Abstract:
:From September 1987 through May 1988, 86 patients (62 men and 24 women) underwent percutaneous laser-assisted balloon angioplasty, and 2 patients (1 man and 1 woman) underwent laser-assisted balloon angioplasty via cutdowns, in our free-standing catheterization laboratory. The patients' ages ranged from 36 to 81 years. One hundred limbs were treated; each had at least 1 total occlusion, and many had multiple significant occlusions (greater than 50%). Vascular access was attained via the common femoral artery in 62 limbs, via the popliteal artery in 34 limbs, and via a posterior tibial artery cutdown in 4 limbs. In all, 232 lesions were treated either by percutaneous laser-assisted balloon angioplasty (172 lesions) or by balloon angioplasty alone (60 lesions). Technical success was defined as "recanalization and dilation of the occluded arterial segment, resulting in a recognizable improvement in pulse that persisted until hospital discharge." The technical success/attempt ratios for the 172 laser-assisted treatments were as follows: iliac artery, 11/17 (64.7%); common femoral artery, 8/9 (88.9%); superficial femoral artery, 62/80 (77.5%); popliteal artery, 25/30 (83.3%); peroneal artery, 14/16 (87.5%); anterior tibial artery, 6/7 (85.7%); and posterior tibial artery, 9/13 (69.2%). Technical failure occurred in 25 limbs. Failure was not related to sex, age, approach artery, or diabetes, but it was related to the indication of impending limb loss (p < 0.01), previous vascular surgery (p < 0.01), amputation (p < 0.01), and lesion length of 20 cm or greater. Clinical success was defined as "clinical improvement in symptoms, with persistence of an improved pulse at follow-up." Recurrence was observed in 10 limbs. Recurrence was not related to sex, age, approach artery, diabetes, or lesion length, but it was related to the indication of impending limb loss (p < 0.05); to the fact that the patient was a cigarette smoker at the time of the procedure (p < 0.02); and (inversely) to the number of tibial vessels that remained patent post-intervention. Five patients required emergency surgery after laser-assisted angioplasty, but no limb amputation has been necessary. Minor complications included perforation (16 cases), hematoma formation (6 cases), dissection (3 cases), hemorrhage (1 case), hives (1 case), and fracture of the laser probe (1 case). We conclude that percutaneous laser-assisted balloon angioplasty can be safely accomplished in a free-standing laboratory and that the procedure is reasonably successful in patients with totally occluded lower-extremity arteries.
journal_name
Tex Heart Inst Jjournal_title
Texas Heart Institute journalauthors
Thomas HM Jr,Siragusa V,Bowers JA,Allen N,Gallant Gsubject
Has Abstractpub_date
1989-01-01 00:00:00pages
216-23issue
3eissn
0730-2347issn
1526-6702journal_volume
16pub_type
杂志文章abstract::In this case report, we describe direct percutaneous delivery of a muscular-ventricular-septal-defect occluder device to close a left ventricular pseudoaneurysm. The occluder was positioned and deployed with the aid of concurrent transthoracic ultrasonography, transesophageal echocardiography, and fluoroscopy. In cont...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-14-4243
更新日期:2015-08-01 00:00:00
abstract::We describe an operative technique used in 30 patients from 1982 to 1995, in which sinus venosus atrial septal defect with anomalous pulmonary venous connection is repaired through longitudinal incision confined to the vena cava. A single oval patch is folded like the wings of a butterfly: the posterior wing is used t...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1995-01-01 00:00:00
abstract::The indications for transcatheter aortic valve implantation have been increasing with the development of new-generation valves and delivery systems. Our patient, an 81-year-old man with aortic stenosis, had an existing coronary artery bypass graft and bilateral aortoiliac bypass grafts. We used the transfemoral approa...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2012-01-01 00:00:00
abstract::In recent years, researchers have investigated the relationship between biological markers of inflammation and prognosis in patients who experience acute coronary syndromes; however, the association between plasma fibrinogen and coronary heart disease is still not clear. We studied the prognostic value of fibrinogen, ...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2010-01-01 00:00:00
abstract::Pseudoaneurysms of the ascending aorta after the original inclusion/wrap technique of the Bentall procedure present a difficult surgical management problem and are associated with substantial morbidity and mortality. Patients with Marfan syndrome frequently develop aneurysms and dissections that involve multiple aorti...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2003-01-01 00:00:00
