Nuclear cardiology results before and after percutaneous transluminal coronary angioplasty (PTCA): 1978-1986.
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Angioplasty, Balloon↗
Biomedical subjects
G Kober
Publications and source records attributed to G Kober.
Acute hemodynamic effects of the vasodilating and beta-blocking agent carvedilol in comparison to propranolol.
In a randomized double-blind study, oral doses of 50 mg carvedilol were compared to 40 mg propranolol in 16 male patients with coronary heart disease (12 without significant stenosis after percutaneous transluminal coronary angioplasty) at rest, during and after exercise, and before and 80 min after drug application. Systemic and pulmonary pressures, heart rate, cardiac index, and lower limb blood flow were measured, and systemic and pulmonary resistances calculated. Carvedilol does not lead, as the classical beta-blocker propranolol does, to an increase in systemic or pulmonary resistance, nor to a decrease in cardiac output, or to an increase of the pulmonary capillary wedge pressure during exercise. In contrast to propranolol, the postexercise lower limb blood flow has increased significantly. The differences in action between the two beta-blockers can be explained by the vasodilating properties of carvedilol. Due to these acute effects, carvedilol may be of advantage compared to propranolol in the treatment of peripheral occlusive artery disease, hypertension, and coronary vasospasm.
Adrenergic beta-Antagonists↗
[Repeated recurrences after balloon dilatation--dilate or operate?].
In a total of 333 patients who had undergone a first successful transluminal coronary angioplasty (TCA) of a single stenosis in a native coronary vessel, restenosis occurred in 15% (follow-up angiography was performed in 94% of these patients). The restenosis rate was higher in bypass stenoses (45%) and in reopened vessels (54%). Repeat dilatation of restenoses showed a high primary success rate (93%) and only a few complications (2%). In this group, recurrent restenosis was observed in 33% of patients. Thirteen patients with recurrent restenoses (11 patients with two recidivations and two patients with three) underwent a total of 41 dilatation attempts. The degree of the recurrent stenosis (prior to the first TCA: 89%; prior to the second: 82%; prior to the third: 74%), the number of eccentric stenoses (8; 7; 5, respectively) and the length of the stenotic obstruction (5.2 mm; 4.7 mm; 4.3 mm, respectively) decreased. Accordingly, exercise tolerance was improved (99 W, 133 W, 146 W). To date, follow-up angiography and functional investigations have been performed in 11 out of 13 patients. Good long-term results have been observed in eight patients and another restenosis in three. It is concluded that repeat angioplasty is a reasonable therapeutic approach also in patients with recurrent restenosis.
Angioplasty, Balloon↗
[Angiographic and functional long-term results 2 to 8 years following coronary angioplasty].
Functional and angiographic follow-up was performed in 61 patients 3.9 months (range 2-8 months) and 3.7 years (range 2-8 years) after successful transluminal coronary angioplasty. The mean degree of stenosis prior to angioplasty was 78.7% and after the procedure, 36%. After 3.9 months there was a slight increase to 39% because of 12 recurrences. In three of these patients a second angioplasty was performed; nine were continued on medical treatment because of sustained clinical benefit. After 3.7 years, the mean degree of stenosis was 29%. No patient with persistent vessel patency after 3.9 months showed an increase of the dilated stenosis of more than 15% after 3.7 years. Prior to angioplasty, 41 patients (75%) had one-vessel disease; 19 (18%) two- and 4 (7%) three-vessel disease. 2-8 years after successful angioplasty, 48% of patients showed no stenosis of greater than or equal to 50% narrowing. Progression of coronary artery disease was found in 29/61 patients at the late follow-up. Of these 29 patients, 11 underwent another angioplasty because of a new stenosis in another vessel or segment; 18 were treated medically. There was no need for bypass surgery. It is concluded that a sustained success 3.9 months after angioplasty predicts excellent long-term vessel patency.
Adult↗
[Transluminal coronary angioplasty: parameters of increased risk of recurrence].
