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Biomedical subjects

L Finci

Publications and source records attributed to L Finci.

At least 91 records · Page 5Linked to original sources
PubMed1986

[Trefoil balloon, a new instrument for percutaneous valvuloplasty].

Complete obstruction of blood flow during balloon inflation is a major problem of percutaneous balloon valvuloplasty. To ensure continued transvalvular blood flow the authors have developed the "Trefoil balloon" consisting of three identical angioplasty balloons mounted on a single catheter. The Trefoil balloon was tested in the aorta and aortic valve in 4 dogs and produced a pressure gradient from 5 to 40 mm Hg where conventional balloons were completely occlusive. The Trefoil balloon was then used in 3 children with congenital valvular stenoses (2 pulmonary and 1 aortic stenosis). The immediate results of these valvuloplasties were satisfactory. Continued flow during balloon inflation was documented by right ventricular injection of contrast medium in the cases of pulmonary stenosis and by a systolic aortic pressure of 75 mm Hg during balloon inflation in the case of aortic stenosis. The Trefoil balloon is a promising new device for percutaneous valvuloplasty.

Angioplasty, Balloon↗
PubMed1986

Trefoil balloon for percutaneous valvuloplasty.

A new balloon (Trefoil balloon) was developed to avoid complete interruption of blood flow during percutaneous balloon valvuloplasty. It consists of three identical 2- to 4-cm-long angioplasty balloons mounted in a parallel fashion on a single catheter. Filled simultaneously, they assume the cross section of a rosette, allowing for continued blood flow. Trefoil balloons of various sizes were tested in five dogs (aorta and aortic valve). They created a gradient ranging from 5 to 40 mmHg where conventional, single balloons of comparable size were completely obstructive. In three consecutive patients with congenital pulmonary stenosis, Trefoil balloons were used successfully and without significant complications. Continued transvalvular blood flow during the actual dilatation process was documented in all cases. The Trefoil balloon is a promising new device for percutaneous valvuloplasty and, perhaps, coronary angioplasty.

Adolescent↗
PubMed1986

Clinical evaluation of soft-tipped catheters for coronary angiography.

New soft-tipped Judkins catheters for coronary angiography were compared with conventional femoral catheters for coronary angiography in a randomized, controlled fashion with cross-over exchange of catheters when problems occurred. The problems encountered with a first generation of soft-tipped catheters (n = 113) versus conventional catheters (n = 103) were as follows: difficult introduction 27% versus 1% (p less than 0.01), difficult placement 13% versus 8% (not significant), difficult aspiration 4% versus 0% (p less than 0.05), wedging 5% versus 0% (p less than 0.05), spasm 3% versus 0% (not significant), overselectivity 7% versus 2% (not significant), cross-over necessary and successful 18% versus 1% (p less than 0.01). Problems with a second generation of soft-tipped catheters (n = 200), modified according to the experience gathered from the first generation, versus conventional catheters (n = 194) were as follows: difficult placement 10% versus 7%, difficult aspiration 2% versus 0.5%, wedging 2% versus 1%, spasm 1% versus 0%, overselectivity 3% versus 2%, ventricular fibrillation 1.5% versus 0%, cross-over necessary and successful 3% versus 2%. None of the differences attained statistical significance. The performance of soft-tipped catheters for coronary angiography was inferior for the first generation but comparable for the second generation to that of conventional catheters. In terms of safety, soft-tipped catheters were not superior on the basis of our criteria.

Angiography↗
PubMed1986

Tandem balloon catheter for coronary angioplasty.

The Tandem balloon catheter is a triple lumen steerable catheter for coronary angioplasty with two separately inflatable balloons of different diameters. Indications and results of 26 consecutive patients treated with a Tandem balloon catheter are reviewed. Adequate distal pressure measurements were obtained in 71% of the cases. In ten patients, the Tandem balloon catheter was selected for two stenoses in different segments of the same coronary artery. Angioplasty was successful for all lesions in five and for at least the strategic lesions in five patients (in one only after changing to a single-balloon catheter). In the seven patients with stenoses in two different coronary arteries of various calibers, angioplasty was successful for both vessels in three and for one vessel in four patients. In the six patients with a very tight stenosis, where the Tandem balloon catheter was selected to predilate with the small balloon, the procedure was technically successful in all, but there was a myocardial infarction in one patient. In the three patients with a chronic total occlusion, where the stiffness of the Tandem balloon was the reason for selection, one recanalization was successful. The Tandem balloon catheter provides a handy tool for complex coronary angioplasty. It offers comparable ease in manipulation and pressure transmission and may save time, money, and radiation exposure by avoiding catheter exchanges.

Aged↗
PubMed1986

Mechanical emergency recanalization of the left main coronary artery.

Acute occlusion of the left main coronary artery is normally fatal. According to the literature, only a few cases have been treated by intracoronary thrombolysis; the prolonged period of ischemia, however, resulted in severe left ventricular dysfunction and numerous complications. Therefore, effort should be directed to recanalize the left main coronary artery within the shortest possible interval. We followed this approach in a case of acute occlusion of a subtotal stenosis of the left main coronary artery which could be mechanically reopened and dilated within a few minutes. The intervention resulted in immediate reversal of profound cardiogenic shock and complete restoration of normal left ventricular function. At hospital discharge, the patient was asymptomatic with a negative bicycle stress test. Immediate mechanical recanalization and angioplasty appear to be a feasible approach in life-threatening coronary occlusion.

Aged↗
PubMed1986

Percutaneous transluminal angioplasty of right and left internal mammary artery grafts.