abstract::We report the case of a 29-year-old male Jehovah's Witness who presented with hemolysis and right heart failure as a consequence of extreme calcification of an aortic valve-containing allograft and Dacron prosthesis that had been placed 22 years earlier to repair tetralogy of Fallot. Reoperation had been denied by sev...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2003-01-01 00:00:00
abstract::Thrombosis involving a permanent infusion catheter in the subclavian vein and superior vena cava is relatively common, especially in cancer patients. Edema of the arms and head is a well-known clinical consequence of this thrombosis, with an intrinsic risk of pulmonary embolism; however, systemic embolization into the...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract::The Bentall procedure is the standard operation for patients who have lesions of the ascending aorta associated with aortic valve disease. In many cases, however, mechanical prosthetic conduits are not suitable. There are few reports in the English-language medical literature concerning the mid- to long-term outcome o...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2004-01-01 00:00:00
abstract::Percutaneous coronary intervention in tortuous or calcified vessels poses a substantial challenge for interventional cardiologists. Many techniques have been described to overcome the challenge, including the use of stiffer wires, buddy wires, the anchor balloon technique, and deep seating of the guide catheter. Herei...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract::Many patients who undergo cardiac transplantation do so as a result of end-stage dilated cardiomyopathy (DC). Little is known about the causes of this condition, but long-term follow-up studies reveal a high incidence of DC in patients who have had acute viral myocarditis. The following article examines the role of my...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1987-09-01 00:00:00
abstract::A woman with intravenous leiomyomatosis experienced syncope 7 years after a total abdominal hysterectomy and oophorectomy for a uterine fibroid. The workup revealed a tumor that extended from the iliac veins to the right ventricle. It was totally removed under cardiopulmonary bypass. One year later, the patient was fo...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1983-09-01 00:00:00
abstract::We present the case of a 69-year-old man with a history of hypertension and a recent pelvic fracture who presented with acute chest pain, shortness of breath, and severe hypotension. The history of recent pelvic fracture and the clinical manifestations, including the sudden onset of acute respiratory distress, hypoten...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2001-01-01 00:00:00
abstract::Apical akinesis and dilation in the absence of obstructive coronary artery disease is a typical feature of stress-induced (takotsubo) cardiomyopathy, whereas apical hypertrophy is seen in apical-variant hypertrophic cardiomyopathy. We report the cases of 2 patients who presented with takotsubo cardiomyopathy and were ...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-13-3191
更新日期:2014-04-01 00:00:00
abstract::This report describes an unusual case of subaortic stenosis in which hypertrophic obstructive cardiomyopathy was found in combination with both anomalous insertion of papillary muscle directly into the anterior mitral leaflet and "sawfish" systolic narrowing of the left anterior descending coronary artery. Definitive ...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1994-01-01 00:00:00
abstract::We report a case of stab wound to the heart resulting in an atrial septal defect and perforation of the anterior leaflet of the mitral valve, which we repaired successfully 7 years after the injury. To our knowledge, repair of an atrial septal defect due to penetrating trauma has never before been reported. Investigat...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract::Malignant melanoma has a very high tendency to metastasize to the heart. Although most cardiac metastases of melanomas are clinically silent, the lesions may present with life-threatening cardiac morbidities, including dysrhythmia, right ventricular outflow tract obstruction, myocardial dysfunction, pericardial effusi...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2010-01-01 00:00:00
abstract::We present a case in which endovascular stenting was used for recurrent proximal para-anastomotic stenosis 11 years after aorto-bi-iliac bypass grafting for severe aorto-iliac occlusive disease. A 55-year-old woman presented with worsening bilateral hip and buttock claudication. At presentation, her resting ankle-brac...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2002-01-01 00:00:00