Data about the primary success and complication rates following transluminal coronary angioplasty are comparable worldwide. Reports on the frequency of recurrences, however, differ considerably. Data concerning factors enhancing the risk of restenosis are contradictory. We compared a group of 62 patients with angiographically confirmed restenosis with a group of 62 patients without restenosis. There were no significant differences with regard to age, sex, onset of symptoms and severity of angina pectoris, number of previous infarctions, incidence of multivessel disease, maximum size of the balloon catheters used and primary dilatation results. The following factors were significantly associated with the occurrence of restenosis: high-grade stenoses prior to dilatation, stenoses involving long segments of coronary arteries, eccentric stenoses, the necessity to apply high balloon pressures, long duration of balloon inflation, and also the patient being overweight, a nonsmoker and having undergone an alteration in continuous treatment.
Adult↗
Long wire technique--experience with 100 procedures.
Derived from more than 1000 procedures the long wire technique has proven to facilitate coronary angioplasty. Maneuvering of the wire is unhindered because the wire is introduced without balloon catheter. Optimal contrast display is possible during crossing of the stenosis. Precision and safety of the procedure is therefore considerably improved. Balloon catheters can be exchanged without recrossing the stenosis including super low profile catheters of small diameter. In case of acute coronary occlusion occurring during angioplasty the long wire allows reintroduction of catheters without danger of via falsa. If necessary a 4.5 f perfusion catheter can be introduced and coronary perfusion with 60-100 ml per minute blood from the femoral artery can be performed by hand. In contrast to the monorail technique the ability to measure pressures through the balloon catheter including intracoronary gradients and coronary capillary pressure is preserved.
Angioplasty, Balloon↗
[Coronary-dilating effect of minimal doses of nitroglycerin].
A previous study verified the antianginal efficacy of 0.025 mg nitroglycerin without it having any effect on heart rate and blood pressure. In a randomized double-blind study, 40 patients with coronary heart disease received intravenously either 0.025 mg nitroglycerin or placebo. Before and 1-2 min after injection, the aortic and left ventricular (n = 20) pressures were recorded and coronary angiography performed. Mean heart rate, systolic and diastolic aortic pressure, left ventricular filling pressure and the pre- and poststenotic diameter of the coronary arteries, as well as the diameter of a distal coronary artery segment, showed no significant changes (p greater than 0.05). The stenotic segment diameter of the coronary artery remained unchanged after placebo administration (1.01 +/- 0.5 to 1.13 +/- 0.49 mm; p greater than 0.05) but increased significantly after the injection of nitroglycerin (from 1.15 +/- 0.68 to 1.32 +/- 0.73 mm; p less than 0.01). These results support the hypothesis that dilatation of coronary stenoses is an important aspect of the antianginal action of nitroglycerin. This may have practical consequences in the treatment of patients with angina and low blood pressure or severe headaches after the administration of conventional doses of nitroglycerin.
Angina Pectoris↗
Long-term treatment of hypertrophic cardiomyopathy with verapamil or propranolol in matched pairs of patients: results of a multicenter study.
The effects of a 2-year treatment with high-dose propranolol (mean, 340 +/- 135 mg/day) and verapamil (mean, 493 +/- 136 mg/day) were compared in two groups of patients with hypertrophic cardiomyopathy. Both groups were broadly identical at the beginning of the trial and were formed of matched pairs. Out of 137 patients entering the study, 37 pairs completed the 2 year follow-up. The mean group symptomatology (NYHA-classification) improved significantly only following verapamil treatment. Individual improvement was seen more often following verapamil (V), but deterioration was almost exclusively seen during propranolol (P) treatment. Reduction of the Sokolow-index was significant in the V group only. Reduction in the resting heart rate and maximum gradient was more pronounced following P. No correlation could be found between the change in clinical symptoms and electrocardiographic, echocardiographic or hemodynamic data, nor to the dosage of V or P administered. From clinical and echocardiographic findings and in respect of side effects, V is advantageous over P in the treatment of hypertrophic cardiomyopathy, although a considerable number of patients improve after P. Objective data do not allow one to anticipate responders or non-responders to either treatment.
