To determine the value of color Doppler in the diagnosis of vascular complications resulting from cardiac catheterization 5 consecutive patients, with the clinical suspicious of vascular iatrogenesis potentially requiring surgical repair, were analyzed. In 2 patients a femoral mass developed after a diagnostic catheterization but 3 patients underwent previously an interventional catheterization technique. In 3 patients color Doppler readily visualized a systolic jet originated in the femoral artery entering an anterior echo-free cavity, and a reversal flow in diastole, suggesting a femoral pseudoaneurysm. In 1 patient the clinical diagnosis of arteriovenous fistulae was confirmed by color Doppler which demonstrated a continuous turbulent flow within the femoral vein. In the remaining patient a diagnosis of simple femoral haematoma was made after the demonstration of a relatively echogenic structure overlying the femoral artery and vein but not interfering with their flows. In the 3 patients with femoral pseudoaneurysms and in the patient with arteriovenous fistulae the diagnosis was confirmed by angiography and during surgery. Our preliminary findings underscore the value of color Doppler, using the technology currently available in echocardiographic laboratories, in the differential diagnosis of vascular complications after cardiac catheterization.

Aged↗

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[Coronary angioplasty with a rotary atherotome].

Several new coronary dilatation systems, including those using laser energy, atherectomy devices and stent implantation, are being developed as alternative or complementary procedures to coronary artery balloon angioplasty. We report our initial experience performing coronary angioplasty with a new rotational atherectomy device, the transluminal extraction catheter, which simultaneously cut and aspirate fragments from the atherosclerotic plaque. The components of the whole system are a special guidewire to cross the stenosis, the atherectomy catheter and the conduction-control unit. This unit, connected when the atherectomy catheter is positioned across the lesion, produces rotation of the conical bladder located in the catheter distal tip and simultaneous aspiration of residual particles. The procedure was performed in 11 patients in whom 13 lesions were dilated. All patients were male (mean age 55 +/- 23 years, range 45-77). The reason for the angioplasty was stable angina in 2 patients and unstable angina in the remaining seven. Initial success (residual stenosis less than 50% of vessel diameter) was obtained in 10 of 13 lesions. In two, conventional balloon angioplasty was required to improve atherectomy result. The only unsuccessful procedure was in a proximal right coronary artery venous graft, in which a large dissection occurred. Patient had angina but no myocardial infarction. Pathologic examination of aspirated material revealed fibrous tissue in 12 cases and cholesterol crystals in four. We conclude, with the limitation of a preliminary study, that rotational atherectomy with the transluminal extraction catheter is a useful procedure to relief coronary stenosis of the coronary arteries.

Aged↗

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[Percutaneous mitral valvulotomy using the Inoue balloon technique].

We have reviewed our initial experience with percutaneous mitral valvulotomy (PMV) in 29 consecutive patients with mitral stenosis using the Inoue mono-balloon technique. In all cases, the venous transeptal anterograde approach was used. Age was 49.5 +/- 12.5 years (range 21-78) and only 5 (17%) patients were male. Clinical status was as follows: 15 patients were in NYHA class II, 13 NYHA class III and one in NYHA class IV. Atrial fibrillation was present in 15 (52%) patients and 16 (55%) were on coumarin. An echocardiographic score was employed to assess mitral valve anatomy, parameters including degree of thickening, mobility, calcification and subvalvular involvement were scored independently from 1 to 4. The echocardiographic score so determined was 7.72 +/- 2.1 for the entire group. Ten patients presented mild (+) mitral regurgitation prior to PMV. The mean duration of PMV was 76.2 +/- 29.6 minutes. In only one patient an inadequate positioning of the balloon prevented dilatation of the valve whereas the remaining 28 patients had their valves successfully dilated. Mitral valve area, by means of both Gorlin and Doppler (pressure half time) methods, increased in all cases: from 0.95 +/- 0.17 cm2 to 1.92 +/- 0.31 cm2 (p less than 0.001) and from 0.97 +/- 0.22 to 1.84 +/- 0.33 cm2 (p less than 0.001), respectively. Mitral regurgitation increased angiographically in more than 1 degree only in 1 patient, but no other cardiac or vascular complication occurred. Thus, in our experience PMV with the Inoue mono-balloon catheter is a safe and effective method for dilating mitral valve stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

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[Color Doppler study of 2 complicated aortic abscesses ruptured into the right ventricle and left atrium].

