0000000000121638
AUTHOR
G. Görge
Coronary Artery Shape and Flow Changes Induced by Myocardial Bridging.
Changes in coronary shape and blood flow induced by myocardial bridging were analyzed in a 56-year-old patient with symptoms of unstable angina after the exclusion of other heart disease. Coronary angiography demonstrated a 1.8-cm long myocardial bridge in the middle part of the left anterior descending coronary artery. In systole, an eccentric compression of the artery occurred, resulting in a stenosis that occupied 86% of the diameter and 96% of the area. Intraluminal ultrasound was performed with a 20-MHz transducer in a 4.8-Fr catheter sheath (Boston Scientific Corp.) connected to an ultrasound console (Diasonics Inc.). A side saddle catheter was introduced into the left anterior descen…
Prediction of rapid versus prolonged healing of infective endocarditis by monitoring vegetation size.
The diagnostic value of transesophageal echocardiography in monitoring the clinical course has been evaluated in 83 patients with echocardiographic evidence of infective endocarditis. A total of 103 vegetations attached to the aortic or mitral valves were detected by use of the transesophageal approach. The patients were monitored for a mean of 74 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations. Group A included patients with increasing or remaining constant size of vegetation (8.2 +/- 1.5 to 11.2 mm, p less than 0.05) during 4 to 8 weeks of antimicrobial therapy, whereas group B was formed by patients with decreasing vegetation size (8.3 +/- …
Identification of abscess formation in native-valve infective endocarditis using transesophageal echocardiography: implications for surgical treatment.
The object of the study was to follow patients with endocarditis-associated abscesses in order to evaluate the clinical outcome with and without surgical intervention. Transesophageal echocardiography successfully displayed the location and extent of abscess cavities in 14 patients (group A) with aortic valve endocarditis. The infective process was limited to the perivalvular tissue in two, extended into the ascending aorta in six, and included the interventricular septum, the right ventricular outflow tract, interatrial septum, and/or mitral valve annulus in six patients. The complication rate was significantly higher in group A than in group B, which consisted of 27 patients with proven s…
Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis
Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction and congestive heart failure being more common in patients with echocardiographically discernible vegetations. The transoesophageal approach affords consistently high quality images with excellent structural resolution. Two-hundred and eighty-one patients with clinically suspected infective endocarditis were studied, to evaluate the prognostic value of ascertaining the site of vegetations. Among them were 118 patients with vegetations attached to the aortic or mitral valve. These patients were followed for a mean period of 14 months. Mitral valve vegetations were associated with a signif…
Acute coronary artery closure following intracoronary ultrasound examination
Two patients undergoing intracoronary ultrasound examination were complicated by acute coronary artery closure. One of the complications was thought to be caused by intimal dissection and thrombus formation and the other was thought to be caused by intimal dissection and subsequent embolization. The complications were successfully managed conservatively in both cases. © 1995 Wiley-Liss, Inc.
Tomographic left ventricular volume determination in the presence of aneurysm by three-dimensional echocardiographic imaging. I: Asymmetric model hearts
To improve the accuracy of measurements of left ventricular volume in the presence of an aneurysm, we used three-dimensional echocardiographic imaging to analyze the shape of left ventricles in 23 asymmetric model hearts with eccentric aneurysms of different sizes, shapes, and localizations. A standard 3.75 MHz ultrasound probe with a rotation motor device was used to obtain a three-dimensional data set. By rotating the probe stepwise 1 degree, 180 radial ultrasound pictures were digitized. On the basis of the three-dimensional data set, the following parameters were determined and compared with the dimensions of the model hearts obtained by direct measurement: total left ventricular volume…
Isolated in-vitro perfusion of pig hearts obtained from the abattoir: an alternative to animal experiments?
