[Percutaneous coronary transluminal angioplasty with extracorporeal circulation: preliminary results]. / Angioplastica coronarica percutanea transluminale con assistenza circolatoria extracorporea: risultati preliminari.

Percutaneous transluminal coronary angioplasty (PTCA) in patients with low ejection fraction (EF) and/or a large area of remaining viable myocardium served by the target vessel can cause hemodynamic collapse in case of acute closure. We report 11 patients in whom the cardiopulmonary bypass support (CPS) was instituted because of contraindication to surgery (Group I) or unstable angina associated with low EF and/or a large amount of myocardium perfused by the target artery (Group II). Nine were male and 2 female, mean ages of 70, with Canadian angor class I (1), II (1), or IV (9) and EF ranging from 12 to 65% (mean 34%). Thirty were the lesions to dilate; 28 were dilated successfully; in 2 an aortic dilation was also performed. One death occurred after the procedure related to collapse due to hypovolemia; another death occurred 8 months after PTCA because of pulmonary neoplasia. The other 9 patients followed-up at 1 to 8 months (mean 3.9) disclosed Canadian angor class I. The procedure's technique and the related complications are discussed. We conclude that cardiopulmonary bypass support can be used safely in patients refused to surgery and with high risk PTCA; such a procedure may expand the indication of PTCA.

SWAT team approach to ventricular assistance.

In 1986, the Cardiovascular Research Institute in Sion, Switzerland, created a flying bridge-to-cardiac transplantation team. This team, consisting of two physicians, a physicist, a biomedical engineer, and two intensive care nurses, has participated in 23 bridges to cardiac transplantation in 11 cardiovascular surgery centers in Europe. The cardiac function of all patients was 100% supported by paracorporeal pneumatic biventricular Pierce-Donachy devices. Twenty of the 23 patients have had transplantation, and 11 are alive and well. The bridge-to-cardiac transplantation team, which travels with a transportable driver and the ventricle sets, supervises the bridged patients 24 hours a day until cardiac transplantation is performed.

Late systolic stress-diameter relation in patients with aortic valve disease before and after valve replacement.

The end-systolic pressure-diameter ratio (Ees) and the maximal pressure-diameter ratio (Emax) during systolic ejection were determined in 10 control patients and 25 patients with aortic valve disease before and 18 months after successful valve replacement. The pressure-diameter ratio was determined from simultaneous M-mode echocardiograms and high-fidelity pressure measurements. A new index of myocardial contractility, as proposed by Pouleur and co-workers, was assessed from the late systolic stress-diameter relationship during one single heart cycle. The slope of this stress-diameter relationship was used for determination of myocardial contractility. Meridional wall stress was calculated from echo-pressure measurements at time intervals of 5 to 10 msec. The aortic valve patients were divided into two groups according to the preoperative angiographic ejection fraction: group 1 (ejection fraction greater than or equal to 57%) consisted of 16 patients and group 2 (ejection fraction less than 57%) of 9 patients. Standard hemodynamics showed a significant decrease in left ventricular end-diastolic pressure from 18 to 11 mm Hg in group 1 (P less than 0.01) and from 16 to 12 mm Hg (NS) in group 2. Peak systolic pressure decreased from 186 to 135 mm Hg (P less than 0.01) in group 1 and from 155 to 140 mm Hg (NS) in group 2. Left ventricular end-diastolic volume decreased from 137 to 105 ml/m2 in group 1 and from 225 to 150 ml/m2 in group 2 (P less than 0.05) whereas left ventricular ejection fraction remained unchanged in group 1 (67 versus 65%) and increased slightly in group 2 (45 versus 51%) following surgery. Emax and Ees were preoperatively significantly decreased in group 2 when compared to group 1. Postoperatively, Emax and Ees were no longer significantly different between the two groups although left ventricular ejection fraction remained significantly depressed in group 2 after surgery when compared to group 1. The slope of the late systolic stress-diameter relationship (beta) and the diameter at zero stress (D0) did not show any difference between the two groups pre- as well as postoperatively. Thus it is concluded that Ees and Emax might help to identify myocardial dysfunction in preoperative patients with aortic valve disease. However, in the presence of persistent myocardial dysfunction, as evaluated from systolic ejection fraction, following successful valve replacement, both Ees and Emax do not allow to identify patients with postoperative depressed myocardial function.(ABSTRACT TRUNCATED AT 400 WORDS)