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  • 1
    Electronic Resource
    Electronic Resource
    Haemodynamic effects of intravenous cibenzoline in patients with coronary heart disease (1984)
    Springer
    European journal of clinical pharmacology 26 (1984), S. 297-302 
    Details
    ISSN: 1432-1041
    Keywords: cibenzoline ; antiarrhythmic drug ; coronary heart disease ; cardiac performance ; drug plasma level ; cardiac catheter ; inotropic action
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The effect of a single dose of cibenzoline ((diphenyl 2,2 cyclopropyl) -2 imidazoline, Cipralan), a new compound with antiarrhythmic properties was studied in 14 patients undergoing routine heart catheterization for suspected coronary artery disease. The effect of the drug on dP/dt, Vmax TP, Vce, negative dP/dt, heart rate (HR), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), cardiac index (CI) and systemic vascular resistance (SVR) was measured before and after drug administration. A significant decrease in left ventricular isometric contraction parameters was manifested immediately after injection, with its maximal effect 2 to 5 min after injection. An increase in HR, a decrease in LVSP, a decrease in CI and an increase in SVR were observed; LVEDP was not significantly altered, nor was negative dP/dt. The effect of the drug on Vmax TP and LVEDP was also examined during two atrial pacing stress tests (APST) done before and 10 to 20 min after drug administration. Although the negative inotropic action of the drug was apparent during the second APST, the effect was less pronounced at higher paced heart rates. No difference in the two tests was found between the maximal paced heart rate, nor was there a difference in the angina threshold. Finally the plasma level of the drug and the changes in certain parameters were compared. A positive correlation was found between the plasma level and dP/dt, Vmax TP and cardiac index.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00548758
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  • 2
    Electronic Resource
    Electronic Resource
    Clinical and Angiographic Outcome Following Implantation of the New Less Shortening Wallstent in Aortocoronary Vein Grafts: Introduction of a Second Generation Stent in the Clinical Arena (1994)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 7 (1994), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: One of the factors felt to have contributed to the high rate of stent occlusion in the European registry of the coronary Wallstent in the 1980s was the frequent deployment of more than one stent to cover the target lesion. This resulted from a high degree of shortening of the Wallstent upon expansion. To overcome this limitation the design of the Wallstent was modified to reduce the degree of shortening. We report the results of a study of the first patients to undergo implantation of the new Less Shortening Wallstent. Thirty-five Wallstents were electively deployed in aortocoronary vein grafts in 29 patients. Stent deployment was successful in 35 of 36 attempts in 30 lesions. In five of the 30 lesions, a second scent was required to cover the proximal portion of the lesion. Angiographic success (〈 50% residual diameter stenosis as determined by off-line quantitative coronary angiography) was achieved in all 29 patients. During the in-hospital phase, no tnajor adverse cardiac event occurred (reintervention, re-CABG, myocardial infarction, or death) and five patients had hemorrhagic complications. Following hospital discharge, one patient had a subacute stent occlusion associated with symptoms and elevated cardiac enzymes at 11 days, another patient had symptoms and elevated cardiac enzymes (CK 300 U/I) at 22 days with a patent stem, five patients required balloon angioplasty within the 6 month follow-up period (four for restenosis and one for stent occlusion), one patient underwent re-CABG for a native artery stenosis distal to the anastomosis of the patent stented vein graft. The results of this introductory study suggest that the new Less Shortening Wallstent may be associated with a reduction in the requirement for multiple stern deployment and a lower rate of thrombotic occlusion in comparison to its pioneering prototype. On the basis of these results, a number of larger multicenter clinical trials have been initiated to, further evaluate the new coronary Wallstent. (J Interven Cardiol 1994:7:557–564)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1994.tb00496.x
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  • 3
    Electronic Resource
    Electronic Resource
    Angioplasty for stable versus unstable angina pectoris: Are unstable patients more likely to get restenosis? (1988)
    Springer
    The international journal of cardiovascular imaging 3 (1988), S. 87-97 
    Details
    ISSN: 1573-0743
    Keywords: recurrent stenosis ; quantitative coronary angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Current evidence with regard to the possible association between clinical expression of coronary disease prior to the time of angioplasty, and the subsequent risk of restenosis following successful dilatation, remains inconclusive. To prospectively compare the incidence of restenosis in stable versus unstable angina pectoris patients, follow-up angiography was performed in 85 percent of patients from a consecutive series with a successful PTCA, irrespective of presence or absence of recurrent ischemic symptoms. Furthermore, changes in lesion severity were assessed quantitatively by an automated edge-detection technique rather than visual analysis. Employing such a study design and follow-up protocol, it was found that the incidence of restenosis in patients with stable coronary artery disease was similar to that of patients with unstable rest angina, irrespective of the type of angiographic definition used.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01814881
