25% and mixed in 53.2%. Pulmonary functions were normal in 16.1% of the patients. Bronchoscopy revealed tracheobronchial mucosal congestion in all cases, hemorrhagic spots in 35.7%, erosions and ulcers in 12.5%. All patients were treated with oxygen, aminophylline, hydrocortisone and antibiotics. Haematemesis (n = 1) and pulmonary oedema (n = 2) developed 12 hours after the admission. Two other patients developed pneumonia 48 hours later. All patients recovered satisfactorily. On follow-up 16 patients had no sequelae after one year. Pulmonary functions were normal in 5 patients after 3 years of follow-up.

Coronary arteriographic findings soon after non Q wave myocardial infarction.

We performed early coronary arteriography in 27 patients (23 males, 4 females) having non Q wave MI. Infarct related vessel (IRV) was totally blocked in 25.9%, whereas 66.7% had severe residual stenosis (greater than or equal to 70%). Left main was involved in 7.5%, and at least 2 major coronary arteries were involved in 51.8%. Visible collaterals were seen in 11%. We feel, as compared to transmural MI, where total occlusion of IRV is common, the higher incidence of subtotal occlusion of IRV with severe residual stenosis, poor collaterals and significant involvement of at least one other major coronary artery may be responsible for observation of early recurrent ischemic episodes in non Q wave MI.