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Anterior Descending (anterior + descending)
Kinds of Anterior Descending Terms modified by Anterior Descending Selected AbstractsEvaluation of Subendocardial and Subepicardial Left Ventricular Functions Using Tissue Doppler Imaging after Complete RevascularizationECHOCARDIOGRAPHY, Issue 2 2009Hüseyin Sürücü M.D. Objective: We aim to evaluate subepicardial and subendocardial left ventricular (LV) functions in patient single coronary artery lesion at early stage after percutaneous coronary intervention (PCI). Additionally, a comparison of LV functions between patients and control cases was aimed. Method: Patients with culprit left anterior descending (LAD) lesion (n = 25) and subjects with normal coronary angiography (n = 25) were evaluated. Patients underwent PCI and at least one coronary stent was placed. After PCI, the pulsed-wave tissue Doppler imaging (pw-TDI) parameters taken from subepicardial and subepicardial layers were compared among the patients. Results: Left atrium (P = 0.050), LV end-diastolic (P = 0.049), and end-systolic (P = 0.006) diameters were larger compared to the control group. LV inflow velocities were not different between the patient and the control group. But, the myocardial performance index was different (P = 0.049). The systolic and diastolic pw-TDI parameters were apparently different between the patient and the control group. While the systolic pw-TDI parameters did not change, the diastolic pw-TDI parameters taken from both subepicardial (circumferential contraction) and subendocardial layers (longitudinal contraction) improved after PCI. After PCI, it was shown that while Ea velocity (P = 0.012) taken from the subendocardial layer increased, IVRa velocity (P < 0.001) taken from the subepicardial layer decreased. Conclusion: In our study, it could be said that LV, left atrium, and aortic valve diameter increase in patients with coronary artery disease. The systolic and diastolic functions were impaired at subendocardial and subepicardial layers. These dysfunctions can be easily presented with pw-TDI. Although systolic dysfunction persists, diastolic dysfunction improves at early stage after PCI. [source] Transthoracic Doppler Echocardiographic Coronary Flow Imaging in Identification of Left Anterior Descending Coronary Artery Stenosis in Patients with Left Bundle Branch BlockECHOCARDIOGRAPHY, Issue 10 2008Ozer Soylu M.D. Background: Conventional noninvasive methods have well-known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Methods: Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two-step (0.56,0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. Results: The hyperemic diastolic peak velocity (44 ± 9 cm/sec vs 62 ± 2 cm/sec; P=0.01) and diastolic CFR (1.38 ± 0.17 vs 1.93 ± 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of <1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. Conclusions: CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB. [source] Comparison of Coronary Flow Velocities Between Patients with Obstructive and Nonobstructive Type Hypertrophic Cardiomyopathy: Noninvasive Assessment by Transthoracic Doppler EchocardiographyECHOCARDIOGRAPHY, Issue 1 2005Seden Celik M.D. Background: We aimed to compare coronary flow velocity (CFV) measurements of patients with nonobstructive (NHCM) and obstructive hypertrophic cardiomyopathy (HOCM) by using transthoracic Doppler echocardiography (TTDE). Methods and Results: In 11 patients with NHCM and 26 with HOCM, CFV in the distal left anterior descending (LAD) coronary was measured by TTDE (3.5 MHz) under the guidance of color Doppler flow mapping in addition to standard 2D and Doppler echocardiography. The results were compared with 24 normal participants who had no evidence of cardiac disease. Peak diastolic velocity of LAD was also higher in NHCM and HOCM than controls (52 ± 14 cm/sec and 54 ± 20 cm/sec vs 41 ± 11 cm/sec, respectively, P < 0.01). The analysis of systolic velocities revealed abnormal flow patterns in 16 (61%) patients with HOCM (12 systolic-reversal flow and 4 no systolic flow) and 6 (54%) (5 reversal flow and 1 zero flow) patients with NHCM (,11 ± 30 cm/sec and ,13 ± 38 cm/sec, vs 24 ± 9 cm/sec, respectively, P < 0.001). Linear regression analysis demonstrated no correlation between intraventricular pressure gradient and coronary flow velocities in HOCM patients. However, there were significant positive and negative correlations between septal thickness and diastolic and systolic velocities, respectively (r = 0.50, P < 0.002, and r =,0.43, P < 0.005). Conclusion: We