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  • 4
    Electronic Resource
    Electronic Resource
    Correlations between quantitative cineangiography, coronary flow reserve measured with digital subtraction cineangiography and exercise thallium perfusion scintigraphy (1988)
    Springer
    The international journal of cardiovascular imaging 3 (1988), S. 133-139 
    Details
    ISSN: 1573-0743
    Keywords: quantitative cineangiography ; coronary flow reserve ; thallium perfusion scintigraphy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The goal of this investigation was to establish which anatomical parameters of stenotic lesions correlate best with its functional severity. Therefore, thirty-eight patients with single vessel disease underwent coronary cineangiography and exercise/redistribution thallium-201 scintigraphy. Cross-sectional area at the site of obstruction (OA), percentage diameter stenosis (DS), the calculated pressuredrop over the stenosis (PD), as well as coronary flow reserve (CFR) derived from myocardial contrast appearance time and density were determined. The relations between CFR and the 3 anatomical parameters were described by the following equations: $$\begin{gathered} CFR = 4.6 - 0.53 DS,r = 0.82, SEE:0.79, p〈 0.001 \hfill \\ CFR = 0.5 + 0.75 OA,r = 0.87, SEE:0.68, p〈 0.001 \hfill \\ CFR = 3.6 - 1.5 log PD,r = 0.90, SEE:0.62, p〈 0.001 \hfill \\ \end{gathered} $$ The calculated pressuredrop was highly predictive of the thallium scintigraphic results with a sensitivity of 94% and a specificity of 90%. Therefore, the calculated pressuredrop is a better anatomical parameter for assessing the functional importance of a stenosis than percentage diameter stenosis or obstruction area. However, the 95% confidence limits of the relation between pressuredrop and coronary flow reserve are wide, making measurement of CFR a valuable addition to quantitative angiography, especially when determining the functional importance of moderately severe coronary artery lesions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01814886
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  • 5
    Electronic Resource
    Electronic Resource
    Intraluminal real-time ultrasonic imaging: Clinical perspectives (1989)
    Springer
    The international journal of cardiovascular imaging 4 (1989), S. 89-97 
    Details
    ISSN: 1573-0743
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion Intravascular, real-time, high-resolution echography is an exciting new development. It produces circumferential images of the artery segment of interest and allows measurement of lumen dimensions, wall thickness and extent of wall disease. This unprecedented diagnostic potential opens new horizons for clinical research and practical applications are rapidly emerging. It can be used to characterise and quantify the degree of arterial Table 3. Future perspectives Combination with ablation techniques Combination with pressure measurement Combination with Doppler velocimetry Three-dimensional reconstruction Tissue characterisation Forward (down-stream) imaging disease, to study its natural history, and to grade the effects of pharmacologic interventions. It will become a major adjunct to second-generation angioplasty procedures, as a guidance tool and for the immediate evaluation of results, since it is more easy to use and provides unique information much faster than other imaging modalities.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01745138
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  • 6
    Electronic Resource
    Electronic Resource
    Intravascular echographic assessment of vessel wall characteristics: a correlation with histology (1989)
    Springer
    The international journal of cardiovascular imaging 4 (1989), S. 105-116 
    Details
    ISSN: 1573-0743
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In vivo application of intravascular high frequency ultrasonic imaging for peripheral and coronary artery disease is a promising technique for vascular surgeons, radiologists and cardiologists. This report demonstrates in vitro results obtained with a high frequency imaging catheter (40 MHz) in 70 human specimens including arteries with and without atherosclerosis, veins, coronary artery bypass grafts and vascular prosthetic material. Correlation between the ultrasonic images and the histologic characteristics of the corresponding vessel wall tissue and lumen geometry was established. In addition, the effect of intervention techniques i.e. balloon angioplasty, spark erosion and laser were studied with ultrasound and histology. It is anticipated that development of such a catheter imaging technique has potential for diagnostic imaging and for combination with therapeutic systems.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01745140
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  • 7
    Electronic Resource
    Electronic Resource
    Three-dimensional reconstruction of myocardial contrast perfusion from biplane cineangiograms by means of linear programming techniques (1988)
    Springer
    The international journal of cardiovascular imaging 3 (1988), S. 141-152 
    Details
    ISSN: 1573-0743
    Keywords: three-dimensional reconstruction ; myocardial contrast perfusion ; coronary flow reserve ; biplane cineangiography ; quantitative coronary angiography ; quantitative left ventriculography ; linear programming techniques
