Utility of myocardial fractional flow reserve for prediction of restenosis following sirolimus-eluting stent implantation.

Drug-eluting stents reduce restenosis due to neointimal growth suppression. Considering long-term outcomes, it is both difficult and important to predict drug-eluting stent restenosis. Thus, this study was designed to examine the utility of myocardial fractional flow reserve (FFR) as a predictor of sirolimus-eluting stent (SES) restenosis. Thirty-three patients (35 lesions) were enrolled. Upon completion of SES implantation, FFR was obtained under hyperemia. At 8 months of follow-up, coronary angiography revealed that five lesions had restenosis. Percent diameter stenosis (restenosis 68.7 ± 12.8% vs. non-restenosis 68.7 ± 12.4%, p = 0.78) and lesion length (restenosis 15.8 ± 9.4 mm vs. non-restenosis 14.4 ± 9.2 mm, p = 0.60) were similar. At post-intervention, percent diameter stenosis (restenosis 16.4 ± 6.1% vs. non-restenosis 14.0 ± 7.4%, p = 0.48) and minimum stent area (restenosis 6.01 ± 1.08 mm2 vs. non-restenosis 6.27 ± 1.85 mm2, p = 0.92) were also equivalent. However, proximal edge lumen area was smaller (restenosis 4.24 ± 1.40 mm2 vs. non-restenosis 7.73 ± 2.64 mm2, p = 0.004) and FFR was lower in the restenosis group (restenosis 0.81 ± 0.12 vs. non-restenosis 0.92 ± 0.06, p = 0.029). SES patients with restenosis had a lower FFR post stent deployment, suggesting the decreased FFR may be a useful predictor for SES restenosis.

Utility of novel volumetric intravascular ultrasound analysis software for coronary artery disease.

BACKGROUND: Volumetric intravascular ultrasound (IVUS) analysis has contributed significantly to the assessment of coronary artery disease. The aim of this study is to validate the novel IVUS analysis software (NICORAS) compared to the previously validated software (EchoPlaque). METHODS: Selected from clinical cases, we used 30 IVUS images that utilized motorized pullback at 0.5 mm/sec. Judging from at least two vascular landmarks, identical coronary artery segments were selected and analyzed with two software systems (NICORAS and EchoPlaque). Lumen and external elastic membrane (EEM) borderlines were traced at every 0.5 mm interval. Plaque area was calculated as EEM minus lumen area. Then, volumetric IVUS data were calculated using interpolated frame data from which lumen, EEM, and plaque volume were computed. RESULTS: The average analyzed coronary segment was 15.4 +/- 4.3 mm. There was excellent agreement between NICORAS and EchoPlaque for lumen volume (r = 0.999, p < 0.0001), EEM volume (r= 0.999, p < 0.0001), and plaque volume (r = 0.998, p < 0.0001). CONCLUSION: The new volumetric IVUS analysis software provided IVUS data similar to previously examined software.

Left ventricular-right atrial communication by perforation of the atrioventricular portion of the membranous septum and severe aortic valve regurgitation caused by infective endocarditis.

We report the case of acquired left ventricle (LV) to right atrial (RA) communication through an aneurysm of the atrioventricular septum caused by infectious endocarditis. A severe aortic valve regurgitation and destruction of the aortic valve was detected by echocardiography. Transesophageal echocardiography revealed a flail aortic valve with vegetation and abnormal shunt flow from the LV to RA with ruptured aneurysm of the membranous septum. An abscess cavity of the aortic ring was introduced. Because of worsening congestive heart failure, the patient underwent emergency aortic valve replacement and patch closure of the communication of the membranous septum. The patient's postoperative course was uneventful.