conclude that the coronary flow velocity abnormalities are independent from the type of hypertrophic cardiomyopathy. [source] Is Left Ventricular Diastolic Thickening Documented During Dobutamine and Pacing Stress Echocardiography Related to Myocardial Ischemia?ECHOCARDIOGRAPHY, Issue 1 2002An Animal Model Study Transient increase in diastolic wall thickness (pseudohypertrophy) during pacing stress echocardiography has been reported in normal myocardium. To evaluate the occurrence of pseudohypertrophy and to investigate the contribution of myocardial ischemia on its production during pacing and dobutamine stress echocardiography, we produced a physiologically significant coronary stenosis in 14 open chest dogs. The stenosis in the circumflex artery was measured by quantitative coronary angiography (range: 50% to 89% reduction in luminal diameter), and no resting segmental wallmotion abnormalities were observed by epicardial echocardiography (short-axis, papillary level). In each study, dobutamine (5,40 ,g/kg/min) and pacing (up to 260 beats/min) were performed randomly. Positivity of stress echocardiography tests was quantitatively determined by a significant (P < 0.05) reduction or failure to increase in absolute and percent systolic wall thickening in the myocardial area supplied by the stenotic artery as compared to the left anterior descending (LAD) artery-related areas. Diastolic wall thickness and left ventricular diastolic area were compared before and after each stress test in the circumflex and LAD artery-related regions. Pseudohypertrophy was observed in 57% and 86% of dogs for pacing and dobutamine, respectively, in the circumflex region, and in 50% and 64% in the LAD region. Despite its increased incidence in the circumflex region, the augmented diastolic wall thickness did not correlate with coronary stenosis severity or stress test positivity, but correlated inversely with changes in left ventricular diastolic area. In addition, it correlated directly with changes in heart rate only for pacing. In conclusion, pseudohypertrophy was a frequent finding during pacing and dobutamine stress echocardiography tests but was not related to myocardial ischemia in this animal model. [source] Digital Analysis of Myocardial Contrast Echocardiography: A Clinical Study Using an Air-Filled Agent in Normal SubjectsECHOCARDIOGRAPHY, Issue 3 2000EDWARD A. GEISER M.D., F.A.C.C. The purpose of the present study was to determine whether direct digital image analysis would allow improved detection of myocardial contrast. Eighteen normal subjects were recruited and separated into two groups. In group 1, the time-brightness curves of the left ventricular cavity and three myocardial perfusion beds were formed from digitized video tape, with output power and imaging time as secondary variables. In group 2, curves constructed from direct polar digital data were compared, with fundamental and second harmonic image formation as variables. In group 1 subjects, using fundamental imaging, the area under the curve in the left ventricular cavity increased slightly with intermittent imaging. No consistent myocardial opacification was identified. In group 2 subjects, using intermittent imaging, the area under the myocardial curve and peak intensity increased with high output second harmonic imaging in the left anterior descending and right coronary artery regions. Intermittent, second harmonic imaging and digital processing can demonstrate myocardial contrast even with an air-filled agent. [source] Real-time Visualization and Quantification of Retrograde Cardioplegia Delivery using Near Infrared Fluorescent ImagingJOURNAL OF CARDIAC SURGERY, Issue 6 2008Aravind T. Rangaraj M.D. Presently, there exist no established methods to quantitatively assess cardioplegia distribution intraoperatively and determine when retrograde cardioplegia is required. In this study, we evaluate the feasibility of near infrared (NIR) imaging for real-time visualization of cardioplegia distribution in a porcine model. Methods: A portable, intraoperative, real-time NIR imaging system was utilized. NIR fluorescent cardioplegia solution was developed by incorporating indocyanine green (ICG) into crystalloid cardioplegia solution. Real-time NIR imaging was performed while the fluorescent cardioplegia solution was infused via the retrograde route in five ex vivo normal porcine hearts and in five ex vivo porcine hearts status post left anterior descending (LAD) coronary artery ligation. Horizontal cross-sections of the hearts were obtained at proximal, middle, and distal LAD levels. Videodensitometry was