Should Patients Be Submitted to Coronary Arteriography After Echocardiographic Diagnosis of Idiopathic Dilated Cardiomyopathy?

Objectives: The present study was designed to determine if patients with an echocardiographic diagnosis of idiopathic dilated cardiomyopathy should be submitted to coronary arteriography. Background: Whether echocardiography allows distinction of idiopathic dilated cardiomyopathy from severe coronary heart disease remains controversial. Methods: A questionnaire was sent out to the members of the Swiss Society of Cardiology. In the first study 78 patients with an echocardiographic diagnosis of idiopathic dilated cardiomyopathy who had undergone coronary arteriography or had been followed-up for > 5 years were investigated. In a second study, the echocardiograms of 50 patients with either idiopathic cardiomyopathy or severe coronary heart disease, all of whom had also undergone coronary arteriography, were reviewed by two independent echocardiographers without access to any complementary information. Result: The questionnaire revealed that one half of the Swiss cardiologists generally refer such patients for coronary arteriography. The first study showed that the diagnosis of idiopathic dilated cardiomyopathy was confirmed in all cases, in which the echocardiographer had been certain of the diagnosis (64/78 [82%]). In the uncertain cases (14 [18%]) coronary arteriography revealed 9 idiopathic cardiomyopathies, 3 coronary heart diseases, and 2 mixed etiologies. The second study showed that a correct diagnosis was achieved in 85% of cases. Furthermore, the echocardiographers were able to specify those patients with an uncertain diagnosis who would therefore require coronary arteriography. Conclusions: In the overwhelming majority of cases, echocardiography can distinguish idiopathic dilated cardiomyopathy from severe coronary heart disease. Coronary arteriography is only indicated when the echocardiographer is uncertain of the diagnosis. The routine and costly practice of coronary arteriography of these patients does not appear to be justified .     

Incidence and age distribution of patients with myocardial infarction and normal coronary arteriograms

Over a 41 month period selective coronary arteriography was performed on all patients age 35 and under seen at our hospital with a documented myocardial infarction. In these 25 patients, 4 (16%) demonstrated no arteriographic evidence of coronary artery disease. One-hundred and fifty-two patients over age 35 with a documented myocardial infarction underwent selective coronary arteriography during the same period. In each of the 152 cases, obstructive coronary artery disease was demonstrated. The generally favorable prognosis of patients with myocardial infarction and normal coronary arteriograms has been previously documented. On the basis of our experience and a review of the literature, it is recommended that all patients age 35 and under sustaining a myocardial infarction should undergo selective coronary arteriography, in order to establish prognosis.     

Angled views in the evaluation of the right coronary artery

The use of cranial and caudal angulated views in the angiographic evaluation of the right coronary artery (RCA) was assessed in 61 patients. Each patient had a standard LAO and RAO view, followed by one or more angled views. The standard LAO view showed the area about the origin of the posterior descending artery (PD₀) adequately in 33 of 46 patients (72% ), and the mid and distal portions of the posterior descending artery (PD_m&d) adequately in 26/46 (56% ). The standard RAO view showed the PD₀ adequately in only 17/46 (37% ) and the PD_m&d adequately in 41/46 (89% ). With the LAO cranial view, however, the PD₀ was seen well in 45/46 (98% ), and PD_m&d was seen well in 44/46 (96% ). The RAO angled views, although of more limited utility, also afforded improved visualization of the distal segments of the RCA. We recommend the use of angled views in the evaluation of the right coronary artery, as these views, particularly the LAO cranial view, afford improved visualization of the distal segments of the RCA.     

Use of a pigtail catheter to engage a difficult internal mammary artery.

Increasing use of bilateral internal mammary arteries for coronary surgery will increase the number of interventions in these grafts. Such interventions may be technically challenging because of often tortuous and angulated vessels. We describe a technique to intubate an acutely angulated right internal mammary artery that was inaccessible with conventional catheters.     