This report describes 2 patients with infective endocarditis who subsequently developed aortic abscesses which eventually ruptured, in one case to the right ventricular outflow tract and, in the other, to the left atrium causing, in both patients, severe hemodynamic derangement. The site of communication between the abscesses and the receiving chamber was accurately diagnosed by color flow Doppler imaging which provided more valuable preoperative information than conventional techniques.

Abscess↗

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[Clinical profile and results of transluminal coronary angioplasty in women. Comparison with men].

To determine if the results of percutaneous transluminal coronary angioplasty are similar in women and in men or any difference between both sexes exists, we have compared 43 clinical and 61 angiographic or procedural variables of 85 consecutive transluminal coronary angioplasties performed in women with 421 similar consecutive procedures in men. Only cigarette smoking was more frequent in men (84 vs 11%, p less than 0.001), being the remaining coronary risk factors more common in women (hypertension 69% vs 37%, p less than 0.001; hypercholesterolemia 46% vs 33%, p less than 0.05, and diabetes mellitus 42% vs 14%, p less than 0.01). In addition, unstable angina was a more frequent indication of coronary angioplasty in women than in men (74% vs 61%, p less than 0.05), whereas coronary angioplasty after intravenous thrombolysis was more frequent in men (12% vs 1%, p less than 0.001). Coronary angioplasty angiographic success (87% vs 91%), and minor (16% vs 10%) or major (5% vs 3%) complications were not statistically different in the two groups. Nevertheless, success of the procedure in the absence of any complication was achieved in a higher percentage (86% vs 76%, p less than 0.05) of men than in their female counterparts. After coronary angioplasty 88% of women had an angiographic follow-up available which yielded a restenosis rate of 41% (vs 32% in men, NS), despite the absence of symptoms in the 89% of these patients in their last visit. In conclusion, we have found that the feminine population subjected to coronary angioplasty have a higher incidence of coronary risks factors and more frequently unstable angina than the masculine group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

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[Repeat coronary angioplasty in the treatment of restenosis. Results and follow-up].

With the aim of assessing the value of repeat angioplasty in the treatment of coronary restenosis we have compared the clinical, hemodynamic and procedural variables of 404 consecutive angioplasties, where 468 original lesions were treated, with 57 repeat angioplasties with 63 restenosed lesions attempted. The procedure was performed in the treatment of a myocardial infarction only in the group with original lesions (13% vs 0%, p less than 0.05). The hemodynamic variables including ejection fraction (63 +/- 14 vs 67 +/- 15) and the presence of multivessel disease (38% vs 41%) were similar in both groups, but more angioplasties in the restenosed group were performed in the left anterior descending coronary artery (70% vs 50%, p less than 0.01) whereas less were performed in the circumflex artery (6% vs 19%, p less than 0.05). Long lesions (greater than or equal to 12 mm), and concentric lesions, were more frequently found in the group with restenosis (33% vs 16%, p less than 0.05, and 48% vs 32%, p less than 0.05, respectively). In addition, more angioplasties in the restenosed group were performed during the diagnostic coronary angiogram (68% vs 24%, p less than 0.001). The results both per lesion (98% vs 88%, p less than 0.05) and per procedure (96% vs 86%, p less than 0.05) were better in the restenosed group, with a similar rate of major complications (2% vs 4%). With an angiographic follow-up higher than 90%, the restenosis rate was again similar in both groups (36% and 35%). We conclude that repeat angioplasty is an effective means of treating coronary restenosis with a higher success than the original procedure, probably reflecting an anatomic substrate more prone to be successfully dilated in the restenosed lesion. Accordingly, we are using repeat angioplasty as the treatment of choice for symptomatic restenosis.

Angioplasty, Balloon↗

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