performed to quantify distribution of fluorophore content. Results: The progressive distribution of cardioplegia was clearly visualized with NIR imaging. Complete visualization of retrograde distribution occurred within 4 minutes of infusion. Videodensitometry revealed retrograde cardioplegia, primarily distributed to the left ventricle (LV) and anterior septum. In hearts with LAD ligation, antegrade cardioplegia did not distribute to the anterior LV. This deficiency was compensated for with retrograde cardioplegia supplementation. Conclusions: Incorporation of ICG into cardioplegia allows real-time visualization of cardioplegia delivery via NIR imaging. This technology may prove useful in guiding intraoperative decisions pertaining to when retrograde cardioplegia is mandated. [source] A New Technique for the Old Arterial Graft: Internal Thoracic ArteryJOURNAL OF CARDIAC SURGERY, Issue 2 2008Ufuk Tutun M.D. It stays patent well in the long-term period, and this evidence is directly related to the superior later outcome in terms of longevity. Coronary artery bypass grafting with multiarterial grafts can be performed safely, and better long-term result can be expected with the use of arterial conduits, especially ITA. We describe a simple and practical technique for the left ITA grafting by dividing the ITA graft and using its proximal and distal parts in situ for the distal left anterior descending (LAD) artery and the obtuse marginal artery grafting. [source] Does Off-Pump Revascularization Reduce Coronary Endothelial Dysfunction?JOURNAL OF CARDIAC SURGERY, Issue 5 2004Harold L. Lazar M.D. This experimental study sought to determine whether OPCAB reduces endothelial dysfunction, compared to standard cardiopulmonary bypass (CPB) with and without the anticomplement agent soluble complement receptor-1 (sCR1). Methods: In 10 pigs, OPCAB was simulated by snaring the left anterior descending (LAD) artery for 15 minutes followed by 3 hours of reperfusion. On-pump revascularization was simulated in 20 pigs by 15 minutes of LAD occlusion on CPB with cold blood cardioplegic arrest followed by 3 hours of reperfusion. Ten of these animals received sCR1 (10 mg/kg) prior to CPB. Inflammatory response was monitored by percent (%) lung water increase, wall motion scores (WMS) with transthoracic echocardiography where 4 = normal to ,1 = dyskinesia, and endothelial function in the distal LAD with bradykinin-induced coronary artery relaxation using organ chamber methodology. Results: OPCAB had no effect on lung edema (% increase = 1.7 ± 1.4 OPCAB vs. 3.4 ± 0.5 CPB vs. 2.3 ± 0.9 CPB + sCR1) and failed to prevent wall motion changes (WMS = 2.65 ± 0.08 OPCAB vs. 2.70 ± 0.04 CPB vs. 3.10 ± 0.07* CPB + sCR1, *p < 0.01) and coronary endothelial dysfunction (% relaxation = 41 ± 9 OPCAB vs. 40 ± 9 CPB vs. 78 ± 8** CPB + sCR1, **p < 0.001), which was best preserved with sCR1. Conclusions: This study suggests that agents which directly inhibit complement activation such as sCR1 are more important in preventing endothelial dysfunction during coronary revascularization than merely avoiding CPB. [source] A Xiphoid Approach for Minimally Invasive Coronary Artery Bypass SurgeryJOURNAL OF CARDIAC SURGERY, Issue 4 2000Federico Benetti M.D. However, opening the pleura has been a limitation of using these approaches. Aim: We used the xiphoid approach as an alternative to opening the pleura and to minimize pain after minimally invasive coronary artery bypass surgery. Methods: We review our surgical experience in 55 patients who underwent minimally invasive direct coronary artery bypass (MIDCAB) surgery through a xiphoid approach between October 1997 and August 1999. Thoracoscopy (n = 31) or direct vision (n = 24) were used for internal mammary artery (IMA) harvesting. Mean patient age was 67 ± 10 years and 65% were men. The mean Parsonnet score was 23 ± 10. Performed anastomoses included left IMA (LIMA) to the left anterior descending (LAD) artery (n = 53), LIMA-to-LAD and saphenous vein graft from the LIMA to the right coronary artery (n = 1), and LIMA-to-LAD and right IMA (RIMA) to right coronary artery (n = 1). Results: Postoperative complications included atrial fibrillation (12%), acute noninfectious pericarditis (12%), and acute renal failure (5%). Mean postoperative length of stay was 4 ± 2 days. Angiography was performed in 16 patients and demonstrated excellent patency of the anastomoses. There was no operative mortality. Actuarial survival was 98% in a mean follow-up period of 11 ± 5 months. Conclusions: Minimally invasive coronary artery bypass can be performed safely through a