Coronary artery dissection secondary to coronary arteriography: Presentation of three cases and review of the literature

Three cases of coronary artery dissection secondary to coronary arteriography are presented. Two of these include autopsy material demonstrating medial degeneration in the coronary arteries, which may have predisposed these arteries to dissect The literature on catheter-induced coronary artery dissection is reviewed and an analysis is presented.     

成角近段旋磨对严重钙化成角冠状动脉病变的治疗价值

目的:在严重钙化成角冠状动脉(冠脉)病变患者中,对比成角近段旋磨和全程旋磨的手术成功率、术中并发症及临床预后,评估成角近段旋磨对该类病变的治疗价值。方法:连续纳入我院2017年1月至2019年12月接受冠脉旋磨介入治疗且冠脉均存在严重钙化伴成角(≥45°)的患者共245例,依据旋磨手术策略分为全程旋磨组(n=179)和成角近段旋磨组(n=66)。比较两组手术成功率和术中并发症发生率,观察两组患者的临床转归,观察终点包括院内和1年主要不良心血管事件(MACE,包括心原性死亡、靶血管再次血运重建、支架内血栓)发生率。结果:成角近段旋磨组的手术成功率为97.0%,2例(3.0%)患者因术中球囊无法扩张而最终转换为全程旋磨;全程旋磨组的手术成功率为99.4%,1例(0.6%)患者因冠脉穿孔导致手术失败而行急诊冠脉旁路移植术。全程旋磨组发生旋磨头嵌顿和心包填塞各2例(1.1%)、冠脉穿孔4例(2.2%),而成角近段旋磨组未出现这些严重并发症;两组术中慢血流/无复流的发生率差异无统计学意义(P>0.05),但全程旋磨组术中冠脉夹层的发生率显著高于成角近段旋磨组(43.6%vs.19.7%,P<0.05)。两组的院内总MACE发生率相当,但全程旋磨组1年MACE发生率明显高于成角近段旋磨组(27.4%vs.13.6%,P<0.05)。结论:对于严重钙化伴成角的冠脉病变,成角近段旋磨联合球囊扩张的手术成功率和临床转归与全程旋磨相似,而术中并发症尤其严重并发症的发生风险明显低于后者,说明仅采用成角近段旋磨治疗此类病变是安全和有效的。     

成角近段旋磨对严重钙化成角冠状动脉病变的治疗价值

目的:在严重钙化成角冠状动脉(冠脉)病变患者中,对比成角近段旋磨和全程旋磨的手术成功率、术中并发症及临床预后,评估成角近段旋磨对该类病变的治疗价值。方法:连续纳入我院2017年1月至2019年12月接受冠脉旋磨介入治疗且冠脉均存在严重钙化伴成角(≥45°)的患者共245例,依据旋磨手术策略分为全程旋磨组(n=179)和成角近段旋磨组(n=66)。比较两组手术成功率和术中并发症发生率,观察两组患者的临床转归,观察终点包括院内和1年主要不良心血管事件(MACE,包括心原性死亡、靶血管再次血运重建、支架内血栓)发生率。结果:成角近段旋磨组的手术成功率为97.0%,2例(3.0%)患者因术中球囊无法扩张而最终转换为全程旋磨;全程旋磨组的手术成功率为99.4%,1例(0.6%)患者因冠脉穿孔导致手术失败而行急诊冠脉旁路移植术。全程旋磨组发生旋磨头嵌顿和心包填塞各2例(1.1%)、冠脉穿孔4例(2.2%),而成角近段旋磨组未出现这些严重并发症;两组术中慢血流/无复流的发生率差异无统计学意义(P>0.05),但全程旋磨组术中冠脉夹层的发生率显著高于成角近段旋磨组(43.6%vs.19.7%,P<0.05)。两组的院内总MACE发生率相当,但全程旋磨组1年MACE发生率明显高于成角近段旋磨组(27.4%vs.13.6%,P<0.05)。结论:对于严重钙化伴成角的冠脉病变,成角近段旋磨联合球囊扩张的手术成功率和临床转归与全程旋磨相似,而术中并发症尤其严重并发症的发生风险明显低于后者,说明仅采用成角近段旋磨治疗此类病变是安全和有效的。     

