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At least 37 records · Page 2Linked to original sources
PubMed1993

Supported angioplasty with synchronized retroperfusion in high-risk patients with left main trunk or near left main trunk obstruction.

To test the feasibility of synchronized retroperfusion (SRP) as a support device of percutaneous transluminal coronary angioplasty (PTCA) for high-risk patients, 10 patients with left main trunk or near left main trunk obstruction underwent PTCA with SRP. An 8.5F retroperfusion catheter was inserted from the antecubital vein into the coronary sinus. Arterial blood was supplied through the catheter into the myocardium with a retroperfusion pump during the diastolic phase by means of ECG triggering. In all patients, the narrowings were successfully dilated and an improvement of more than 20% in the luminal diameter stenosis was achieved; however, narrowing of more than 50% (58%) remained in one patient. In all patients, systemic hemodynamics was maintained for more than 30 seconds during balloon inflation. In seven patients, a 60-second balloon inflation was possible without any collapse of systemic hemodynamics. To test the protective effect of SRP on myocardial ischemia and impairment of systemic hemodynamics, balloon inflation without SRP was performed in eight patients after successful dilatation. The duration for balloon inflation with SRP (71 +/- 30 seconds; n = 8) was significantly longer than that without SRP (56 +/- 30 seconds; n = 8). The decrease in systolic aortic pressure, the increase in pulmonary diastolic pressure, and ST-T segment elevation in the precordial lead of ECG during balloon inflation with SRP were less than those during balloon inflation without SRP. After PTCA, angina was not provoked by exercise stress testing in any of the 10 patients. We concluded that SRP is a beneficial support device of PTCA for high-risk patients.

Aged↗
PubMed1994

Influence of right coronary artery stenosis on exercise test responses and survival in patients with left main or left main equivalent disease.

Forty-two patients with angiographically documented left main coronary artery (LM) disease (luminal occlusion > or = 50%) and 30 patients with left main equivalent (LMEQ) disease (> or = 70% luminal occlusion of both the proximal left anterior descending artery and proximal left circumflex artery) were studied to determine the role of right coronary artery (RCA) involvement on exercise test responses and survival. Significant (> or = 70%) RCA stenosis was present in 30 (72%) of the 42 LM patients and 16 (53%) of the 30 LMEQ patients. No significant differences were observed between LM and LMEQ patients in any clinical or exercise variables or survival. Thus both groups were combined for analysis of the influence of RCA involvement (i.e., LM/LMEQ with RCA versus LM/LMEQ without RCA disease). Greater ischemic responses were observed in the LM/LMEQ group with significant stenosis of the RCA. The presence of RCA stenosis was associated with significantly greater horizontal or downsloping ST-segment depression during exercise (2.4 +/- 1.2 mm vs 1.3 +/- 1.4 mm; p < 0.001), and prolonged recovery time until normalization of the ST segment (3.2 +/- 1.4 min vs 2.0 +/- 1.9 min; p < 0.01). The LM/LMEQ without RCA disease group behaved like the subgroup with two-vessel disease, and responses of the LM/LMEQ group with RCA disease were similar to the group with three-vessel disease. The annual survival in LM/LMEQ with RCA disease was worse than that in LM/LMEQ without RCA disease (average annual mortality rates = 7.5% vs 1.0%, respectively; p = 0.05). Infarct-free survival in LM/LMEQ with RCA disease was also lower than that in LM/LMEQ without RCA disease. Thus although patients with LM and LMEQ were similar in terms of survival and exercise responses, the presence of RCA stenosis was associated with significantly greater ST-segment depression, a prolonged recovery time until normalization of the ST segment, a fivefold increase in the death rate, and higher morbidity from myocardial infarction over a 5-year period of follow-up. Involvement of the RCA should be considered when making decisions concerning medical-surgical management of patients with severe coronary artery disease.

Aged↗
PubMed2002

Clinical study of chronic pancreatitis with focal irregular narrowing of the main pancreatic duct and mass formation: comparison with chronic pancreatitis showing diffuse irregular narrowing of the main pancreatic duct.

