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ABSTRACT: Despite normal flow in the infarct-related artery after primary percutaneous coronary intervention, patients may not achieve adequate perfusion at the tissue level. We examined the applicability of pulsed wave tissue Doppler (PTD) in detection of successful myocardial reperfusion.
In all, 24 patients with anterior infarction were enrolled. All patients underwent primary percutaneous coronary intervention. PTD was performed 2 days and 2 weeks after percutaneous coronary intervention, and recorded from 6 different locations at the mitral annular level. Peak systolic wave was determined and was related to various markers of reperfusion.
Systolic PTD measurement in patients with myocardial blush grades 0 to 1 significantly deteriorated between second day and second week (6.5 +/- 1.1-5.3 +/- 1.1 for the anterior wall, and 6.2 +/- 1.3-5.3 +/- 1 for the anterior septum, P < .05 and P < .01, respectively). Systolic PTD parameters improved significantly in patients with myocardial blush grades 2 to 3 (6 +/- 1.5-7.2 +/- 2 for the anterior wall, and 5.4 +/- 1.1-7.1 +/- 1.6 for the anterior septum, P < .05 and P < .01, respectively). A significant relationship was observed between PTD and thrombolysis in myocardial infarction flow, S-T resolution, and creatine phosphokinase peaking. PTD recovery was highly sensitive and specific for the detection of left ventricular function recovery.
We demonstrated a significant relationship between systolic PTD parameters and invasive and noninvasive markers of reperfusion. Larger studies are needed to confirm these results.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 02/2008; 21(1):47-52. · 2.98 Impact Factor
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The Journal of invasive cardiology 05/2005; 17(4):233-6. · 1.84 Impact Factor
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ABSTRACT: We present three patients with cryptogenic stroke who underwent transcatheter closure of a patent foramen ovale. All patients have had history of deep venous thrombosis and pulmonary embolism with placement of inferior vena caval filters. The patients were not initially considered suitable candidates for the procedure because of risk of dislodgment of previously implanted inferior vena cava filter.
Catheterization and Cardiovascular Interventions 11/2004; 63(2):242-6. · 2.29 Impact Factor
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ABSTRACT: Catheter-induced left main coronary artery dissection is quite rare. We describe two cases of iatrogenic left main coronary artery dissection. In the first case, the aortic root was involved in the dissection process, and stenting of the entry point did not halt the progression of dissection. In the second case, the dissection did not involve the aortic root.
Journal of Interventional Cardiology 09/2004; 17(4):253-7. · 1.18 Impact Factor
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ABSTRACT: Catheter-induced left main coronary artery dissection is quite rare. We describe two cases of iatrogenic left main coronary artery dissection. In the first case, the aortic root was involved in the dissection process, and stenting of the entry point did not halt the progression of dissection. In the second case, the dissection did not involve the aortic root.
Journal of Interventional Cardiology 07/2004; 17(4):253 - 257. · 1.18 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate prospectively the feasibility and accuracy of using echocardiographic measurements by transesophageal and intracardiac echocardiography (TEE and ICE, respectively) for interatrial septal defect sizing during percutaneous transcatheter closure. Forty-two patients underwent balloon sizing of interatrial septal defects using TEE in 21 of them and ICE in the other half. These measurements were correlated with quantitative fluoroscopic analysis and evaluated for bias and agreement between methods using a Bland-Altman analysis. Echocardiographic measurements were obtained by ICE and TEE in all patients. An excellent correlation was found between TEE and quantitative fluoroscopy (r = 0.898; P < 0.001) and between ICE and quantitative fluoroscopy (r = 0.876; P < 0.001), with a significant agreement (P < 0.001) and minimal positive bias toward the echocardiographic measurements. Both TEE and ICE are excellent methods of interatrial defect sizing when compared with quantitative fluoroscopic measurements.
Catheterization and Cardiovascular Interventions 07/2004; 62(3):415-20. · 2.29 Impact Factor
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ABSTRACT: Percutaneous coronary intervention (PCI) in acute myocardial infarction (MI) has been associated with a high incidence of slow-, no-reflow. The slow-, no-reflow phenomenon is known to complicate both thrombolytic therapy and PCI. Removing intracoronary thrombus before PCI in acute MI patients may reduce the incidence of slow-, no-reflow phenomena. We studied the procedural outcome of 21 patients who underwent rheolytic thrombectomy using Possis rheolytic thrombectomy catheter in the setting of acute MI as compared to twenty-eight patients who underwent PCI in the setting of acute MI using other modalities (PTCA with or without stenting) without thrombectomy. The study included 49 consecutive patients with 21 patients in the rheolytic thrombectomy group, and 28 patients in the no-rheolytic thrombectomy group. There was no significant difference between the two groups as regards to gender, age, and prevalence of coronary artery risk factors. The left ventricular ejection fraction was 44.7 12 in the rheolytic thrombectomy group, and 37.6 10.8 in the no-rheolytic thrombectomy group (p = 0.08). Thirty eight percent of the patients in the rheolytic thrombectomy group experienced slow flow, no-reflow, while 28.6% of the patients in the no-rheolytic thrombectomy group experienced slow flow, no-reflow (p = 0.5). In this matched series of patients with acute MI undergoing PCI, rheolytic thrombectomy by the Possis rheolytic thrombectomy catheter device does not appear to reduce the risk of slow flow, no-reflow, or in-hospital death, compared to standard PTCA and stenting of the infarct-related artery.
