[Origin of spasm of coronary vessels in experimental coronary insufficiency].
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Coronary Artery Disease↗
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[Effect of camphor on the coronary vessels in experimental coronary insufficiency].
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Camphor↗
[Emergency cardiac pacing via a coronary vessel during percutaneous coronary angioplasty].
Percutaneous coronary angioplasty (PCA) is sometimes complicated by bradyarrhythmias necessitating emergency temporary cardiac pacing. This is usually performed by the classical transvenous endocardial approach. This experimental study investigated the possibility of using the metallic guide wire used during PCA as a monopolar electrode. Systematic electrical stimulation at different levels of the coronary arteries in 6 anaesthetised pigs showed threshold levels in the distal segments of 3 to 15 mA, close to the values observed in the right ventricule. Short periods of pacing were well tolerated. On the other hand, prolonged pacing (2 to 5 days) invariably led to the formation of a thrombus in the coronary segment occupied by the metallic guide wire and so should be avoided. This study shows that the metallic guide wire can be used as an emergency pacing electrode during PCA but this should be limited to a short period. This technique could replace the systematic introduction of classical transvenous pacing catheters.
Angioplasty, Balloon↗
[Use of coronary vessel prosthesis. Complex coronary angioplasty under general anesthesia].
In 1995 we attempted to treat with PTCA 437 ischemic patients. We stended 29 patients (6.6%) with 34 stents. Emergency stenting was done in 5, semi-elective stenting in 6, and elective stents were applied in 18 patients with restenosis. We have achieved good angiological results without occurrence of myocardial infarction, with no emergency open heart surgery or death. No intracoronary thrombosis was observed during one-month follow-up with combined aspirin and ticlopidin treatment. Hemodynamical and angiological high-risk patients were treated under general anesthesia with assisted respiration. No complications were observed during the procedures. In cases of in-stent restenosis (17%) we redilated the coronary artery. This technique proved to be promising and is routinely applied world-wide to optimise immediate and long-term results of PTCA. The realisation of such interventional cardiological centers with appropriate financial background is an absolute requirement for spreading this technique in Hungary.
Aged↗
Cellular and molecular mechanisms of coronary vessel development.
Development of coronary vessels is a complex process in developmental biology and it may have clinical implications. Although coronary vessels develop as a form of vasculogenesis followed by angiogenesis, the cells of the entire coronary system do not arise from the developing heart. The key events of the coronary system formation include the generation of primordium and proepicardial organ; formation of epicardium; generation of subepicardial mesenchymal cells, and the formation, remodeling and maturation of the final vascular plexus. These events represent a complex regulation of the cell fate determination, cellular migration, epicardial/ mesenchymal transformation, and patterning of vasculatures. Recent studies suggest that several transcription factors, adhesion molecules, growth factors and signaling molecules play essential roles in these events. This article reviews the literature on the development of coronary vessels, and discusses current advances and controversies of molecular and cellular mechanisms, thereby directing future investigations.
Acetyltransferases↗
[Computer-assisted reconstruction of coronary vessels].
End stage coronary artery disease with linear stenosis of the main vessels despite several coronary interventions is a current challenge for surgical treatment. As the long term results are mainly determined by the pathology of the coronary vessels a simple revascularisation with arterial or venous grafts provides no adequate solution of the problem. An exactly controlled 3D-reconstruction of the coronary vessels enabling selective thrombendarteriectomy (TEA) seems to be a new approach, that may be limited by neointimal hyperproliferation of the coronary vessels. Intraoperative brachytherapy may be a tool to inhibit this process.
Atherectomy, Coronary↗
Development of the coronary vessel system.
Formation of the coronary vessels is a fundamental event in heart development. Congenital abnormalities in the coronary system can have major deleterious effects on heart function. It is also possible that subtle variation in the patterning of coronary vessels has significant but uncharacterized effects on myocardial structure and function. In addition, generation of the coronary vascular system represents a complex system for analysis of regulation of cell fate determination, cell and epithelial migration, epithelial/mesenchymal transition, and patterning of a complex three-dimensional structure. In this review, we present the descriptive embryology of this process as well as the recent data that shed light on the unique developmental mechanisms underlying generation of coronary vessels. This review also attempts to identify areas where additional research is needed and highlights the questions that must be answered for a meaningful understanding of coronary vessel development.
Animals↗
Coronary vessel development: the epicardium delivers.
Coronary artery disease accounts for 54% of all cardiovascular disease in the United States. Understanding how coronary vessels develop is likely to uncover novel drug targets and therapeutic strategies that will be useful in directing the repair or remodeling of coronary vessels in adults. Recent insights have identified the importance of cells derived from the proepicardium and epicardium in the formation of coronary vessels. This article reviews the basic steps in coronary vessel development, the molecules implicated in these steps, and the pressing questions awaiting answers.
Animals↗
[Model for practicing suture technics for reconstructive surgery on coronary vessels].