Isolated pig hearts (German farm pigs) were characterized after global in-vivo ischaemia as a potential alternative to in-vivo animal studies. Hearts were harvested from adult farm swine at the abattoir 10.3 +/- 2.1 min after incision of the carotid artery. They were immediately perfused and thereafter stored in ice-cold cardioplegic (St Thomas's) solution. After 38 +/- 3 min, retrograde perfusion was started with oxygenated pig blood (37 degrees C; 5000 U Heparin.l-1; pH 7.38 +/- 0.1; 11 mmol glucose.l-1) at a flow rate of 85 ml.min-1 100 g-1 wet weight (gww-1) for 30 min (n = 10). Additionally, shortly after obtaining the hearts, ATP and CP content were measured by enzymatic tests in 10 p…
High-Frequency Rotational Angioplasty
In 19 patients with significant coronary artery disease, PTCR was used instead of PTCA. The PTCR was successful in all patients, but in nine patients additional PTCA was successfully performed. Coronary luminal narrowing could be reduced from 78 ± 19% to 32 ± 14% after rotablation and by combined treatment to 21 ± 14%. Only in one patient did coronary dissection occur; the patient was sent to surgery and had an uneventful outcome. No vessel perforation was observed. In one patient peripheral diagonal branch occlusion occurred. All vessels were open according to 24-control coronary angiography. Restenosis (>70% stenosis) occurred in 4/15 patients controlled after 6 months, mainly in those wi…
Interventional cardiology: Differences in the morphology of unstable and stable coronary lesions and their impact on the mechanisms of angioplasty. An in vivo study with intravascular ultrasound
The aim of this study was to compare the morphology of stable and unstable coronary lesions using intravascular ultrasound in patients undergoing coronary balloon angioplasty and to determine whether lesion morphology had any influence on the mechanism of balloon angioplasty. Thirty three (15 stable and 18 unstable) patients undergoing single lesion percutaneous transluminal coronary angioplasty were studied with intravascular ultrasound before and after intervention. All examinations, recorded on S-VHS video tape, were studied off-line and matched sites from the point of minimum lumen area after the procedure and the corresponding site prior to intervention were compared. The morphology of…
Bioconcentration, metabolism and toxicity of substituted anilines in the zebrafish (Brachydanio rerio).
The LC50 (96 h) values and the bioconcentration factors (BCF) for nine anilines (aniline; 2-, 3-, 4-chloroaniline; 2-, 3-, 4-nitroaniline; 2,4- and 3,4-dichloroaniline) in the zebrafish (Brachydanio rerio) were determined. Biotransformation products of anilines in the zebrafish were analyzed by HPLC. The aim of the investigations was to find relationships between accumulation/elimination/metabolism and toxicity on the one hand and between chemical structure and biotransformation on the other. We found a good correlation of log BCF and of log Pow with log LC50. This concurs with the assumption that the internal dose determines the toxicological effect. All anilines investigated, with the exc…
Spontaneous plaque rupture visualized by intravascular ultrasound.
An intravascular ultrasound examination was performed in order to evaluate an angiographically complicated lesion. Intravascular ultrasound was able to demonstrate spontaneous plaque rupture in a patient with recent acute subendocardial infarction. The inconclusive angiographic appearance was clarified by the intravascular examination and led us to conclude that the myocardial infarction was due to plaque rupture with subsequent thrombotic occlusion, which had spontaneously resolved by the time of the study.
Intravascular ultrasound imaging of arterial wall architecture.
Intravascular ultrasound (IVUS) is a promising new technique for assessing vascular morphology and structure. Controversy exists whether the three-layer appearance of the arterial wall correctly reflects the histologic structures of the intima, media, and adventitia. We performed an experimental study to clarify the three-layer appearance. The vessel wall architecture was analyzed by IVUS on eight different kinds of plastic cylinders, 24 normal blood vessels from pigs, and 59 human arterial segments. A distinct three-layer appearance was observed on all the plastic cylinders when the ultrasound beam was perpendicular to the wall. A three-layer appearance was also seen in the arterial wall, …