A complex case of angulated and bifurcated lesion facilitated by excimer laser coronary angioplasty

Angulated lesions have been shown to be associated with abrupt closure or periprocedural myocardial injury. In particular, when disease is present at the level of the angulated or bifurcated lesion, balloon dilatation may help in wire crossing but it may also cause branch occlusion. Several methods and devices have been described to manipulate coronary guidewires across angulated and bifurcated lesions. This case report describes a highly angulated coronary bifurcated lesion where, after the failure of multiple wires to cross the lesion toward the main branch, it was successfully crossed after excimer laser debulking, which facilitated the wire crossing into the main branch, without causing branch occlusion.     

The “furrowing effect”: Guidewire-induced “directional” lesion ablation in rotational atherectomy of angulated coronary artery lesions

We discuss a guidewire induced asymmetric abiative effect in three cases of rotational atherectomy facilitated angioplasty of angulated coronary artery lesions. © 1996 Wiley-Liss, Inc.     

Right coronary arteriography: experience with standard-torque and limited-torque techniques in children and young adults.

Coronary spasm and intimal injury may occur during selective right coronary arteriography. The safety and efficacy of right coronary arteriography in children and young adults were retrospectively reviewed for this report. Right coronary arteriography was performed in 200 patients. A standard-torque technique was used in 150 patients, a limited-torque technique was used with a reshaped left coronary catheter in 53 patients. The standard-torque technique was associated with proximal coronary spasm in nine patients, nonsustained ventricular tachycardia in one patient, and ST segment changes in one patient. The limited-torque technique was associated with no complications. The standard-torque technique was effective in one patient when the limited-torque technique failed to define distal coronary branches clearly. The limited-torque technique was effective in nine patients when the right coronary artery could not be engaged while attempting the standard-torque technique. In conclusion, right coronary arteriography may be performed in a safe and potentially more effective manner using a new catheter design and a limited-torque technique.     

A new complication of coronary arteriography

The introduction of a sharply angulated catheter through an arterial sheath for percutaneous coronary arteriography was associated in 7 cases with dissection of the iliac arteries; this extended to the lumbar aorta at the level of the coeliac axis. The catheter tip should be introduced gently and preferably straightened out with a good length of guide wire to avoid this complication.     

心电图与冠状动脉造影相关性分析

心电图是临床上常用的检查方法,而冠状动脉造影则是确诊冠心病的必需手段,但因后者系侵袭性操作,且价格偏贵,故在实际应用中有其局限性。如果能通过比较两种检查手段的最终检查结果,探寻两种检查方法的内在关联性,提高心电图的参考价值,以期用最简易的心电图检查为临床医生提供尽可能多的临床信息,则会为进一步制订治疗策略提供更多帮助,对临床工作大有裨益。而本综述正是以冠状动脉造影最终结果为依据,总结出心电图对心肌缺血定性、定位甚至定量方面的参考价值,为临床工作提供一定的帮助。     

Transvenous coronary arteriography via ventricular septal defect for infants and children with tetralogy of fallot

Selective coronary arteriography was performed by the antegrade transvenous technique in 13 cases of young children with tetralogy of Fallot utilizing two specially designed catheters. Right coronary arteriography was successfully performed in all, and left coronary arteriography was successful in the latest four cases. The importance of the catheter design is discussed based on the anatomical characteristics of the anomaly.     

A simplified reverse wire technique using an angulated supercross microcatheter

Bifurcation lesion with an extreme angulated side branch remains a challenge in coronary intervention. Reverse wire technique was originally described by Dr. Kawasaki and nowadays this can be done by double‐lumen catheter. We report a novel “simplified reverse wire technique with a specialized angle tip microcatheter,” Supercross microcatheter? (Teleflex). This can facilitate wiring of extreme angulated side branch by this simple and feasible method without using double lumen catheter.     

Double-inversion technique for coronary angiography viewing in dextrocardia.

This report describes a simple angiographic viewing rule for coronary angiography in patients of dextrocardia with obstructive coronary artery disease, which could correct the unfamiliar angulated pictures of the coronary tree in dextrocardia into the familiar conventional angiographic pictures of a normally located heart and its associated ease of interpretation.     