Surgery on coronary vessels requires high surgical skill. For this reason generally, operations on experimental animals are carried out for exercise. These operative interventions require an extensive display of technique and personnel. A phantom, i.e. an arrested perfused porcine heart, was used to exercise the surgical technique. Material and personnel could be spared by this way, and a great number of exercising operations was performed. The phantom is described and its efficiency discussed.
Animals↗
[The necessary conditions of chronic total occlusion of all three coronary vessels--the relationship between portions of coronary occlusion and collateral vessels].
This study was performed to define the conditions present in chronic total occlusion of all three coronary vessels. Each left descending coronary artery (LAD), left circumflex branch (LCX) and right coronary artery (RCA) was totally occluded angiographically in 5 patients (mean age 64, male 3, female 2). Four of them had history of myocardial infarction. Anginal type was effort angina in all patients, and two cases showed unstable angina. Good collateral supply was found in the distal portions of occluded vessels from proximally located branches, such as Conus branch, Right ventricular branch, Septal branch and Left atrial circumflex branch. Almost all of the occlusions were located at mid portions (13/15: mid, 2/15: proximal). Ejection fractions (EF%) of the 5 patients were 70%, 69%, 60%, 28% and 22% respectively. EF was correlated with the degree of collateral supply and one of them (22%) ended in sudden death. These findings suggest that the mid portion occlusion, good collateral supply and a long history of angina pectoris are important factors involved in chronic total occlusion of the three coronary vessels.
Adult↗
Difference in fibrinolytic activity between multivessel coronary spasm and one-vessel coronary spasm.
Plasminogen activator inhibitor activity was higher in 18 patients with multivessel spasm than in 20 patients with 1-vessel spasm and in 22 control patients. Tissue plasminogen activator antigen was also higher in patients with multivessel spasm than in those with 1-vessel spasm and control patients. The increased plasminogen activator inhibitor activity in patients with multivessel spasm indicates that the fibrinolytic system is more impaired in such patients than in those with 1-vessel coronary spasm; this may be related to the higher incidence of refractory angina during hospitalization and cardiac events during the follow-up period.
Angina Pectoris↗
Detection of restenosis following percutaneous coronary angioplasty in single-vessel coronary artery disease: the value of clinical assessment and exercise tolerance testing.
Chest pain and submaximal exercise testing were prospectively assessed over a 6-month period, for detecting the evolution of restenosis in patients undergoing percutaneous coronary angioplasty, following either acute myocardial infarction or treatment of an anginal syndrome. Seventy-eight patients with one-vessel coronary artery disease underwent a modified treadmill exercise test at the 1-week, 3-month and 6-month follow-up after angioplasty, when a final angiogram was also performed. Forty-four patients (group A) were examined after myocardial infarction; in 34 patients (group B) angioplasty was done for incapacitating angina. Both groups showed similar results with low sensitivity and relatively moderate specificity of both chest pain and exercise tests; this was also the case for the time of restenosis to occur. It is thus concluded that the parameters examined are somewhat limited markers of restenosis following coronary angioplasty.
Adult↗
Graft patency in off-pump and conventional coronary artery bypass grafting for treatment of triple vessel coronary disease.
OBJECTIVE: To compare graft patency in off-pump and conventional coronary artery bypass grafting by using the transit time flow meter in the treatment of triple vessel coronary artery disease. METHODS: Between June 2000 and April 2001, 60 patients with triple vessel coronary artery disease underwent coronary artery bypass grafting. They were divided into two groups: off-pump and conventional coronary artery bypass. All completed grafts were tested intraoperatively using Transit Time Flow Measurement (TTFM). Preoperative and postoperative variables of the two groups were also compared. RESULTS: There were no significant differences in sex, age, weight, acute or remote myocardial infarction, hypertension, diabetes and type of bypass grafts between the two groups. The number of bypass grafts and the assisted respiratory time of the off-pump coronary artery bypass grafting (OPCAB) group were significantly less than those of the conventional coronary artery bypass grafting (CCABG) group. The flow and pulsatile index (PI) of the left anterior descending artery bypass grafts and the right coronary artery bypass grafts were not significantly different between the OPCAB and CCABG groups. The flow of OM in the CCABG group with the multiple anastomosis site of sequential grafts was higher than that in the OPCAB group. Diffused narrow coronary artery bypass grafts in both groups had less flow. CONCLUSION: No significant differences in graft patency were observed in patients with triple vessel coronary artery disease who had undergone OPCAB or CCABG.
Aged↗
Small coronary vessel disease and sudden coronary death.
