Transient platelet aggregation as a mechanism of unstable angina. Aggressive treatment with coronary angioplasty

Decreased oxygen supply rather than increased demand may be the primary pathogenic mechanism of myocardial ischemia in patients with unstable angina. Coronary artery spasm and in vivo platelet aggregation may play an important role in the mechanism by which the magnitude of fixed obstruction secondary to coronary atherosclerosis is transiently exacerbated. In this case report, we describe a patient who developed chest pain accompanied by ischemic ECG changes during coronary arteriography, due to a transient thrombotic aggravation of a fixed, significant coronary stenosis. Percutaneous transluminal coronary angioplasty was performed with relief of the coronary stenosis and of the symptoms.

Angioplasty for primary treatment of aortic coarctation: immediate results in two adult patients

Two adult patients with severe aortic coarctation were treated by angioplasty performed percutaneously through the right femoral artery. A 20 mm balloon catheter was used, being inflated several times within the stenosis. The final angiographic result was excellent in both cases. The gradients were 38 and 46 mm Hg before and 5 and 3 mm Hg after angioplasty, respectively. The arterial pulses in the legs were normal after the procedure and no complication was observed.

Balloon valvoplasty in calcific aortic stenosis: a therapeutic alternative

Percutaneous balloon valvoplasty was used to treat calcific aortic stenosis in 3 women aged 73, 67 and 61 years, respectively. We approached through the left brachial artery in the first case and the right femoral artery in the other two. An 18 mm balloon was used in all cases, the systolic gradient being reduced from 50, 180 and 48 to 7, 50 and 35 mm Hg, respectively. A mild and transitory systemic embolization was observed in one case. Aortic regurgitation was not present in two patients either before or after valvoplasty. In the other case, a grade 1/6 murmur indicative of regurgitation prior to the procedure increased to a grade 2/6 afterwards. A small and localized aortic dissection was present in one case but disappeared in the control angiography performed 11 days later.

Percutaneous mitral valvuloplasty in rheumatic mitral stenosis by isolated transarterial approach. A new and feasible technique

A highly symptomatic 20-year-old woman with rheumatic mitral valvular stenosis was referred for cardiac catheterization. Following the procedure it was decided to perform a mitral valvuloplasty with a balloon catheter. An isolated transarterial approach through the right femoral artery was used. A Sones catheter was introduced into the left atrium and through it a long teflon-coated guide wire was placed into this cavity. The Sones catheter was removed and an 18 mm diameter balloon catheter was placed under the mitral valve and inflated several times for about 15 sec each. The pulmonary wedge and pulmonary artery pressures were significantly lower than the pre-valvuloplasty ones. The angiograms showed better mitral valve opening.

Coronary angioplasty through an old saphenous vein graft: is it a safe procedure?

A 60-year-old man had myocardial revascularization 13 years ago by means of coronary by-pass surgery. During the described admission, he underwent coronary angioplasty to the marginal branch of the left circumflex artery using the saphenous vein graft as the means of approach. After the procedure, thrombosis occurred within the venous segment with severe reduction of flow despite the atherosclerotic lesion itself being successfully dilated. The patient died one hour later.

Spasm of the left main coronary artery: an indication for surgery?

A patient with severe angina at rest was studied by coronary angiography. A severe spasm in the left main coronary artery was observed; after nifedipine and isosorbide dinitrate a moderate stenosis was still present and surgery was successfully performed.

Complete and delayed reversal of a large dyskinetic area with early spontaneous reperfusion during evolving myocardial infarction

Sequential angiographic studies have shown that spontaneous reperfusion occurs in approximately 30 to 40% of patients during evolving myocardial infarction. However, it is difficult to establish the effects of spontaneous reperfusion on left ventricular function. We report the case of a 65 year old woman with clinical features of acute myocardial infarction with early spontaneous reperfusion and complete recovery of ventricular function 1 year later.