xiphoid approach with low morbidity, mortality, and a relatively short hospital stay. [source] The Intracoronary Electrocardiogram in Percutaneous Coronary InterventionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2009ANDY SC YONG M.B.B.S. The technique of obtaining an epicardial electrocardiogram trace by connecting the guidewire during coronary angioplasty to an electrocardiogram lead has been used since 1985. The intracoronary electrocardiogram appears to be more sensitive than the surface electrocardiogram in detecting transient ischemia, particularly in the territory of the left anterior descending and left circumflex coronary arteries. Importantly, recent studies have shown the intracoronary electrocardiogram to be particularly useful in demonstrating pre- and postconditioning during interventional procedures, predicting periprocedural myocardial damage, and in the determination of regional viability in the catheterization laboratory. Barriers to the use of the intracoronary electrocardiogram in the clinical setting include the lack of standardized methods for acquiring and analyzing the intracoronary electrocardiogram, and the lack of commercially available continuous intracoronary monitoring systems to permit analysis while performing coronary interventions. Facilitating these relatively simple technical developments may permit optimal integration of the intracoronary electrocardiogram into the catheterization laboratory. [source] Inflammatory Cytokine Imbalance after Coronary Angioplasty: Links with Coronary AtherosclerosisJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2007NATALE DANIELE BRUNETTI M.D., Ph.D. Aim:To investigate release of some inflammatory cytokines (Cys) after coronary angioplasty and its links with coronary atherosclerosis. Methods:Twenty-seven consecutive subjects with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) were enrolled in the study: serial blood samples were taken in order to evaluate plasma concentrations of Interleukin (IL)-2, IL-10, IL-18, TNF,, and IFN, just before PCI at 12 and 24 hours. Patients were then divided, considering balance between each inflammatory Cy and IL-10, an antiinflammatory Cy, into four groups, ranging from a prevalent antiinflammatory response (stable inflammatory Cy,increasing IL-10 values) to a marked inflammatory imbalance (increasing inflammatory Cy,stable IL-10 values). Results:All Cys showed significant increases in plasma concentrations if compared with baseline values. Release curves were not significantly different when comparing subjects with ST-elevation myocardial infarction (STEMI) versus unstable angina,non-STEMI (UA-NSTEMI), diabetics versus controls. Subjects with marked inflammatory response showed a higher incidence of stenosis on left anterior descending (LAD) coronary artery (IL-2 ,2 and IFN, P < 0.05); Cy release was higher in patients with multivessel coronary disease (IL-2 and IFN,, ANOVA P < 0.01). Correlations were also referable between Cys and myocardial enzyme release. Subjects treated with sirolimus-eluting stents (SES) showed significantly lower Cy periprocedure ratio if compared with those treated with bare metal stents. Conclusions:A significant Cy release is detectable after PCI: inflammatory response seems to correlate with both PCI due to plaque instabilization and coronary atherosclerosis. A blunted inflammatory response is detectable in subjects treated with SES. [source] Immediate and Long-Term Outcome of Recanalization of Chronic Total Coronary OcclusionsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002FEDERICO PISCIONE M.D. Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was<30 days (subacute total occlusion [STO]: 25 patients; range 1,30 days) or>30 days (chronic total occlusion [CTO]: 58 patients; range 3,144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complication, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 ± 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success. [source] 3D coronary motion tracking in swine models with MR tracking cathetersJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2009Ehud J. Schmidt PhD Abstract Purpose To develop MR-tracked catheters to delineate the three-dimensional motion of coronary arteries at high spatial and temporal resolution. Materials and Methods Catheters with three tracking microcoils were placed into nine swine. During breath-holds, electrocardiographic (ECG)-synchronized 3D motion was measured at varying vessel depths. 