Stent implantation in severely angulated lesions: Safety,efficacy, and morphological remodelling

Balloon angioplasty of severely angulated lesions is associated with a higher complication rate and lower success rate compared with non-angulated lesions. Whether this is true also of stenting such lesions is not known, nor has the alteration of vessel morphology produced by placing stents in these angulated segments been systematically investigated. We retrospectively analysed data from 60 patients who underwent stent implantation. Thirty patients formed a consecutive group whose stents were implanted in severely angulated lesions (>45°, group A). The other 30 were a consecutive contemperaneous group whose stents were implanted in straight or less angulated lesions (group S). Change in morphology was assessed using a straightening index. In group A, 29 of the 30 patients had a successful angiographic and clinical outcome. In group S, 27 of the 30 patients had a successful outcome. Thus, unlike simple balloon angioplasty, stenting severely angulated lesions was not associated with a high-complication or low-success rate. Change in stented vessel morphology (straightening index) was greatest for right coronary (0.45 ± 0.05), similar for left anterior descending (0.27 ± 0.08) and circumflex (0.30 ± 0.03), and least for vein grafts (0.14 ± 0.10). The straightening index did not correlate with the preangioplasty lesion angulation, the maximum pressure used to inflate the stent, the size of the artery stented, or the type of stent used. Cathet. Cardiovasc. Diagn. 40:261–264, 1997. © 1997 Wiley-Liss, Inc.     

Separate origin of a large septal perforator branch

A patient with an inferior myocardial infarction was successfully treated with thrombolytic therapy. At selective coronary arteriography a large septal perforator branch originating from the right coronary sinus anastomosing to the proximal left anterior descending coronary artery was seen. As far as we know, this has never been described before.     

Major Variations in Anatomical Origin of the Coronary Arteries: Angiographic Observations in 4,250 Patients without Associated Congenital Heart Disease

In 51 (1.2%) of 4,250 patients studied by selective coronary arteriography, one or more major elements of the coronary arterial system originated from the sinuses of Valsalva in an ectopic manner. The majority of variations involved the left coronary artery. The majority of ectopic ostia were located in the right sinus of Valsalva. Failure to recognize variations in coronary arterial origin can prolong arteriography procedures and lead to errors in interpretation of coronary artery anatomy and pathology. It is concluded from this experience that the incidence and location of major variations in coronary arterial origin are relatively predictable. The data are useful in expediting coronary arteriography procedures and thus improving patient care.     

Use of a deflectable tip catheter to facilitate complex interventions beyond insertion of coronary bypass grafts: three case reports.

We present three patients with angulated ostial lesions beyond the insertion point of coronary artery bypass grafts. Use of the Venture Catheter, a deflectable tip 3.5F wire control catheter, facilitated successful percutaneous coronary intervention after prolonged, unsuccessful attempts at conventional guidewire passage.     

Coronary angiography post first myocardial infarction in the asymptomatic or mildly symptomatic patient: Clinical,angiographic, and prospective observations

The role of coronary arteriography In the asymptomatic or mildly symptomatic post first myocardlal infarction patient is controversial. Thirty-one class 0–1 patients (Canadian Heart Association Grading System) underwent coronary arteriography within six months (mean 67 days) of their first myocardlal Infarction. Coronary arteriography revealed three-vessel disease in nine (29%), two-vessel disease in ten (32%), single-vessel disease in ten (32%), and normal coronary arteries in two (6%). No pattern had left main disease, and two (6%) had teft main equivalent disease. In 12 patients with single-vessel disease or normal coronary arteries there were no morbid events over a mean follow-up period of 26 months. In the 19 with multivessel disease, eight (40%) developed a cardiac event during a mean follow-up period of 11.4 months. These Included one who elected to undergo immediate aortocoronary bypass surgery, two with unstable angina, three acute myocardial infarctions, and two deaths. Based on these date and a review of the literature, a scheme Is proposed for the subsequent evaluation and treatment of this patient group.