Cardiomyopathy, Hypertrophic↗
[Imaging of aortocoronary bypasses with intravenous digital subtraction angiography].
We examined 24 patients with 52 coronary bypass grafts, an average of 18 months after their respective operations. During the course of 1 week, a coronary angiography and a digital subtraction angiography (DSA) incorporating an intravenous injection of contrast medium were performed. Conventional coronary angiograms showed 40 bypasses as being open, ten as being occluded, and two could not be displayed at all. With the aid of digital angiography, 50 out of 52 bypasses could be classified as either open or occluded. In 44 out of 52 bypasses, DSA and coronary angiogram results were identical. Using DSA, three out of ten angiographically occluded bypasses were falsely diagnosed as being open and three out of 40 open bypasses as occluded. Two bypasses could not be interpreted due to poor picture quality. In the diagnosis "open bypass" the degree of both sensitivity and specificity subsequently amounted to 92.5%, and 70% in the diagnosis "occluded bypass". The distal part of the bypasses, as well as the proximal and distal part of the anastomoses, could not be evaluated for the most part. Furthermore, on account of the comparatively inferior quality of the pictures, detection of bypass stenosis is not reliable using digital subtraction angiography. Intravenous digital subtraction angiography may therefore serve as a screening method in the evaluation of coronary bypass grafts.
Coronary Angiography↗
[Radiation burden in heart catheter studies--significance of measures for reducing scatter radiation].
During diagnostic and, more particularly, therapeutic intervention, such as transluminal coronary angioplasty, the operator may be exposed to a considerable degree of scatter radiation. In our study, we measured the level of radiation exposure of the head, unprotected knees and lower legs. A flexible lead screen, attached to the catheterization table (0.5 mm Pb) reduced scatter radiation of the lower legs by 95%. In addition, scatter radiation exposure of the head decreased by 54% by covering the patient with a rubber leaden blanket (0.25 mm Pb). Finally, the use of these supplementary yet simple measures did not hinder or interfere with the examination procedure in any way.
Cardiac Catheterization↗
[Transluminal valvuloplasty of a stenotic and calcified aortic valve].
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Angioplasty, Balloon↗
[Successful angioplasty of a coronary stenosis followed angiographically for 9 years].
A short 80% peripheral stenosis of the anterior interventricular branch which remained unchanged for nine years was successfully dilated by transluminal balloon coronary angioplasty using long-wire technique with angiographically demonstrated reduction of the stenosis to 30%. The patient has since been without symptoms, even on severe physical exertion. It has previously been thought that increasing hardening of the atheroma of a long-standing stenosis prevented successful lasting dilatation.
Angiography↗
[Aortocoronary bypass operation as an emergency intervention after transluminal coronary angioplasty. Which factors prevent the incidence of a major infarct?].
Among 830 patients in whom transluminal coronary angioplasty (TCA) was undertaken there were 41 (4.9%) who required an aortocoronary bypass operation for acute complications (vessel dissection with markedly reduced flow; complete occlusion or contrast-medium extravasation). The group of 41 was divided into two, based on angiography (25) or ECG (16) criteria. Group 1 comprised 30 patients, who developed no or only a small infarct peri-operatively; group 2 had eleven patients with large infarcts. The patients of group 1 had a greater exercise tolerance pre-operatively than those of group 2 (118 +/- 28 vs 91 +/- 45 Watt; P less than 0.05) and had a higher revascularization time (interval between end of the cardiac catheterization and onset of reperfusion: 154 +/- 58 vs 264 +/- 173 min; P less than 0.05). Collaterals to the area supplied by the treated vessel were observed only in group 1 patients (10), but not of those in group 2. Age, history of previous infarction, number of diseased coronary arteries, ischaemic reaction during ergometry, initial left-ventricular ejection fraction and symptoms after onset of complications were without significance. It is concluded that an aortocoronary bypass operation should be performed as early as possible after post-TCA vascular complication in order to prevent the development of larger infarcts.