3D motion was measured in American Heart Association left anterior descending (LAD) segments 6,7, left circumflex (LCX) segments 11,15, and right coronary artery (RCA) segments 2,3, at 60,115 beats/min heart rates. Similar-length cardiac cycles were averaged. Intercoil cross-correlation identified early systolic phase (ES) and determined segment motion delay. Results Translational and rotational motion, as a function of cardiac phase, is shown, with directionality and amplitude varying along the vessel length. Rotation (peak-to-peak solid-angle RCA ,0.10, LAD ,0.06, LCX ,0.18 radian) occurs primarily during fast translational motion and increases distally. LCX displacement increases with heart rate by 18%. Phantom simulations of motion effects on high-resolution images, using RCA results, show artifacts due to translation and rotation. Conclusion Magnetic resonance imaging (MRI) tracking catheters quantify motion at 20 fps and 1 mm3 resolution at multiple vessel depths, exceeding that available with other techniques. Imaging artifacts due to rotation are demonstrated. Motion-tracking catheters may provide physiological information during interventions and improve imaging spatial resolution. J. Magn. Reson. Imaging 2009;29:86,98. © 2008 Wiley-Liss, Inc. [source] Exercise-Attenuation of Q-Waves in II, III, and aVF, and R-Waves in V1 and V2 in a Patient with an Inferior Infarction and Anterior Wall IschemiaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2008JOHN E. MADIAS M.D. A 63-year-old male patient with inferior infarction revealed transient attenuation of the Q-waves in II, III, and aVF, and R-waves in V1,V3 during an exercise stress test. Myocardial scintigraphy disclosed ischemia of the anterior wall and coronary arteriography, a 90% stenosis of the left main coronary artery (LMCA). The mechanism involved appears to be a transient failure of the anterior wall to generate adequate depolarization forces for the genesis of Q-waves in the inferior leads and R-waves in the anterior leads. This electrocardiogram sign is diagnostic of severe anterior wall ischemia due to left anterior descending or LMCA stenosis. [source] Predictive Value of Admission Electrocardiogram For Multivessel Disease in Acute Anterior and Anterior-Inferior Myocardial InfarctionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2002Turhan Kürüm M.D. Background: Our aim was to investigate the correlation between admission ECG and coronary angiography findings in terms of predicting the culprit vessel responsible for the infarct or multivessel disease in acute anterior or anterior-inferior myocardial infarction (AMI). Methods: We investigated 101 patients with a diagnosis of anterior AMI with or without ST-segment elevation or ST-segment depression in at least two leads in Dll, III, aVF. The patients were classified as those with vessel involvement in the left anterior descending (LAD) coronary artery and patients with multivessel disease. Vessel involvement in LAD + circumflex artery (Cx) or LAD + right coronary artery (RCA) or LAD + Cx + RCA were considered as multivessel disease. Thus, (a) anterior AMI patients with reciprocal changes in inferior leads, (b) anterior AMI patients with inferior elevations, (c) all anterior AMI patients according to the ST-segment changes in the inferior region were analyzed according to the presence of LAD or multivesssel involvement. Results: Presence of ST-segment depression in aVL and V6 was significantly correlated with the presence of multivessel disease in anterior AMI patients with reciprocal changes in the inferior leads (P = 0.005 and P = 0.003, respectively). No statistically significant difference between the leads were detected in terms of ST-segment elevation in predicting vessel involvement in the two groups of anterior AMI patients with inferior elevations. When all the patients with anterior AMI were analyzed, the presence of ST-segment depression in leads aVL, V4, V5 and V6 were significantly associated with the presence of multivessel disease (P = 0.035, P = 0.010, P = 0.011, P = 0.001, respectively). Conclusions: The presence of ST-segment depression in anterolateral leads in the admission ECG of anterior AMI patients with reciprocal changes in inferior leads was associated with multivessel disease. [source] Cocaine and Ethanol: Combined Effects on Coronary Artery Blood Flow and Myocardial Function in DogsACADEMIC EMERGENCY MEDICINE, Issue 7 2009Lance D. Wilson MD Abstract Objectives:, In combination, cocaine and ethanol are more cardiotoxic than is either substance alone. These substances together constitute a drug abuse combination that commonly results in fatality. Previously the authors have demonstrated that cardiotoxicity of cocaine