1/66. Percutaneous revascularization modalities in heart transplant recipients.Accelerated allograft vasculopathy significantly limits the survival of heart transplant recipients. The prevalence of allograft coronary artery disease is as high as 18% by 1 year and 50% by 5 years following heart transplant. heart failure and sudden cardiac death are the two most common clinical presentations. In heart transplant recipients with severe, discrete focal allograft vascular disease, percutaneous balloon angioplasty is a viable palliative option. However, its application is limited by a significant restenosis rate and progression of allograft disease in nontreated segments. Diffuse disease with tapering of vessels may be approached by debulking devices. Emerging revascularization modalities for focal stenoses and some of the diffuse tapering vessels include coronary stents, rotational atherectomy, various wavelength lasers, and, to a lesser extent, directional atherectomy. Conceivably, stents will reduce restenosis rates related to focal, discrete plaques; yet it is unknown whether they will be efficacious in short- and long-term treatment of diffusely diseased segments affected by allograft disease. Accurate assessment of clinical outcomes and long-term evaluation is imperative prior to acceptance of these devices as fundamental interventional tools for treatment of allograft coronary artery disease.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/66. Acute acalculous cholecystitis complicated by penetration into the liver after coronary artery bypass grafting.BACKGROUND: Perforation or penetration due to acute acalculous cholecystitis is a rare complication after open-heart surgery. The mortality rate of this disease is high. methods: A 71-year-old woman complained of a sudden onset of right upper abdominal pain with development of peritoneal signs at 21 days after coronary artery bypass grafting. Abdominal ultrasonography and laboratory examination performed at 1 day earlier had revealed no abnormalities. Neither anticoagulants nor antiplatelet agents were administered following the bypass operation. An exploratory laparotomy was performed to locate a presumed embolization to the superior mesenteric artery. RESULTS: laparotomy revealed acute acalculous cholecystitis complicated by penetration into the liver, causing a subserosal hematoma. The hematoma had ruptured into the abdominal cavity. A cholecystectomy was performed. The gallbladder wall which was in contact with the liver was necrotic. Most of the gallbladder mucosa was necrotic. Microscopical examination revealed atherosclerosis of the cystic artery which was partially obstructed by thrombus. CONCLUSIONS: Given the atherosclerotic condition of the cystic artery, hypotension during the bypass in combination with postoperative total parenteral nutrition and hypovolemia may have induced the cystic artery thrombosis. Surgeons who manage patients with cardiovascular disease should be aware of this potentially lethal development.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/66. Treatment of acute right coronary artery occlusion during anesthesia.PURPOSE: Perioperative coronary artery occlusion is a potentially dangerous complication causing myocardial infarction and circulatory collapse. We report a case showing severe ST segment depression in leads II and V5 during anesthesia. diltiazem and nifedipine, but not nitroglycerine, partially improved the ST changes which were normalized by a percutaneous cardiopulmonary system (PCPS). CLINICAL FEATURES: A 71-yr-old man with cerebrovascular disease was scheduled for coronary artery bypass grafting (CABG). Past medical history included myocardial infarction due to right coronary artery (RCA) occlusion. Both the femoral artery and vein were cannulated percutaneously before operation and the PCPS was prepared as a back-up system. depression of the ST segments in leads V5 and II was observed following heparinization. Although hemodynamic stability was maintained with continuous infusion of catecholamines, the ST changes were not improved by intravenous nitroglycerine. Intravenous diltiazem followed by nasal nifedipine partially improved the ST changes. The changes were normalized after induction of PCPS. No neurological complications were observed. The postoperative coronary angiography confirmed the total occlusion of RCA. CONCLUSION: calcium channel blockers were more effective than nitroglycerine in treating perioperative ST depression. However, none of them produced complete reversal of the ischemic changes which were normalized with PCPS.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/66. ticlopidine-induced severe agranulocytosis after the placement of coronary artery stent--a case report.ticlopidine is an oral antiplatelet agent frequently utilized in the treatment of cerebrovascular disease. It is rarely associated with severe bone marrow suppression. A case of an elderly woman is reported who developed febrile agranulocytosis two months after commencing ticlopidine but who had a favorable outcome after cessation of that drug and treatment with granulocyte colony-stimulating factor (G-CSF). All patients should have regular monitoring of their blood counts during therapy with ticlopidine.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/66. coronary artery bypass grafting in a patient with human immunodeficiency virus: role of perioperative active anti-retroviral therapy.In a patient with severe ischemic heart disease and advanced human immunodeficiency virus (hiv) infection, vigorous perioperative treatment with anti-retroviral agents was given and coronary artery bypass surgery using cardiopulmonary bypass was successfully performed. This strategy could become the standard for patients with cardiovascular disease and advanced hiv infection. The following aspects of this case require further investigation: (1) lack of a reactive increase in the neutrophil count, (2) transient extreme reduction of lymphocytes, and (3) a relative decrease in the CD8 cell ratio.