INTRODUCTION: Main pancreatic duct (MPD)-narrowed chronic pancreatitis (CP) may be an autoimmune abnormality. It also has been called autoimmune pancreatitis and sclerosing pancreatitis. It is unclear whether cases with focal pancreatographic changes are part of the same clinical entity as cases with diffuse MPD changes. AIM AND METHODOLOGY: We reviewed seven cases of chronic pancreatitis (CP) with focal narrowing of the main pancreatic duct (MPD), evidenced by endoscopic retrograde cholangiopancreatography (ERCP), and swelling of one or two segments of the pancreas, evidenced by ultrasonography (US) /computed tomography (CT), and indicated the clinicopathologic features of focal-type MPD-narrowed CP. RESULTS: The patient group comprised six men and one woman, and their age range was 28-75 years, with a mean of 63.7 years. Affected sites were in the head in two patients, the body in one patient, the tail in one patient, and the body and tail in three patients; ERP showed narrowing in six patients and obstruction in one. Stricture of the lower portion of the common bile duct (CBD) that caused obstructive jaundice was shown by ERC in two cases in which the pancreas head was affected. In all six patients, a dynamic study by CT or MRI homogeneously showed delayed enhancement of involved segments of the pancreas. Serum levels of pancreatic enzyme were elevated in five patients, but only one subject had pancreatitis-like epigastric pain. Serological evidence suggestive of autoimmune abnormality was detected in only three patients with hypergammaglobulinemia (> or =2.0 g/dL) or positive titers of antinuclear antibody (ANA; > or =80). Histological assessment was available for five patients, who characteristically had dense lymphocytic or plasmocytic infiltration with severe fibrosis that caused luminal narrowing. The clinical, serologic, and histologic findings as described above were comparable to those for 12 CP patients with diffuse narrowing of the MPD, diagnosed during the same period. Surgical resection was performed in 5 patients, in 2 of whom a similar inflammatory process recurred in the remnant head of the pancreas, whereas pancreatitis no longer developed in the other 3 patients. One patient was initially treated with steroids, with clinical remission, although there was neither hypergammaglobulinemia nor positive ANA. CONCLUSION: These results indicate that CP with focal narrowing of the MPD is part of the same clinical spectrum as CP with diffuse narrowing of the MPD, and whether the distribution is diffuse or focal seems to be related to the stage or the extent of the disease. It is therefore important to recognize the possible existence of this focal variant to avoid unnecessary surgery.

Adult↗
PubMed1999

[Minimum intensity projection image and curved reformation image of the main pancreatic duct obtained by helical CT in patients with main pancreatic duct dilation].

Contrast enhanced CT was performed in seven patients with pancreatic disease (chronic pancreatitis, n = 3; pancreatic head cancer, n = 2; mucin-producing pancreatic tumor, n = 2) who showed dilation of the main pancreatic duct (MPD) Minimum intensity projection (Min-IP) images of the pancreas were obtained using multi-projection volume reconstruction (MPVR) software by selecting an oblique slab that contained the entire MPD. Curved reformation (CR) images were obtained using multiplanar reformation (MPR) software by tracing the MPD on the Min-IP image. Both Min-IP images and CR images clearly showed the dilated main pancreatic duct in all seven patients. In three of the seven, obstruction of the MPD in the pancreatic head and the cause of obstruction (tumor mass, n = 2; caliculus, n = 1) were also clearly seen. Min-IP and CR images seem to be useful for the diagnosis of pancreatic diseases.

Chronic Disease↗
PubMedDate not supplied

Left main coronary artery compression by dilated main pulmonary artery in endocardial cushion defect.

A 56-year-old man was evaluated for exertional dyspnoea. Chest X-ray showed mild cardiomegaly and a dilated main pulmonary artery. On echocardiogram he was found to have ostium primum atrial septal defect with moderate tricuspid insufficiency. Cardiac catheterization revealed an oximetry step-up of 14% at low right atrium with angiogram demonstrating a cleft in the mitral valve, an elongated left ventricular outflow tract and ventricular septal defect closed by a septal aneurysm. Coronary angiogram revealed ostial compression of the left main coronary artery with the rest of the coronary artery anatomy being normal.