International Journal of Angiology 07/2003; 12(3):183-187.
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Abid R Assali,
Ali Moustapha,
Stefano Sdringola,
Joseph Salloum, Hany Awadalla,
Sangeeta Saikia,
Mohammad Ghani,
Susan Hale,
G Schroth,
Oscar Rosales,
H Vernon Anderson,
Richard W Smalling
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ABSTRACT: Elderly patients are increasingly referred to percutaneous coronary interventions (PCIs). Recent reports suggest complications rates are declining in the elderly. We sought to determine whether procedural and in-hospital outcomes are different in patients aged > or = 75 years undergoing nonemergent PCI as compared to patients age < 75 years. The outcome of 266 consecutive patients age > or = 75 years undergoing nonemergent PCI was compared to that of 1,681 consecutive patients age < 75 years. Compared with younger patients, greater proportions of elderly patients were women and had a history of hypertension, peripheral vascular disease, and cerebral vascular events. Elderly patients had more extensive coronary involvement. Procedural success was similar in both groups (94%). The in-hospital cardiac death rate was significantly higher in the elderly patients (2.3% vs. 0.7%; P = 0.03). Aged patients also had a significantly higher incidence of vascular and bleeding complications. Blood transfusion was required more often in the elderly group (4.5% vs. 2.6%; P = 0.07). The hospitalization length was significantly higher in the elderly group (4.1 +/- 6.0 vs. 2.5 +/- 4.3 day; P = 0.0004). By multivariate logistic regression (adjusted for baseline clinical and angiographic variables), age > or = 75 years was found to be an independent predictor of in-hospital cardiac death (odds ratio = 3.9; 95% CI = 1.3-11.5; P = 0.015). Although PCI is technically successful in patients aged > or = 75 years; it is associated with more acute cardiac and vascular complications and higher in-hospital cardiac mortality.
Catheterization and Cardiovascular Interventions 06/2003; 59(2):195-9. · 2.29 Impact Factor
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Abid R. Assali MD,
Ali Moustapha MD,
Stefano Sdringola MD,
Joseph Salloum MD,
Hany Awadalla MD,
Sangeeta Saikia MD,
Mohammad Ghani MD,
Susan Hale MD,
G. Schroth MD,
Oscar Rosales MD, [......],
Stefano Sdringola,
Joseph Salloum, Hany Awadalla,
Sangeeta Saikia,
Mohammad Ghani,
Susan Hale,
G. Schroth,
Oscar Rosales,
H. Vernon Anderson,
Richard W. Smalling
[show abstract]
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ABSTRACT: Elderly patients are increasingly referred to percutaneous coronary interventions (PCIs). Recent reports suggest complications rates are declining in the elderly. We sought to determine whether procedural and in-hospital outcomes are different in patients aged ≥ 75 years undergoing nonemergent PCI as compared to patients age < 75 years. The outcome of 266 consecutive patients age ≥ 75 years undergoing nonemergent PCI was compared to that of 1,681 consecutive patients age < 75 years. Compared with younger patients, greater proportions of elderly patients were women and had a history of hypertension, peripheral vascular disease, and cerebral vascular events. Elderly patients had more extensive coronary involvement. Procedural success was similar in both groups (94%). The in-hospital cardiac death rate was significantly higher in the elderly patients (2.3% vs. 0.7%; P = 0.03). Aged patients also had a significantly higher incidence of vascular and bleeding complications. Blood transfusion was required more often in the elderly group (4.5% vs. 2.6%; P = 0.07). The hospitalization length was significantly higher in the elderly group (4.1 ± 6.0 vs. 2.5 ± 4.3 day; P = 0.0004). By multivariate logistic regression (adjusted for baseline clinical and angiographic variables), age ≥ 75 years was found to be an independent predictor of in-hospital cardiac death (odds ratio = 3.9; 95% CI = 1.3–11.5; P = 0.015). Although PCI is technically successful in patients aged ≥ 75 years; it is associated with more acute cardiac and vascular complications and higher in-hospital cardiac mortality. Cathet Cardiovasc Intervent 2003;59:195–199. © 2003 Wiley-Liss, Inc.
Catheterization and Cardiovascular Interventions 05/2003; 59(2):195 - 199. · 2.29 Impact Factor
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ABSTRACT: We report a successful case of percutaneous transcatheter coil embolization of a coronary fistula originating from the ostium of the left main, simultaneously with a second fistula arising from the left anterior descending artery, in a patient with exercise-related angina and evidence of myocardial ischemia.
Catheterization and Cardiovascular Interventions 11/2002; 57(2):221-3. · 2.29 Impact Factor
