BACKGROUND: Many different stent types are available for intracoronary placement. No clinical trial has demonstrated clearly the superiority of any stent design over another. METHODS: This study was designed to analyze clinical and angiographic results after using intracoronary PURA-VARIO (Devon Medical, Hamburg, Germany) (PUVA) stents. A total of 306 implanted stents were investigated in a series of 217 unselected patients (61.2 ± 10.7 years, 74.3% male). Stenting was performed electively and during acute coronary syndromes. Stents were manually mounted on angioplasty balloons and expanded in the target lesion. Angiographic measurements were carried out by quantitative coronary angiography. RESULTS: Stenting was successful in 214/217 patients (98.8%). During hospitalization (median three days) 206 patients (94.9%) were free from adverse cardiac events. Stent thrombosis occurred in five patients (2.3%), Q-wave infarction in one (0.5%) and urgent percutaneous target vessel revascularization in four (1.8%). Follow-up angiography, performed in 170 patients (78.3%) showed a restenosis (≥50% diameter stenosis) in 44/170 patients (25.9%), requiring angioplasty in 29 (17.2%). A surgical revascularization was recommended in 13 patients (7.6%). One patient died during follow-up from an unknown cause; however, sudden cardiac death was most likely. CONCLUSIONS: PUVA stents are characterized by a high level of safety and efficacy. Clinical and angiographic results are comparable with those of other approved stents. (Int J Cardiovasc Intervent 2003; 5: 156-160)
It is well known that mobile or large left atrial myxoma may lead to valve obstruction and insufficiency, and affect transmitral valve flow. The case is reported of a 47-year-old woman with severe mitral regurgitation (MR) and huge left atrial myxoma (6?4?3 cm). Preoperatively, the MR appeared related to the myxoma and was classified as moderate. Following extirpation of the myxoma, intraoperative transesophageal echocardiography (TEE) revealed a severe mitral regurgitant jet. After mitral valve repair by ring implantation, the MR was reduced to minor insufficiency. Hence, a large atrial tumor may mask the severity of concomitant unrelated MR in routine echocardiography. Intraoperative TEE helped in assessing correct mitral valve function after tumor extirpation. Preoperative echocardiography should focus on mitral valve dysfunction in order to separate tumor-related and -unrelated valvular pathologies.
Purpose: Patients with acute coronary syndromes (ACS) should undergo early invasive diagnostic and treatment strategy according to the individual risk stratification. However, in a few cases angiography presents a normal angiogram. Echocardiography in ACS may help to assess the patients' risk and to disclose differential diagnosis in unclear cases. Few data are available on the analysis of echocardiographic findings in a patient population with ACS but normal angiogram. Methods: A total of 51 unselected patients (72.5% male, 53.3 ± 14.5 years) were included between 1999 and 2002. All patients underwent an emergency coronary angiography due to suspected ACS but showed a normal angiogram. Patients underwent echocardiographic examination prior to invasive procedure. Results: The preangiographic risk stratification was as follows: unstable angina (76.5%), elevated troponin T (30%), elevated creatine kinase (24%), electrocardiographic signs of ischemia (60.8%). Thirty‐one patients (60.6%) presented with a normal wall motion. The following regional wall motion abnormalities were seen: septal (n = 4, 7.8%), inferior (n = 9, 17.6%) and anterior (n = 7, 13.7%). A normal ejection fraction was detected in 40 patients (78.4%), a discrete reduction in 8 patients (15.7%), and a relevant reduction in three cases (5.9%). The invasive measurements of the ejection fraction (67 ± 14%) were without any difference to the echocardiographic measurement (68 ± 14%). Conclusions: In spite of a normal angiogram during ACS echocardiography shows regional left ventricular wall motion abnormalities in a relevant number of patients. These findings may influence the need of further diagnostic procedures and perhaps of pharmacological treatment in those patients. Echocardiography should be added to routine diagnostic procedures in patients with ACS.
In this prospective study, we aimed to document the rate and localization of deep venous thromboses in patients with spinal cord injuries. Patients with paraplegia or tetraplegia were screened by a serial color duplex sonography protocol for deep venous thrombosis within the first 36 hours after admission, at day 7, and at day 21. Sonography was performed by a complete scan including the veins below the knee. A total of 139 patients were included (19-90 years, 63.5% male). Cumulative rate of deep venous thrombosis after 3 duplex scans was 45.3% (n = 63). In 71.4% (n = 45), thromboses were localized below the knee. Because of the relevant number of distal vein thromboses, inclusion of the calf veins during screening scans is suggested. Further studies are needed to analyze the clinical benefit of diagnosing and treating distal vein thromboses.
Aim Aortic valve replacement is a standard procedure for the treatment of severe aortic valve stenosis. Due to lower flow velocities stentless valves are associated with a more effective regression of left ventricular hypertrophy in comparison to stented valves. However, mismatch between body surface area and valve size supports unfavourable hemodynamic results. The aim of the study was to analyze hemodynamic parameters by echocardiography after implantation of the Shelhigh SuperStentless bioprosthesis and to analyze the occurrence of patient-prosthesis mismatch and left ventricular remodelling in this specific valve type. Methods A total of 20 patients with severe aortic stenosis underwent implantation of a Shelhigh Super Stentless prosthesis. Clinical and echocardiographic assessment was done prior to, immediate after and six months after surgery. Results All surgical procedures were successful, no surgery-related complication was documented perioperatively. One patient died after development of multiorgan failure. Echocardiography during the first eight days after surgery showed mean gradients of 16 mmHg, mean valve orifice areas of 1.8 cm(2) and indexed effective orifice areas at 0.95 cm(2)/m(2). Six-months follow-up data were obtained in 19/20 patients. There were no relevant changes in echocardiographic hemodynamic findings at the time of follow-up measurements. Significant regression of left ventricular hypertrophy was shown (P=0.0088). A patient-prosthesis mismatch occurred in one patient (0.54 cm(2)/m(2)). No recurrent symptoms were documented. Conclusion Patient-prosthesis mismatch after implantation of SuperStentless Shelhigh prosthesis is rare. A significant regression of left ventricular hypertrophy could be shown after six months. Hemodynamic valve function assessed by echocardiography may be predicted early after surgery.
Am Anfang jeder Intervention steht die Indikationsstellung. Die Grundlage hierfür gibt die klinische Symptomatik und/oder der Nachweis der Myokardischämie. Die technische Durchführbarkeit und das Risiko des Eingriffs hängen von morphologischen Befunden und charakterisierbaren individuellen Faktoren ab. Eine sorgfältige Vorbereitung der Patienten ist für den Untersuchungsablauf unerlässlich.