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The assessment of coronary flow reserve from the instantaneous distribution of the contrast agent within the coronary vessels and myocardial muscle at the control state and at maximal flow has been limited by the superimposition of myocardial regions of interest in the two-dimensional images. To overcome these limitations, we are in the process of developing a three-dimensional (3D) reconstruction technique to compute the contrast distribution in cross sections of the myocardial muscle from two orthogonal cineangiograms. To limit the number of feasible solutions in the 3D-reconstruction space, the 3D-geometry of the endo- and epicardial boundaries of the myocardium must be determined. For the geometric reconstruction of the epicardium, the centerlines of the left coronary arterial tree are manually or automatically traced in the biplane views. Next, the bifurcations are detected automatically and matched in these two views, allowing a 3D-representation of the coronary tree. Finally, the circumference of the left ventricular myocardium in a selected cross section can be computed from the intersection points of this cross section with the 3D coronary tree using B-splines. For the geometric reconstruction of the left ventricular cavity, we envision to apply the elliptical approximation technique using the LV boundaries defined in the two orthogonal views, or by applying more complex 3D-reconstruction techniques including densitometry. The actual 3D-reconstruction of the contrast distribution in the myocardium is based on a linear programming technique (Transportation model) using cost coefficient matrices. Such a cost coefficient matrix must contain a maximum amount of a priori information, provided by a computer generated model and updated with actual data from the angiographic views. We have only begun to solve this complex problem. However, based on our first experimental results we expect that the linear programming approach with advanced cost coefficient matrices and computed model will lead to acceptable solutions in the 3D-reconstruction of the myocardial contrast distribution from biplane cineangiograms.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01814887
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  • 8
    Electronic Resource
    Electronic Resource
    Aortic valvuloplasty of calcific aortic stenosis with monofoil and trefoil balloon catheters: practical considerations (1990)
    Springer
    The international journal of cardiovascular imaging 5 (1990), S. 249-260 
    Details
    ISSN: 1573-0743
    Keywords: aortic valvuloplasty ; aortic stenosis ; balloon catheters ; computed axial tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to evaluate the relation between balloon design (monofoil, trefoil) and valvular configuration, experimental aortic valvuloplasty was performed in four post-mortem hearts with calcific aortic stenosis of various morphology. The degree of obstruction of the aortic orifice was assessed by computed axial tomography during inflation of monofoil 15 and 19 mm and trefoil 3×12 mm balloon catheters. We also evaluated the hemodynamic repercussion of balloon inflation (fall in systolic aortic pressure) in four elderly patients with acquired aortic stenosis who underwent a percutaneous transluminal aortic balloon valvuloplasty, with stepwise increasing balloon sizes of 15 mm, 19 mm and 3×12 mm, as during ourin vitro experiments, and who underwent aortic valve replacement later on. In these patients, we correlated the anatomy of the excised aortic valves with the retrospective analysis of aortic pressure curves recorded during previous valvuloplasty procedures. Our experimental and clinicopathological observations showed that the degree of obstruction of the aortic orifice in post-mortem specimens and the tolerance to balloon inflation in live patients are dependent of the valvular configuration. Although trefoil balloons have the theoretical advantage to avoid complete obstruction of the aortic orifice during inflation, we observed that in presence of a tricuspid configuration, they could be potentially more occlusive than monofoil balloons since each of the 3 individual components of the trefoil balloon occupied the intercommissural spaces while inflated. However, they offered more residual free space when inflated in aortic valves with a bicuspid configuration (i.e. congenitally bicuspid valves or tricuspid valves with one fused commissure). In our opinion, these observations are relevant, since degenerative disease of the aortic valve (i.e. tricuspid valve without commissural fusion) is now recognized as the most common etiology of aortic stenosis in the elderly.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01797842
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  • 9
    Electronic Resource
    Electronic Resource
    Myocardial contrast two-dimensional echocardiography (1989)
    Springer
    The international journal of cardiovascular imaging 4 (1989), S. 53-56 
    Details
    ISSN: 1573-0743
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01795124
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  • 10
    Electronic Resource
    Electronic Resource
    Intravascular real-time, two-dimensional echocardiography (1989)
    Springer
    The international journal of cardiovascular imaging 4 (1989), S. 63-67 
    Details
    ISSN: 1573-0743
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion Intravascular, real-time, high resolution echography is an exciting new development. It produces circumferential images of the artery of interest and allows measurement of lumen dimensions, wall thickness and extent of atherosclerotic disease. This unique diagnostic potential can be used to characterise and quantify the degree of atherosclerotic disease, to grade the effect of pharmacologic intervention and to guide angioplasty procedures and evaluate their effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01795127
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