abstract::Right ventricular failure secondary to pulmonary embolism is associated with morbidity and death. The Impella RP System has often been used for percutaneous mechanical circulatory support in patients with right ventricular failure from other causes, including myocardial infarction, cardiac surgery, and left ventricula...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-17-6316
更新日期:2018-06-01 00:00:00
abstract::Cardiogenic shock after acute myocardial infarction is associated with a high mortality rate despite modern reperfusion methods and intra-aortic balloon pump support. For myocardial infarction patients in cardiogenic shock that is refractory to intra-aortic ballon pump counterpulsation and pressors (severe refractory ...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2007-01-01 00:00:00
abstract::A 60-year-old man with an acute inferior-wall myocardial infarction was noted, on arteriography, to have an occluded distal right coronary artery. The vessel was reopened with intravenous tissue plasminogen activator; during resolution of the clot, spasm was observed arteriographically but was successfully treated wit...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1988-01-01 00:00:00
abstract::We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicar...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章,评审
doi:10.14503/THIJ-14-4792
更新日期:2016-06-01 00:00:00
abstract::Because of clinical symptoms and findings at physical, echocardiographic, and angiographic examination, a patient was suspected of having a tumor in the right ventricle. Results of surgical and pathological examination, however, revealed a thrombus obliterating the right ventricle. The purpose of this article is to de...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1983-12-01 00:00:00
abstract::Lambl's excrescences are filiform fronds that occur at sites of valve closure. They originate as small thrombi on endocardial surfaces (where the valve margins contact) and have the potential to embolize to distant organs. We describe the case of a 61-year-old woman who presented with repeated episodes of stroke. She ...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章,评审
doi:
更新日期:2007-01-01 00:00:00
abstract::Lesions of the ascending aorta associated with aortic valve disease are usually treated by implanting a prosthetic valved conduit (Bentall procedure). In this report, we present our experience in which a valved homograft conduit was used for the procedure. Six patients underwent a Bentall procedure with the use of a c...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract::Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. A...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-15-5353
更新日期:2016-08-01 00:00:00
abstract::A 36-year-old, otherwise-healthy woman with a 6-year history of progressive dysphagia underwent an esophagogram that revealed an oblique extrinsic defect with an inferior-to-superior (left-to-right) course consistent with an aberrant right subclavian artery. An aortogram confirmed the diagnosis of aberrant right subcl...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2004-01-01 00:00:00
abstract::Willem Einthoven (1860--1927), known as the creator of the electrocardiograph, won a Nobel Prize in 1924 for his contributions to the field of electrocardiography. He was dedicated to research and learning. In developing the electrocardiograph, Einthoven built on the work of earlier physiologists who had studied the e...
journal_title:Texas Heart Institute journal
pub_type: 传,历史文章,杂志文章
doi:
更新日期:2008-01-01 00:00:00
abstract::Minimally invasive cardiac surgery is rapidly gaining interest because of fast recovery, reduced morbidity, shorter hospital stay, lower costs, and better cosmetic results. Aortic valve surgery can be performed through a small (10- to 12-cm) transverse sternal incision, and femoro-femoral cannulation is used for cardi...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00
abstract::We present herein the case of a 48-year-old patient who had undergone repair of total anomalous pulmonary venous return at the age of 14 months, in March 1960, at Texas Children's Hospital. When this patient voluntarily underwent re-examination in 2007, echocardiography revealed the late results of surgery that had be...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2008-01-01 00:00:00
abstract::Three groups of consecutive patients who had undergone primary elective coronary artery bypass operations were compared at 10 to 20 years of follow-up (mean, 13.6 years), in order to test the supposition that arterial conduits provide better long-term outcome than do the "standard" left internal mammary-to-left anteri...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2005-01-01 00:00:00