Angioplasty, Balloon↗
[Percutaneous valvuloplasty of the aortic valve in adults].
In a 23-year-old patient with congenital stenosis of the aortic valve the pressure gradient could be reduced from 80 to 35 mm Hg using percutaneous balloon aortic valvuloplasty. The systolic pressure in the left ventricle fell from 200 to 165 mm Hg. A pre-existing mild aortic insufficiency did not worsen. In a 44-year-old female patient retrograde passage of a balloon catheter across the aortic valve failed due to technical reasons. At the present time percutaneous balloon aortic valvuloplasty in adults is more difficult than pulmonary valvuloplasty. It can, however, be considered, prior to surgery, in suitable patients with noncalcified valves.
Adult↗
The long wire technique for coronary angioplasty.
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Angioplasty, Balloon↗
Left predominant coronary circulation in patients with valvular aortic stenoses.
This study was conducted to examine whether a correlation exists between the incidence of aortic stenosis and predominant left coronary perfusion. Therefore, coronary angiograms of 77 patients with mitral stenosis (Group 1), 50 patients with combined mitral valve disease and pure mitral insufficiency (Group 2), 61 patients with aortic insufficiency with or without mitral valve disease (Group 3), 49 patients with pure aortic stenosis (Group 4), and 69 patients with combined aortic valve disease and aortic stenosis with concomitant mitral valve disease (Group 5) were reviewed. Group 6 consisted of 20 patients with coronary heart disease. A statistically significant accumulation of left coronary circulation was found in patients with pure aortic stenosis (Group 4) (33%) as well as in patients with combined aortic valve disease (19%). The frequency of predominant left coronary circulation was comparable in all other patients (Group 1: 8%; Group 2: 10%; Group 3: 8%; Group 6: 7.5%). Thus, the presence of left predominance in a diagnostic coronary arteriogram performed in a patient with aortic stenosis could be a clue that the aortic stenosis is congenital.
Adult↗
[Indications in angina pectoris: balloon dilatation].
Nine years after the introduction of transluminal coronary angioplasty by Andreas Grüntzig, large medical centers all over the world report on an acute success rate between 85 and 90%. Complications leading to an emergency bypass operation are observed in 3-7%. The mortality rate is less than 1%. The technical progress with the development of new guiding catheters and steerable balloon systems led to an extension of indications. Probably prognostical aspects of indication may become more important in the future.
Angina Pectoris↗
[Effects of intracoronary nitroglycerin administration on poststenotic vascular diameter before and following transluminal coronary angioplasty].
Percutaneous transluminal coronary angioplasty (PTCA = TCA) was performed in 38 patients with coronary single vessel disease. Coronary angiograms were analysed to detect the influence of mechanical as well as nitroglycerin-induced dilation on organic stenoses, prestenotic and poststenotic coronary segments and non-stenosed reference vessels. 28 patients (group I) were evaluated retrospectively. Bolus injection of 0.5 mg of nitroglycerin (NTG) was followed by an increase in all measured segments: prestenotic segments +15.4%, stenoses +17.9%, poststenotic segments +39.3%, reference segment of a nonstenotic vessel +29.9% above control value before NTG. Subsequent mechanic dilation of stenosis by 108.3% resulted in no further significant increase of poststenotic diameters (+42.6% above control value), while diameters of reference vessels decreased (+9.7% above control value). In order to demonstrate whether this behaviour was due to a loss of NTG activity at the end of TCA, we attempted to reinduce vasodilation in another 10 patients (group II) by a second intracoronary bolus injection of 0.5 mg NTG. In these patients NTG injection before TCA resulted in an increase in poststenotic diameters as well as in reference vessels (21.2% and 14.0% respectively above control value). At the end of TCA an increase in the poststenotic diameter could be found to 22.1% above control value, while diameters of reference vessels had markedly decreased (4.1% above control value). The second injection of NTG resulted in an increase of poststenotic as well as reference segments (39.3% and 17.4% respectively above control value).(ABSTRACT TRUNCATED AT 250 WORDS)
Angioplasty, Balloon↗