Cardiac Catheterization↗
PubMed2003

Coronary fistula from left main stem to main pulmonary artery.

We describe a patient with a rare coronary arteriovenous fistula connecting the left main stem to the main pulmonary artery. This rare case was discovered during routine coronary angiography for the evaluation of the patient s coronary heart disease.

Angioplasty, Balloon, Coronary↗
PubMed1989

[Angioplasty of the left main coronary artery--report of a case with left main coronary stenosis and aortic valve stenosis].

A 58-year-old woman was admitted to our hospital suffering from repeated chest pain. Selective coronary angiography (CAG) showed severely stenotic lesion in the left main coronary artery. There was no additional lesion in the left anterior descending and circumflex arteries. Aortography showed severe calcification in the aortic valve. The aortic was incised and divided completely at the aortic root 1 cm distal to the aortic valve. The incision was then extended toward the opening of the left coronary artery. An atheromatous plague was found and resected at the ostium. A saphenous vein patch was used to enlarge the internal diameter of the artery. The aortic valve was replaced using #21 SJM prosthetic valve. The patient recovered the surgery well, and anginal attacks have disappeared. Postoperative coronary angiograms revealed no stenotic lesion in the left main coronary artery.

Aortic Valve Stenosis↗
PubMed1979

Surgical treatment of left main and left main equivalent coronary artery disease.

There is a tendency to equate left main (LM) and left main equivalent (LME) coronary artery disease in terms of the surgical risk and benefit. Eighty-seven patients with LM disease were compared to 78 patients with LME disease as to operative mortality rate and long-term benefits. One hundred percent follow-up was obtained. Although the two groups were similar preoperatively with regard to age, sex, and ventricular function, the operative results in the two groups differed. There was a significantly higher operative mortality rate in the LM group of patients (12.6% versus 2.5%). However, the incidence of graft patency and relief of symptoms was lower in the LME group of patients. The late mortality rate was 4% in both groups. LME disease appears to represent a subgroup of patients with three-vessel disease and cannot be equated with LM disease.

Coronary Artery Bypass↗
PubMed1988

[Surgical treatment of the left main trunk and left main equivalent coronary artery disease].

The comparative studies on operative and hemodynamic results following aorto-coronary bypass grafting were performed in 9 patients with left main trunk (LMT) stenosis and 20 with left main equivalent (LME). One of 20 LME had bypass grafts occluded on the postoperative angiogram. There were two operative deaths, one in LMT, another in LME, and one late death. Following results were obtained in 8 LMT (Group I) and 15 LME (Group II) whose all bypass grafts were patent. There were significantly higher operative mortality rate and the incidence of perioperative myocardial infarction in Group I (11.1% versus 5.0%). Cardiac index and left ventricular ejection fraction significantly increased postoperatively in both groups. Mean Vcf and PLVSP/LVESV significantly increased postoperatively in Group II, but not in Group I. Left ventricular anterior segmental wall motion significantly increased in both groups and apical in Group I, whereas it did not in the postero-inferior segment. The completely revascularized patients had a better postoperative left ventricular function comparing with the incompletely revascularized patients. Angina disappeared postoperatively in all patients in Group I and 12 (75%) in Group II. In both groups, NYHA classification was improved from class III or IV preoperatively to class I or II postoperatively. Postoperative 8 years actuarial survival rate was 88.2% in Group I and 84.6% in Group II. In conclusion, it was suggested that much more strict perioperative management and complete revascularization were needed in the patient with LMT.

Adult↗
PubMedDate not supplied

Left main coronary artery compression by dilated main pulmonary artery in atrial septal defect.