Four patients with recurrent severe angina and evidence of myocardial ischemia two to six months after surgical coronary revascularization have been submitted to percutaneous transluminal angioplasty of the distal insertion of internal mammary artery grafts or of the recipient vessel distal to it. These cases illustrate the feasibility and safety of transluminal angioplasty of right and left internal mammary artery grafts, using the mammary artery as a way of access.

Adult↗
PubMed1986

Coronary artery dissection after transluminal angioplasty. Possible deleterious effects of treatment with intracoronary streptokinase.

Percutaneous transluminal coronary angioplasty (PTCA) is a nonsurgical alternative in the management of selected patients with coronary artery disease. Intimal dissection is the mechanism by which PTCA dilates coronary obstructions. Acute vessel occlusion is a rare but severe complication. Vessel patency can often be restored by fibrinolytic therapy when occlusion occurs immediately after angioplasty. A case of a patient with coronary dissection after PTCA and delayed obstruction, possibly aggravated by streptokinase is presented.

Adult↗
PubMed1985

[Multivessel percutaneous coronary angioplasty].

Between August 1983 and October 1984, 44 patients (39 male and 5 female, mean age 53 years) underwent multivessel percutaneous transluminal coronary angioplasty involving 2 vessels in 37 (84%), 3 vessels in 4 (9%), 4 vessels in 1 (2%) and coronary artery bypass graft plus 1 or 2 vessels in 2 (5%). A mean of 2.2 vessels per patient were attempted. Dilatations of multiple stenoses in the same vessel were not included. Primary success was achieved in 87 of 97 vessels (90%) and in 37 of 44 (84%) patients. Primary success per patient was defined as primary success in all or at least in the strategic lesions associated with clinical improvement of the patient. Complications included one death (2%), emergency coronary artery bypass surgery in one (2%) and myocardial infarction in 2 (4%) patients. Five other patients underwent elective coronary artery bypass surgery. Recurrence of lesion was 14% (5/37 patients) during a follow-up period of 3 to 12 months. Repeat angioplasty was successful in 4 patients (80%) and unsuccessful in 1 patient who underwent elective surgery. It is concluded that, in selected cases, multivessel percutaneous transluminal coronary angioplasty is a feasible alternative to coronary artery bypass surgery, with comparable risks. A satisfactory long-term amelioration without coronary artery surgery can be obtained in 2/3 of patients.

Adult↗
PubMed1985

Non-selective intra-arterial digital subtraction angiography for the assessment of coronary artery bypass grafts.

Non-selective intra-arterial digital subtraction angiography (DSA) was performed immediately before selective coronary and bypass angiography in 33 consecutive symptomatic patients 48 +/- 30 months after coronary surgery, for the assessment of 75 coronary bypass grafts. Forty ml of non-ionic, low-iodine content contrast medium (iohexol) were injected into the ascending aorta at 10-20 ml/sec through a 7 or 8 F femoral pigtail catheter. Electrocardiogram-triggered images were acquired on a Siemens Digitron II apparatus in multiple projections in 24 patients and in a single projection in 9 patients. The results of this technique were compared by two independent angiographers with those of selective graft angiography in the same patients. Patency was shown by DSA in 45 of 54 grafts confirmed to be open by selective angiography (sensitivity 83%). Of 21 occluded grafts, stumps were clearly visible at selective angiography in 18 and at DSA in 9 (sensitivity for graft stumps = 50%, p less than 0.01). Of 54 patent grafts with selective angiography, the distal anastomosis could be visualized by DSA in 28 (52%), but the resolution was comparable to selective angiography in 20 grafts (37%) only. A non-significant difference in the sensitivity of DSA was observed between patent saphenous grafts to the left anterior descending coronary artery versus all other coronary arteries (95 vs 85%, respectively), while only 1 of 5 patent left internal mammary artery grafts to the left anterior descending coronary artery was visualized. In 16 of 50 grafts (32%) visualized in a second projection substantial additional diagnostic information was obtained. In conclusion, non-selective intra-arterial electrocardiogram-triggered DSA can visualize patent saphenous grafts with a high sensitivity and may be a useful screening tool for bypass grafts patency; false negatives, however, and poor visualization of distal anastomoses limit its routine clinical use.

Adult↗
PubMed1985

Conversion of supraventricular arrhythmias to sinus rhythm using flecainide.

We evaluated the efficacy of flecainide acetate (given intravenously to a maximal dose of 2 mg kg-1 and then orally in a dose of 100 mg b.d. or 100 mg t.d.s.) in the conversion to sinus rhythm of 50 patients exhibiting supraventricular arrhythmias (39 with atrial fibrillation, 6 with atrial flutter, 4 with supraventricular tachycardia and one with supraventricular tachycardia in association with the Wolff-Parkinson-White syndrome). Conversion was achieved in 36 patients (72%) (29 cases with atrial fibrillation, 4 cases with supraventricular tachycardia, 2 cases with atrial flutter and one case with Wolff-Parkinson-White syndrome), over a mean period of 7.4 +/- 9 h. The patients in which conversion was achieved had arrhythmias which had been in existence for a shorter time (5.3 +/- 9.8 days) than those in which conversion was not achieved (16.7 +/- 26.2 days) (P less than 0.01). The mean dosage of flecainide used to achieve conversion was 2.5 +/- 2.36 mg kg-1. Flecainide appears to be an effective agent for the conversion to sinus rhythm of atrial fibrillation and supraventricular tachycardias. Its efficacy in cases of atrial flutter has not yet been demonstrated.

Adult↗