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/66. Applying evidence-based medicine to current practice: a round table panel discussion.Over the past decade, an expanding body of epidemiological and clinical trial data has been collated, culminating in the development of guidelines designed to help physicians make decisions about intervention and the intensity of treatment, based on objective assessments of the overall level of risk for cardiovascular disease. However, guidelines are not prescriptive and allow physicians leeway in interpretation. Thus, it is of clinical interest to explore some of the issues that may influence the use of these guidelines in clinical practice. This paper summarises a round table panel discussion that highlighted the usefulness of current guidelines, but also demonstrated that these guidelines, and the evaluation of cardiovascular risk, need to be used with care and always interpreted in the light of sound clinical judgement.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/66. Glitazones and the potential improvement of lipid profiles in diabetes patients at high risk for cardiovascular disease.Most deaths and hospitalizations in patients with diabetes are related to atherosclerotic vascular disease. An asymptomatic patient with type 2 diabetes has a cardiovascular risk comparable to that of a patient without diabetes who has a history of a myocardial infarction. The american heart association classifies diabetes as a coronary heart disease risk equivalent. Thus, it is important in patients with diabetes to aim for systolic blood pressures less than 130 mm Hg, using an angiotensin-converting enzyme inhibitor-based regimen. The target hemoglobin A1C (HbA1C) for those patients is < 7%. New oral insulin-sensitizing medications, known as thiazolidinediones or glitazones, are useful to improve glycemic control. Most patients with diabetes require 2 or more oral agents to achieve optimal glucose control. Glitazones generally lower HbA1C by 1% to 2%. They also raise high-density lipoprotein cholesterol levels and lower triglycerides. Thus, they may potentially improve low-density lipoprotein (LDL) particle sizes by converting small, dense LDL particles into larger, less atherogenic ones. Current data concerning the lipid effects of pioglitazone and rosiglitazone are reviewed in this article.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
8/66. Multiple vasculogenic disabilities : a challenge in rehabilitation.A 37 year old male presented with left hemiplegia, left below knee amputation, right partial foot amputation and claudication pain. The limitations in the rehabilitation management in such a high-risk patient are multiplied. The appreciable benefits from supervised rehabilitation and judicious goal setting can help in improving the functional status and retard the disease progression in such patients. This study highlights that coexisting cerebrovascular, coronary and peripheral vascular diseases can pose a real challenge and can result in multiple disabilities.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/66. erectile dysfunction: is there silent obstructive coronary artery disease?erectile dysfunction (ED) has long been ascribed to the ageing process. patients presenting with ED often have their symptoms ignored in terms of both underlying aetiology and treatment. It is now clear that, in many cases, the pathological processes in ED are common to those involved in vascular disease. men with proven coronary artery disease (CAD) have a high incidence of ED when directly questioned. In some, the onset of ED pre-dates the symptoms and diagnosis of CAD as exemplified in our two cases. Patient 1 developed ED two months before an acute anterior myocardial infarction. Patient 2 had several cardiovascular risk factors but only the presence of ED prompted investigations which eventually led to an angiographic diagnosis of three-vessel disease. The presence of silent co-existing myocardial ischaemia should be considered in men who present with ED, particularly when they have other cardiovascular risk factors.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/66. Tetrahydrobiopterin improves endothelial dysfunction in coronary microcirculation in patients without epicardial coronary artery disease.OBJECTIVES: We aimed to determine whether intracoronary supplementation with nitric oxide (NO) synthase co-factor tetrahydrobiopterin (BH4) improves NO-dependent coronary microvascular dilation in patients with coronary risk factors but no significant organic stenosis. BACKGROUND: Impaired coronary microvascular dilator reserve attributable to endothelial dysfunction plays an important role in the regulation of coronary blood flow (CBF). methods: Fifteen patients were measured for CBF (Doppler-wire and quantitative coronary angiography). Stimulated release of NO in the coronary microcirculation was evaluated by percent increase in CBF (¬BF) at graded doses of intracoronary acetylcholine (1, 3, 10 and 30 microg/min). Measurements were repeated after intracoronary co-infusion of BH4 (4 mg/min) and acetylcholine. RESULTS: The patients were divided into two groups on the basis of CBF responses to acetylcholine: those with "diminished" (ÞltaCBF <300%, n = 8) and "normal" (ÞltaCBF >300%, n = 7) flow responses. Tetrahydrobiopterin significantly (p < 0.0001) improved acetylcholine-induced increases in CBF in patients with diminished flow responses, but exerted no effect in those with normal flow responses. Among the 15 studied patients, the magnitude of flow improvement by BH4 was inversely correlated with baseline flow responses (p < 0.02). Microvascular dilator response to direct NO donor (isosorbide dinitrate) was not affected by BH4. CONCLUSIONS: We demonstrated for the first time that intracoronary BH4 improved acetylcholine-induced microvascular dilator responses in patients with endothelial dysfunction in vivo. Thus, supplementation with BH4 may be a novel therapeutic means to increase NO availability for patients with coronary microvascular disease.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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