Left main coronary artery compression by dilated pulmonary artery in patients with atrial septal defect has previously been reported, but not well characterized. Accordingly, we review retrospectively data of patients with atrial septal defect in whom selective coronary angiograms were done. 41 patients (26 females), aged 47.3 +/- 7.4 years were studied. The pulmonary artery mean pressure was 22.7 +/- 8.3 mm Hg and all patients had left to right shunt ratio of 2:1 or more (mean ratio: 3.9 +/- 1.7). Two patients (4.8%) had left coronary ostial stenosis. There were no clinical or haemodynamic parameters to differentiate the patients with or without these changes. Two patients (4.8%) had coexistent atherosclerotic coronary artery disease. In conclusion, left main coronary trunk compression rarely occurs in patients with atrial septal defect. This information may be relevant in evaluating patients with atrial septal defect.

Adult↗
PubMed1993

Prognosis and management of anterolateral myocardial infarction in patients with severe left main disease and cardiogenic shock. The left main shock syndrome.

BACKGROUND: To identify the determinants of survival in patients with severe (> 75%) stenosis of the left main coronary artery (LM) and an acute (48 hours) anterolateral myocardial infarction (AAMI), we retrospectively analyzed the course of 34 such patients who presented to our institution over the last decade. METHODS AND RESULTS: LM disease was diagnosed arteriographically at presentation, and AAMI was determined by ECG, enzymatic, and kinetic criteria. Of the nine patients (26%) managed medically, seven patients (78%) were in cardiogenic shock (cardiac index < 2.0, left ventricular end-diastolic pressure > 25, and pulmonary edema), and all seven died in hospital. Twenty-five (74%) of the 34 patients were managed surgically or with angioplasty. Nine of these patients, of whom eight were in cardiogenic shock, also died in hospital. Regardless of the method of treatment, the presence of cardiogenic shock in this population was reproducibly a grave prognostic indicator. That is, 15 (94%) of the 16 patients in cardiogenic shock at presentation died in hospital, and only 1 (5%) of the 18 patients without cardiogenic shock died (P < .001). CONCLUSIONS: Thus, we propose that, because patients presenting with AAMI, severe LM stenosis, and cardiogenic shock (left main shock syndrome) have such a grave prognosis regardless of management, conservative measures may be indicated.

Aged↗
PubMed2003

The Maine electronic document delivery project: a cooperative project of Maine hospital libraries and the NN/LM New England Region.

The article discusses an Ariel document delivery project with seven Maine hospital libraries, the University of Massachusetts Medical School Library (UMass), and the New England Regional office of the National Network of Libraries of Medicine. Funding was awarded to six network members to purchase equipment or Ariel software. UMass served as a document provider. During the test, libraries received documents from UMass via Ariel or via the Web as a PDF document. This form of document delivery was faster than standard service with better quality of delivered articles. The column describes the project and outlines possible future steps.

Computer Communication Networks↗
PubMed1994

Dipyridamole stress echocardiography in patients with severe left main coronary artery narrowing. Echo Persantine International Cooperative (EPIC) Study Group--Subproject "Left Main Detection".

From a population of 2,698 patients (579 evaluated early after an uncomplicated acute myocardial infarction) who underwent dipyridamole echocardiography testing (DET) and subsequent coronary angiography, left main (LM) stenosis > or = 50% was present in 73 (61 men and 12 women, mean age 62 +/- 8 years). These 73 patients were compared with a control group comprising 100 consecutive coronary patients without LM disease. Both groups were similar regarding mean age, sex, incidence of previous myocardial infarction, left ventricular function at rest, and severity of coronary artery disease by the number of diseased vessels excluding the LM. The proportion of patients receiving antianginal therapy during DET was higher in the LM than in the non-LM group (32 vs 14%; p < 0.01). No major complication (severe hypotension, sustained arrhythmia, myocardial infarction or death) occurred during DET. Of 73 patients with LM disease, 68 had positive DET (sensitivity 93%), dipyridamole time was 7.1 +/- 3.8 minutes, and the rest-peak stress variation in dipyridamole wall motion score index (1 = normal to 4 = dyskinesia, in an 11-segment model) was 0.37 +/- 0.23; 14 patients (19%) were resistant to aminophylline and needed nitrates to resolve ischemia. In the non-LM group, DET was positive in 72% (p < 0.001 vs LM), with a longer dipyridamole time (9.6 +/- 5.2 minutes; p < 0.001 vs LM), lower rest-peak stress wall motion score index variation (0.29 +/- 0.25; p < 0.05 vs LM), and less frequent antidote resistance (1%; p < 0.001 vs LM).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Plaque composition in the left main stem mimics the distal but not the proximal tract of the left coronary artery: influence of clinical presentation, length of the left main trunk, lipid profile, and systemic levels of C-reactive protein.