and ethanol is in part due to synergistic myocardial-depressant effects. However, it remains unclear whether this myocardial depression is associated with concomitant adverse effects on coronary blood flow in relation to these substances. The aim of this study was to investigate combined effects of cocaine and ethanol on myocardial blood flow, in relation to indices of myocardial function. Methods:, Anesthetized dogs were instrumented for hemodynamic monitoring with Doppler flow probes placed on the circumflex and left anterior descending (LAD) coronary arteries. Dogs were randomized to three groups (each n = 6): ethanol (E, 1.5 g/kg followed by placebo), cocaine (C, placebo followed by cocaine, 7.5 mg/kg IV), or cocaine plus ethanol (C + E). All measurements were made at control, after placebo or ethanol, and then at fixed time intervals after cocaine or placebo bolus over 3 hours. Results:, In both the C + E and the C groups, circumflex blood flow (CBF) decreased by 71% (95% confidence interval [CI] = 56% to 85%) and 57% (95% CI = 43% to 72%, both p < 0.04 vs. baseline) immediately after cocaine bolus. This was associated with transient depression of cardiac output, myocardial contractile function, and rate-pressure product (RPP), all indices of myocardial oxygen demand. A subsequent rebound increase of coronary sinus blood flow (CSBF) of 56% (95% CI = 26% to 137%, p < 0.03) compared to baseline occurred only in the C group and was associated with increases of myocardial contractile function and RPP. In the C + E group, 2 hours after drug administration, there was a decrease in CSBF of 49% (95% CI = 32% to 67%; p < 0.01) compared to baseline, which was associated with concomitant numerical decreases of the indices of myocardial oxygen demand and accumulation of cocaethylene. Conclusions:, Acute decreases in myocardial flow secondary to cocaine, and cocaine and ethanol in combination, were similar and temporally associated with cocaine's direct myocardial-depressant effects. Rebound increases in myocardial function and blood flow due to cocaine were attenuated by ethanol. Delayed myocardial depression and decreases in myocardial blood flow were observed only with coadministration of cocaine and ethanol. [source] Long-term complication after LM bifurcation treatment,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2010Marco V. Wainstein MD Abstract Two months after left anterior descending (LAD) artery and left circumflex (LCx) artery bare metal stent implantation, a proliferative subocclusive in-stent restenosis in LCx coronary with severe LM coronary (LM) involvement developed. The present clinical case describes a simplified strategy for unprotected LM percutaneous coronary intervention using two bioabsorbable biolimus-eluting stents without involvement of the LAD coronary using an "L" technique. © 2010 Wiley-Liss, Inc. [source] Percutaneous coronary intervention or bypass surgery in multivessel disease?CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2004A tailored approach based on coronary pressure measurement Abstract The optimal revascularization strategy, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), for patients with multivessel coronary artery disease (MVD) remains controversial. The aim of the present study was to compare the long-term outcomes after selective PCI of only hemodynamically significant lesions (fractional flow reserve, or FFR < 0.75) to CABG of all stenoses in patients with MVD. In 150 patients with MVD referred for CABG, FFR was determined in 381 coronary arteries considered for bypass grafting. If the FFR was less than 0.75 in three vessels or in two vessels including the proximal left anterior descending (LAD) artery, CABG was performed (CABG group). If only one or two vessels were physiologically significant (not including the proximal LAD), PCI of those lesions was performed (PCI group). Of the 150 patients, 87 fulfilled the criteria for CABG and 63 for PCI. There were no significant differences in the angiographic or other baseline characteristics between the two groups. At 2-year follow-up, no differences were seen in adverse events, including repeat revascularization (event-free survival 74% in the CABG group and 72% in the PCI group). A similar number of patients were free from angina (84% in the CABG group and 82% in the PCI group). Importantly, the results in both groups were as good as the surgical groups in previous studies comparing PCI and CABG in MVD. In patients with multivessel disease, PCI in those with one or two hemodynamically significant lesions as identified by an FFR < 0.75 yields