In an attempt to determine the importance of atherosclerosis in medium-sized coronary arteries, the hearts of 20 patients dying of cardiac disease, within 24 hours of the onset of symptoms, were compared with 19 controls. Post-mortem coronary angiograms were performed and the coronary arteries dissected in detail. Severe stenoses, or complete occlusions, were present in 34 of 80 major coronary arteries in the sudden cardiac death (SCD) group and 5 of 76 in the controls. Medium-sized branch vessels were severely stenosed or occluded in 20.5 per cent (37 of 180 vessels) in the SCD group and 6.4 per cent (11 of 171 vessels) in the controls. Forty of the 48 diseased branch vessels arose from the left anterior descending artery. In the SCD group, 18 patients died from major coronary artery atheroma, one from hypertensive heart disease and only one from disease of a branch vessel. We conclude that, in most cases of SCD, careful macroscopic examination of the major coronary vessels will provide an adequate explanation for death. Detailed dissection of all medium-sized branch vessels is unlikely to be of value as a routine procedure but, at the very least, pathologists should identify and dissect the first septal and diagonal branches of the left anterior descending artery in every post-mortem.
Coronary Disease↗
Predictors of myocardial infarction after distal embolization of coronary vessels with percutaneous transluminal coronary angioplasty. Experience of 21 consecutive patients with distal embolization.
Of 1,855 patients with angina pectoris who underwent percutaneous transluminal coronary angioplasty (PTCA) in our hospital, 21 experienced distal embolization. Five of the patients had slow washout of contrast medium distal to the dilated stenosis accompanied by S-T segment elevation (slow-flow pattern). In the other 16 cases, a dislodged embolus was found distal to the dilated stenosis (occlusive pattern) following balloon inflation. Of the 21 patients, 8 (38%) developed acute myocardial infarction (MI). All patients with acute MI were thought to have intraluminal thrombus on angiography performed before PTCA. Interestingly, patients with recent MI or worsening angina had a significantly higher rate of acute MI (p < 0.05).
Adult↗
[The effect of digitalis preparations on the coronary vessels of patients with coronary insufficiency].
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Aged↗
Relation between myocardial thallium-201 kinetics during exercise and quantitative coronary angiography in patients with one vessel coronary artery disease.
This study examined the relation between the kinetics of thallium-201 and coronary stenosis in 30 patients with one vessel coronary artery disease; 25 patients had no visible collateral vessels. The myocardial thallium concentration in the postexercise images and percent washout were determined in the distribution of the diseased vessel and a normal vessel, and each was expressed as a ratio. Coronary stenosis was assessed as minimal diameter stenosis, minimal area stenosis and percent diameter stenosis. The correlations between the myocardial concentration ratio or washout ratio and the descriptors of coronary stenosis improved when the patients with collateral vessels were excluded. There were significant correlations between the myocardial thallium concentration ratio and minimal diameter stenosis (r = 0.73, p less than 0.001), minimal area stenosis (r = 0.72, p less than 0.001) and, to a lesser degree, percent diameter stenosis (r = -0.51, p less than 0.01). Similarly, there were significant correlations between washout ratio and minimal diameter stenosis (r = 0.50, p less than 0.01) and minimal area stenosis (r = 0.45, p less than 0.02) but not percent diameter stenosis (r = 0.37, p = 0.06). Thus, variation in thallium kinetics in relation to the severity of coronary stenosis can be demonstrated with conventional imaging in patients with one vessel disease. The myocardial thallium concentration and washout are physiologic expressions of the severity of perfusion deficit and are dependent on collateral flow. The myocardial thallium concentration ratio and washout ratio correlate better with minimal diameter and area stenosis than with percent diameter stenosis.
Aged↗
Combination of minimally invasive coronary bypass and percutaneous transluminal coronary angioplasty in the treatment of double-vessel coronary disease: Two-year follow-up of a new hybrid procedure compared with "on-pump" double bypass grafting.
OBJECTIVE: Percutaneous transluminal coronary angioplasty (PTCA) or surgery can be chosen as first-line therapies in multiple-vessel coronary disease. A mammary-to-left anterior descending (LAD) graft is the most important statistical determinant of a favorable outcome after coronary artery bypass grafting (CABG) and can be performed with lower morbidity off pump through a minithoracotomy. PTCA and stenting of the "non-LAD" vessels compete with CABG in terms of patency rates. Our purpose was to compare a combination of minimally invasive direct coronary artery bypass (MIDCAB) and PTCA with double CABG as a treatment for double-vessel coronary artery disease involving the proximal LAD. METHODS: Two matched groups of 20 patients with double-vessel coronary disease undergoing either sequential MIDCAB and PTCA (group 1) or double CABG on cardiopulmonary bypass (group 2) were compared. Angiographic control, complications, hospital costs, quality of life, and 2-year follow-up of ischemia are reported. RESULTS: All bypasses were patent at early control. Three adverse events were noted in group 1 and 17 in group 2. The hybrid-procedure group exhibited a shorter intensive care unit stay, fewer blood products transfused, less pain, better early quality of life, faster return to work, and similar cost. Three patients required a second PTCA in group 1, one of which for restenosis. At 2 years all the patients are asymptomatic with no residual ischemia. CONCLUSIONS: We conclude from this pilot study that the hybrid procedure is feasible and appears to be a safe therapy for double-vessel coronary artery disease and that it appears to generate less perioperative morbidity than classic double CABG does. Therefore we believe that there is room to undertake prospective randomized studies on a larger-scale basis.
Aged↗