OBJECTIVES: We sought to investigate whether plaques located in the left main stem (LMS) differ in terms of necrotic core content from those sited in the proximal tract of the left coronary artery. BACKGROUND: Plaque composition, favoring propensity to vulnerability, might be nonuniformly distributed along the vessel, which might explain the greater likelihood for plaque erosion or rupture to occur in the proximal but not in the distal tracts of the coronary artery or in LMS. METHODS: A total of 72 patients were included prospectively; 48 (32 men; mean age 57 +/- 11 years; 25 with stable angina and 23 affected by acute coronary syndromes) underwent a satisfactory nonculprit vessel investigation through spectral analysis of intravascular ultrasound radiofrequency data (IVUS-Virtual Histology, Volcano Corp., Rancho Cordova, California). The region of interest was subsequently divided into LMS and LMS carina, followed by 6 consecutive nonoverlapping 6-mm segments in left anterior descending artery in 34 patients or in circumflex artery in 14 patients. RESULTS: Necrotic core content (%): 1) was minimal in LMS (median [interquartile range]: 4.6 [2 to 7]), peaked in the first 6-mm coronary segment (11.8 [8 to 16]; p < 0.01), and then progressively decreased distally; 2) was overall greater in patients with acute coronary syndromes (11.4 [5.5 to 19.8]) than stable angina (7.3 [3.2 to 12.9]; p < 0.001); 3) was largely independent from plaque size; and 4) did not correlate to systemic levels of C-reactive protein or lipid profile. CONCLUSIONS: Plaques located in the LMS carry minimal necrotic content. Thus, they mimic the distal but not the proximal tract of the left coronary artery, where plaque rupture or vessel occlusion occurs more frequently.

Adult↗
PubMedDate not supplied

Prediction of moderate or severe pulmonary hypertension by main pulmonary artery diameter and main pulmonary artery diameter/ascending aorta diameter in pulmonary embolism.

We investigated the accuracy of computed tomographic measurements of main pulmonary artery diameter (MPAD) and of MPAD/ascending aorta diameter (AAD) in predicting moderate or severe pulmonary hypertension in 190 patients with acute pulmonary embolism. A pulmonary artery systolic pressure of > or = 50 mm Hg measured by Doppler echocardiography was considered moderate or severe pulmonary hypertension. A MPAD of > 28.6 mm and a MPAD/AAD ratio of > or = 1.00 measured by computed tomography were considered abnormal. A MPAD of > 28.6 mm had a 75% sensitivity and specificity, a 52% positive predictive value, a 89% negative predictive value, a 3.0 likelihood ratio for a positive test, and a 0.33 likelihood ratio for a negative test in predicting moderate or severe pulmonary hypertension. A MPAD/AAD ratio of > or = 1.00 had a 59% sensitivity, a 82% specificity, a 55% positive predictive value, a 84% negative predictive value, a 3.3 likelihood ratio for a positive test, and a 0.50 likelihood ratio for a negative test.

Adult↗
PubMed1976

Atherosclerotic narrowing of the left main coronary artery. A necropsy analysis of 152 patients with fatal coronary heart disease and varying degrees of left main narrowing.

Histologic sections of the left main (LM) and the other three major coronary arteries were studied in 152 patients. The lumen of the LM in 35 patients was greater than 75% narrowed; in thirty, 50-75%; and in 87, less than 50% narrowed. The patients with greater than 75% narrowing were younger. Angina pectoris and hyperlipoproteinemia, specifically type II, were more common (P less than 0.02) and acute transmural and healed subendocardial myocardial infarcts were less frequent (P less than 0.05) in the patients with greater 75% LM narrowing than in those with less than 50% narrowing. Of the three other major coronary arteries, the average number narrowed in the patients with greater than 75% LM narrowing was 2.9; in those with 50-75% LM narrowing 2.7, and in those with less than 50% LM narrowing, 2.4. Of the 35 patients with greater than 75% LM narrowing, 33 had greater than 75% luminal narrowing of each of the other three major coronary arteries. Narrowing of the LM, therefore, indicates severe narrowing of usually all major coronary arteries.