a similar favorable outcome as CABG in those with three or more culprit lesions despite a similar angiographic extent of disease. Catheter Cardiovasc Interv 2004;63:184,191. © 2004 Wiley-Liss, Inc. [source] Gender-Related Differences in Coronary Artery Dimensions: A Volumetric AnalysisCLINICAL CARDIOLOGY, Issue 2 2010Jennifer A. Dickerson MD Abstract Background Women consistently have poorer revascularization outcomes and more coronary vascular complications compared to men. This has been attributed to smaller coronary arteries, though limited data exist to support this assumption. Hypothesis By using volumetric data obtained from multidetector cardiovascular computed tomography (CCT), we sought to determine to what extent gender influences coronary artery dimensions and test the hypothesis that women would have smaller coronary dimensions even after normalizing for body surface area and cardiac mass. Methods CCT examinations completed on a 64-slice scanner were identified from a university cardiovascular database. Data sets from 50 women and 44 men without coronary artery disease were selected for analysis. Cross-sectional areas of proximal and distal segments of the left anterior descending (LAD), circumflex (LCx), and right coronary artery (RCA) were measured, blinded to patient gender. Measurements were compared using 2-sample t tests and linear regression analysis techniques accounting for body surface area (BSA) and left ventricular (LV) mass. Results Analysis of cross-sectional coronary artery areas, unadjusted for BSA and LV mass showed smaller coronary artery size in women compared to men in the proximal portion of both the LAD (P = .01) and RCA (P = .002), but no significant difference in the remaining coronary segments. Conclusion Gender significantly impacts proximal LAD and RCA size. Differences in coronary artery dimensions may explain some, but not all excess gender-related risk with coronary artery revascularization, underscoring the importance of considering multiple contributing factors. Copyright © 2010 Wiley Periodicals, Inc. [source] Systolic Total Narrowing of Left Anterior Descending Coronary Artery and Flow Interruption Secondary to Myocardial Bridge: A Rare Case Report and Review of LiteratureCLINICAL CARDIOLOGY, Issue 10 2008Fehmi Kacmaz MD Abstract A 33-y-old man was admitted to the emergency department with sudden onset of severe substernal chest pain radiating to the left arm and neck. No pathological signs were recorded upon physical examination. The admission electrocardiogram (ECG) recorded during chest pain showed a large anterior wall myocardial infarction. Intravenous (IV) infusion of 1.5 million units of streptokinase over 1 h was initiated. Coronary angiography revealed total narrowing and flow interruption in the midsegment of the left anterior descending (LAD) coronary artery secondary to a myocardial bridge during systole and disappearance with diastole. He was discharged on aspirin (300 mg/d), metoprolol (100 mg/d), enalapril (10 mg twice daily), and atorvastatin (40 mg/d) treatment at the follow-up period. Copyright © 2008 Wiley Periodicals, Inc. [source] Acetylcholine- and ergonovine-induced coronary microvascular spasm reflected by increased coronary vascular resistance and myocardial lactate productionCLINICAL CARDIOLOGY, Issue 3 2000Masashi Horimoto M.D. Abstract Diagnosis of coronary microvascular spasm remains largely speculative because it has been mostly based on chest pain and electrocardiographic ST-segment shift with slow filling of contrast medium into the coronary artery. A patient with resting chest pain and normal coronary angiograms underwent provocative tests with intracoronary acetylcholine (ACh) and ergonovine. During the tests, coronary diameter and flow velocity in the left anterior descending (LAD) coronary artery were measured with quantitative coronary angiography and intracoronary Doppler guide wire, respectively. Vascular resistance of the LAD and lactate production were determined separately. With injections of 100 ,g of ACh and 20 ,g of ergonovine, chest pain occurred with ST-segment elevation in the precordial leads in the absence of epicardial coronary spasm. Coronary vascular resistance increased by 2.2- and 1.6-fold of the baseline value with ACh and ergonovine, respectively. Myocardial lactate production was noted during the ST-segment elevation. Coronary microvascular spasm was verified by the increment in coronary vascular resistance and myocardial lactate production with concomitant ST-segment elevation in the presence of normal coronary angiograms. [source] | ||||||||||