Recovery of regional myocardial dysfunction after successful coronary angioplasty early after a non-Q wave myocardial infarction

Angioplasty of the septal perforators: acute outcome and long-term clinical efficacy

Critical stenosis of a large septal perforator artery can cause significant myocardial ischemia. Since septal perforators are generally not accessible for bypass grafting, balloon angioplasty offers an excellent alternative for revascularization of these vessels. The short-term outcome and long-term clinical follow-up angioplasty of the septal perforator was evaluated retrospectively in 21 patients. Fourteen of the 21 (66%) had previous myocardial infarction, 9 of 21 (43%) had previous coronary bypass surgery, 10 of 21 (48%) had previous percutaneous transluminal coronary angioplasty (PTCA), and 6 of 21 (28%) had congestive heart failure. Additional PTCA of one or more vessels was undertaken in all patients. Primary success of PTCA of the septal perforator was achieved in 20 of 21 (95%) patients. The mean stenosis was improved from 89.8 +/- 10% to 18.4 +/- 11.7%. No acute closure, emergency coronary bypass, or myocardial infarction was observed or needed during hospital stay. At long-term follow-up (18 +/- 9 months), event-free survival was 95%. No cardiac death occurred. In 86% of cases, there was significant improvement in anginal class at 2 years. Five of the six patients with congestive heart failure showed marked improvement in functional class at 2 years. In conclusion, balloon angioplasty of the large septal perforator artery is technically feasible, with a high success rate, and does not increase the rate of acute complications of the procedure. Along with PTCA of other arteries, it provides long-term relief of angina in a majority of symptomatic patients with complex multivessel disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Increase in serum cardiac myosin light chain I associated with elective percutaneous transluminal coronary angioplasty in patients with ischemic heart disease

Changes in serum myosin light chain I (MLCI) due to elective percutaneous transluminal coronary angioplasty (PTCA) were studied after PTCA (0, 8 and 48 hours) in 57 patients with old myocardial infarction (MI group) and 20 patients with angina pectoris (AP group). The AP group showed no increase after PTCA. In contrast, in the MI group there were 16 patients in whom MLCI at 48 hours was increased by 1.0 ng/ml or more (MI1 group) and another group of 41 patients who showed no increase in MLCI (MI2 group). The MI1 group had a significantly higher incidence of (1) non-Q wave myocardial infarction (62.5% vs. 17.1%, p < 0.01), (2) 99% stenosis of a coronary artery (50.0% vs. 12.2%, p < 0.01), and (3) redistribution in a hypoperfusion area found in the delayed image of resting thallium-201 (201Tl) myocardial scintigraphy (85.7% vs. 15.8%, p < 0.01). The left ventricular ejection fraction (LVEF) was significantly improved in the MI1 group, 3 to 4 months later (from 0.49 +/- 0.12 to 0.58 +/- 0.11, p < 0.01), in contrast to the patient of MI2 group who did not show any improvement. The AP group was not considered to have a bulk of myocardium impaired enough to show a release of MLCI due to PTCA-associated transient coronary occlusion. In the MI1 group, however, MLCI was probably released from the chronically under-perfused, but still salvageable, portion of the myocardium. This is consistent with the improvement in LVEF observed 3 to 4 months after the relief of severe coronary stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)