Adult↗
PubMedDate not supplied

Left main coronary artery disease. Clinical and angiographic features. A retrospective study regarding two groups of patients with left main coronary artery disease and three-vessel disease.

BACKGROUND: The aim of this study was to assess the ability of clinical and instrumental features to identify patients with left main coronary artery disease (LMCD) compared with a three-vessel coronary artery disease group. METHODS: A cohort of 70 patients with LMCD was matched with another one of 66 patients with three-vessel disease. A history of angina before angiography was similar in both groups; the higher degrees of stable angina and the forms of unstable angina were moderately prevalent in the group with LMCD. RESULTS: In the last subgroup a significantly reduced incidence of previous acute myocardial infarction (AMI) was observed (p < 0.05). The resting electrocardiogram (ECG) showed higher incidence of atrial fibrillation (fa) and left bundle branch block (BBS) in the subjects with LMCD, with a statistic value (p < 0.05). The exercise test performed by a lot of patients appeared equally positive for inducible ischemia in the 2 groups. Significantly higher exercise peak load was achieved by the patients with three-vessel disease (p < 0.05). The coronary angiography showed a prevalence of right dominant circulation in the 2 groups; significantly the collateral circulation was more represented in the subjects with three-vessel disease (p < 0.05). Most patients with LMCD underwent a bypass coronary artery graft surgery (CABG surgery) more frequently than the ones with three-vessel disease (p < 0.01). In the former group the cardiovascular mortality within an average 2-year follow-up proved higher as to the latter group even if without statistic significance. CONCLUSIONS: Nevertheless this retrospective study showed some limitations. Particularly the incidence of clinical and instrumental variables and their capacity to differentiate LMCD patients from those with three-vessel disease were not demonstrated.

Acute Disease↗
PubMed2000

[The Hepatitis Network in Maine-et-Loire city hospitals: six year follow-up of patients and physicians. Hepatitis Network of Maine-et-Loire].

OBJECTIVES: To evaluate 6 years of a city-hospital hepatitis network. The network was set up in 3 steps: 1988: intrahospital network, 1991: city-hospital network, 1997: compliance with government regulations. METHODS: The whole activity from 1991 to 1997 was evaluated and special attention was paid to patient files and participating physicians. RESULTS: From June 1991 to December 1997 (6.5 years), 759 patient files were registered which corresponds to 531 patients (male 57%) with a mean age of 44 +/- 16 years (+/- standard deviation). Four hundred and twenty one patients (79%) had hepatitis C, 95 (18%) hepatitis B and 15 (3%) co-infection; 83% of patients had had a liver biopsy confirming cirrhosis in 21.5%. The annual number of files registered increased continuously. This was more a result of recruiting known patients than new patients, after the network had been in place for several years, mainly with hepatitis B virus (known patients in 1997: hepatitis B virus: 53% vs 33% for hepatitis C virus, P<0.05). Treatment protocols (73%) were more frequent for hepatitis C virus patients than for hepatitis B (73% vs 59%, P<0.01). Therapeutic trial proposals (37%) increased from 21% in 1991 to 59% in 1997, P<0.01. Participation in monthly meetings by academic hepato-gastroenterologists increased slightly while that of regional hospital hepato-gastroenterologists increased markedly and that of private hepato-gastroenterologists remained stable. The annual proportion of files submitted by academic hepato-gastroenterologists decreased in parallel to the increase in submission of patient files by other hepato-gastroenterologists. CONCLUSIONS: During 6 years of activity, the network grew with an increase in the annual number of patient files, growing participation in therapeutic trials as well as in monthly meetings by practitioners.

Adult↗