Safety and effectiveness of the Arani curve guiding catheters in Palmaz-Schatz stenting of right coronary artery stenosis.

The purpose of this study was to evaluate the safety and efficacy of Arani curve guiding catheters in Palmaz-Schatz stenting of right coronary artery (RCA) stenosis. A total of 15 stents was implanted in 13 right coronary arteries. For stenting of the RCA with marked superior orientation and shepherd's crook configuration of the proximal segment, a catheter with a 75 degrees primary curve was used. A catheter with a 90 degrees primary curve was usually the best choice for stenting of the RCA with slight superior, horizontal, or interior orientation of the proximal segment. These catheters provided excellent support in 12 of 13 cases (93%) and resulted in successful stent deployment in these patients. There was one dissection which occurred distal to the stent following poststent balloon dilatation, and which required emergency coronary artery bypass graft surgery. There were no complications attributed to these guiding catheters. An extraordinary formation of pseudostenosis occurred in one patient. We conclude that Arani curve guiding catheters provide strong support and are safe and effective in stenting of RCA stenosis.

Combined aortic valve replacement and closure of patent ductus arteriosus in the elderly.

Two cases of patent ductus arteriosus (PDA) and aortic stenosis are presented. Both were diagnosed at routine cardiac catheterization and significant aortic gradient was concomitantly encountered. The first patient had subacute bacterial endocarditis due to B. cereus infection. Eventually it was proven to be localized on the PDA on the pulmonary artery side. Both patients underwent closure of PDA through endopulmonary closure and aortic valve replacement. Postoperative courses were uneventful. These cases demonstrated the technically easy closure of the PDA in the elderly. The literature has documented only six cases including our two cases.

Intramyocardial calcification in the elderly. A diagnostic and therapeutic puzzle.

A 70-year-old woman presented with anular and progressive intramyocardial calcification within a five-year period. She had become increasingly symptomatic with mitral regurgitation and coronary insufficiency during the same period. The subvalvular (mitral) calcified intramyocardial mass was found to be "grumous atherosclerosis." This was obliterated while the mitral valve was replaced with a prosthetic valve and the coronary arteries were bypassed x3. She is surviving and well four years postoperatively.

Effectiveness of the Arani double-loop guiding catheters in angioplasty of aorto-coronary vein grafts.

Double-loop guiding catheters have been used for angioplasty of aorto-coronary vein grafts (VG) or grafted arteries through the VG in 31 cases. A catheter with a 90 degrees primary curve was usually the best choice for angioplasty of the VG to the right coronary artery (RCA). For angioplasty of the VG to the left coronary artery branches (LCA), a 90 degrees primary curve was used when the proximal segment of the VG was oriented horizontally and a 75 degrees (USCI, C.R. Bard, Inc., Billerica, MA) was used when the proximal segment was directed superiorly. Angioplasty of 32 lesions was attempted in 31 patients. These catheters provided good "back-up" in angioplasty of 30 lesions (94%). The lesions were crossed with balloon catheters in 29 cases (91%). There was one acute VG occlusion requiring coronary artery bypass graft (CABG) surgery, a complication not attributed to the guiding catheter. We conclude that Arani guiding catheters provide strong back-up, are helpful in angioplasty of the vein grafts, and could be used as the primary choice for VG angioplasties.

Double loop guiding catheter: a primary catheter for angioplasty of the right coronary artery.

Double loop guiding catheters have been used for percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) in 42 consecutive cases. A catheter with a 90-degree primary curve was used when the proximal RCA had horizontal or inferior orientation. When the proximal segment of the RCA was oriented superiorly (shepherd's crook), the catheter with a 75-degree primary curve was used. Catheters were fabricated with short (1.5 cm) or long (2.3 cm) (USCI, C.R. Bard, Inc., Billerica, MA) distal tips. Short-tip catheters were satisfactory in the majority of cases. When the RCA had a complex course and more backup was necessary or when the ascending aorta was wide, long-tip catheters were found to be the best choice. Angioplasty of 49 lesions was attempted in 42 consecutive patients. In 39 patients successful dilatation was achieved (93%). In three patients the procedure was unsuccessful. In one patient, the lesion could not be crossed with the guidewire despite an excellent backup. In another patient, two of three stenoses were dilated successfully; the distal lesion was crossed with a guidewire but could not be crossed with the balloon catheter in spite of a good backup. The lack of a satisfactory engagement and inadequate backup were responsible for the failure in only one patient. There were no complications related to these guiding catheters. We conclude that double loop guiding catheters are safe and can be the primary choice in all right coronary angioplasties. These catheters provide an excellent backup with consequent high success rate.

Lack of effect of smoking on the metabolism and pharmacokinetics of quinidine in patients.

The urinary metabolite profile of quinidine and the oral clearance of this drug were studied under steady state conditions in five smoking and nine non-smoking patients. No significant differences were observed in the urinary recovery of unchanged quinidine, 3S-3-hydroxyquinidine, 2'-oxoquinidinone or quinidine-N-oxide between smokers and non-smokers. In addition, the plasma clearance of quinidine was not affected by the smoking status of subjects. These results suggest that cigarette smoke does not induce any of the main pathways for quinidine metabolism in a typical patient population and that the consideration of smoking status is of little utility in aiding in the selection of initial dosage regimens for this drug.

Long-term survival after coronary bypass surgery. Comparison of various subsets of patients with general population.

Life-table analysis consecutive cases of isolated coronary bypass surgery at the Buffalo Hospital between 1973 and 1977 showed an estimated survival of 94 per cent at five years, equal to that of an age- and sex-matched group of the US population. Subsets of these patients divided according to sex, age, number of vessels narrowed, number of segments grafted, history of myocardial infarction, ejection fraction, and presence of unstable angina have estimated survivals not statistically less in any of these subsets than that of matched cohorts of the general population.

Radioimmunoassay for human myoglobin. Initial experience in patients with coronary heart disease.

A radioimmunoassay for human myoglobin has been used to study the serum myoglobin level in 13 normal individuals and 68 patients admitted to a Coronary Care Unit because of chest pain. Values in normal individuals ranged from 3 to 75 and averaged 25 +/- 23 (SD) ng/ml. Thirty-two patients with myocardial infarction initially examined within 12 hours of the onset of chest pain all showed clear-cut elevations in serum myoglobin, peak values ranging from 200 to 5500 and averaging 1368 +/- 1357 ng/ml. Seventeen patients with clinically atypical chest pain and no subsequent evidence of myocardial necrosis had myoglobin levels in the normal range, as did 11 of 19 patients with chest pain thought clinically to represent myocardial ischemia but no subsequent evidence of myocardial necrosis by conventional criteria. The final eight patients in the latter group showed mild elevations of serum Mb, peak values ranging from 102 to 280 and averaging 162 +/- 52 ng/ml; the basis for these elevations remains to be clarified.