Seismocardiographic changes associated with obstruction of coronary blood flow during balloon angioplasty.

Seismocardiography, a new noninvasive technique, detects low-frequency cardiac vibrations on the chest wall during ventricular contraction and during both early and late ventricular filling. To evaluate the ability of seismocardiography to detect ischemia caused by decreased coronary blood flow, 35 patients were studied during coronary angioplasty. Seismocardiograms and electrocardiograms were recorded twice at baseline, with the catheter across the lesion before first inflation (n = 15), every 30 seconds during the first inflation, 1 and 2 minutes after the first inflation and greater than or equal to 5 minutes after the final inflation. For comparison, sequential seismocardiograms were also obtained from 15 healthy volunteers. Electrocardiograms were blindly scored for ST change from baseline (0 = none, 1 = 0.5 mm ST depression, 2 = greater than or equal to 1.0 mm ST depression, 3 = ST elevation). Seismocardiograms were blindly scored for change from baseline (0 = none, 1 = mild, 2 = moderate, 3 = marked) for both the systolic and diastolic waves. The average maximal systolic seismocardiographic score was 2.5 +/- 0.8 for patients who had undergone angioplasty and 1.0 +/- 0.9 for volunteers (p less than 0.001). The average maximal diastolic seismocardiographic score was 2.3 +/- 0.8 for angioplasty patients and 0.7 +/- 0.9 for volunteers (p less than 0.001). The percentage of angioplasty patients with electrocardiographic, systolic and diastolic seismocardiographic scores greater than or equal to 2 was, respectively: 0, 11 and 14% at second baseline; 23, 67 and 53% with catheter across the lesion; 44, 75 and 59% after 30 seconds of inflation; 42, 71 and 61% after 60 seconds of inflation; 23, 74 and 61% after 1 minute of deflation; and 0, 71 and 47% 5 minutes after final inflation.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical application of percutaneous cardiopulmonary bypass for high risk coronary angioplasty.

Percutaneous cardiopulmonary bypass support was electively instituted prior to coronary angioplasty in 16 patients at high risk for hemodynamic collapse. In all cases the dilated artery supplied greater than 2/3 of the functioning myocardium. Eight patients had moderate LV dysfunction with ejection fraction 25-40%. Eight patients had an ejection fraction less than 20%. A 21 French cannula and a 17 French cannula were percutaneously inserted into the femoral vein and artery. Cardiopulmonary bypass support was instituted using a Bio-Medicus centrifugal pump just prior to coronary angioplasty at flow rates of 3.5-5 liters/minute. Thirteen patients had single vessel angioplasty and three patients had multivessel angioplasty. Complete loss of systolic function was observed in 9 (56%) patients. This finding when present confirms the absolute requirement for cardiopulmonary support. Technical success was achieved in all 16 patients (100%), clinical success was achieved in 14 patients (88%). Patient followup (mean 10 months) revealed 3 patients with class I-II angina and 10 patients were asymptomatic. There was one late death. In conclusion, percutaneous cardiopulmonary bypass support for carefully selected high risk patients may allow coronary angioplasty to be performed safely and effectively despite complete loss of systolic function during balloon inflation.

The Nimbus Hemopump: a new left ventricular assist device that combines myocardial protection with circulatory support.

Recent advances in hemodynamic support can allow patients at high risk for cardiovascular collapse to become candidates for coronary interventions. A new axial blood flow pump has recently been developed and made available for clinical testing. This intravascular pump utilizes an Archimedes screw pump rotating at 25,000 rpms to provide a flow of 2 to 3.5 liters/minute. The 7 mm inlet cannula of the cable driven pump is delivered across the aortic valve. The pump discharges blood into the descending aorta. This design does not require a membrane oxygenator. This pump would be expected to: 1) provide circulatory support irrespective of heart arrhythmias; 2) provide left ventricular unloading and 3) lack the fluid and coagulation abnormalities of prolonged cardiopulmonary bypass. This unique device offers great promise to the interventional cardiologist.

Intra-aortic balloon counterpulsation support for elective coronary angioplasty in the setting of poor left ventricular function: a two center experience.

A two-center elective coronary angioplasty experience with intra-aortic balloon pump support for patients with severe left ventricular dysfunction is reported. To prevent hemodynamic collapse, an intra-aortic balloon pump was inserted percutaneously before coronary angioplasty in 97 patients with a left ventricular ejection fraction less than 35% (26% of whom had ejection fractions less than 25%). The cohort was predominantly male (71%) with a mean age of 64 +/- 9 years. Angioplasty was successfully performed in 83 (85.6%) patients and 80 (82.5%) of these successful patients were discharged from the hospital. Seven patients had unsuccessful angioplasty without a major cardiac event. Seven patients (7.2%) suffered a major cardiac event; 4 had emergent coronary bypass surgery with q-wave infarction, 2 had uneventful emergency coronary bypass surgery, and one patient died in the operating room after a failed angioplasty. Using logistic regression analysis, the presence of multivessel disease and a history of prior myocardial infarction were associated with more complications during angioplasty (p less than 0.05). Intra-aortic balloon pump placement did not interfere with the angioplasty procedure. Two patients had limb ischemia which resolved when the intra-aortic balloon pump was removed. Of the 80 successful patients discharged, 72 were followed for a mean of 22 months. At the latest follow-up, 52 had not suffered a myocardial infarction and were alive. Of the 20 late deaths, 16 were cardiac and 4 non-cardiac.(ABSTRACT TRUNCATED AT 250 WORDS)

Directional atherectomy for long lesions: improved results.

The percutaneous treatment of complex stenoses, specifically long lesions, has improved substantially during the past decade. To determine the success of directional atherectomy in the treatment of long lesions, a cohort of 88 patients with lesions greater than 10 mm were evaluated and compared to 376 patients with long lesions treated with conventional balloon angioplasty. Directional atherectomy was successful in 97% and PTCA was successful in 93% of patients with long lesions. There were no differences in complication rates for these cohorts (< 2%). Directional atherectomy and PTCA appear to have safely and successfully broadened the percutaneous treatment of coronary disease to include long coronary stenoses.

Monorail Piccolino catheter: a new rapid exchange/ultralow profile coronary angioplasty system.

The Monorail Piccolino coronary angioplasty balloon catheter (MBC) was evaluated on 118 patients at two centers. Technical success was achieved in 110 patients (93%). Time for catheter exchange and total fluoroscopy time were significantly lower for the Monorail catheter than with standard equipment (exchange time 97 vs. 170 seconds P less than .05 and fluoroscopy time 17 vs. 88 seconds P less than .001). The advantages of rapid exchange and the ability of utilize 2 Monorail balloon catheters through one 9F guiding catheter for simultaneous inflations allowed for maximal flexibility in treating patients with bifurcation lesions. The double wire approach utilizing one Monorail balloon catheter with a 7F guiding catheter was also technically successful. The Monorail Piccolino balloon catheter has unique features that allow for greater ease of operator use, rapid catheter exchange, and optimal angiographic visualization. It is felt that this catheter design provides distinct advantages over standard angioplasty equipment.